How do you manage EMS pt's?

[MikeyBSN]

I'm sure this question plagues most ER's. We have gone through a few systems and haven't really found anything that works, although I do think our current system is better than the old ones. We used to send EMS pt's to triage if they didn't look sick, which overwhelmed the triage nurse. If they did appear sick, the CN would have EMS "dump" them in a bed and may or may not remember to tell the nurse in that section. We eventually went to a system where the EMS pts were all triaged by the CN or float nurse (if we had one). This system works a little better, but still has its problems. How do you manage your EMS patients?

[BrnEyedGirl, BSN, MSN, RN, APRN]

I'm not sure I understand your question. We recieve report PTA and the pt is assigned to a bed or hall bed. We have a "bed board" that we enter the EMS unit # on that tells EMS which bed to place the pt in. Which ever nurse has that bed will get report from EMS when they get there. We do occasionally send EMS pts to triage those with back pain for 6 months or c/o migraine HA or fall from standing position w/o c/o "just thiught I should be checked out". Our ER is divided into 3 sections,.the trauma side (13 rooms/7 hall beds) is physically closer to the Ambulance bay and the majority of the pts on that side are EMS pt.

[jayne109, RN]

I work at a level I trauma center but I know that even the little hospitals in MO do this:Radio is called to us PTA or if it is minor or something odd, the medics call report from their cell phone. Either way we get a report. Depending on how busy we are, we assign a bed or hallbed and then the paramedics give report to the accepting nurse. If We are swamped, the medics will tell us it is appropriate for triage or not or we just ask. Headaches, belly pains, back pains, knee pains, stuff like that, we will triage out front. We do rely on the medics to give us a good enough report to make that decision though. Do they not radio report where you are?

Hope this helps.

Melissa

[S.T.A.C.E.Y, LPN]

Well EMS gets triaged by the triage nurse, as does everyone else. We get report PTA on anything that is serious. If the person is well enough, they go to the waiting room. If they are resus, a bed is found for them immediately. However, we have quite a problem with people who aren't well enough to get off the EMS stretcher, but not well enough to be brought in to a room immediately. Stable little old lady with a fractured hip, or a little old bedridden man who is a failure to cope stays in the EMS stretcher for hours on end, usually because we are too busy bringing in fresh MI's and acute abdo pains, strokes and the such. Its a crummy system but thats the way it is for us right now.

[mandasueRN]

We have two separate areas to triage pts at our facillity: an ambulance triage and an ambulatory triage. We get so many ambulance pts that it would overwhelm one or two triage nurses. There are usually at least two nurses in each area. Ambulance pts are triaged as they arrive and if they are sick enough to be sent straight back they are assigned to either the medical or trauma side of the ER and triage will notify the charge RN of either area that they are getting a pt. Pts who are level IIIs or IVs can be sent to the waiting room if needed. This works well for our level I center, but might not be feasible for a small hospital where you couldn't assign a nurse to triage ambulance pts only. As always, its difficult to balance your walk-in pts with your EMS pts when you have a limited number of beds.

[Dave11, BSN, RN]

The only time EMS notifies us PTA is if they are bringing in a code or someone who will need "the big room". The charge nurse is the one who signs them in and assigns them to a nurse. If the patient isn't that sick, we send them to triage. It can get overwhelming at times when 4 or 5 ambulances show up at once but it seems to work out pretty well overall.