Er and ems liason

[celticcare]

Thank you Dwayne, you hit it on the head. The situation that presented itself, was that a patient was bucked from their horse, now the MOI of the patient landing DID NOT indicate a C-collar and the patient met the in field requirements for spinal clearance and the ED physician also concured with this. The nurse questioned the Paramedic in front of the family and I felt this was wrong. When I spoke to her afterwards about it, she didn't know that in the field clearance of C-Spine can take place. This isn't the first instance that it has occured where Nurses have questioned paramedics abilities or knowledge in the field and time and time again I have had to explain things to them about what can and can't be done out in the field.

Another aspect is we upgraded and built a brand new Emergency Department and upgraded all of our patient monitors which utilise the same ecg dots as the ambulance, I had one ambulance crew remove their twelve lead dots as they didn't think that we had monitors to interconnect *which we didn't in the last ER but we do now* and so what I want to learn about, develop and hopefully implement, is a nurse who, along with a med director or other advanced paramedics, give education sessions to RN's about advancements in the field, technology that is being used in the ambulance, organise regular ride alongs and the same for us for paramedics, to come and spend a day in resus/crash rooms with us or continue more assessment, IV or 12 lead assessments with us. I want to see intergration/support for both sides. I am not out to piss anyone off, or say "you are a paramedic you can't do this or shouldn't do this".

I am lucky in the essence I am the only RN in there with an EMS background and credentials *just have had to put EMS riding on hold for a bit balancing the last of a masters degree, getting married, working full time and being a dad, had to put something on hold for a short while*. I don't want to see situations like what occured occur again, hence I am asking if there was an ER liason nurse role, what would you see he/she doing in this role? Organising training together? Organising shifts together? Being a go to with questions about the ER or any problems that may have arisen in the shift?

Thanks Dwayne though, and your feedback has been appreciated, as has the rest of the comments on this thread. Hope this post has clarified it up a bit more.

Scotty

[zippyRN]

if this was about a patient / client group we'd be talking about 'cultural competence' and that is exactly how the issue should be dealt with ....

[celticcare]

if this was about a patient / client group we'd be talking about 'cultural competence' and that is exactly how the issue should be dealt with ....

I'm sorry I dont follow? Coldral has clogged the brain.

Scotty

[HERBIE1]

A Liaison would need to be well versed and familiar with not only prehospital and ER protocols, but the actual day to day issues each group deals with. A prehospital provider may not understand bed availability issues, delays in admitting/discharging patients because of slow labs, waiting for a transporter, busy procedure rooms, back ups waiting for Xrays, waiting to give reports, waiting for attendings to call back- the list is endless. Many EMS folks only see that they have no ER beds to transfer their patient to. An ER person may not understand the pressures of being told to get back in service, of the horrible conditions we sometimes see, of the weather extremes, of the difficult scenes, of the frustration of waiting for supplies, of the pressures of missing sleep, meals, the frustration of not having housekeeping to clean up the rig after a particularly messy call, of having no down time, of sometimes having to wrestle/restrain a combative patient with no help around, of performing our jobs in less than ideal conditions....

I would like to say that understanding is a 2 way street. I've been in both settings- field and ER- while I can count on one hand how many ER nurses I interact with can say they have done anything more than a mandatory shift or 2 for their critical care nursing class, trauma nurse specialist, or telemetry nurse class. Thus, if I know what happens in an ER, it does not stop the ER nurse from getting snotty. Yes, we can escalate things and make formal complaints about personality conflicts or nasty behavior, but I prefer to handle it on my own.

So who would this liaison be? A staff member of either group that has worked in both capacities. Obviously that would be ideal, but not always possible. Lacking that, the person would need to be actively involved in regular meetings/sessions to discuss the issues of both.

[celticcare]

A Liaison would need to be well versed and familiar with not only prehospital and ER protocols, but the actual day to day issues each group deals with. A prehospital provider may not understand bed availability issues, delays in admitting/discharging patients because of slow labs, waiting for a transporter, busy procedure rooms, back ups waiting for Xrays, waiting to give reports, waiting for attendings to call back- the list is endless. Many EMS folks only see that they have no ER beds to transfer their patient to. An ER person may not understand the pressures of being told to get back in service, of the horrible conditions we sometimes see, of the weather extremes, of the difficult scenes, of the frustration of waiting for supplies, of the pressures of missing sleep, meals, the frustration of not having housekeeping to clean up the rig after a particularly messy call, of having no down time, of sometimes having to wrestle/restrain a combative patient with no help around, of performing our jobs in less than ideal conditions....

