Look at any EMS discussion forum, and you won’t have to look far to see some sort of equipment thread. The two most common are probably threads about stethoscopes followed by threads about EMS pants. Coming in behind those are the threads about holsters and (shudder) emergency lights for POVs (for the record, if you put a $1000+ light system on your vehicle, I don’t want to hear about how expensive paramedic school is). What is interesting is that there’s no discussion about one of the most used pieces of personal equipment short of a stethoscope, or more importantly, what should be inside. Namely, your clipboard case, and what it contains besides the standard PCR forms and blank incident reports. Additionally, this is why you should carry a clipboard case regardless of if you’re using ePCRs or paper. Two important categories of documents that you should carry are copies of rarely used, but high risk policies such as DNR policies and a “mandated reporter” kit.
My first EMS job was a regional ambulance service based in Orange County, CA. For those unfamiliar with California EMS, protocols and policies are set by the government “Local EMS Agencies” (LEMSA), which are either individual counties or groups of counties. As such, the rules for ambulances based in Los Angeles County and Orange County have different rules and treatment protocols; however these rules are, with limited exception, the same for all services within the LEMSA regardless of the name on the side of the vehicle. Despite my complaints about how Southern California EMS is set up, one thing I will credit both LA and OC LEMSAs with are their rather liberal Do Not Resuscitate (DNR) protocols (PDF warning). Specifically, family members can decline resuscitation on behalf of their loved ones. Running a hospice discharge from a hospital with no physician signature on the DNR? Sign my run sheet please. End stage cancer patient at home who wants to go extra far despite the beginning the spiral down the drain where the family are all on the same page? Sign here. No fuss, no problem, saves pain for everyone. It should also be noted now that in Orange County EMTs do not have access to online medical control.
Now the golden question. How many EMTs have actually read the policy instead of working off of the boiler plate standard set forth in class? Definitely not as many that should have and I’ll admit that I’m slightly deranged and don’t mind reading policies like this. I consider it part of my job and find it interesting to compare how things are handled elsewhere. So you’re on scene of said end stage lung cancer patient, no DNR, no online medical control short of calling paramedics, and the husband and daughter both want the patient to go to their home hospital instead of the closest. No problem, sign here, however your partner objects because she doesn’t know the actual policy. Also not a problem. Hand her the protocol, have the family sign the PCR, and be on your merry way. Wash, rinse, and repeat with other high risk policies that you or someone else would like to quickly reference such as patients requiring physical restraint or for longer clinical scales such as the Los Angeles Prehospital Stroke Screen (PDF warning). Just be careful to limit the number of policies you need. This is an aid for your own memory and your partners, not a replacement for learning them in the first place. Additionally, the more pieces of paper your clipboard contains, the harder it will be to find the one you want.
The next thing that I suggest having is a mandated reporter kit. While the specific laws and procedure varies by state, virtually all states specifically state EMS providers as being mandated reporters for child abuse and most states require the same for dependent and/or elderly adults. However on the scene of a suspected case of abuse is not the time to figure out how to report it. So do a little preparation and build your own kit, which is simple to do. Get a copy of the local procedure for reporting, the local report form, a company incident report, and a pre-addressed stamped envelope. Now on the rare chance you might need it, instead of figuring out everything on the fly you just need to take out your kit, fill in the blanks, and mail it off. You can meet your reporting mandate before your shift ends. Hopefully you’ll never need it, in which case all you’re out is a stamp and a few scraps of paper, but if you do need it, the incident becomes much more manageable.
What do you feel is an essential resident of your clipboard?