I try to time my calls so that I have everything done that I need to have done by the time the ambulance backs into the hospital ED bay. I know some medics are taught to do everything on scene. If a patient is sick and needs immediate care, I will absolutely treat them on scene, but in most cases, it is more time and patient efficient to do things on the move. By the time I get to the hospital, I need to have done the following: full assessment, at least two sets of vitals, 12-lead and IV if indicated, any needed treatment, patient history, meds and allergies, patient demographics (name, DOB, SS#). Much of this can be done simultaneously while also moving toward the hospital. I insert an IV while asking about history, all while the wheels are moving toward our destination. The farther I am from the hospital, the sooner I like to start transporting. If I am close, I may take a little time before transporting just to get the bare essentials done. I also need to radio the hospital about the incoming patient, and I like to clean up my mess, (all IV, ECG wrappers and other supply wrappers put in waste can), heart monitor hung on back of monitor, and me ready to jump out and be starting to put the stretcher out of the back when my partner comes around to help. I do all of this while also writing my run form on the lap top if I am able. I like to complete it while waiting in triage or while giving my bedside patient report. Hit the restroom, wash my hands, and then back out there.
I don’t always achieve this. If the call is a bad trauma, the back may be a bloody mess and I may not even have a patient name. You do what you can. And completing the run form by patient turnover is also difficult. Most times, I have to complete it in the EMS room, but I try to at least get a good start on it.
One thing that can really throw off my timing is if I make a critical error in the beginning. That error is failing to get the patient comfortable on the stretcher in the first place. It is so incredibly difficult to try to reposition someone on the stretcher when you are in the back of a moving ambulance by yourself and they have any weight to them at all. Even more difficult is sitting there ignoring a patient in discomfort. You feel like a torturer. I try to stand behind the head of the bed and grab the sheets on both sides of the patient and pull up, but it is hard to get it right, and takes time i need for other tasks. I never like standing in the ambulance when it is moving.
My advice: When you first get the patient on the stretcher, ask them if they are comfortable. Even if they say yes, ask yourself, do they look comfortable? If not, offer to reposition them. Tell them, it is hard to reposition them once moving. Use padding if you have to. Comfort is important –absolutely for the patient, and a bit for the time schedule.