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Patient care: Are you sitting comfortably?
Make them feel comfortable and safe while they entrust you with their care
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By Art Hsieh
| Editor's note: With a Tenn. ambulance ride getting a rough rating from a patient's husband, Editorial Advisor Art Hsieh takes a look at the comfort issue in ambulances. |
As the comments being posted indicate, we know that the underlying issue surrounding this situation is the fact this medically fragile patient is being transported on an unyielding backboard that would cause discomfort to a healthy person — no less a patient whose condition predisposes her to significant pain on a normal day.
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I'm not suggesting that the crew did anything incorrect — protocols being what they are, and medical establishments being slow to respond to changes in practice — it's not surprising that the patient was immobilized to the board.
It's more that the care we need to provide has to include a good measure of comfort and compassion. Could the board have been padded? Might analgesics be provided? Not all of what we provide as care in the back of the unit is based in hard science and statistics.
I've lamented about one of the disadvantages of converting from an automobile-based ambulance platform to a van or truck was the loss of the ride characteristics for the patient.
Even with air suspensions, today's ambulance vehicles are no match for the Meteors of 50 years ago in terms of patient comfort.
The "Sprinter" chassis has been an improvement in the trend — its longer wheelbase and suspension helps to smooth out life's bumpy rides. Yet it's still a clunky ride.
What about some additional suspension inside the vehicle? A floating platform that adds additional dampening while the vehicle is in motion? How about suspension on the gurney itself?
I could even see some type of device that isolates the patient from the gurney during transport. Food for thought.
In any case, share some of the Valentine's Day love with your patients today and every day — make them feel comfortable and safe while they entrust you with their care.
Aidan Tasker-Lynch Wednesday, February 15, 2012 1:56:52 AM The backboard should have stayed in the 50's..... 
Richard Berger Wednesday, February 15, 2012 4:26:56 PM I trust the "Meteor" reference was one line of Caddy-lances available until roughly 1986, due to the then latest KKK1822 requirements. Those things rode smooooooth! 
Sherman Tomlinson Saturday, February 18, 2012 9:30:23 AM How about the medics in the back...it's just as rough for us too. Don't get me startred on the van ambulances. 
Hunter Reed Saturday, February 18, 2012 9:43:22 AM listen I am all for making the patient as comfortable as possible. however when it all boils down it we are here to provide emergency medical treatment and transport to definitve care. I guess what I am trying to say is that if the patient is sick I am not going to worry about if the paitent is comfortable I will be worried the treatment of my patient. 
Aline Kloeppel Saturday, February 18, 2012 9:54:13 AM You can only do so much for patient "comfort" in the back of a rig. The idea of a suspension system for the pram sounds like a good idea, but I can see some issues. One being that the patient on the bed is moving differently that the Medic/EMT. Example: You are trying to start an IV in the back of a moving rig...the pram has it's own suspension for patient comfort...as you go to start the IV, the Pt "glides" one way and the medic is bounced another way. Nothing like adding more difficulties to an already difficult Pt care situation. Just my $.02 worth. 
Erik Kloeppel Saturday, February 18, 2012 11:06:26 AM It seems to me that the operative phrase in any protocol book is "comfortable as possible". There are limits to what technology and economics can provide. I'm not in EMS, nor do I play a medic on TV, but it seems to me that the primary question should not be one of comfort, but of survival. Did the patient make it to the hospital? I know that's all *I* would care about if I were involved. Whether or not I (or my loved one) has a pillow or is not sitting in an easy chair is.. well, not even in spitting distance to my list of priorities. Anything that makes the job harder for the medic is contra-indicated. Period. 
James Miller Saturday, February 18, 2012 5:56:08 PM In case you have forgotten, most of the units that are in use today are still TRUCKS. They are not the Cadillacs of years gone by. Even with an air-ride suspension systems still ride rough. I'm sorry about the ride but if the patient is complaining about the ride, are they really sick enough to be in the unit? 
Art Hsieh Monday, February 20, 2012 10:03:02 PM The following comments come courtesy of Dale Leich. I am reposting them here with Dale's permission; I think he has several salient points.
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several issues come to mind-
#1- EMTs used to be taught to use padding of voids and other items to aid in patient comfort when immobilized on a backboard. I rarely see that either taught in classes today nor are medics in the field (at least the ones I see) using these methods (either for lack of knowledge or simply not caring to comfort the patient, maybe for the sake of time?)
#2- Not all air ride systems are the same. And even with an air ride system, it needs to be adjusted AFTER the normal equipment load and passenger weights have been added. Most places that complain have either not made these adjustments or have problems with their air ride systems due to a lack of maintenance (draining water from storage tanks, leaking valves, dislodged air bags, etc.)
#3- Type 1 (Truck) chassis are designed to haul freight and therefore have a stiffer suspension system that even an air ride cannot completely overcome. Type III (cutaway) chassis are designed differently to normally haul occupants (as an ambulance, RV, school bus, etc.) so those normally don't require an air ride system unless the addition of an aftermarket 4x4 system creates a higher floor level or a rougher ride.
#4- Even with the best suspensions and maintenance, if you have someone driving who doesn't understand veihcle dynamics, the ride will always be rough no matter what kind of vehicle you are riding in. We have all had partners who didn't seem to miss a pothole or know how to threshhold brake.
#5- Some roads are rough on any vehicle, even the nicest car. Rural roads can be a nightmare but even many urban roads are full of potholes, patches, manhole covers, etc. that you cannot avoid.
My comments are based upon 20+ years of EMS experience (including leadership and fleet management roles) and another 20+ years in ambulance sales. 
Sherry Al-Alawi Tue Feb 21 00:21:01 PST 2012 I was a patient on a abackbord & agree the journy was a painful experince ina addtion to my trauma.
Skip Kirkwood Tuesday, February 21, 2012 4:21:21 AM 95% of people placed on backboards have no reason to be there. It has just become habit for medics to place people on that device (as opposed to a scoop, or just right on the stretcher) regardless of the discomfort of the patient. 
Thomas Little Tue Feb 21 04:59:19 PST 2012 Too many of us were taught to look at the mechanism of injury and secure. "You will never be wrong using a spine board". I guess we need another culture shift.
Garry Pomerleau Tue Feb 21 05:44:17 PST 2012 Anything flat and hard can't do any good for a patient of any age..if confine an animal it will fight and further harm itself same concept here except with people.. The culture changes for the better
Dave Kozina Tue Feb 21 08:54:11 PST 2012 It took a lot for me to get away from boarding someone just on mechanism. And now I've got a new guy that I need to teach it to. Skip Kirkwood Wed Feb 22 17:24:33 PST 2012 Good for you, Dave. Start by strapping your new partner on a board, put him in the back of an ambulance, and tour some of the finer roads in your jurisdiction. It will be an enlightening experience for him.
