25 Things Every Bme Should Know

BMET RESOURCE FILE

25 Things Every Biomed Should Know Chris Poulsen

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linicians rely on biomeds to be a key resource for resolving technical problems that occur during the diagnosis and treatment of patients. We are tasked with delivering solutions every day, in situations that are usually complex, often change rapidly, and are always demanding when it comes to quality, safety, and economy. A high-performing biomed provides more than maintenance services—he or she is a valuable partner in delivering a quality healthcare experience. When you think of the skills a biomed should possess, you may first think of competence in electronics, mechanics, and specific healthcare technologies. However, other competencies are essential to performing the job well. Possessing these skills and practicing them regularly not only allows you to maintain a reputation as a top performer, but also helps you realize the most satisfaction and enjoyment you can throughout your career. While this list is certainly not comprehensive, it is a collection of knowledge and know-how that covers the practical, technical, and business domains. It is based on my 25 years of experience as a biomed, as well as lively discussions with other biomeds and healthcare technology professionals on what we must master to deliver the highest standards of excellence in healthcare technology services. Items marked with an arrow have additional resources listed in “Build Your Skills.”

The Practical Skills

1. Rapidly learn and apply new skills. This may seem obvious, but a biomed encounters daily challenges that require on-the-spot training and education. The ability to quickly absorb new information and apply it to the task at hand is essential to top performance. 2. Be self-reliant. I have worked alongside a number of biomeds who have the ability to resolve practically any problem without difficulty and meet challenges head on, regardless of their familiarity with the equipment. Using what you know, who you know, and what you’ve learned in the past to tackle complex challenges allows you to Biomedical Instrumentation & Technology

build a base of knowledge that helps you resolve problems independently and accurately. 3. Be a team player. Just as being able to work independently is an essential skill, so is being able to work within a group. Whether it is other biomeds of varying skills, clinicians, or corporate personnel, listening actively, sharing knowledge, and working together to resolve issues is essential to keeping the business of healthcare delivery running smoothly. 4. Communicate effectively. For many biomeds, lack of clarity in communication is a defense mechanism against giving a clinician bad news about a repair. If speaking indistinctly is a habit that you have developed, practice your message in front of a mirror. If possible, share what you wish to convey with people you feel comfortable with. This will help you better develop the message in your mind. Remember to be confident—you are the expert! 5. Get (and stay) organized. For many biomeds, it can be exceedingly difficult to get (and, more importantly, stay) organized. Keeping a well-ordered shop, from tools to paperwork, may seem overwhelming and time consuming. The best advice is to make organizing your work area a regular and consistent part of your day. It is a classic scenario of “some pain now” versus “much pain later.” Set up drawers, bins, and boxes for work tools, spare parts, and other materials for repairs. Create a simple, easy-to-remember filing system for maintaining documentation, filing reports, retaining invoices, and saving important internal and external communications. Once you have completed your setup, you may only need to spend a few minutes each day putting everything in its intended place. Believe me, the small amount of time invested will pay off when it’s time to prepare for Joint Commission visits and other safety and financial audits! 6. Know how to find and share information. A competent biomed knows that he or she cannot have all of 381

BMET RESOURCE FILE 25 Things Every Biomed Should Know

the answers all of the time. That’s where the power of the professional network becomes essential, and the Rolodex becomes your best friend. Reach out and get to know people in your industry via professional organizations, online communities, and trade publications. Do not be afraid to ask for help when needed, and do not hesitate to provide insight when you are able. By sharing information and making use of the knowledge of everyone in the industry, we become more effective and respected professionals.

The Technical Skills

7. Troubleshoot effectively. Troubleshooting is a method of problem solving that involves a systematic process of eliminating possible causes to determine the root cause of a device or system malfunction. A biomed must be able to apply the following basic troubleshooting principles in a logical manner: • Discuss the malfunction with the end user and capture the particular surroundings associated with the incident. • Reproduce the malfunction. • Compare the malfunction with others from your past experiences. • Rule out possible end-user errors. • Compare existing state with expected operation. • Note the environment and any relevant changes. 8. Understand Ohm’s Law. Ohm’s Law is the cornerstone theory of electronics and electricity. These formulas are very easy to learn and are used extensively throughout biomed tutorials. Without a thorough understanding of Ohm’s Law, you will not get very far in understanding or troubleshooting even basic electrical circuits. Ohm’s Law defines the relationship between power, voltage, current, and resistance.

