Rituals can be a good thing...

Contrary to some belief, I think some 'rituals' are a good thing, even here in EMS. Sometimes those rituals get us into good habits. And as long as they are based on sound goals and objectives, well, they can be good.

Checking-off the ambulance at the beginning of your shift is an important thing. It is a ritual of sorts. We should be doing it at the beginning of every shift. I guess in a perfect world you could trust your off-going shift to be diligent in ensuring that you and your unit can take that call that comes in immediately after you go on duty. But usually, that is when I get my nastiest surprises. You see, as much as I like them, sometimes, well, they forget stuff. Or in some cases, they just don’t care. Yes, I have worked with some of those people during my career.

So I take matters into my own hands. Some surprises are good, but others are not. First thing, you need to arrive at work with enough time to check a few things before going on duty. So, if your shift changes at 0800, then you need to be at work NLT 0730. Change at 0700? Be there at 0630. No, you are not going to get paid for it. Not money, anyway. But it can pay you dividends that you can appreciate it. More on that in a few minutes.

The first thing I check is the main onboard oxygen cylinder. The second thing is the defibrillator batteries (those actually in the defibrillator and the spares). The third thing is my portable oxygen. A quick look around the unit to verify that things seem to be in place takes care of my ‘initial’ check.

The next thing I do is change the portable radio batteries (unless I know that they were changed just prior to me receiving the radio).

I try and get some sort of turnover report from the off-going crew, then, I or my partner start on the complete check-off. If we get a call in the middle of it, then, my partner or I can continue the check-off while the other is completing the report at the ED.

There are things that you can do to make the check-off easier. At my service, we seal certain items with a numbered seal tag. The things we seal are the ET kits, the pediatrics bag, our drug box, and our Mark I kits. Other things could be sealed, like cabinets with little-used items (OB kits, burn sheets, etc.).

The rest of it is just a matter of finding things on the checklist and then finding them in the unit. Of course, after only a few days you should know where just about everything is, so it should not take a lot of time.

And somewhere up there at the beginning, before the other shift leaves, I like to verify my narcotics and controlled drugs. There is nothing quite like discovering a morphine or fentanyl that has not been accounted for. After the other shift has gone home. And of course, no documentation is available, and the last shift’s call reports are in the ‘HIPAA box’.

But back to the check-off. Usually, it can be done before or shortly after our official shift begins.

So what other benefits can be gained by this? Well, if you establish the standard, maybe the other crew(s) will reciprocate. After all, if you are there at 0730 and a call comes in at 0745, then you should take the call. Again, you probably are not going to get paid for it, depending on your agency’s HR policies or your union contract. But the other crew does not have to take that late call, and they should be appreciative. Enough so to return the favor the next day. I know I would, since

I really hate those 0745 calls. Seems like they only come in when I have to be somewhere at a specific time.

But what if they don’t return the favor? Well, several of the crews I work with are like that. And that’s OK. At my old service I always tried to arrive between 0730 and 0740 for an 0800 shift change. My new job has an 0700 shift change, and I want to be there between 0630 and 0640. It hasn’t worked out thus far since the other half and I have been down to one vehicle for a little while now. But as soon as I get the 9E1-mobile back, then I will be leaving home at 0620-ish.

Rituals can be good. As long as we have solid goals behind our rituals.