Stretcher to the House?

[Beagle189]

I know this is a silly question so I probably shouldn't ask, but anyway -

If you are the Emergency response and transporting agency, When you go to a private residence do you take the cot/stretcher in with you initially or do you have it retrieved after gaining access and assessing the pt.?

I ask this because of an argument at my service. We have BLS First Responders in are area so they get there first, then we come in. Some ambulance crews try to take the cot in w/ equipment on it before seeing the layout of the house. They have to struggle getting it through the door then go around it to gain access to the pt. Others carry in the 3 bags of jump equipment, gain pt access and do an assessment - then have a crew member w/ First Responders get the cot. Either way is accepted. But if you take the cot initially to the house it delays any ALS treatment trying to get it through the door. If you wheel it up to the door and take the equipment in you leave it outside in the weather.

If you don't take it in and you don't get any BLS responders then only one crew member has to struggle w/ it.

I know if you go to a business it really doesn't matter - bigger doors, easier inside access(usually), etc..etc..

We were wondering how other agencies/ EMT's/ Medics do this simple task.

[Ace844]

"beagle,"

Typically here we take the 1st bag, o's, etc.. and a stairchair/sheet-blanket into the residence. Usually we leave the stretcher in the truck, or by the sidewalkstairs until we get an idea for the who, what, why of how we're going to do things....Worst case we leave the stretcher in the truck and send a Fire monkey to pull it out for us and set it up..!! :shock: :shock: 8)

out here,

ACE844

[Just Plain Ruff]

Here's what I've done in the past.

Most of the time my partner and I are the only ones that are gonna be there. Maybe 1 Police but usually not.

So, this is how we do it. Put all the junk on the cot, monitor, o2, jump bag, and whatever else we need. Run the cot with all the stuff on it to the door or to the patient.

Now if you have fire monkeys and such then by all means use them to get the cot for you but........... many times you don't have a fire monkey to get the cot for you.

The other benefit of taking to cot to the door or patient is that you don't have to lug all those pounds of equipment and mess up your back.

[Beagle189]

But what if its raining/snowing? Do you still leave the cot at hte door? Have you ever tried to get a cot into a house and there is so much junk in the way you can't get it in w/o manuvering furniture - what if the pt is in resp distress/ resp or cardiac arrest? Do you still fight w/ the cot in the doorway first? If your the only one's on scene is there a better way? Granted a stairchair works well but on hypotensive pt's w/ decreasing LOC a supine carry would be better. Any other opinions / ideas.

[Dustdevil]

When I was a new EMT, and all we had to carry was one kit, we used to bring the cot in with us. I don't think I have done that since 1979. I didn't think anybody was still doing that. It's really a bit pointless in an ALS system, and even counterproductive. I think taking a cot in with you on arrival is one of those stupid, bad habits that rookies pick up while working as a transfer truck driver, and then carry over with them when they finally get an EMS job, and never bother to rethink it because they think they already know everything from their three years of nursing home transfers.

In the ALS age, where you have multiple kits to carry and a good five to fifteen minutes of patient assessment and care to perform before moving to the ambo, I agree, it is slowing you down from being at your patient's side. I find it much more natural and productive to only take my kits in and get immediately to my patient. Then, once I have determined what I no longer need with me in the house, my partner can take that equipment back to the ambo and retrieve the cot for us, as well as a backboard or anything else we need.

Of course, this ties in to the whole reason you don't strap your pillow down to the cot. When you pull the stretcher out, you should already know the needs of your patient. More than half will not need a pillow (especially if they're on a backboard), so you can toss it on the squad bench as you pull the cot out.

If you have firemonkeys or other first responders who are smart enough to operate a cot, then having them fetch it for you makes them feel at least somewhat useful, and it gets them out of your way for a minute or two. And if you don't have firemonkeys, then going back for the cot ensures that you don't end up having to carry the cot, the patient, and four different pieces of equipment back with you all at once.

I have found that that second trip for the cot AFTER patient contact is a very important factor in ensuring that you don't end up leaving equipment on scene, since anything not attached to the patient gets taken back before you leave. That in itself is enough reason to work that way.

As always, there are obviously exceptions to every procedure. High rises, long foot walks to remote scenes, etc...

