Today’s paramedics have available to them a wide variety of equipment and a vast array of medications. The selection of the equipment is often not decided by the paramedics themselves. A common-sense selection program, though, will represent the end user’s preferences, and seek to position the equipment as close as possible to the patient(s) being cared for. The process for evaluating a piece of equipment is fairly straightforward. The best processes start with a need – i.e., either anentified gap in the current treatment provided by the emergency medical services (EMS) system or a mandated addition/change in that treatment. In deciding what equipment to purchase, members of the equipment selection team should ask themselves some basic questions, including the following: (1) What does this item add to the paramedic’s diagnostics or treatment capabilities? There are almost as many features as there are manufacturers of a specific type of device. Deciding which meets the need of an individual EMS service is often a simple matter of weighing the desired feature against the features that come with the specific device. A diagnostic function allows the paramedic to determine the cause of the patient’s illness or injury, whereas a treatment function allows him to correct – and/or arrest or at least slow down – the disease process. It is not enough, though, that an equipment feature allows the paramedic to diagnose a condition he (or she) otherwise would not be able to – the paramedic also must possess the capability to treat that condition and/or facilitate the speed and/or efficiency of treatment at the hospital. The capacity to treat a particular condition need not be inherent in the feature or device; a separate capacity to provide treatment usually would be enough. To be truly effective a treatment should be either life-saving or should correct a condition that causes severe pain or other problems. (2) How much does it weigh and how convenient is it to carry? Paramedic equipment must be both portable and rugged. The author’s personal experience in New York City suggests that a two-person paramedic team will A diagnostic function allows the paramedic to determine the cause of the patient’s illness or injury, whereas a treatment function allows him to correct the disease process consistently be able to carry about 75 pounds of gear to a patient’s (or victim’s) bedside. When more gear is required, the team will have to decide which equipment items are the most essential and which are the least useful. As a rule of thumb, smaller, lighter, and more compact are almost always better; however, it should be remembered that big hands wearing thick exam gloves may have considerable difficulty in manipulating tiny buttons; this factor translates into a functional limit to the “miniaturization” of some devices. A more effective strategy, therefore, may be combining a number of functions into one and the same device. Many of the manufacturers of defibrillator/cardiac monitors designed for paramedics have made the “combination” option a staple of their product lines, often by incorporating individual features into plug-in modules that can added as optional extras. (3) Will it function in a pre-hospital environment? There are many devices that provide similar or sometimes better functional capabilities than other devices that are typically carried in an ambulance – but many of those seemingly better devices are impractical, for various reasons, in the EMS world. Some are unusable, for example, because they have to be tethered to a source of electric power or oxygen; others fail the usability test because they need a stable platform to operate effectively. By their very nature EMS capabilities must be mobile, and paramedics carry out much of their patient care separated not only from a fixed healthcare facility but even from their own vehicles. Paramedics frequently have to carry not only equipment but also patients across unsteady and broken terrain – which is another reason that many promising medical devices have been eliminated from consideration for purchase after a test drive in a moving ambulance has found them not suitable for use in a rugged or mobile environment.eally, of course, equipment selected for EMS use must be able to function even when slung over the paramedic’s back. A well-considered selection process should answer all of the preceding questions, and more, before the selection team tackles one of several even more daunting questions – namely, can the equipment be funded, both on the immediate “set up” level and, after the initial purchase, for the foreseeable future? Before answering that last question it should be kept in mind that all equipment has ongoing costs attached, either of consumables or in the maintenance and/or replacement of worn-out equipment.
For additional information on the following products, visit:
M Series Defibrillator http://www.zoll.com/product.aspx?id=76
LIFEPAK 12 Defibrillator/Monitor http://www.physiocontrol.com/products/defibrillators/product-detail.aspx?id=546
Joseph Cahill is the director of medicolegal investigations for the Massachusetts Office of the Chief Medical Examiner. He previously served as exercise and training coordinator for the Massachusetts Department of Public Health and as emergency planner in the Westchester County (N.Y.) Office of Emergency Management. He also served for five years as citywide advanced life support (ALS) coordinator for the FDNY – Bureau of EMS. Before that, he was the department’s Division 6 ALS coordinator, covering the South Bronx and Harlem. He also served on the faculty of the Westchester County Community College’s paramedic program and has been a frequent guest lecturer for the U.S. Secret Service, the FDNY EMS Academy, and Montefiore Hospital.