19 January 2010

On Duty

I almost feel a bit of shame for writing this piece, but it's fresh in my mind. My intentions when I started this was to write original stuff that one may consider impactful.

So I feel kinda bad that I have so soon deviated from my own path and taken the lead of another. But hey, this is EMS. Nothing original in this field, right? We all borrow from each other and expand and expound on one anothers ideas. After all, isn't that the whole idea behind EMS 2.0....sort of?

Last week Medic 999 did an article on what the most important piece of equipment was to the paramedic. I found it quite insightful and really enjoyed reading the discussions and rationales for everyones choice.

I want to take this one level lower; to the personal level. What do I carry on myself when I am "on duty"? Now this could vary somewhat depending on what day of the week it is for me. A lot of folks call me a "whacker" because of all the junk I carry in my personal vehicle in my response bag. And of course there are times when I am just out and about when I happen to be in the area of a call and decide I need to respond for one reason or another.

But when I am purposely available, whether it be on the job or at a volunteer station, there are things I want immediately at my disposal.

First of all, I want to be recognized as a professional. A uniform sets you apart from everyday citizens and identifies you as a part of a group that is specially trained for a specific task. This uniform must be neat and clean and readily identify your association. I'm not so worried about level of training be identified, because we're all ambulance drivers anyway.
Just a quick thought about the pants in a minute. First, the boots. Gotta have some rugged looking duty boots, and of course they must have the zipper on the side. It's hard to wake up in the middle of the night and try to tie the darn things while finding your mouth wash and trying figure out where you're actually going. It's a whole lot easier to just slip 'em on and go. Now, those pants. If you wear pants that don't have eight pockets, two of which you'll hardly ever use and two on the bottom leg that you'll never use, are you really a true EMT to begin with?

The next thing is just purely personal preference. I like to wear a rescue belt with a quick connect buckle. This can serve two purposes. One, if I have to go down an embankment to access a patient, I have something to tie "me" off to and if I need to keep things with me I can attach it to my belt. Two. A rescue belt can be used in the event a patient is in immanent danger and you need to anchor the patient somehow. And of course...it keeps your drawers up.

A radio is absolutely essential piece of equipment. I can think of nothing worse than being in a house while your partner steps out to get something from the truck and something goes wrong. The patient could crash. Family member or bystander goes crazy. What about an unknown domestic dispute and the aggressor jumps out of the closet. I want someone to not only know where I am at all times, but I want to be able to let someone know if something goes wrong. This is also the primary way to know what is going on in your district and position yourself for a call or an intercept.

Ink pen. Pretty self explanatory. If it wasn't written...it wasn't done. For me, it's more like if I don't write it, I don't remember it.

Some don't wear a watch. Some can't wear a watch as part of department/agency policy. I personally feel naked with out one, so I have to have one on all the time. I know you can tell if a patient is tachy or not with out one, but I just want a good sound number.

I also keep at least two pair of gloves on me at all times. Rule number one; if it's wet and sticky, I don't want it on my hands or any other part of me if I can at all help it. I'll be the first to admit that I've got a bad habit of getting in a hurry and neglect to put gloves on, but I make sure I have an extra set of hands to help with a procedure. Beside, how did everyone get that NREMT-P... B-S-I, scene safe. I'll try to do better.

Aaahhh, the ever symbolic trauma shears, or parameds if you prefer. Nothing says trauma like a scissor toting Paramedic. I don't care if the last time I used them to expose was a month ago. There's always the loose and wayward screw that needs tightening or the tough as steel bag of Doritos that needs to be opened in an OCD fashion.

Last but not least is the stethoscope. Of course no self respecting medical professional can be with out the signature stethoscope slung about the neck.

I read an article in JEMS a while back about the status symbol of the stethoscope. I never really gave it much thought as to why we wear it around our necks like we do, but I do. I think I do it just to show off my Littmann Master Cardiology my wife got me as a gift last christmas. But seriously, I do like to have it handy when I go in to do a complete assessment. Some lung and heart sounds are just heard better with one.

Well folks, that's what I'm wearing when I'm ready for action(on the outside anyway). I know I forgot something, but that's the great thing about having an edit button. Oh yeah! Somebody will for sure bring up "Lite Brite", my high visibility reflective jacket. Since I work nights all the time...I want to be seen.

Mark, sorry I took a lead from you on this topic, but I haven't had any good, bad or ugly stuff in the past day or two. My well was just about dry.


  1. What department/agency doesn't allow a watch? How else do you do something as simple as vitals?

  2. Some departments consider it an infection control issue. In reading the article I referenced, Mark stated he is not allowed to wear a watch in the NorthEast of England Ambulance Sevice, and actually serves as policy system wide for the NHS(National Health Service) Trust. Some places are even instituting a bare-below-the-elbow policy and don't allow long sleves. Not that I agree with either, but I see their points in regards to biological contamination.

    As for how to take a pulse without a watch...use a clock on the wall or a bystander maybe. I dunno; but I want a watch on personally. Experience will enable you to tell if the pulse is regular, irregular, tachy or otherwise abnormal.