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 Lee on June 25, 2009 at 10:07pm: In an ideal world Skip, I would agree with you. The thing is, we don't live in an ideal world, and there are still places in this country where if these few individuals weren't there, the citizens would have nobody to provide the service. I have personally lived in a couple of these places.

That being said, I strongly believe that even in the smallest rural community, one is entitled to the same quality of care that one would receive in the large metropolitan cities. But I also know how much money it takes to provide that type of care, and there are some areas of the country who do not have the tax base or the population necessary for donations. Unfortunately, I don't have a solution for this.

It's ok to be ornery. I am known to carry a big spoon and like to stir the pot. That is what discussion and debate is about, and why we have forums like this. Besides, if we lived in an ideal world, fire, law enforcement, and EMS wouldn't be necessary.

Skip Kirkwood said:
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.

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Permalink Reply by Skip Kirkwood on June 26, 2009 at 7:18am: Interesting points.

First, that everybody is entitled to the same quality of care. Hmmm....what does quality mean? If you mean "availability" I have to disagree. People who live in remote areas do not want, and do not want to pay for, the same availability of services as those who live in cities. I spent a lot of time learning this when I worked in Oregon, where we (the state) tried to force EMS systems on remote communities. The people who lived there knew, accepted, and built their lives and values around self-sufficience and acceptance of what that meant. They knew that they had to be able to protect themselves from crime, to prevent or extinguish fires (or that a fire would mean the building would burn down), and that medical care was far away. They do not expect 8 minute paramedic response. They know that school is far away, that a hospital is far away, etc. And they choose to live there, as a matter of right, knowing those limitations.

Second, this IS the United States ... unless it is specified in a constitution (state or national), nobody is entitled to anything. If they want it, they buy and pay for it, either privately or collectively (through taxes).

But if by quality you really mean QUALITY, then sending two physically incapable people to an incident that requires six physically capable people.....that's not quality. That's an illusion.

And I do not accept the notion that if one group of people doesn't do it for free, then the service will not be available. It MAY not be available, if the beneficiaries (the citizens) don't want it. Or, some other method will evolve, if the community wants it. Sending an ambulance that isn't really able to do the job creates the ILLUSION that there is a service, when there is not. This PREVENTS improvement in the local system. The basic Darwinian cycle entails replacement of those who can't meet the standards with those who can. Think pterodactyls.......; ▶ Reply to This

Permalink Reply by Larry W. Paine on July 6, 2009 at 1:47am: I see the problems of rural EMS is outside of some EMT's scope of practice. Normally, we try to have at least one strong back on each run and at least three people on a run. Several of our members often respond when they can't make the run just to help load. And of course, when the problem was truly great I have seen a dozen people respond. LEO's, Amish kids, rangers, firemen, and assorted retiree's.

Last week I was informed one major cot mfg has stopped production of "H" frame cots because of libility problems. The old Ferno 28's are about gone, and even Ferno doesn't seem to be pushing the new style 28's.
So I guess the only real question is do we stay with manual "X" frames, or find the money for a power cot. Of course everyone has there own preference,.
However, one Cot mfg claims they developing an afordable loading system. It is suppose to be suitable for routine use not just in unit which carry the 700 plus people.; ▶ Reply to This

Permalink Reply by Bryan Fass on July 6, 2009 at 6:01am: Once again, I see everyone making good points but, from a biomechanical perspective we as a profession need to be strong enough for the job! The prevention of a single back injury, average cost of $23k and many well into the 6 figures, more than justifies any program that aims to make a responder stronger healthier. Over a year or two that will add up to a lot of new gear! As I explain to my golfers, a better club will not make you a better golfer, but a better body will.

Larry W. Paine said:
I see the problems of rural EMS is outside of some EMT's scope of practice. Normally, we try to have at least one strong back on each run and at least three people on a run. Several of our members often respond when they can't make the run just to help load. And of course, when the problem was truly great I have seen a dozen people respond. LEO's, Amish kids, rangers, firemen, and assorted retiree's.