11. Wire hospital-grade AC plugs. This very basic skill is often overlooked, though it is assumed even an entry-level technician will have it. While it is becoming more common to replace entire line cords, the ability to rewire a plug properly is critical. 12. Work with basic computers and networking technology. Biomedical technology is becoming more computer oriented. Many new biomeds are more confident resolving a major network issue than they would be repairing an aspirator. Try to understand operating systems and network topographies, especially those specific to equipment you are responsible for. 13. Troubleshoot automated blood pressure machines. Automated blood pressure machines are often falsely accused of being inaccurate. It is important to understand how cuff size and location relate to readings. 14. Use a multimeter. A multimeter is one of the most versatile and useful instruments in a biomed’s toolkit. A multimeter is actually three devices in one: a voltmeter that measures electrical potential across a device in volts, an ammeter that measures the amount of electric current through a device, and an ohmmeter that measures the electrical resistance of a device. Multimeters may also have other functions, such as diode and continuity tests. A common mistake when using a multimeter is to forget to move the test leads to the proper jacks when switching between current measurements and voltage or resistance measurements.

9.  Understand electrical safety. Many biomeds diligently perform electrical safety testing on a regular basis, but do not truly understand why it’s done or the theory behind electrical leakage. It’s important that we understand the reasoning behind what for most of us is a large portion of our responsibilities.

15. Read a schematic diagram. Reading a schematic requires knowing what the symbols mean, what the represented components do, and how they are annotated. There are literally hundreds of symbols, and even basic electronic components will have multiple variations. When first learning to read schematics, it’s best to look at older equipment that will likely have simpler schematics than more complicated, modern devices. The real fun comes when a biomed has to interpret schematics written in another language.

10. Know how to solder. While it may no longer be necessary to keep a hot soldering iron on your workbench at all times, it’s important to know how to properly solder when the need arises. Most biomed shops have an abundance of defective circuit boards on which to practice.

16. Understand basic diagnostic imaging technology. Many biomeds are given the opportunity to receive training in diagnostic imaging equipment, such as magnetic resonance imaging (MRI), computed tomography (CT), positron emission tomography (PET), ultrasound,

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BMET RESOURCE FILE Chris Poulsen

and x-ray. Servicing this equipment may become a regular responsibility with some biomeds choosing to specialize in diagnostic imaging full time. Even if you rarely service this equipment, becoming familiar with the technologies will provide several advantages. First, it gives you an advantage over people who are looking to enter the field. Second, offering yourself as a professional in conventional biomed as well as imaging may be an attractive economic incentive. If possible, find a mentor who is currently servicing imaging equipment and observe what they do. It’s more than likely they will appreciate the help.  17.  Know  and  use  Einthoven’s Triangle. This is something every biomed should know by heart! Einthoven’s Triangle is a representation of an equilateral triangle with the heart at its center and each line representing one of the three standard limb leads of the electrocardiogram (EKG). The corners of the triangle represent RA (right arm), LA (left arm), and LL (left leg). These bipolar leads use a single positive and a single negative electrode between which electrical potentials are measured and amplified into an EKG trace. When problems arise, a biomed can quickly identify which lead is being problematic if they can memorize the following mnemonic: Lead I=Left Arm/Right Arm (contains 1 L) Lead II=Left Leg/Right Arm (contains 2 Ls) Lead III=Left Arm/Left Leg (contains 3 Ls) 18. Understand medical batteries and charging systems. Battery failures account for a large percentage of equipment failures and many critical devices such as defibrillators and portable monitors rely on battery power. Not only can a faulty battery fail to supply power to a device, but it can overheat, swell, and leak electrolytes, resulting in severe damage to a device. A biomed must understand when a device requires a battery change or reconditioning. It is also important to be aware of various battery chemistries and charging systems and their impact on battery longevity. 19. Understand NFPA 99. NFPA 99 is the National Fire Protection Association standard that recommends the minimum safety requirements needed to reduce the Biomedical Instrumentation & Technology

risk of fire, explosion, and electrical shock in healthcare facilities. While there isn’t a federal law that mandates compliance with the standard, individual states or local jurisdictions may adopt all or parts of NFPA 99. If this is the case in your area, then the parts of NFPA 99 that state or local jurisdictions have adopted must be adhered to. 20. Get the most out of technical training. Most of us have short attention spans and may not retain much of what we learn from technical classes. The best way to counteract this is to pass along what you have learned to another technician as soon as you return from training.

