Quality Corner: Ambulance Checkout

Nothing is more unnerving to me than having to take a call that comes in just as I arrive for shift change, without having had time to check out my ambulance.

Except for the actual patient care we render, there is probably nothing as important as checking your ambulance to ensure you’re as ready as can be for whatever fate throws your way. It seems that every one of the few times I’ve not had the opportunity to check my ambulance before a call, there was a necessary item missing—a piece of equipment whose battery was dead or a portable oxygen tank that was bone-dry…on a respiratory distress call, of course. If I don’t check it, it won’t be there. Such is my luck.

I’m often amazed by some of the providers who come in at the same time as me. I’m rummaging through my ambulance like a maniac, setting things up as much as allowed by law, while they sashay in, peek into the back window of their ambulance, “Yep, there’s a litter, and I think I saw the jump kit,” and they’re comfortable that they’re ready to go.

Maybe it’s insecurity on my part—the feeling that there’s always a call waiting for me out there that will catch me unprepared and result in failure to accomplish what needs to be done and end in the ultimate tragedy: a salvageable life lost.

I’ve always been diligent in checking my ambulance at the beginning of the shift. Then, after 20 years, I retired from EMS. I figured no one could call me a quitter after 20 years. As fate would have it, my retirement was short-lived. I found life as a normal person to be blasé, boring and unfulfilling. Three years later I was back and in deeper than ever. I started instructing, and thanks to all of my experience (and timing), I was hired as a line officer. I couldn’t help but think of the similarities of my situation and what Al Pacino said about the mafia in the Godfather III: “Just when I thought I was out, they pull me back in.”

Being gone for so long, I was required to do a preceptorship all over again to regain my active medic status. My preceptor monitor ended up being Doug Wargny, a brilliant young man who proved to be every bit as capable and quotable as the first group of medics to hit the streets who trained me two decades prior. As proof that EMS does progress, it quickly became apparent to me that Doug and the newer medics were much better trained than us older medics. I actually learned quite a bit from my new mentor.

There was also a surprising revelation: On the first few calls, I was amazed at how much got done in such a short period of time. For the most part it was the same amount I’d done all those years without thinking anything of it. But it was only then, after 20 years of doing the job, leaving and coming back, that I came to truly appreciate just how extraordinary this job and its practitioners really are. I was so impressed by what I observed that I actually wondered if I’d ever be able to become that smooth and efficient again.

Despite being thorough in checking my ambulance throughout my first 20 years in EMS, I now became infatuated with what else I might do to stack the deck in my favor. So I started looking for ways I might save a minute or two or make completing an intervention a little quicker or easier. For most calls a couple minutes here or there or a little wasted motion doesn’t matter all that much. Then there are those less frequent but inevitable calls when every little thing can matter greatly—the kind of call when it’s all on the line, the pressure is on, and you’re all alone with your patient in the back while your partner tries to get you to the hospital, but where adrenaline and a world full of oblivious drivers only add to the challenges of mobile intensive care.

One of the best examples of efficiency in critical care management I’ve found is the trauma bay. I noticed they frequently have IV bags prespiked. And they do this despite having a veritable cast of thousands, as opposed to just me being the lone provider in the patient compartment. So it seemed reasonable for me to prespike a bag of normal saline myself. I also placed electrodes on the ECG leads, which easily saves a couple minutes when doing a 12-lead. And of course going through your airway and IV kit and ECG monitor not only ensures you have all the equipment and supplies you might need, it also helps you know exactly where everything is, so you don’t have to go hunting for something when you’re forced to do a one-man show.

I know how manic this all may seem to some people, but I can attest that on those occasions when I’ve had a critical patient and Mr. Murphy’s tried to come along for the ride, being organized, prepared and knowing exactly where everything was made, for me, all the difference in the world.

Every EMS provider has their own preferred way of doing things, their own idiosyncrasies and certain ways they like things set up. No matter what your preference is, spending just a few minutes at the beginning of your shift checking and setting up your ambulance can go a long way in giving you comfort and confidence on those calls where it matters most.

Joe Hayes, NREMT-P, is deputy chief of the Bucks County Rescue Squad in Bristol, PA, and a staff medic at Central Bucks Ambulance in Doylestown. Contact him at jhayestpc@gmail.com.