Interesting interview question popped up today... Remove one piece of equipment

[Hockey]

If you could get rid of ONE piece of equipment in your ambulance, what would it be?


I froze because honestly, I don't know. I mentally went through an entire truck. I made an arse out of myself by saying Ked Board


One item I could keep from my rig. I made an arse out of myself again by saying BP cuff. Seriously a BP cuff what the hell was I thinking? They asked, even over O2? I said well the radio too.

Stupid questions.

Apparently this is the first time they did an oral board interview so I got to be the guinea pig or something

 

[medic417]

Actually great question. Question allows us to see persons ability to reason and even if they understand the true medical value of equipment.

 

[Hockey]

Actually great question. Question allows us to see persons ability to reason and even if they understand the true medical value of equipment.

I first said nothing because I can't predict the next call for service is. He told me I can't play that way.


I redid my answer for the what equipment could you not lose, and I said the radio because if not, we will be blind out there

 

[Hockey]

So what would your one thing to save or getting rid of? BLS truck (none of that ALS stuff..you have too many things you can chose from )

 

[WolfmanHarris]

My top 3 in no particular order"
- CPR Board. Ministry required, never used. (this one came to me almost instantly. Hate the bulky thing)

- Long spine board. When will we drop these piece of equipment and use vacuum matresses and clinical judgment? Besides, I much prefer the scoop.

- Squad bench in the back. I don't want my back to be the crumple zone in a minor side impact. Front/rear facing captain's chair that can be rotated if necessary for pt. care.

 

[Onceamedic]

flippin' useless bite stick - DHS demands we carry one and it is the most useless thing ever... every month we blow the dust off of it count it

 

[WuLabsWuTecH]

I would get rid of the MAST pants.

I would keep my gloves.

 

[usafmedic45]

REMOVE:
-MAST
-CPR board
-Long spineboard
-Bite sticks/jaw screws
-Inflatable splints (as opposed to vacuum splints)
-Gas-powered manual resuscitators

 

[Maya]

no pants. hmmm... interesting.

 

[rescue99]

The pulse-ox. There are other ways to evaluate and the SPO2 is not all that reliable.

 

[PapaBear434]

I went to MAST pants, but we don't carry them anyway. So, out of the stuff we have... I guess some of the redundancy. We have a Broslow bag and a Peds kit. We have a trauma jump bag and a box in the cabinet we can use when they get to the truck. There is really no point of either of these redundancy measures when each bag and box has multiple of each tool.

If I had to choose something to get rid of, altogether? The CORR and HEAR radios. We never use them. I have personally NEVER used them at all. We use the 800mhz radio for pretty much anything and everything. They just take up needless room.

 

[usafmedic45]

The pulse-ox. There are other ways to evaluate and the SPO2 is not all that reliable.

I'll give you a chance to pull your foot out of your mouth. OK, time's up. The problem with pulse oximetry is usually how it is applied and by whom it is being interpreted. Most EMS providers have a very weak understanding of how to interpret and troubleshoot issues. Do not throw the baby out with the bathwater simply because of a misplaced bias. There's a really great joke about accuracy of lab results and how to address problems:

-Precise and accurate: Give the technician a pay raise
-Precise but not accurate (you get a technically acceptable result but it's not correct): Calibrate the machine
-Accurate but not precise (you have problems getting the reading but it comes out correct once you do): retrain the technician
-Neither precise nor accurate: fire the technician and get rid of the machine

Most of the problems I hear EMS providers bring up about fall under the "accurate but not precise" criteria above. Quite frankly, if you put even the best equipment in the hands of a poorly trained troglodyte, you're going to get crap for results.

Short of a blood gas, there is no more reliable measure- in skilled hands- than a pulse oximeter and it has a vital role to play in the titration of oxygen therapy. Sure, you have to correlate it with what you are seeing with the patient but one could technically argue that we should throw away our BP cuffs because you can use other assessment findings to judge perfusion. There have been studies done that show a very poor correlation between assessment findings and demonstrable hypoxia. Contrary to the popular held belief, not all that is dyspneic is hypoxic. Likewise, the old tendency in our field to blame the equipment is not the best approach.

