Menu

Blog Posts

EMS

EMS Providers: An Extension of the ED in the Field

Posted on Mon, May 16, 2016
EMS Providers: An Extension of the ED in the Field

By Albert Ritter, MD, FACEP
 
It’s National EMS Week and we are reminded of the contribution our partners provide in the pre-hospital setting.
 
Twenty-four hours a day, seven days a week, whether it’s steamy hot or freezing cold, on the side of the highway with tractor trailers rushing by or in the third floor walk-up apartment. Some are volunteers serving their communities on their time off from a day job.
 
EMS providers in our communities, both paramedics and basic EMTs, should be viewed as an extension of our care into the field. The care they provide in the first few minutes of a medical emergency or traumatic injury can make the difference between a good outcome and a bad outcome. Good communication and a congenial, respectful, relationship between pre-hospital providers and emergency department staff is essential for patients to receive the best possible treatment. This kind of relationship encourages a dialog that directly benefits ED staff, the healthcare facilities we work in, and ultimately our patients.
 
Pre-hospital medicine is evolving and becoming increasingly more complex. EMS providers are being tasked with more responsibility in the care of patients experiencing sepsis, STEMI, CVA and trauma. The appropriate use of therapies such as TXA and CPAP and changing standards for pre-hospital activation of cath labs, stroke teams and spinal motion restriction are critical to good care. By maintaining an open and friendly dialog and providing education, we can influence how this care is provided to our patients and ensure that standards are met and maintained. I’m always impressed by the curiosity and interest EMS providers show regarding educational opportunities, whether provided in didactic settings or as informal anecdotal feedback regarding a patient. It’s crucial to provide this teaching in a supportive and educational manner that’s appropriate to their level of training.
 
Another aspect of maintaining good relationships with our EMS partners is that they are the best advocates for our facilities within the communities we serve and with local government. This can be extremely helpful for community outreach and with public health initiatives such as stroke and heart attack recognition and CPR programs. The providers also instill confidence in our patients that they will receive the best of care on arrival, relieving a lot of anxiety and improving patient cooperation.
 
Finally, this is a group of committed individuals who often work in really difficult conditions to treat and transport our patients. In many communities, they are volunteers who train and care for patients on time off from work and away from their families. They deserve our thanks and our appreciation.
 
Albert Ritter, MD

Albert Ritter, MD, FACEP, is an attending emergency physician at Morristown Medical Center, Morristown, N.J., and is medical director of Atlantic Ambulance Corporation, operated by Atlantic Health System.
 

Share    

Studer Spotlight: Effective Care Transitions from EMS to the Emergency Department

Posted on Wed, Jan 20, 2016
Studer Spotlight: Effective Care Transitions from EMS to the Emergency Department

Since 2010, EmCare has maintained a strong partnership with Studer Group to improve clinical and operational results for our client hospitals. As a result of this partnership, Studer Group has provided access to exclusive content only available on StuderGroup.com. Each month, one of Studer Group's insightful articles will be made available to emcare.com blog readers. For more information about EmCare's partnership with Studer Group, click here. For more exclusive content, including webinars, learning labs, networking opportunities and more, visit StuderGroup.com.

By Bob Murphy, RN, JD

Effective care transitions from Emergency Medical Services (EMS) to the Emergency Department (ED) are critical to providing safe and quality patient care. Both EMS and the ED team must develop the necessary skills to efficiently handover patients to provide appropriate care and has the potential to save lives and improve patient eligibility for time-sensitive therapies such as stroke or acute myocardial infarction care. Conversely, an Australian study showed that nearly one in 10 patients may be adversely affected as the result of poor handovers..

Effective care transitions actually start before a patient is even encountered. Here are a few important points:
 

  • EMS leaders and medical directors, working with ED physician leadership, should communicate regularly to plan, train and assess how transitions of care should be performed. They should agree on the minimum information expected to be shared about the patient from the scene, both en-route to the ED and upon arrival at the ED.
  • Mutual respect and an understanding of our roles is necessary. Both pre-hospital and ED teams work hard to do their best to care for patients and a recognition that we have different work environments, equipment, personnel resources and time pressures in which we provide care is critical. We are all members of the same team in providing excellent care.

Before the patient arrives at the ED:
EMS providers have a critical role in gathering and transferring essential information and should gather as much relevant information as feasible about the patient to share with ED providers. This includes:
 
  • Information that was available only to the EMS crew, including the patient’s living and social conditions (including indications of abuse or neglect), accident circumstances, key contacts, witnesses to events, and medication and problem lists.
  • When circumstances suggest that advance directives are in effect, EMS personnel should ask if a document is available and whether a copy can be transported with the patient.

