Both Rescue 999 and Too Old To Work, Too Young To Die posted recently about what they considered essential ambulance equipment. Very thoughtful posts that sparked me to consider offering my own take on the subject (and I expect I will), but first I have been diverted due to a new post by CKEMTP of Life Under the Lights raising the spector of the dreaded bedpan.
Somewhere Around Here
I have to confess in my twenty-one years in EMS, I have only gotten the bed pan out less than a dozen times. I also admit there were occasions when the bed pan was not always in the first place in the ambulance I looked (this was at a time when I was in a different ambulance every shift — “I know it is in one of these cabinets. Somewhere.” I either didn’t know where it was or perhaps, I was stalling for time.
Now please don’t think I am heartless. I write this as someone who just a few moments ago assisted a very obese supine man with a urinal. Assisting a morbidly obese supine man with a urinal basically means I do all the work (scooping the end of his penis into the urinal) while he merely relaxes when I give him the all set equipment in position update.
I should mention this episode did not occur in the ambulance, but in the hospital ED where our patient was assigned to a crowded hallway. When I was able to corral a passing nurse, she needed my help pushing the stretcher into a temporarily vacant room where the patient could have some equally temporary privacy.
It was then that the question of his being able to use the urinal by himself or needing help came up. Since the nurse was a female, and it wasn’t her patient, and she had at least responded to my request only because she has a perpetual smile and is a good-hearted care-giver — unlike the other nurse who, perhaps a waiter in a previous job, walked straight past my wavying arms without making eye contact (No tip for you) — well, I ended up volunteering to put the gloves on.
We’re Almost There
This is not to say I haven’t pulled out my share of urinals in the ambulance. I will get a urinal or a bed pan if I must. However, my first response to a request for a urinal or a bed pan is “Can you hold it?” (Followed by “We’re almost there. Just a couple more blocks.”)
They usually can hold it. But not always. When they insist that they cannot, I get the urinal out. When I do get it out, I have found a great many men suffer from performance anxiety trying to stuff their male IDs into urinals while riding down the road despite the attendant’s elsewhere gaze. The only patients peeing is easy for are the drunks. Considering they grab the urinal as if it were another frosty beer, as well as the orgasms of relief they emit when they tap their bladders, I can understand why.
On the Move
But back to the bed pan. Here’s the problem with the bed pan. It’s hard enough pooping in a hospital bed, but when you are bouncing down the road, strapped onto a stretcher, and still wearing your pants or nylons or whatever, and you need to get them pulled down, it is a production, particuarly if you are 300 plus pounds, and overflowing the stretcher to begin with. And then there is the TP part. I have never mastered the skill of giving a good wipe on the move.
So I avoid bed pans if I can.
What I do not avoid, and I will brag here (which I shouldn’t because I am just doing my job) is if I am in a patient’s house and they are covered in shit, I do not wrap them up and toss them on the stretcher with an extra blanket on top to contain the order and leave the dirty work to the ED techs. Male or female, I wipe them clean, get them in the shower if I have to (condition permitting) get them in some nice clean, cotton pajamas or just the hospital johnny I carry on my stretcher.
A police officer came up to me one day and said, “You really impressed me on that call yesterday.” I said, “huh?” trying to recall a cardiac arrest where I sunk the tube as soon as I walked in the door, used a blow dart gun to catheterize the jugular vein and then caused the person to rise up and do a just resucitated happy to be alive jig where she had previously lain quite dead.
“I’m talking about you got right into it and wiped that old lady’s ass. That was some nasty shit. That was above and beyond.”
I love intubating. I love recognizing a STEMI. I love giving people morphine to take their pain away. And while I may not like many of the components of it, I love helping a patient in their lowest moment feel as if they are blessed members of the human community, which they all are.
I love doing these things because I love being a paramedic.
Under the Bench
Props to CKEMTP for honoring the lowly bed pan. I just rechecked my rig. Under the bench seat, you can find a pink bed pan, a pink female urinal, and two male urinals. True the bed pan is a little dusty, but maybe I’m just having a dry spell on bed pan calls. I will try to be better about getting it out. Maybe one less, “We’re almost there.”
Writing this I realized that the arguement I often use to give a patient another dose of morphine in the parking lot is that time to the hospital doesn’t always equate to time to medical care in the hospital. Studies have shown hospitals can have a median time of 149 minutes to medication after triage. I wonder what the numbers are with regards to time to the hospital versus time to the bedpan in the hospital.