 

[rescue99]

Excuse me? Pull my foot out of my mouth? Wow..not necessary! It happens to be a NR question.

 

[usafmedic45]

It happens to be a NR question.

Oh, excuse me, I didn't realize that inclusion on the NR exams was the penultimate Level I evidence. Just because it's on a test does not mean it's correct.

Wow..not necessary!

Sorry to come across as snide, but I don't like people making indefensible statements based on BS, spin and supposition. Now if you care to point to something of scientific value that indicates that pulse oximetry in the hands of properly trained providers is inaccurate we'll talk like adults and I'll depart from my current guess that your knowledge in this area is a little lacking and based largely on hearsay. Got anything that says that it's inaccurate? That it is unreliable? That it's a bad idea to use it as a diagnostic tool? For future reference, it's not a good idea to make definitive statements in a professional setting- and this forum counts since you're dealing with colleagues- without being prepared to back them up with more than just "it's a NR question."

 

[rescue99]

Who said it isn't a useful tool? There are other ways to assess and if I had to make a decision on what tool of the trade I could leave behind, it would be the SPO2. It is a good tool but, isn't an absolutely necessary tool and in many instances, not my most reliable tool.

 

[WuLabsWuTecH]

It always surprises me how few people know that pulse oximeters need to be calibrated.

Its more or less a IR specroscopy machine or a UV-Vis spectoscopy machine. Would you walk into a chem lab and not calibrate those? We calibrate our "spec's" at least once an hour! Why on earth would you never have to calibrate a pulseox?

 

[daedalus]

I'll give you a chance to pull your foot out of your mouth. OK, time's up. The problem with pulse oximetry is usually how it is applied and by whom it is being interpreted. Most EMS providers have a very weak understanding of how to interpret and troubleshoot issues. Do not throw the baby out with the bathwater simply because of a misplaced bias. There's a really great joke about accuracy of lab results and how to address problems:

-Precise and accurate: Give the technician a pay raise
-Precise but not accurate (you get a technically acceptable result but it's not correct): Calibrate the machine
-Accurate but not precise (you have problems getting the reading but it comes out correct once you do): retrain the technician
-Neither precise nor accurate: fire the technician and get rid of the machine

Most of the problems I hear EMS providers bring up about fall under the "accurate but not precise" criteria above. Quite frankly, if you put even the best equipment in the hands of a poorly trained troglodyte, you're going to get crap for results.

Short of a blood gas, there is no more reliable measure- in skilled hands- than a pulse oximeter and it has a vital role to play in the titration of oxygen therapy. Sure, you have to correlate it with what you are seeing with the patient but one could technically argue that we should throw away our BP cuffs because you can use other assessment findings to judge perfusion. There have been studies done that show a very poor correlation between assessment findings and demonstrable hypoxia. Contrary to the popular held belief, not all that is dyspneic is hypoxic. Likewise, the old tendency in our field to blame the equipment is not the best approach.

I love this post! I have always fought the whole "Treat the patient, not the machine" because the phrase is overused and misunderstood. It is imperative that any medical provider have a mastery of physical assessment and a good PE can bring hidden truths to light. However, there is a reason why EKGs, ABGs, Pulse oximeters, glucometer, CT scanners, X ray, etc were developed. To augment and enhance the PE. Of course you are going to treat findings from diagnostic studies, as long as you are educated enough to know when they are precise and accurate and you are not being fooled by them. (Kudos to those who know the difference between precise, and accurate. If not, read up on it, and while you are at it, read up on specificity and sensitivity)

 

[usafmedic45]

There are other ways to assess

Ever heard of inter-rater reliability? It's a way of examining the differences between a number of people who are looking at the same thing. The problem with these "other ways" is that the inter-rater reliability is generally crappy mostly because of the fact that not everyone who looks hypoxic is hypoxic and some people have a better ability to separate the two. The reliability of these "other ways" in other words, is marginal at best. Since reliability seems to be a primary concern of yours, then I am surprised that you are not aware of this.