And don't even get me started on all the idiots who insist on taking every patient to their truck before initiating care. :roll:

[mediccjh]

And don't even get me started on all the idiots who insist on taking every patient to their truck before initiating care. :roll:

Some of us "Idiots" do it in the high-crime Urban areas because the back of the bus is the only safe haven we have. It's not fun working on a patient in the house when you have high/drunk/pissed family members, and PD is too busy to come and help. At least in the back of the bus, you can control who comes in and out, and if it the outside gets too hostile, take off a couple of blocks, then pull over and do your work if needed. Albeit, I ALWAYS carry all of my gear, especially the airway kit, into the house with me, and if they need treatment right there and then, they get it.

My personal way of doing things depends on where I'm working. My f/t suburbia job, the litter stays in the back of the bus until we know how we're getting the patient out, and even then, it's stairchair right through the side door of the bus and then lift or help pt over to the litter. In the city, stairchair always comes in.

[Ace844]

But what if its raining/snowing? Do you still leave the cot at hte door? Have you ever tried to get a cot into a house and there is so much junk in the way you can't get it in w/o manuvering furniture - what if the pt is in resp distress/ resp or cardiac arrest? Do you still fight w/ the cot in the doorway first? If your the only one's on scene is there a better way? Granted a stairchair works well but on hypotensive pt's w/ decreasing LOC a supine carry would be better. Any other opinions / ideas.

Beagle,

please read the posts, your wasting your time with the stretcher...leave it alone and worry about you, your partner, your equip.,the other FR's, and the pt..Wasting time with a stretcher in the snow/wind/whatever, is a waste of time and energy.PERIOD...?'s see "dust's" post above..

!!

Hope this helps,

ACE844

[chazmedic]

Beagle,

You know my advice: just keep hitting the EMT 'til the twitching stops. I'll come over and help dig the pit. Still got the bag of lime? I took the cot in a couple of times when my back was stiff (paramedic Chaz speaking) just because the gear weighs so d@nm much. I mean, does the airway kit really need to 2 steel E tanks?

The firedawgs don't mind getting the cot anyway. At least 99% of them. Except your son-in-law (we know, it's a waste of his talents). We (fireman Chaz speaking) don't want to take over EMS or even get ALS engines. We're happy to see you come in and take over. Glad to help.

What burns me (medic Chaz) is our EMTs that insist on backing up the driveway first, then get the cot, then put everything on it, then go in, then play "I'm a little battalion chief and I'm going to stand here and be in charge and tell everyone what to do and talk on the radio a lot and not do my job." All three of them. Hit them 'til the twitching stops.

[MedicRN]

When I was a new EMT, and all we had to carry was one kit, we used to bring the cot in with us. I don't think I have done that since 1979. I didn't think anybody was still doing that. It's really a bit pointless in an ALS system, and even counterproductive. I think taking a cot in with you on arrival is one of those stupid, bad habits that rookies pick up while working as a transfer truck driver, and then carry over with them when they finally get an EMS job, and never bother to rethink it because they think they already know everything from their three years of nursing home transfers.

In the ALS age, where you have multiple kits to carry and a good five to fifteen minutes of patient assessment and care to perform before moving to the ambo, I agree, it is slowing you down from being at your patient's side. I find it much more natural and productive to only take my kits in and get immediately to my patient. Then, once I have determined what I no longer need with me in the house, my partner can take that equipment back to the ambo and retrieve the cot for us, as well as a backboard or anything else we need.

Of course, this ties in to the whole reason you don't strap your pillow down to the cot. When you pull the stretcher out, you should already know the needs of your patient. More than half will not need a pillow (especially if they're on a backboard), so you can toss it on the squad bench as you pull the cot out.

If you have firemonkeys or other first responders who are smart enough to operate a cot, then having them fetch it for you makes them feel at least somewhat useful, and it gets them out of your way for a minute or two. And if you don't have firemonkeys, then going back for the cot ensures that you don't end up having to carry the cot, the patient, and four different pieces of equipment back with you all at once.

I have found that that second trip for the cot AFTER patient contact is a very important factor in ensuring that you don't end up leaving equipment on scene, since anything not attached to the patient gets taken back before you leave. That in itself is enough reason to work that way.

As always, there are obviously exceptions to every procedure. High rises, long foot walks to remote scenes, etc...

And don't even get me started on all the idiots who insist on taking every patient to their truck before initiating care. :roll:

A cot never saved a life.

[Dustdevil]

What burns me (medic Chaz) is our EMTs that insist on backing up the driveway first, then get the cot, then put everything on it, then go in, then play...

Wow, that's another move I haven't seen since the late 70's. Up through the mid 80's, I would still occasionally see some idiot try to back the ambo up the driveway, but we put a stop to that nonsense really quick.