While on scene or en-route to the ED, EMS agencies attempt to contact the ED by radio or phone. This brief report helps the ED staff know what resources to have in place when the patient arrives and can set the tone for the rest of the interaction and will impact care the patient receives.

The call by EMS should include:
 
  • A brief, but relevant history including why EMS was called and the chief complaint.
  • What EMS observed while on scene.
  • Relevant vital signs and assessment.
  • Treatment initiated so far and the patient’s response to treatment.


ED staff should respond to the call by EMS by:
 

  • Responding in a timely manner. This shows respect for the EMS crew.
  • Listening carefully.
  • If possible, assign a room number or treatment area so the crew and patient is not left waiting in a hallway when they arrive.
  • Using a professional tone. Remember, the EMS crew observed things you did not. And, the patient or family may be listening.


Upon arrival at the ED both EMS and ED staff should demonstrate professional behavior during announcement of patient arrival, history and handover of the patient. Below are some communication tips for both EMS and ED staff.

The EMS crew should:
 

  • Provide a succinct yet complete history of the patient.
  • Share any changes since the initial report.
  • Include additional information that may help the ED team.
  • Show gratitude and appreciation for the work of the ED team.
  • Transmit all information from pre-hospital EMS transports for real-time review and use, whether in print or electronically. This can be accomplished by equipping emergency departments with docking stations/printers compatible with EMS computers or by fully enabled electronic transfer to the department’s EMR system.


Upon arrival at the ED, the ED staff should:
 

  • Immediately assess each patient upon arrival and assign a bed or treatment location quickly. The EMS crew will likely be under pressure to get back in the field.
  • Keep a cordial tone and treat EMS team members with respect.
  • Be receptive to their findings and the individuals themselves.
  • Show gratitude and appreciation for the work of the EMS team. They may influence where patients receive care.


We also recommend both EMS and ED teams use Key Words at Key Times when completing care transitions. For example, the EMS team can introduce and manage up the ED caregivers by saying “Ms. Jones, you are in good hands with Dr. Smith and the ED team here.” The ED team can reciprocate by sharing “The paramedics did a great job in caring for you. We plan to continue that excellent care while you are in our emergency department.”

Our goal is to ensure a smooth and efficient transfer from prehospital care to Emergency Department care. This model of communication can decrease the risk of communication failures and improve the care we provide our patients. This also improves the working relationship between EMS and ED teams.

Sources:
"ACEP Transitions of Care Task Force Report." ACEP.org. September 1, 2012. Accessed December 6, 2015. http://www.acep.org/workarea/DownloadAsset.aspx?id=91206.

"Transfer of Patient Care Between EMS Providers and Receiving Facilities." ACEP.org. October 26, 2015. Accessed December 6, 2015. http://www.acep.org/Transfer-of-Patient-Care-Between-EMS-Providers-and-Receiving-Facilities/.

Ye K, Taylor D, Knott J, et al. Handover in the emergency department: Deficiencies and adverse effects. Emerg Med Australia. 2007;19(5):433–441.


Bob Murphy is a well-known senior leader and international healthcare presenter with more than 30 years in healthcare. His experience includes work as an EMT and Paramedic, phlebotomist, nursing assistant, registered nurse, department leader of emergency/trauma services, quality leader, risk manager, Chief Operating Officer, and hospital Chief Executive Officer. Murphy is also an attorney and is board certified in healthcare administration. Bob is now attending seminary and is pursuing a master’s degree in divinity.

Bob currently serves as a senior leader of Studer Group where he presents at healthcare conferences and seminars and coaches senior leadership teams.

Share    

Longer Shift Length Tied to EMS Worker Injury

Posted on Sat, Sep 19, 2015
Longer Shift Length Tied to EMS Worker Injury

Those who work shifts of eight hours or less have lowest risk of occupational injury, illness

Longer shift lengths are tied to increased risk of occupational injury and illness among emergency medical services (EMS) workers, according to a study published online Sept. 14 in Occupational & Environmental Medicine.

Matthew D. Weaver, PhD, from the University of Pittsburgh, and colleagues analyzed data from three years of shift schedules and occupational injury and illness reports from 14 large EMS agencies.

The researchers' analysis involved 966,082 shifts, 4,382 employees, and 950 outcome reports. They found that the risk of occupational injury and illness was lower for shifts ≤eight hours in duration (relative risk [RR], 0.7) compared with shifts >eight and ≤12 hours. Similarly, compared with shifts >eight and ≤12 hours, risk of injury was 60 percent greater (RR, 1.6) for employees who worked shifts >16 and ≤24 hours.

"Shift length is associated with increased risk of occupational injury and illness in this sample of EMS shift workers," conclude the authors.

Abstract
Full Text



Copyright © 2015 HealthDay. All rights reserved.

Share