I would like to say that understanding is a 2 way street. I've been in both settings- field and ER- while I can count on one hand how many ER nurses I interact with can say they have done anything more than a mandatory shift or 2 for their critical care nursing class, trauma nurse specialist, or telemetry nurse class. Thus, if I know what happens in an ER, it does not stop the ER nurse from getting snotty. Yes, we can escalate things and make formal complaints about personality conflicts or nasty behavior, but I prefer to handle it on my own.

So who would this liaison be? A staff member of either group that has worked in both capacities. Obviously that would be ideal, but not always possible. Lacking that, the person would need to be actively involved in regular meetings/sessions to discuss the issues of both.

Thanks Herbie, well I wont lie, I would like this role quite a bit if it were to become a reality. I think that it would be a great one to have with a paramedic and RN on the groups together and like I said, I'm one of the only ones in there with an EMS background along with nursing. It would be a great step forward for things I do feel. Plus I am working on my Nurse Practitioner qualifications to be able to man the rapid response jeeps in the future as an emergency care practitioner, so being an RN support for both EMS and the ER would be a role I would enjoy.

Scotty

[scubanurse]

I feel like this could easily be a charge RN's duty. Stay current on the protocols and educated their shift on EMS practices. They can also act as the liaison between the field and the ER.... Sounds like a good job for Scotty

[Paramagic]

I appreciate that this is something that could be beneficial to your working relationship with the nursing stuff, but I wonder if it actually requires a permanent position per se? Would it be possible to help the cross education of staff with some in-service education. I assume that you have some kind of ongoing education requirements, and that the nursing staff have time set aside each week or month for lectures.

Would it then be possible to arrange with the Nurse Educator to present an in-service on Ambulance operations and clinical guidelines? Maybe it could be a regular event, say every time you guidelines are updated?

I would imagine that if the choice for your employer is between funding a full (or part) time position or allowing a day or two for in-service, the cheaper option would be more likely to win.

We don't have so much to do with the nursing staff, however we do have a good relationship with the medical staff in our ERs and ICUs. We have an open invitation to attend the M&M meetings, PCI audits, continuing education sessions and special lectures that the Hospital arranges, which is great for fostering that relationship.

[celticcare]

Thanks for that magic. I am doing this as part of my masters requirements in creating a new nursing role within my working area and its something I think could be beneficial. I dont know if a full time role or even part time is required, more it would be a portfolio held by a staff member to specialise with.

I am stoked to hear that you guys have a good relationship, we dont have anything really like that where I am, I would like it though

Scotty

[Doczilla]

All of the hospitals in this area have an EMS Coordinator that helps arrange followup on critical patients, manage con-ed offerings at the hospital (and at the squads), and look into issues that arise from either end. They tend to be RN+paramedic, with field experience as well as ER experience. They are typically some of the smartest people I've had the pleasure to work with.

'zilla

[Happiness]

Aww scotty do you still have the man cold....poor poor bunny ;P

Noramally we have a great relationship with our hospital staff (there are those that may look down their nose at us) but be in mind that alot of staff are temps so we have to adjust our thinking alot. The most important thing that I have learned in the ER setting is this "Just because a nurse isn't looking at you and nodding their head while you are giving your report dosn't mean they are not listening to you" I have found in the past that this is a big complaint as medic's dont feel that they have been heard.

What we do togeather is the following:

When there is training for the nurses and there is a spot or two open they will call us and ask if we would like to participate. We do the same.

At the end of our report we ask "Do you have any questions for us" and if they do we answer to the best of our ability. For example new years eve call Nurse" How much narcan did you give the pt" Me "8mg as noted on my form" Nurse (with funny look of her face "Oh we only give 4mg" Me "oh ya and how do you do it?"

Nurse "through I.V." Me "well thats why the difference is because I do it through injection in the thigh" Nurse "oh that makes sense now" Just one little question and a simple answer and then there is no "God the nurse/medic is an idiot" attitudes.

If we have issues I personally have not got a problem with dealing with the nurse up front and have done so many times and vise versa. If I am not getting any where I then go to the head nurse. One time the head nurse came to me and said "did you tear a strip off my new nurse?" I said no but if you would like me to talk to her if she thinks that I did, I will. Head Nurse said Nope she needs to toughen up anyways and Im sure you were right anyways lol. FYI pt was a 10/10 pain, from MS and we had put him in the ER bed, this nurse wanted him to get up and walk to the clinic. I said to her quite nicely (or I thought) Dont you think if he could have walked to the clinic he would have instead of calling us?

We also do fund raisers together, community activities, and social events. These are great as they bring everyone together and on our own we talk about each others roles and jobs.

Scotty I think you would be an awsome choice for this kind of position as you are very pro active and somehow have an ability to read people well. Good luck

happiness