Options for paramedic supply storage
The way supplies are stored and restocked can definitely influence the health of the relationship between an ED and its EMS services. Paramedics want to get their supplies and exit the ED as quickly as possible, while EDs need to ensure accurate charging and avoid theft. Here are some storage methods to consider:
• Storage room. Athens (GA) Regional Medical Center's ED has a storage room with separate areas where equipment for specific agencies is stored, such as backboards, straps, and splints. "Every time they come to drop a patient off, they check to see if there is any equipment left in their area," says D.W. Pettigrew, MD, FACEP, Medical Director of the ED and EMS. Although the area is open and not secured, theft hasn't been a problem. "It's in direct visualization of our dispatch where the ambulances come and go, and they would see people walking out with other stuff because most have big identifying marks on their equipment," he notes.
• Locked cabinets. At Riverside Methodist Hospital in Columbus, OH, supplies belonging to agencies are kept in locked cabinets near the squad entrance. Paramedics must get the key from a protective service officer or technician. "They're supposed to walk with the paramedics to the cabinets, to make sure they only take what belongs to them, but sometimes it's just too busy and they let them go by themselves," says Gail Loadman, RN, CEN, Director of Emergency Services. "Then they're on the honor system, so there is always the possibility they'll take another agency's equipment."
• Returning equipment of non-local agencies. When an agency travels a long distance to bring a patient to Riverside Methodist, the ED staff returns the equipment by mail promptly. "Since we are a tertiary referral center we sometimes have ambulances come from other counties," says Loadman. "We try to make it as convenient as we can for them to get their equipment back, since they probably don't get here very often."
• Individual lockers. At Loma Linda (CA) University Medical Center, every agency has its own cabinet, with drawers at the bottom for sandbag straps. The cabinets are locked with a master lock, with the combination given to each agency. "We don't take responsibility for any of their equipment, but we do lock them as a courtesy so their equipment is secured," says Carerie Kozak, RN, BSN, CEN, the ED's MICN-Prehospital Coordinator.
The locks have since been removed by the individual agencies, that wanted easy access to their supplies. "We haven't really had any problems because they keep on top of tracking their own equipment," says Kozak.
Tracking of EMS equipment. Tracking systems for equipment are one possibility, but when things get hectic, the system is likely to be bypassed. "At one point we did have a card system to track equipment coming and going, but the paramedics were pretty noncompliant so we discontinued it," says Loadman.
Sign-in sheets are used at Loma Linda to keep track of equipment left behind by paramedics. "If a trauma tech takes a backboard off a patient, we clean it, put it in the agency's locker and sign it in for them," says Kozak. When that agency comes to pick up their equipment, they sign it out so it can be tracked. The ED's trauma technicians routinely call the agencies to remind them to pick up equipment that has been left behind.
Restocking supplies used by paramedics
• Contracting with local agencies to restock supplies. Paramedics appreciate being able to drop off a patient and restock in a single location. "We have a drug box resupply contract with several other county EMS units, and that facilitates them bringing patients here because it's a one-stop deal. They can leave our ED without going to yet another location to get resupplied," says Pettigrew.
• Immediate restocking. While some EDs will only restock supplies on the paramedics' next visit, EMS crews find it frustrating to wait. In an effort to make things as convenient as possible, many EDs restock their supplies immediately. "They hand us a sheet that tells us exactly what they used with the patient, and then we go ahead and get the supplies together for them right out of the ED," says Loadman.
The system poses a challenge during hectic times when nurses aren't readily available to assist paramedics in getting the supplies. On those occasions, paramedics sometimes get tired of waiting and take it upon themselves to restock from the unlocked storage area. "If everyone's playing fair, the system works well, but at times they come in and help themselves and often take more than they use," says Loadman.
When relying on the honor system, lost supplies are a common problem. "A good example is the disposable analyzer for carbon dioxideit's a $30 item, and we don't use them very often, but we were keeping them on the code carts in case a physician did ask for them. They were disappearing, and we knew we weren't using them," says Loadman. Although lost supplies are a problem in many EDs, keeping the supplies in a locked, secure area is not always an option. "It's almost impossible to keep all the supplies locked and still have them accessible to staff," says Loadman. If items are inexpensive, accessibility may take precedence over security. Less costly items such as oxygen masks, IV fluid, IV tubing, and angiocatheters are stored in a supply drawer in the main ED, and paramedics are permitted to restock their own supplies.
