EMS, Engine Company, Fire Department

Creative, Disciplined Equipment Purchasing

Issue 2 and Volume 15.

When making purchases for your service, it’s important to be creative to take advantage of all available resources. And it’s important to be disciplined to make sure you get the right tool for the best value. It helps to put together a team to help you define your needs and then look for the material solutions.

Purchasing equipment for your service is a great opportunity to give your personnel a sense of inclusion. By forming a committee to review equipment needs, they get a chance to become a part of the process with a sense of ownership.
As a manager, you get a chance to hear the department’s needs expressed in a way that might dissuade you of some of your assumptions about what it’s like on the street for your people. Whatever the committee is looking to purchase, the work should start with defining needs. Why are we buying this particular item? Rather than changing your practice to fit a particular item, you should define the job to be done and find the tool that fits best.

Let’s look at some specific types of purchases we make, starting with vehicles.

Here’s an excellent opportunity to find out things you didn’t know you were missing. Rather than assuming you need to replace current stock with the same type, do an analysis of the environment in which your vehicles are used and the manner in which you staff them. There are a lot of variables from one service to another. If you start with your needs rather than trying to make your needs fit a particular model, you may find there is a better way to put wheels under your people.

Define Your Service

First, define your service, whether it is fire-based, third service or private. This is important as fire personnel on an ambulance may be carrying much more gear than non-fire personnel. Bunker gear and SCBAs are going to need space on the vehicle without compromising the space needed for medical equipment. Are you advanced life support (ALS), emergency medical technician (EMT) advanced or basic life support? This too will become a space issue as the volume of equipment and supplies grows along with the level of care provided.

Consider the environment where these vehicles will operate. It could be open and varied terrain or narrow city streets. This will call for appropriate size, as well as engine and transmission, decisions based on where you will be using these vehicles. While everyone loves the space provided by large box ambulances, narrow city streets may compel you to consider smaller more nimble vehicles that can get to all of your citizens easily. On the other hand, a more powerful heavier vehicle may be best if you have varied terrain and weather to consider.

Finding Space

Think about what you will have to carry. Just as the level of service dictates how much equipment you may have to carry, we also have to consider bunker gear and other personal fire equipment if your ambulance crew responds as part of fire companies. Beyond that, you will need to find space for durable and non-durable supplies.

Durable means the equipment you will re-use whenever needed, such as stretchers, backboards, monitors and traction splints. You want to have storage space that is accessible and doesn’t require digging through piles of gear to get to what you need. Manufacturers may have to deal with a limited amount of space in the model you’re looking at, but they are pretty flexible in creating access to that space. An example might be compartments with access from inside and outside the vehicle.

Space for monitors should be secure and safe, but you also have to plan on where the monitor will be when in use so that is visible to the crew during transport. Monitors must be secure during transport so you will have to determine where you want it and how it will be secured.

Non-durable refers to the things that are classified as single patient use, such as bag masks, dressings and IV supplies. This is what commonly takes up much of the space in bins along the wall near where the stretcher is secured. The compartments should be easily accessible while storing the supplies safely so they don’t fall during transport. They should be set up with a logical storage plan, and items that are likely to be used together should be stored near one another.
Purchasing durable goods is another good job for your committee. If you begin with a description of the work you do, it’s more likely that you will buy the stretchers, monitor/defibrillators and other durable items that best support the environment where you work, the people you serve and your crew.

Unnecessary Spending

Purchasing non-durable goods is a place where you can waste a lot of money if you’re not careful. If you select unique disposable equipment that cannot be exchanged with the facilities receiving your patients, you may be unnecessarily spending money to replace simple products like syringes and dressings.

An example of a tragic waste of limited resources is the purchase of expensive gear that has little or no utility. Devices come and go that are someone’s idea of a good tool. Some are devices in search of problems rather than a device designed to solve a documented problem. Before you buy an expensive trendy device, find out whether it has been shown to be effective through study. When in doubt, talk to your medical directors to determine whether there is sufficient evidence to support the investment.

Buying Quality

There is tremendous opportunity to enable your service to be the best equipped. Reviewing your needs prior to identifying equipment to be purchased will ensure you make the right choices. Buying less, but buying quality, ensures your equipment will last. It also gives you more opportunities to look for additions to your equipment.

Editor’s Note: Will Chapleau, who has more than 30 years of EMS experience, is the Advanced Trauma Life Support (ATLS) program manager for the American College of Surgeons. He is the former chief of the Chicago Heights (Ill.) Fire Department, has served since 1996 as the chairperson for the Prehospital Trauma Life Support (PHTLS) program of the National Association of Emergency Medical Technicians and has been a member of its international faculty since 1984. He is a board member of the National Association of EMS Educators.

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