How EMS impacts our care of patients in the ER

EMS is our partner in crime so to speak. They bring us the good, bad and the ugly. The care that EMS starts is the care that we continue. What they do on the street directly affects what we do. I've been an IL-licensed pre-hospital RN for almost 10 years now on a rural EMS squad. Nurses Announcements Archive Article

How EMS impacts our care of patients in the ER

I'm also an advanced practice nurse in a community ER. Along the way, I've worked in a level one truama center for 10 years too. I give you these qualifications only to reinforce this as firsthand knowledge. We (in the field) need to:

1. Provide the ER with as much info as possible BEFORE we roll thru the door. Some things that we might not always think about: is the pt >500 lbs? Is the scene a suspected crime scene? Is the pt on dialysis? Allergies? Is the pt compliant if they are chronically ill?

2. Give a very concise and to the point report, emphasizing the main complaint (the reason 911 was activated) and then add info as it is pertinent. A list of current meds and allergies is important.

3. Be polite yet assertive. It is important for the ER RN to be aware of things such as violence at the scene, reason for prolonged on-scene time, and inability to get an IV or airway.

And, we as the receiving facility need to help continue this care:

1. Listen to the EMS report. Keep the trauma bay and/or room as quiet as possible when the EMT is giving report. Wait until they are finished and then ask questions.

2. Ensure that you have received all the written info that the EMTs have including a list of meds and/or allergies. Also, if it is an accident scene, take a look at the photos if the EMTs have them - this will give you valuable info about the mechanism.

3. Be especially vigilant if the EMTs report that there was violence at the scene as it often follows the patient to the hospital.

0 Votes
traumaRUs

About traumaRUs, MSN, APRN

Trauma Columnist
88 Articles   21,250 Posts

Share this post

Specializes in Management, Emergency, Psych, Med Surg.

You are right on. Working in the field is very different that working in the ED. We don't see what EMS sees and it is up to them to try to make us understand the scene. They have an extremely hard job an deserve every bit of courtesy and thanks that we can provide.

0 Votes

Thank you-as an 8 year EMT I can't tell you how frustrating it is to roll into the ER and try to give report only to be ignored as the RN/DR interrogates your patient. We are required to give a report but no one really wants it-yes the patient is (usually) the best source of info however just once I'd like someone to pay attention to my report!!

0 Votes
Specializes in Nephrology, Cardiology, ER, ICU.

Diane - thank you! Totally agree that we need to be a team. Better pt care and less frustration for us too.

EMT34 - thank you too! I worked for 10 years in a level one and believe me, since it was a teaching hospital with a BIG emergency medicine residency, there were a boatload of people in the trauma bay when a level one trauma came in. Most of the trauma surgeons though were very good about keeping the side-talk to a minimum so that a good report could be had by all - lol.

BTW - do either of you see digital cameras being used on the scene for pics for mechanism of injury?

0 Votes

Yes-we (my fire/ rescue dept) have done this on occasion, rather by accident (someone just happens to have their digital camera with them!). The ER folks seemed to appreciate being able to visualize the actual scene (a picture IS worth a thousand words). However, its a delicate thing-you have to be really cautious about confidentiality-I take pictures at alot of "scenes" for the FD and squad but I am careful about taking faces. Even emergency personnel can get nervous about being recorded--in one instance a medic was loading a pt. on the helicopter WITHOUT her turnout coat and helmet. I took pictures and she asked me to make sure her boss didn't see! However-back to your original question-I do think its a good idea for MOI, indeed some things are just too weird to explain!!

0 Votes
Specializes in Nephrology, Cardiology, ER, ICU.

The good thing about digital pics is that they can easily be deleted - lol!

0 Votes
Specializes in CCU and Tele. stepdown.

The stories sound even better when you have pictures to back it up. I been on the sending and receiving end of both. It does feel good when a Nurse or Doctor acts like they are listening. CCU Nurse 6 yrs-fire/rescue 11.

0 Votes
Specializes in NICU, ER.

I wanted to say THANK YOU for an informative and very important article addressing the important relationship between EMS and RN. I am a new RN in the NICU environment. I spent 10 years as a Paramedic, 3 years as a flight paramedic. Many people devalue the critical importance of a good structured face to face paramedic to rn report. Photos are a nice addition. Clear communication is paramount in the chain of healthcare, and oftentimes interviewing a pt without listening to the prehospital report is ignoring some very important facts. I.E. The platinum 10 minutes in getting off scene to getting a critical trauma pt to the OR to maintain the golden hour, and reperfusion timing for CVA and AMI. Thanks again. Helicoptergal

0 Votes

i cant tell you how many times a nurse has completely ignored my when it comes time to give report in the ED... interestingly enough the MD usually takes more interest.

0 Votes
Specializes in Emergency Medicine.

as a former chief paramedic in various parts of the world, i have, as a hobby, listened in on ems radio reports between field medics & the er, pretty much nationwide. and what i've heard more times than i can count, are patient assessments to nurses so poor, that i'm not surprised in the least that some medics are "being ignored" when they walk in the door.

when a college-educated rn hears a clown at the other end of the phone who can't pronounce "phenothiazine" or reports that - due to possible neck injury - they have applied a "cervix collar," or the patient's "staples are vital," - who could blame the staff for hoping laurel & hardy would just drop the patient off, and leave the er before they hurt themselves?

the sad fact is, "paramedics" - which began as a career - has deteriorated to little more than a revolving door job for twenty-somethings to get somewhere else. i hate to sound like my dad talking about the 'old days.' but there was a time when, if you wanted to become a medic, you attended medical school. there were almost no free-standing paramedic schools. and those of us fortunate enough to be sponsored did indeed view paramedicine as a career.

at "paramedic parameters" seminar years ago, they did a poll. the typical medic was 30 years old; married; owned a home; had five years experience, and fully expected to work as a medic for 25 years.

compare that with a recent private ambulance poll, which revealed the typical medic is 24 years old and can't wait to become a firefighter.

if a medic is serious about getting respect from nurses & mds, he or she needs to take a good look in the mirror. because in the end, they are turning the patient over to someone who is indeed a professional, and knows a slacker when they see one.

0 Votes