This past weekend, I was looking through the Sunday ads when I commented to my wife that we should run to Staples and pick up some toilet paper, since they had an unusually good price on it. She looked at me funny and laughed, asking, "Staples?!?" Well, yes. I explained to her that it's an office supply store, and since offices employ people, you need stuff like coffee, toilet paper, cleaning supplies, snacks, headache remedies, and so on to run one effectively. After all, as Napoleon has been quoted as saying, "An army marches on its stomach."
The U.S. military understands this. It's often been said that the primary reason for U.S. troops being so successful in combat is due to our ability to maintain a supply chain anywhere in the world. I disagree. I think training is the main reason, with logistics coming in a close second. Case in point: me. I served in Operations Desert Shield and Desert Storm. when I deployed, the only desert camouflage uniforms available had been previously issued on an as needed basis for training. there weren't any new ones. OK, no problem. We can work with that. They were already in the system, and new uniforms began showing up pretty quickly. When we got to the Gulf, we learned that the standard black leather combat boots were useless in a desert environment. Sand is incredibly hard on boots, and they would just disintegrate, as well as being almost unbearably hot during the summer. The then common green canvas jungle boots were more comfortable, but the brass vents that made them appropriate for a tropical environment let a lot of sand into the boot. So something else was needed. The military, in a remarkable display of speed, fast-tracked a tan suede copy of the jungle boot with no vents. It was light weight, breathable, and held up really well under desert conditions. So a critical problem was solved virtually overnight. We got our desert boots eight months after coming home. A solution is meaningless if you can't implement it in a timely manner.
I don't want to bash on the Army (It's too easy.), but they're the service that had the lead in the development of the original desert boot. Fast forward a bit, and we find the Marine Corps (Oohrah!) changing to the now familiar MARPAT uniforms. Headquarters wanted a new, more functional boot to go with the new, more functional uniforms. Was there a huge research project? No. Were millions spent on reinventing the combat boot? No. Were the end users in the ranks happy with the product as delivered? Yep. How, you may ask? Simple. The Marine Corps sent a letter to boot manufacturers specifying what they wanted the boot to do, how they wanted it to look, and how much they were going to spend on it. Want the contract? Meet the specs and pass our quality control tests first. If you want the contract, YOU eat the R&D costs. Guess what? Every manufacturer already had a boot that met those specs in their catalog. Every single one. All they had to do was flip the leather over so it was rough side out and sew the boots together. No long wait, no committee meetings over the number of eyelets, nothing. Box 'em up, and kick 'em out the door. Lesson learned- if you've got a problem, ask someone else if they've already solved it for you. They probably have.
EMS is in a similar situation. Every time you turn around, there's some new innovation out there that's claimed to be the greatest thing since the invention of the ambulance. That's all well and good, but remember, we only have so much space on the unit, there are only so many hours available for training, and your agency only has so much money to buy new toys. Sure, the set of joint specific, semi-customizable splints looks great in the catalog, but the case is the size of a dishwasher, and they don't do anything that can't already be done just as well, if not better, by a SAM splint and a roll of Kerlix, and for a hell of a lot less money. Ankle injury? Substitute a pillow for the SAM, and go to the hospital. Nothing works better. You spent all that time learning to tie a sling and swathe in First Responder or EMT class for a reason. It works. Every time. The fancy splints don't, and if your patient isn't average sized, they won't fit no matter how hard you try. The combination pulse oximeter/carboxyhemoglobin meter sounds like a great idea, and it is. It's also expensive, and not used all that often. Here's a thought: if you run a CO alarm call in the middle of the night, and your patient doesn't feel completely normal, take them to the hospital. They've been exposed, and need at a minimum a couple hours of high flow O2, and potentially hyperbaric therapy. You can't realistically do either one in the field, so just take them somewhere that can. Great tool for an ER, or to have in a dedicated fire rehab unit, but not especially handy for day to day operations. Both of those examples are overly complicated answers to simple questions.
Chances are, if you're faced with an unusual situation out in the field, you already have the solution available. If not, EMS providers are notorious for creative problem solving on the fly. Take a minute to think things through, and an answer will usually present itself. If all else fails, keep the patient breathing, plug any unnecessary holes, throw them on the cot, and go to the hospital. Save the fancy toys for your days off.
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