United by a common goal - optimal patient care and safety- ED and EMS providers must work together for the sake of their patients as well as their team.
"We are all dealing with the same patients," said Nancy Giardina, MSN, RN, emergency department nurse educator at The Hospital of Central Connecticut (THOCC), New Britain, CT. "EMS and emergency nurses are working toward the same goal, recognizing the acuity of the patient's problem and deliver the best care possible. We need to be on the same page for the patients' benefit."
Facilities throughout the region recognize the importance of this partnership and are working hard to foster it with education, outreach, technological advances and team building.
Teaching One Another
Trust and respect across disciplines is imperative for high-quality patient care, which can be achieved and maintained through education. Facilities are initiating a variety of programs aimed at increasing understanding among emergency care providers, both in and out of the ED.
THOCC has been the clinical site for the New Britain EMS Academy, which educates the next generation of EMTs. In 2010 plans were initiated to extend this opportunity to educate EMTs wanting to advance to the paramedic level.
In January 2012, New Britain Emergency Medical Services began its first paramedic program utilizing the staff and resources at THOCC.
After completing the necessary classroom hours, aspiring paramedics participate in nurse-led clinical experiences at THOCC. Students rotate through different units including obstetrics and gynecology, intensive care and, of course, the emergency department.
At the end of their clinical day, Giardina leads a post-clinical conference to allow the students to discuss what they experienced and how the care and skills learned can relate to pre-hospital care. Following clinicals, students round out their education with a field internship.
"Nurses act as their mentors while they are on the floor," Giardina said. "They have the chance to utilize classroom content in actual practice as well as witness what hospital staff do firsthand."
"In addition to learning valuable skills needed to work as a successful paramedic, working with the nurses allowed students to see the continuum of care," added Chelsea Leser, a paramedic student at New Britain EMS Academy. "This can help guide pre-hospital treatment plans and ensure that the continuation of care from EMS to hospital allows for the most comprehensive patient care."
At the same time, nurses gain a better appreciation of the paramedics' scope of practice. "While educating students they have the chance to see patient care from the pre-hospital perspective," Giardina said.
The program benefits both sides and helps lay the foundation for a strong working relationship between the ED and EMS.
Education can take on many forms. For instance, The William W. Backus Hospital, Norwich, CT, provides a monthly inservice on topics and case studies valuable to both EMS and the ED.
Additionally, the hospital invites EMS providers to in-house educational opportunities such as Stroke Rounds & Trauma Grand Rounds - and they attend. Backus nurses provide annual education to the paramedics on the use of infusion pumps and transfer medications as well.
A local commercial ambulance service offers training in basic lifesaving skills, according to Karen Sanders, RN, a nurse at Backus who is also an EMT.
Working and learning together strengthens their caregiver bond, which Backus reinforces with celebration and recognition. During National EMS Week, the ED hosts a BBQ cookout where nurses, physicians, EMTs, and paramedics all partake in a celebration cooked by the hospital's EMS coordinator and EMS medical director at the hospital's ambulance ramp. The event makes for a parking lot full of ambulances and fire trucks outside of the ED.
Alongside education and understanding comes effective communication. Arriving on the scene first, EMTs and paramedics not only make initial contact with the patient, they also are able to observe the surroundings. A lot can be learned from a patient's home environment.
"In this respect, nurses rely heavily on emergency services to get all the information from the field," said Robin Cracco, MSN, RN, emergency department nursing manager at Saint Mary's Hospital, Waterbury, CT. "We communicate constantly; we support one another. We trust one another and both sides are willing to go the extra mile for their team and their patients."
"They are at the forefront of patient advocacy," Sanders emphasized. "And the knowledge they bring to the hospital allows ED staff to be the best patient advocates they can be."
Just like education, communication leads to better understanding and an appreciation of the challenges faced in the field and at the hospital.
FORMING A BOND: Nancy Giardina, MSN, RN, emergency department nurse educator at The Hospital of Central Connecticut, with Chelsea Leser, paramedic student at the New Britain EMS Academy. The hospital is the EMS Academy's clinical site. The program helps layfoundation for a strong working relationship between the ED and EMS.
Sanders, who has experience as a nurse and an EMT, does what she can to bridge the gap. "It is imperative nurses and the ED staff as a whole have a better understanding of the limitations EMS face out in the field," she stressed. "They don't have the same resources and equipment available to them; often all they have to work with is little more than Yankee ingenuity."
Common misconceptions are proved false when honest communication develops. "EMS in general is not well understood nationwide," Giardina said. "EMTs and paramedics are not simply ambulance drivers; they are the people that cut you out of cars and start IVs when you are hanging upside down and they don't have a doctor to turn to or a safe environment to work within."
Effective communication can be enhanced with technology. Seamless care depends not only on trust and support, but also quick and efficient transmission of pertinent patient information, especially in cardiac cases.
For instance, Saint Mary's uses a system that allows paramedics to transmit electrocardiograms directly to the ED via the Internet. ED staff can then prepare for the patient and save valuable time.
"This is particularly helpful if the patient has a STEMI, which requires immediate cardiac cath lab intervention," Cracco said. "This extra time allows us to activate the cath lab before the patient even arrives.
"During the day, all necessary personnel are on site," she added. "But if the call comes during off hours, advanced notice allows us to contact the cath lab immediately. In patients requiring cardiac cath lab intervention, time is of the essence."
With a 90-minute standard of care, technology and teamwork allows hospitals to not only meet this goal, but exceed it. Utilizing this technology and fostering a strong relationship are the keys to success and Saint Mary's, which boasts above-average STEMI performance times, is a prime example.
Education, trust and technology go hand-in-hand; all three must be present for successful outcomes. Streamlined communication speeds the process only if physicians and other ED staff are confident that the information transmitted is correct.
"In order for the care of the patient to be adequately continued in the ED, EMS staff must be able to communicate what they know about the patient and what they have done for the patient to ED staff," Leser said. "ED staff must be able to pick up where EMS left off rather than repeating previously administered care and offer advice and feedback to EMS for future patient care."
"Both sides have valuable information to share to ensure that the care of the patient, which is ultimately the most important thing, is beneficial," she said.
Nurses are key components of a strong working relationship with EMS professionals.
"We are the constant factor," Sanders said. "We're the ones who are always there; the EMS community revolves and changes because there are many different services that come into the ED.
"That is why it is important nurses are open and willing to make contacts and get to know what EMS does on the outside," she added.
Without support from the nursing staff, it is difficult for EDs and EMS to form a strong working relationship. "It must be a collaborative effort that everyone supports," Giardina said. "The nurses need to recognize the importance of imparting their knowledge to a non-nursing person, who in a lot of respects has a scope of practice that goes far beyond the nursing student.
"Nurses need to understand that it is essential that they take the time to instruct them, while the paramedic needs to understand that there is a lot of information they can gain knowledge of from a nurse," she added. "The underlying outcome to this education and relationship building is that as a whole we are giving the best care possible to our patient population."
Catlin Nalley is editorial assistant at ADVANCE.