• Pyxis units for medications. To ensure accurate charging, medications can be restocked through Pyxis after a patient has been registered. At Loma Linda, a sticker is generated after a patient is registered. It is placed on a central supply restocking sheet kept in the paramedic lounge. "They fill out what they need, and our stock person gets it for them, and it's charged to the patient's account," says Kozak.
If agencies need to restock supplies that shouldn't be billed to the patient, a prehospital charge sheet is filled out, and the agency's account is billed. "It helps to ensure that it's a one-for-one exchange," says Kozak. "Before, they went in and helped themselves on the honor system, and the lost revenue was astronomical. This way, no one is losing money and the patient isn't double-billed."
Paramedics would prefer to have open access to supplies. "They sometimes complain about having to walk down the hall to central supply, but while one paramedic is writing up the summation, the other can go get a restock," says Kozak. If a patient dies in the field before being transported to the ED, the hospital allows the paramedics to restock whatever supplies were used and splits the cost.
Paramedic carts. In the rush to gather supplies for waiting paramedics, it can be helpful to store commonly used items on a paramedic cart. At Loma Linda, a paramedic cart is kept in the central supply area, a short walk down the hall from the ED. "There is not open access to paramedics; it's a very controlled system," says Kozak.
The cart contains the following supplies:
antiseptic swabs/wipes
povidone/iodine swabs/wipes
ammonia inhalants
2 disposable syringes, TB, 3 cc, 5 cc/6 cc, 10 cc/12 cc, 20 cc/30 cc, 50 cc/60 cc catheter tip
2 hypodermic needles 18 g, 20 g/21 g, 22 g/23 g, 25 g
2 each: IV catheters #10 and/or #12, #14 and/or #16, #18, #20, #22, #24
1 each: intraosseous needles, #15, #16, and #18
2 Y-type blood tubing
1 three-way stopcock
5 solution administration sets (2 microdrip and 3 macrodrip)
2 IV extension tubings
1 vacutainer
2 chemistry profile tubes
1 bottle glucose monitoring sticks
2 each: Approved Rigid Cervical Collars (large, medium, small, and pediatric)
2 sterile sheets for burns
1 OB kit (bulb suction, two Kelly clamps or cord clamps, sterile scissors or scalpel, sterile sheet and blanket, sterile container, 2 sterile towels, sterile gloves)
2 meconium aspirators
2 each: endotracheal tubes, cuffed 6.0/6.5, 7.0/7.5, 8.0/8.5 (half sizes optional)
3 each: endotracheal tubes, uncuffed, 2.0/2.5, 3.0/3.5 (half sizes optional)
2 each: endotracheal tubes, uncuffed 4.0/4.5, 5.0/5.5 (half sizes optional)
2 approved cricothyrotomy kits or
1 each: catheter over needle devices, #10 or #12 and #14 with adapter for BVM/TLJV
1 each: naso/orogastric tubes (sump tubes), #10 or #12, #14, #16, or #18
1 each: naso/orogastric feeding tubes #5, #6, and #8
1 each: suction catheters, size 6, 8, or 10, 12 or 14 French
1 yankauers tonsil tip
2 small-volume nebulizers
1 each: malleable stylet, (adult or pediatric), water-soluble lubricating jelly, oropharyngeal airways (infant, child and adult) sizes 0-9, nasopharyngeal airways
2 air-occlusive dressings (e.g., vaseline gauze)
2 nasal cannulas (adult, pediatric)
3 adult non-rebreather oxygen masks
2 pediatric oxygen masks or non-rebreather oxygen mask
2 heparin locks
1 one-way flutter valve with adapter or equivalent
2 3cc/5cc containers of normal saline for drug inhalation diluent (unless carrying unit dose or premixed albuterol)
1 intraosseous needle, #14
2 end-tidal disposable carbon dioxide monitors
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