Ambulance Cots

What about some real input? You volunteer for a low volume rural squad and money is an issue. You are a 72 y/o male 220 pound (never confused with Mr. Atlas) EMT-I with a 350 pound CVA patient, one hour since first signs. You are one hour from a stroke center and 40 minutes from any hospital. Air ambulance is not an option. For crew, you have a 65 y/o 90 pound female EMT-B driver and a 30 y/o 80 pound female (possible 1st trimester) EMT-B. The family is useless, and the nearest help is 20 minutes away. If you can get the patient on the cot and in the vicinity of the Ambulance what type of a cot do you want? If you must extract the patient from a house trailer on a cot, what type of a cot do you want? You don’t have money or room for two cots, so the cot must either be the extraction device or you need a 2nd piece of equipment.

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Permalink Reply by greg morgan on June 21, 2009 at 7:36am: The new stair chairs by stryker are great; ▶ Reply to This

Permalink Reply by Kevin Collopy on June 21, 2009 at 7:50am: Larry, you pose a great question, and bring back a lot of memories of mine from when i was a volunteer. Unfortunately money is always an issue. Power cots (stryker or monster medic) are great when you don't have to extricate a patient, but they are heavy and not good for carrying someone down steps. If you are able to get a patient outside to the stretcher then one of these cots is the way to go because all you have to do is support the foot end of the cot and it will raise its own wheels up and you can slide it in. The afore mentioned stryker stair chair with the treading on the back is really a fantastic tool. The treads really take all of the lifting out of the equation.

Unfortunately most 350lb patients don't fit too well on stair chairs. Another option is bariatric tarp, or a reeves stretcher.; ▶ Reply to This

Permalink Reply by Larry W. Paine on June 21, 2009 at 8:04am: greg morgan said:
The new stair chairs by stryker are great; ▶ Reply to This

Permalink Reply by Larry W. Paine on June 21, 2009 at 8:06am: greg morgan said:
The new stair chairs by stryker are great

Okey, but that means double handling and still leaves the question, what cot?; ▶ Reply to This

Permalink Reply by Larry W. Paine on June 21, 2009 at 8:31am: Kevin Collopy said:
Larry, you pose a great question, and bring back a lot of memories of mine from when i was a volunteer. Unfortunately money is always an issue. Power cots (stryker or monster medic) are great when you don't have to extricate a patient, but they are heavy and not good for carrying someone down steps. If you are able to get a patient outside to the stretcher then one of these cots is the way to go because all you have to do is support the foot end of the cot and it will raise its own wheels up and you can slide it in. The afore mentioned stryker stair chair with the treading on the back is really a fantastic tool. The treads really take all of the lifting out of the equation.

Unfortunately most 350lb patients don't fit too well on stair chairs. Another option is bariatric tarp, or a reeves stretcher.

Okey, I am hearing good thoughts.
I can still lift and shove in one motion. I am in trouble if I must lift and hold (or stand). Am I missing something about the correct method of holding one end of any power cot while the wheels are coming up or one end of any manual "X" frame cot while someone is lifting the wheels. I have reasonable luck lifting one end of the cot while my ladies lift the other end. But the standing and holding kills my back.
The obsolete Ferno 28 worked well. I am having a little luck with a manuel stryker "H" frame. The ambulance with the stryker cot also has a stryker stair chair; but it is a double handle. The stryker "H" frame is almost universally hated for it's safties. The obsolete Ferno 28 in the back up unit is worn out.

When I am lucky, I have a 20 to 30 y/o big "buck" to do the heavy work, but to often they are earning a living.; ▶ Reply to This

Permalink Reply by Lee on June 21, 2009 at 1:00pm: What you have to look at is, what the safest for the patient. 350# is no biggie for any stretcher whether it is an ancient 28, 35, or newer power pro. However, when it comes to moving the patient out of the house, when you have limited manpower, what are the odds of tipping the stretcher over coming down the narrow steps of a mobile home.

This is where a stairchair is an excellent tool. Yes you have two moves, but it is a lot safer on you and the patient to leave the stretcher outside, and bringing them out to it.

Utilizing your scenario, why not go ahead and call for manpower (FD, first responders, or LE) as soon as you find a large patient. You are already 1 hr into the stroke protocol, and another hour to a stroke center. Even waiting 20 minutes for the extra help, would still have you within the magic 3 hr window, and the risk of compromising the patients health by dropping them is minimized. The other benefit is you lessen the possibility of injuring you or your partners, thus your overall patient care does not suffer.

Just a thought from one dinosaur to another.; ▶ Reply to This

Permalink Reply by Larry W. Paine on June 21, 2009 at 5:18pm: Lee said:
What you have to look at is, what the safest for the patient. 350# is no biggie for any stretcher whether it is an ancient 28, 35, or newer power pro. However, when it comes to moving the patient out of the house, when you have limited manpower, what are the odds of tipping the stretcher over coming down the narrow steps of a mobile home.

This is where a stairchair is an excellent tool. Yes you have two moves, but it is a lot safer on you and the patient to leave the stretcher outside, and bringing them out to it.

