Improving hospital relationship with EMS

[Doczilla]

Thanks to everyone for the great ideas. Obviously, if we want to get the attention of EMS, it helps to have an idea of what EMS providers are looking for.

The relationship between the hospital and EMS is professional but not that personal. I don't hear about animosity of EMS crews toward the hospital (and the EMS agencies I work with would quickly bring that to my attention if there was), and though there is the occasional dust-up (every workplace has its problem children and occasional snafu), the EMS providers seem to like us fine. The hospital does celebrate EMS week in the usual ways, but I think the powers that be want a more significant and consistent contribution to the EMS community.

Thanks again for the thoughts.

'zilla

[Mateo_1387]

Some ideas that you may already do, but if not may consider...

1) Patient tracking, to let the EMS crew know the outcome of certain patients

2) Do statistics with how you hospital and EMS work together. For example, if the hospital pushes for quick transport times with stemi alerts, stroke alerts, traumas and the like, do the statistics showing patient outcomes, if the alerts were legit, so that not only will they help your agency/hospital to improve, it will also show the EMS service how much they are valued and their actions affect the outcome of patients.

3) Conferences and luncheons and the like with the ER/EMS to show how the quality of patient care. For example, my agency who pushes for on scene cardiac arrest, induced hypothermia, were invited to speak at a dinner/presentation within a hospital to talk about the continuum of care.

4) Within each agency, ER and EMS, make it come down from administration that each other has to show respect. Basically, just to say that the other are not idiots.

5) I really think that for long term "getting along" you need to offer paramedic students lots of time in clinical. The more exposed you are to the hospital environment, the more respect I think you have for them. When I was coming through the certification ranks, I did not have much hospital interaction, or experience within. I always heard, "that nurse is an idiot, that doctor doesn't know what he is doing, paramedics are better than nurses, we can intubate and do surgical crics/thoracentesis" and the regular bull crap. After doing clinicals in the hospital, especially in specialty areas, such as L&D, Burn unit, Pediatrics, I realized how smart these people were. The teamwork environment is different, and the mind set is different, where EMS thought those idiots, the hospital says "what can you do?" Through the interaction, they learned about EMS, and I got a whole education on the Hospital environment. I think that goes a long way, even if I never stepped foot to "work" for a hospital, I will always have the respect for them.

6) Have a system in place so that if hospital staff has a problem with a paramedic, and how they treat a patient, that the hospital needs to take it up with the medical director. Have paramedics walk away from conflicts, not to interact, and to directly contact the medical director, explain their treatment action, and "why" they did what they did. Then the medical director can go to the hospital, and in a way, speak their lingo to handle problems. This keeps the nurse/doctor/paramedic interaction non confrontational. Let the Upper people do the negative interaction, to leave things clean on the lower level, so to speak.

[CBEMT]

Great suggestion CB often times I've wondered what happened to that guy who got hit by the train, then attacked by the rabid possum and then who fell in the water and we had a cold water drowning, you know those types of patients.

It was at the top of my head (the pointy part :roll: ) because I recently attended a meeting of area EMS leadership and our trauma center, and it was brought to our attention that the ED nurse manager is willing to receive emails from services or individual providers requesting info. This was extremely well received. Occasionally it has been possible for individual providers to get patient outcomes based on personal relationships with hospital personnel built over time, or in some cases just happening to run into the same doctor who took the patient from you, etc, but never an official, approved method.

One of the ED attendings, who is also the state EMS Medical Consultant even traveled over the state line to make a personalized feedback presentation of selected cases to a department there who recently started transporting directly to the trauma center instead of to their local ER for later transfer (long story). He had the complete support of hospital management.

[Christopher.Collins]

The feedback thing is really excellent as well.

I remember pulling up to an MVA (motorcycle rearended an SUV) and seeing the pt in a pool of blood with one firefighters fingers halfway into his neck pinching of a severed carotid. He was quite litterally torn open on the right side from his neck all the way down too just below his rib cage... organs and lungs partly visible. CAOx3 to everyones surprise and hows this for MOI, the impact and speed of the motorcycle on to the rear of the (stopped) SUV spun it (the SUV) 180 degrees... we're talking Chevy Suburban! My partner, a senior medic called for additional ALS backup even though we were 3 min out from the trauma center... who in turn had him air lifted to a higher up trauma center out of state.

Anyways, my point is... that call was made all the better for when we were able to find out the pt had a posative prognosiss and was listed in stable condition.

[Spock]

I have to agree with letting the nurses do ride alongs with EMS and paying them to do it. I once worked on a hospital ALS response unit and the DEM nurse manager had all newly hired RN's do at least 2-3 shifts with the response unit. The nurses came away with a new understanding of EMS and were easy to work with because of the personal relationship they developed with even a few shifts. People (both EMS and DEM) need to understand everyones job is easier if we work together.

Live long and prosper.

Spock

[Richard B the EMT]

Forgive my nitpicking, Spock, but this runs a bit afoul of my "anti-non-standard-initialing" initiative.

Does "DEM", as used here, mean Democrat (opposition of Republican), or perhaps it means "Department of Emergency Medicine"?

I am in question of your logic in not posting what the initials stand for.

Peace, and Long Life!

[Spock]

Since you decided to pick nits I will respond. The Department Of Emergency Medicine IS a standard abbreviation and is more acceptable than the emergency room because the area is bigger than a room and encompasses an entire department of a hospital. The ER is a term of the 80's while DEM is a term of the 90's. Since this is a new century it never occurred to me that an explanation of a common abbreviation was necessary.

Logic would suggest--------------- Oh, never mind.

Live long and prosper.

Spock

[reaper]

I thought the new term was ED (Emergency Department)? Never even heard the term DEM used before! :?

[steve_emt_68]

One of the things that I pushed for and helped make happen was EMS run reviews presented by a nursing clinical manager. We invited all area squads to attend. We also asked squads to volunteer cases for review.

We always provided a dinner at no charge and asked at least one physician to attend to give physician insight into the case. We would follow the case thru from dispatch to hospital disposition. We tried to present 3 or 4 cases a night and we did this each quarter. We would have anywhere from 25 to 35 people attend and we gave continuing ed credits.

This was a great program, the squads learned from their mistakes but the also got to enjoy what they did right.

I don't know too many EMS providers that don't like to know how a patient did after they brought them in.

[Doczilla]

I thought the new term was ED (Emergency Department)?

It was, until Bob Dole f&%*ed that up with his Viagra commercials.

'zilla