Last week I was informed one major cot mfg has stopped production of "H" frame cots because of libility problems. The old Ferno 28's are about gone, and even Ferno doesn't seem to be pushing the new style 28's.
So I guess the only real question is do we stay with manual "X" frames, or find the money for a power cot. Of course everyone has there own preference,.
However, one Cot mfg claims they developing an afordable loading system. It is suppose to be suitable for routine use not just in unit which carry the 700 plus people.; ▶ Reply to This

Permalink Reply by greg morgan on July 8, 2009 at 7:57am: There is a new Stryker that folds up at the head and folds down at the feet almost like a stair-chair.; ▶ Reply to This

Permalink Reply by Larry W. Paine on July 9, 2009 at 1:41am: Have a reeves stretcher, and like it. Perferct for unresponsive large Pt in the back bedroom of some trailers.
Depending upon conditions, may take a lot of willing by-standers.

Haven't seen the Stryker that folds up at the head and down at the feet to the point it can be used as a stair-chair. Saw a Stryker that raised the knees. (Didn't ask the price, often use a pillow for this purpose.); ▶ Reply to This

Permalink Reply by Steve Whitehead on July 15, 2009 at 8:31am: Larry it sounds like you’re doing a hell of a job trying to help people out. I worry a bit about how long your back is going to last carrying 350# patients around.

One of the issues I see here is that you’re trying to apply an urban standard of care to a rural community. You have to make compromises in the resources available to you. I get that. But do you get that your patient is going to have to make some compromises in the care delivered?

Your patient chose to live in a rural area, one hour from a stroke center with a small volunteer ambulance squad, gain 350# and live an unhealthy lifestyle. You can’t be expected to magically fix that with two ladies and a cot.
You do have some cot, stair chair, patient mover options. You sound like you’re well versed in all of them. I love my Stryker stair chair and power pram. I never carry the pram up stairs. Carry the patient to the pram. Do the two moves.

But I think your efforts are better served trying to figure out how to get the resources you need when you need them. Recruitment, funding CB radios, pagers, cell phone numbers, whatever. Figure out a way to rapidly (or slowly) summon the Amish kids, firefighters and retirees when you need them. Call them early and understand that your patient can’t expect transport times equivalent to urban EMS systems. Invest in support and community, not power hoists.

And then your tired 72 y/o back and your two female helpers will still be healthy tomorrow for the next crazy rural emergency. You have a duty to them too Larry ;-) Good luck to you.; ▶ Reply to This

Permalink Reply by Brian Tanner on July 17, 2009 at 9:57am: Recognizing your contrariness in this post, I still have to disagree with a couple of points. First, if we don't look after ourselves and our crewmates first, then no one will be around to look after the patients. That means sizing up the scene for safety issues as soon as we arrive, requesting plenty of help (even when that means delaying transport/movement), lifting with our legs- not our backs, and using stairchairs or reeve sleeves or stokes baskets or just a backboard- even when such things require a "double move."

It also means that sometimes we have to go with what and who we have. EMS requires more then having the skills, it also requires a certain personality. You not only have to want to "run in while everyone else is running out," but you have to have the empathy and sympathy to take care of your patients to the best of your abilities, as limited as those may be. I have seen alot of guys in the fire service, career and volunteer, who have EMS training, but only do EMS work when they have to or when it is a really exciting call. Nothing against them, they just have a different mindset. So sometimes we have to make do with crewmates who can't quite lift their share because they have the skills and personality to give the patient the care they need.

But back to Larry's original question. I think most everybody is saying about the same things: Stair chairs and power cots are great, when you have them. Call for help as soon as you see you need it and wait for it to arrive before you put your back and the patient's balance at risk. Accept the fact it is not your fault the patient is where they are when they need your help, and all you can do is all you can do to get them where they need to be. Good Luck.

PS: There are grants available for equipment like powered cots and the stryker stair chairs. Talk to your squad administrators or even your state EMS staff for help.

Skip Kirkwood said:
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