Utilizing your scenario, why not go ahead and call for manpower (FD, first responders, or LE) as soon as you find a large patient. You are already 1 hr into the stroke protocol, and another hour to a stroke center. Even waiting 20 minutes for the extra help, would still have you within the magic 3 hr window, and the risk of compromising the patients health by dropping them is minimized. The other benefit is you lessen the possibility of injuring you or your partners, thus your overall patient care does not suffer.

Just a thought from one dinosaur to another.

Your point about the improved safty by using the stair chair is well taken and welll founded. The extra help may or may not be practical depending on the event. When possible, I use all available help. But sometimes it is just me and a few ladies, therefore the question.; ▶ Reply to This

Permalink Reply by Rocco on June 21, 2009 at 5:57pm: Is the question the cot? or Man power? Depending on the 911 coding of the call depends on what you have for a response. You may have to add notes into your dispatch info for the known obese patients and dispatch the needed resources on the initial call using police or mutual aid. If it is your first contact with this patient you need to ask for the help that you need when you first get on scene and preplan so when help arrives you can move the patient quickly. If you can't lift the cot and get it into the ambulance it really doesn't matter what cot you have. Even if you have a motorized cot and can't hold up the end and load it it will do you no good. I really think this comes down to man power for the call and the need to preplan. Even a bariatric tarp or reeves stretchers may not help if you don't have the man power to move the patient.; ▶ Reply to This

Permalink Reply by Skip Kirkwood on June 25, 2009 at 6:09am: This is a multiple-issue question.

1. The crew sounds badly matched and not physically appropriate for a 2-person ambulance.

2. Adequate equipment is needed - stair chairs and stretchers, particularly if the organization can't avoid #1.

3. Adequate co-response is needed. A two-person ambulance, by itself, is rarely enough for any serious call. In the controlled environment of the hospital, this patient will be cared for by 6-8 or more people, without much need for transportation. Why should the EMS system attempt to do this with only 2?; ▶ Reply to This

Permalink Reply by Lee on June 25, 2009 at 7:46am: In all fairness to Larry, there are many, many services in this country that cover rural areas which are strictly volunteer and must deal with situations such as this all the time. I know when I started in this business, I was affiliated with one. Limited staffing, and budget, sometimes you had to work with what you had.

Now I would add to my previous post, that another possible solution would be to have that particular crew call for assistance at the time of dispatch. They could already be turned around if not needed.

Skip Kirkwood said:
This is a multiple-issue question.

1. The crew sounds badly matched and not physically appropriate for a 2-person ambulance.

2. Adequate equipment is needed - stair chairs and stretchers, particularly if the organization can't avoid #1.

3. Adequate co-response is needed. A two-person ambulance, by itself, is rarely enough for any serious call. In the controlled environment of the hospital, this patient will be cared for by 6-8 or more people, without much need for transportation. Why should the EMS system attempt to do this with only 2?; ▶ Reply to This

Permalink Reply by Bryan Fass on June 25, 2009 at 10:07am: I agree, if the crew is physically unable to handle the call in the first place and the patient along with the crew are now glowing liability and injury issues why are they there? Your equipment is only as good as who is able to operate and control it, we can not rely on a cot to save us from heavy patients. Was this crew able to pass a fitness test or a job specific test? When is the cost of an injury to the crew member or for that matter the risk of delaying care to the patient more important than relying on a cot. I do agree with Skip that calling for help ahead of arrival is pertinent but the fact remains that if the crew is physically unable to move an 'average' patient why are they there. We would not put an officer on the street that is unable to shoot or a fire fighter who can not make it up the stairs but in EMS those rules do not apply do they!

The 'Fit Responder'

Skip Kirkwood said:
This is a multiple-issue question.

1. The crew sounds badly matched and not physically appropriate for a 2-person ambulance.

2. Adequate equipment is needed - stair chairs and stretchers, particularly if the organization can't avoid #1.

3. Adequate co-response is needed. A two-person ambulance, by itself, is rarely enough for any serious call. In the controlled environment of the hospital, this patient will be cared for by 6-8 or more people, without much need for transportation. Why should the EMS system attempt to do this with only 2?; ▶ Reply to This

Permalink Reply by Skip Kirkwood on June 25, 2009 at 9:08pm: Lee, just to be ornery (maybe not -- I think I really believe this):

I'm not interested in being fair to Larry. I'm interested only in being fair to Larry's patients.

In a movie scene that I've immortalized in my own mind, from The Guardian, Kevin Kostner, playing the salty Senior Chief rescue swimmer, confronts a class of candidate rescue swimmers. He announces, "I have only once concern - the people that you will be called upon to save. If I think that you will fail them, I wil fail you."

EMS is not about being fair, or kind, or gentle, to the people who do it. It is (to me) about being prepared to render care to those who need it. And if there are personnel, or agencies, who can't fulfill the minimum requirements of the job, then they shouldn't be in the business. If an agency's personnel are only capable of lifting 50 lbs each, then the agency is obligated to send 6 people on the call. Otherwise it's cheating the only person in the equation that matters.

Some believe that "If you uphold standards, then services and volunteers will go away and there will be nothing." I don't buy it. If a community wants qualified, competent, EMS for itself, it will find a way to get it.

Skip; ▶ Reply to This