How Will The Scope Be Used?
“Prehospital auscultation is much less subtle than what happens in a clinical situation,” says Dr. Jeremy Hess, who works at Grady Hospital, Atlanta's busiest trauma center. While the rounded bell is essential for cardiology, EMTs can get the lung sounds and blood pressures they need with just a flat diaphragm. “Scopes take a beating in the field,” says Hess, “so you may not want to take your chances with the more delicate models.”

How Loud Is Your Work Environment?
In the chaos of an emergency setting, it's vital to block out the world and hear what is going on with your patient. There's nothing worse than trying to hear lung sounds over wind and traffic noise. Reducing ambient noise “starts at the scope-head and goes right up to the ear tips,” says Tony Campagne, technical services specialist for 3M, the company that makes Littmann scopes. Don't confuse noise reduction with sensitivity: The best cardiology scope can be compromised by low quality tubing or bad ear tips.
The harder it is to collapse the tubing between your fingers, the better the noise reduction will be. Longer tubing does not diminish sensitivity, as once thought. Instead, it may give the provider better access to hard-to-reach patients. In addition, soft-sealing rubber ear tips (instead of the hard plastic ones) mold to the shape of the user's ear canal, sealing out unnecessary racket.

How Can You Make Your Scope More Versatile?
Since only a small percentage of your calls are likely to involve kids, it doesn't make sense to carry around a dedicated pediatric scope. Of course, when the call does involve a baby and the tension is high, it's imperative to have the right ears for the job. Many scope-heads have both adult and pediatric functions; a quick flip of the wrist will change from one to the other. If you don't like that option, you can also get a scope that allows you to switch heads quickly so you can change to a pediatric head if the need arises.

Whichever scope you end up buying, remember that proper care is the key to continued quality. Inspect your tubing for cracks, make sure the arms do not become bent or loose, and use only earpieces that are specifically shaped for your ears. And remember that even the best scope is useless after you lose it, so go ahead and spend a little extra to have it engraved with your name and phone number.