EMS Liaison/Hospital Relations

[Bullets]

That is an exceptional clinical experience however I am not sure that is the norm. We did ICU clinicals for a couple local paramedic programs and they were usually only required 1-2 ICU shifts. Some were very interested in the ICU stuff but most were just trying to skill jump and get as much done as possible.

What do you mean by "skill jump"?

All told i did almost 800hours in my clinical rotation, and almost 500 of that was in category III, which was after we completed the didactic and took the psychomotor exam, so we were basically given full authority to work within the states paramedic scope under the direction of RNs and MDs. On many occasions i was involved or pulled into all kinds of cool procedures, lumbar punctures, chest tube placements, rotabed placements, fasciotomys, a vaginal floor reconstruction, and then all the regular medic things we had to do

 

[VFlutter]

What do you mean by "skill jump"?

The "I need 3 more SubQ injections, 2 Tracheal suctions, and an IV" mentality so they focus more on trying to accomplish skills that as opposed to actually learning about ICU care or patho. Having said that, I always tried to rotate the students around to all the rooms during med passes and vent checks so they got the opportunity to get that done.

 

[Summit]

Dont know what your clinicals were like because ... I was assigned a nurse and followed her every day for 8 twelve hour shifts.

And I watched an achilles tendon reconstruction in EMT clinical but I don't go about implying that it is the norm.

Most medic students are not following a nurse for the nurse role and nurse experience. They are going for the best learning experience to make them a functional medic: moving from one procedural skills opportunity, to the next teaching moment, to observing the next unique case/procedure/discussion, to the intubation opportunity in bay 3, to the code in room 14.

There isn't anything wrong with that! But it gives a different perspective than following a nurse in a nursing role or following a patient through a stay, which is what I was implying versus the idea that RNs need to follow a medic on an ambulance to understand their perspective. See my point?

 

[Summit]

I think that's a great thing, until the rest of the ER doesn't care what he thinks because he's not a nurse. or if he bring an issue to management, and they blow him off because "well, that's a nursing thing that he wouldn't understand." Like it or not, ERs (and in fact many hospital departments that deal directly with patients) are ran by nurses, and often if you want more credibility to your point, having a nurse address it is better than a medic.

One of the hospitals I used to transport to had a Tech assigned as the EMS liaison. she would meet with management monthly to discuss issues, make sure the EMS equipment area was kept need and try to keep the EMS room stocked with snacks. but she has no real authority to make any changes, so if there was a serious issue, it was better to bring it directly to management. If you did speak to her about an issue with a nurse, she wasn't likely to fight for EMS, because she still had to work with the RNs as a tech, and didn't want to step on anyones toes. Suffice it to say, she decided not to stay in that position for long.

You have identified how that could be executed poorly: someone with a role that doesn't even require paramedic and who works in a role subordinate to the ED RNs makes a poor advocate. Shocking I say!

In my well executed example, it is a highly educated paramedic (equal educational footing) who doesn't work in a subordinate role. He is respected by the RNs. He also educates for the EMS agencies, QAs their runs (these various agencies use the hospital for medical direction), and works with hospital management in the incident management role. That is how it can work well!

 

[twistedMP]

I'm going to say the same thing others have. I dated a nurse for a while that switched from ICU to ER and part of the ER orientation was that they had to do 2 12hr shifts with the local 911 provider. She ran a cardiac arrest and was amazed and shocked that a EMT driver and paramedic teching ran the whole transport by themselves with a lucas for compressions. She was used to the 5-7 person code team mentality from inside the hospital. It also helps ER nurses realize why we dont have everything done running in a busy urban area with short transport times.

 

[Carlos Danger]

So I took over as the EMS liaison for my hospital and I am trying to find ideas to better build relations between our nurses and EMS crews. I am trying to find ways to show our facilities appreciation toward EMS and below are a few projects I have already started.
Case follow-ups
STEMI/Stroke recognition board
Trying to clean up the EMS room
Stocking drinks

I socialize with the crews as much as I can and always offer if there is anything I can do. I want to find other ideas to recognize our crews. I would like to find some other ideas so hit me with what you got. What do you wish your hospital would do for you?

Those sound like a really good start. Case follow-ups are huge to EMS folks.

A few people mentioned having the RN's ride along with EMS? If there is actual interest in that, and IF staffing will allow it, great. It could be a great experience for everyone involved. Staffing is often very tight in the ED though, and rotating all the RN's out for a shift might be really hard on the department.

Make it a requirement.

Lack of interest is the problem.

It is generally a terrible idea to "force" an adult to do something they don't want to do. Would you like to be forced to go hang out in the ED or ICU for no reason other than acting like you are interested in what they do? Do you really think it'd be beneficial?

 

[DrParasite]

It is generally a terrible idea to "force" an adult to do something they don't want to do. Would you like to be forced to go hang out in the ED or ICU for no reason other than acting like you are interested in what they do? Do you really think it'd be beneficial?