It is a good tool but, isn't an absolutely necessary tool and in many instances, not my most reliable tool.

It's either a good tool, or it's not reliable. Which is it? It is either a good tool or you can't rely on it a lot of the time. It sounds like you're basing this stance off of opinion and personal experience rather than anything valid or defensible.

Just in case you're interested:
Aughey K, Hess D, Eitel D, Bleecher K, Cooley M, Ogden C, Sabulsky N: An evaluation of pulse oximetry in prehospital care. Ann Emerg Med. 1991 Aug;20(8):887-91.

STUDY OBJECTIVES: We performed this study to evaluate the accuracy of pulse oximetry oxygen saturation (SpO2) against direct measurements of arterial oxygen saturation (SaO2) in the field. DESIGN: Prospective, cross-sectional, paired measurements of SpO2 against SaO2. SETTING: This evaluation was done in the prehospital setting. INTERVENTIONS: A pulse oximeter with digital probe was used to measure SpO2 in 30 patients. Arterial blood gases were drawn in the field while the pulse oximeter was in use, and oxygen saturation (HbO2) was measured by CO-oximetry. MAIN RESULTS: There was no significant difference between SpO2 (94.6 +/- 5.4%) and HbO2 (94.9 +/- 5.1%) (P = .495, beta less than .2). There was a strong correlation between SpO2 and HbO2 (r = .898). The bias between SpO2 and HbO2 was -0.3, with a precision of 2.4. When SpO2 was 88% or more, HbO2 was 90% or more in every case. Mean carboxyhemoglobin was 1.3 +/- 0.9%, and mean methemoglobin was 0.9 +/- 0.3%. There was no significant difference between the pulse oximeter heart rate and the ECG heart rate (P = .223, beta less than .2). CONCLUSION: We conclude that pulse oximetry is sufficiently accurate to be useful in the field when SpO2 is more than 88%. It is potentially useful in patients with clinical signs of acute hypoxemia and in patients receiving interventions that may produce acute hypoxemia. Further work is needed to evaluate the accuracy of pulse oximetry in the settings of elevated carboxyhemoglobin, methemoglobin, and very low saturations.

BTW, "very low sats" is really a moot point in the field. If you have clinically correlatable reading that is less than 80% (most pulse oxs state not to rely upon a reading lower than 70-75%) you are not worry any further. It is quite overt hypoxemia and should be treated as such.

It always surprises me how few people know that pulse oximeters need to be calibrated.

Wu, a lot of modern pulse oximeters have a built in calibration check that automatically maintains the validity of the results. In fact, I believe it's effectively an industry standard nowadays. This is per a conversation I had with an engineer from Masimo (one of the major manufacturers of pulse oxs) where I asked about exactly what you just brought up.

 

[reaper]

To add to this, many states have SPO2 has a mandatory vital sign, just like Pulse,BP,and RR. So, it is not something that can be left behind.

To the OP, I would leave the portable stretcher off the truck. The kind that folds in half. We carry them as a requirement, but never use them, except in mountain rescue.

 

[WolfmanHarris]

To the OP, I would leave the portable stretcher off the truck. The kind that folds in half. We carry them as a requirement, but never use them, except in mountain rescue.

I was going to say that at first, but then flashed on a rural 5-car MVC I went to where I had to transport two minor, but boarded patients and had to use it. (The trucks have specifc brackets in the bench to secure a Ferno #9) It was February and this was a rural service. If we'd waited for enough trucks for one patient per it wouldn't have been a good use of resources. To me it's one of those pieces of equipment, that when you need it, you need it, however rare.