The Business Skills

21. Obtain loaner equipment. Eventually the day will come where even the best biomed will be unable to repair a critical device, and a loaner device will be needed. It’s important to know what resources are available to you and to use them sensibly. Ensure that strong relationships are maintained with biomed departments in other local hospitals and with equipment manufacturers. It’s important to maintain a relationship not only with a manufacturer’s service department, but also with the sales department. Salespeople frequently have access to demo equipment that you could borrow in a pinch. 22. Call for technical support. This concept is deceptively simple. With many manufacturers now charging for technical support, it’s important to make sure every call counts. Have a good understanding of a problem before calling and, if possible, have a model number, serial number, and manual at hand before picking up the phone. Try to listen and not jump ahead of the support person. After all, if you knew more about the solution than they do, why would you call? 23. Become a CBET. You may want to consider becoming a certified biomedical equipment technician (CBET) Beyond the information on the AAMI website, it’s best to ask current CBETs about the scope of the exam. Be wary of those who claim the exam is too difficult or too easy. 24. Continue your education. The business of be383

BMET RESOURCE FILE 25 Things Every Biomed Should Know

 Build Your Skills AAMI and other organizations offer a wealth of resources for biomeds. Additional information for some of the recommendations here is listed below. 5. See “Shop Organization,” (BI&T, May/June 2008, page 176). 6. To find your local biomedical society, visit www.aami. org/resources/links/biomed.html. 7. See “How to Troubleshoot…Anything, Part I (BI&T, January/February 2005, page 37) and Part II (BI&T, March/April 2005, page 121). 8. Ohm’s Law is defined as: E=IxR Where: • E = Voltage (Voltage is an electric potential difference between two points on a conducting wire. Voltage is measured in volts and comes from various sources such as electric outlets and batteries.) • I = Current (Current is measured in amps. Current is charged particles which flow from the voltage source through conductive material to a ground.) • R = Resistance (Resistance is the opposition that ing a high-performing BMET goes hand-in-hand with a desire to be a lifelong learner. It’s always a good idea to continue your formal education regardless of your age or position in your organization. Many of us have probably maxed out on any form of formal technical education; now we may look for degrees in business or management. For those who do not have the time, money, or desire to attend a traditional brick-and-mortar college, there are many accredited online programs available and many employers have tuition reimbursement programs for their employees, regardless of the form of education chosen. And finally… 25. Be an advocate for your profession. I saved this one for last because I feel it is the most important of all the skills a biomed can possess. We need to let the clinicians we work with understand what it is we do. We need to get involved with local and national organizations as well as online communities. Educate high school and college students about the profession and encourage them to consider it as a career option. Lastly, the best way we can promote our profession and ourselves is to perform com384

a material body offers to the passage of an electric current. Resistance is measured in ohms.) From IEEE (www.ieee.org). 9. See AAMI’s 2008 Electrical Safety Manual. 11. See “The Basics of Power Cord Specs,” (BI&T, July/August 2007, page 290). 12. AAMI’s IT Horizons Series (www.aami.org/publications/horizons) covers a range of issues related to information technology. See also “Confronting the Network Challenge,” (BI&T, May/June 2008, page 209). 16. DITEC in Solon, OH, offers a variety of courses on diagnostic imaging technology. Visit www.DITECnet. com for more. 17. A diagram of Einthoven’s Triangle is included. 18. See “Batteries: From Alkaline to Zinc Air,” (BI&T, March/April 2004, page 100). 19. Visit www.nfpa.org. 23. Visit www.aami.org/certification for more on the CBET, CLES, and CRES exams. 24. See “The Changing Face of Education,” (BI&T, March/April 2008, page 97). 25. Visit www.aami.org/TMCconnect for resources on how to promote the profession. petently, confidently, and responsibly in every situation. As you read this list, some entries may be obvious, some may be new, but most should be skills you’ve mastered or are working to master throughout your career. Contrary to popular belief, an individual with many basic skills is far better equipped to deal with the typical array of challenges in our profession than someone who is an expert in only a few areas. Continued success as a biomed also hinges on your ability to recognize your strengths and weaknesses, and on leveraging the knowledge of the greater community to support your growth as a healthcare technology professional. The ultimate outcome is a higher quality experience for your clients and greater job satisfaction for you. This list is not, nor will it ever be, all inclusive, and it is open to debate. I would love to hear your thoughts and insights! Visit my website at http://www.currentpath. com and shoot me a message with your “favorite things” every biomed should know. n Chris Poulsen, CBET, has worked in the biomedical technology field since 1984. He is a biomedical service manager at Biomed Technologies, Inc., in New Jersey and is the owner of the healthcare technology website www.currentpath.com.

September/October 2008