Tolland, Connecticut, is a small town like thousands of other towns across the nation. We run a small combination fire and EMS department servicing our 15,000 residents and our mutual aid partners with two ambulances. It is crucial that these ambulances are cleaned, stocked, inspected and ready to roll when the tones drop.
As a small combination department of 6 career and 50+ volunteers, consistent apparatus upkeep was a challenge. Many crews were responding with missing equipment, sharps-caps or sticker plastics on the action bench and the stretcher unmade. Broken, missing or malfunctioning equipment went unreported, often, for weeks.
In late 2015, after many moderately successful attempts at driver checklists, reminders, and hours of training on keeping the ambulances in tip-top shape; the medical officers thought to try a different approach. We decided that our volunteer EMTs should follow a simple, easy-to-remember process to prepare the ambulance both before the start of a shift and after each call. Our presumption was, if we could make cleaning and restocking a habit that accompanied every shift and call, then the ambulances should always remain call-ready.
With that goal in mind, we rolled out a new program called TOP SHELF. The program took a three-pronged approach:
- Create an easy-to-remember acronym to remind crew members what is expected
- Post easy-to-follow job aids on the ambulances and in the ambulance bays
- Verbally reinforce the need to “TOP SHELF” the ambulances at every possible opportunity
At the next monthly meeting, TOP SHELF was rolled out:
- Trash
- Outside
- Patient-Area
- Supplies
- Hand holds
- Equipment
- Linen
- Fuel
The goal was to make TOP SHELF something that every EMS crew could complete in about 10 minutes. None of the officers were naïve enough to think this was a one-and-done solution, so we repeated the rollout at our next EMS training; and then again with every new member as a part of their onboarding. Finally, we reinforce it by asking crews “have you TOP SHELF’d the ambulance today?”
The TOP SHELF acronym provides guidance for EMS crews by detailing what elements of the ambulance we want to focus on. While not intended to be comprehensive, the list serves as a mental tickler to help crews keep the ambulance ready. Here’s how it breaks down:
Trash
- Eliminate trash, packaging and biohazards from work surfaces and floors
- Empty trash receptacles
- Empty and replace sharps containers
- Medical waste to hospital
Outside
- Check signals
- Check emergency lights
- Rinse exterior
- Look for damage
- Connect exhaust hose
- Check tire pressure
Patient-Area
- Clean work surfaces
- Reset HVAC
- Clean and inspect radios
- Stow spare equipment
Supplies
- Replenish bandages and gauze
- Restock airways
- Restock NRB/NC/BVM
- Restock suction tanks and tubes
- Refill oxygen
Hand holds
- Clean and inspect interior hand holds
- Clean and inspect exterior hand holds
Equipment
- Reset radio channels
- Clean and check laptop/tablet
- Clean straps
- Clean stretcher
- Clean cuffs and straps
- Clean boards
- Clean seats and floor
Linen
- Restock towels
- Restock sheets
- Restock blankets
- Dress stretcher
- Stow spare linen
Fuel and fluids
- Refill fuel at ½ (per SOGs)
- Check windshield wipers and washer fluid
- Check oil
- Check coolant
Slowly, the EMS crews incorporated TOP SHELF into each shift; and by mid-way through 2016, it just became part of the job. “TOP SHELF” became more than an acronym. It had evolved to a verb, and even our UCONN trainees ask each other if they had TOP SHELF’d the ambulance. Our ambulance readiness improved, and crews stopped blaming each other for leaving such a mess.
As with any program, it’s important to continuously reinforce what you need done; and we have been successful for more than 6 years at maintaining apparatus that are clean, safe and equipped for the next call. If you think this program might help your department, please download our free job-aid and see if you can start your program this month.
