Collaborative care in an emergency: What EMS providers wish ER docs knew
Key Takeaways
Physicians can recognize differences in the prehospital vs ED settings to appreciate the unique perspective of EMS providers.
Understanding the scope of EMS practice and protocols before jumping to conclusions is of the utmost importance when it comes to providing emergency medical care.
Physicians who work alongside EMS providers can provide constructive feedback to promote a cohesive team environment.
Emergency medical services (EMS) providers play a critical role in the spectrum of emergency care by providing lifesaving interventions in the prehospital setting and transporting patients to the emergency department (ED) in a timely manner.[] As frontline healthcare workers, EMS providers have valuable insights that can help emergency physicians provide the best possible care to shared patients.
Here is what EMS providers want emergency physicians to consider when caring for patients together in order to foster greater collaboration and respect between the professions, ultimately leading to improved patient outcomes.
Types of EMS providers
There are four different levels of EMS providers, each with a diverse scope of training and practice.[] Emergency medical responders (EMRs) are trained to perform patient assessments and provide basic emergency medical care, such as CPR and mouth-to-mouth, before more highly trained medical personnel arrive.
EMRs have limited equipment and resources. Emergency medical technicians (EMTs) have the skills to stabilize and safely transport patients during any emergency calls, but they are limited to the resources and equipment found on the ambulance.
EMTs perform tasks such as stabilizing potential fractures and dislocations and controlling blood loss. Advanced emergency medical technicians (AEMTs) provide all the same services as EMTs, but they are additionally trained to use more advanced medical equipment, administer fluids, and administer/prescribe certain medications.
Paramedics provide the most advanced and extensive care in the prehospital setting. They perform interventions with both basic and advanced equipment found on an ambulance, including diagnostic equipment approved by an agency medical director.[]
MDLinx spoke with a handful of active EMS providers about what else they really want ED physicians to know. Here’s what they had to say.
Recognize differences in the scope of practice
Lillian, EMT in Iowa: “Familiarize yourself with what different levels of certifications and the different services in your area can do. I'm an EMT and was posted in the ER one night. A volunteer service that was EMR/EMT brought in a pedi patient who overdosed on a slew of meds and was unresponsive and had snoring respirations, but had a pulse and was breathing with 97% at room air. Vitals were stable.
“They picked her up, threw her on a cot, and brought her in. The ER was furious that they didn't have an airway, an IV, fluids, and a 12 lead. I had to explain to them that the circus that just dropped her off is made up of mostly EMRs and a couple EMTs, and they don't have a lot of experience because they're volunteers and have a very low call volume.
"They didn't even know the difference between an ALS and BLS rig at all. I was dumbfounded."
"They thought that everyone had the same scope of practice in an ambulance, so make sure you and your ER staff know this isn't the case."
— Lillian, EMT
Anonymous, critical care paramedic in Canada: “Know our scope of practice. This helps in several different regards. If you get a call from paramedics that they want to terminate resuscitation, and you know they are ALS, you know they have the ability to place advanced airways, administer antiarrhythmics, pressors, lOs. Which may significantly alter if you think this is a viable arrest after 30 minutes of resuscitation and they're still asystolic versus BLS paramedics.”
We’re working with limited resources
Anonymous, paramedic in Canada: “The patient we're presenting to you is not necessarily the patient that presented to us. Meaning, you might see someone not looking sick, or you might see someone looking terrible with little info. What you don't see is that the patient looked awful when we found them and now we've corrected things, or that we just carried this guy out of a hoarder house, drunk and covered in vomit, while de-escalating an aggressive spouse. So, I’m sorry that I don't know his COVID vaccination status."
"I'm doing my best in horribly unstable and dynamic conditions. Believe me once in a while, and cut me some slack."
— Anonymous, paramedic
Sam, paramedic in Arizona: “Emergency rooms are more of a controlled environment than we will ever have. Sometimes we have to unwedge a person who coded in between his toilet and the wall, while the floor is covered in vomit and feces, and the dog is barking, and the heroin needle is laying nearby that we have to somehow be aware of, on the third floor with busted elevators."
"We try hard to do our very best, but sometimes the circumstances of the call can really challenge us."
— Sam, paramedic
We appreciate constructive feedback
Erich, paramedic in Maryland: “I personally want to always improve. Positive encouragement of my performance and constructive criticism of how to improve is always welcome. I don't know how to do better on my end, whether my diagnosis was incorrect, and how to improve continuum of care if no-one takes the time to tell me.”
Anonymous, paramedic and firefighter in Colorado: “I run a small emergency services agency and for my 4 years there, I’ve always tried to create a culture of excellence. The only way to do that is to be focused on constant self-evaluation, self-improvement, and ownership of your mistakes. The challenge with doctors and paramedics alike is ego.
“Ego is toxic to the ability to have a healthy, thriving culture of excellence. So it’s always important to come at problems with vulnerability, humility, and the desire to grow and improve. Most of us are eager to learn even from our mistakes, but don’t berate us in front of our peers."
"We would love to learn outside the room what we could have done better next time."
— Anonymous, paramedic and firefighter
What this means for you
The emergency department is unable to function unless there is collaboration amongst all providers. The working relationship between EMS and the ED can sometimes lack understanding from both sides, which in turn is harmful to patient care. When both parties understand each other’s capabilities and view each other as respected members of the team, it can improve patient care, satisfaction, and outcomes. Acknowledging the perspectives of our EMS colleagues will strengthen the emergency response system and better service our patients in their time of need.