In medic school, I was forced to do clinical shifts in the ER, in the ICU, in the Burn unit, and a bunch of other places that I didn't really want to go to. But it was required as part of my class. If a nurse is being paid to be there, it's part of their job. I am forced to go to EMS con ed, as it's required by my job.

My chief doesn't care that most of the EMS con ed is horrible is a waste of time, and doesn't interest me at all; it's a county requirement, so we all do it.

Ride alongs on their own time are a different story. You might find a few volunteers who are looking to see what their friends do, but that's about it. Most (myself included) would object to being forced to spend 12 hours at a work related shift while not being compensated by their employer.

 

[VFlutter]

Some Trauma staff don't have much interest in EMS because is many ways, it doesn't matter. They have the mentality that they should be prepared to treat a level one trauma from the ground up with no prior interventions or report. Most respect and appreciate good pre-hopsital care but others could care less and just rather assess and treat themselves. The latter would probably gain the most from ride a longs but are usually the least interested.

 

[Summit]

In medic school, I was forced to do clinical shifts in the ER, in the ICU, in the Burn unit, and a bunch of other places that I didn't really want to go to. But it was required as part of my class. If a nurse is being paid to be there, it's part of their job. I am forced to go to EMS con ed, as it's required by my job.

Look at your desired outcomes. You want experienced RNs to gain EMS perspective. Perspective is usually acquired by those with open minds. An unpaid student n a mandatory rotation has a different mindset than a seasoned professional. If you send the interested RNs voluntarily, they are likely to gain perspective. They'll both sing that perspective and turn the minds of others to voluntary participation. That is high yield when paying a professional to observe instead of work.

 

[Tigger]

Some Trauma staff don't have much interest in EMS because is many ways, it doesn't matter. They have the mentality that they should be prepared to treat a level one trauma from the ground up with no prior interventions or report. Most respect and appreciate good pre-hopsital care but others could care less and just rather assess and treat themselves. The latter would probably gain the most from ride a longs but are usually the least interested.

No doubt. Our Level 1 facility really does have it down, doesn't matter if the patient got dropped in the parking lot or if the crew that brought the patient in did an awful job. They are unflappable. Until six months ago they were a level 2 and to me that has been the biggest change in their transition. Our Level 2 does a more than fine job with seriously injured folks, but if you dump a trainwreck on them it will certainly effect the way that care is provisioned and probably not in the most positive of ways.

The EMS liaisons at both facilities are very well engaged. Both of them employee nurses and paramedics in that office and both are out in the EMS community regularly meeting with crews and management. The level 1 folks are also starting to include EMS in trauma studies as well.

I think EMS can be a bit overly prideful at times. Be good at what matters and leave it at that. But man, tell paramedics to do less and you'd think they were being publicly shamed.

 

[Carlos Danger]

In medic school, I was forced to do clinical shifts in the ER, in the ICU, in the Burn unit, and a bunch of other places that I didn't really want to go to.

That's a bad analogy for a couple reasons. First, the EMS educational establishment has deemed those clinical experiences sufficiently important and valuable as to be made a mandatory part of a paramedic's initial educational program. Conversely, no one is arguing that an already-graduated, already-licensed, already practicing ED nurse needs to spend time on an ambulance in order to be meet the basic qualifications for their job. Second, you voluntarily asked to be accepted to your paramedic program, knowing those recruitments existed. An ED nurse, on the other hand (assuming it isn't part of their employment agreement or contract, of course), did not take a job as an ED nurse in order to be made to spend time on and ambulance.

If a nurse is being paid to be there, it's part of their job.

Not necessarily. Maybe it is, maybe it isn't. Again, it depends on the employment agreement.

But either way, that misses the point completely. The goal here is to improve relations, right? I can assure you that forcing a professional to do something they don't want to do under threat of losing their job is just not a real good way to engender positive relationship growth.

 

[DrParasite]

They have the mentality that they should be prepared to treat a level one trauma from the ground up with no prior interventions or report.

That's as it should be. Assume the worst, and be prepared to handle it. But if you aren't in worst case scenario, does it really hurt to listen to other healthcare providers?

That same mentality can and should apply to EMS. Always assume the worst, expect to get no first responders, no FD or PD, or other health care provider at MD offices or SNF. But can you see why it might offend those providers, especially if they did their job properly, and got you all the information that you need? And if you don't care about the job they did, why should they even bother to do it?

Expect the worse, but when a fellow healthcare provider is transferring care to you, spend the 60 seconds on listening to their report so you know what was done.... and then go do your thing.

Most respect and appreciate good pre-hopsital care but others could care less and just rather assess and treat themselves. The latter would probably gain the most from ride a longs but are usually the least interested.

I wonder if the latter are the same people who work in the ER (as either doctors, nurses, or techs), and then get mad when the trauma surgeons come in on a truly injured patient and 1) expect the crowd of people to part when they walk into the room 2) tells them to get out of their way so they can do their job and 3) get offended when they totally ignore everything they did and do a complete assessment and treatment themselves, completely ignoring anything that happened before they walked into the room.