How often do EMS crews show up to your dept unannounced?

paccookie · Oct 10, 2009

EMS report is considered a courtesy, not a requirement. That said, I've only brought one patient in without a report and that was because the ED's EMS radio was on the wrong channel. Believe me when I say that EMS crews do not enjoy bringing their patients in to the ER without calling ahead with report. It creates unnecessary hassles with getting a room together and causes a delay in patient care. If the patient is critical enough that calling ahead is impossible for the medic, he or she will ask the EMT driving to call ahead with a very brief "hey, we're enroute with a cardiac arrest, asystole on the monitor, pt is intubated, ACLS protocols in effect, see you in 5" type of report. Gives the ER time to throw a room together and allows the medic to work without worrying about giving a report.

paccookie · Oct 10, 2009

Unannounced,,,,, not too often. At the last minute,,,,,,,most of the time. To the wrong level of care,,,,, far too often. A 92yo F who fell down 13 steps should not show up anywhere other than a Level 1 Trauma, which is protocol. EMS can make up all the excuses they want, they do and will do what they want.

Please remember that medics are governed by medical control. To by pass a hospital, we must ask permission from med control...even if we think that it's a given that the level I trauma center is needed. Sometimes docs say "bring them here" when they don't need to go to that facility. I do agree that sometimes the medics don't think and will just transport to the closest facility...then you must look at other factors. Is there an unstable airway? Is it an arrest situation? Is it a mortal wound that would not survive transport to the LI (such as a GSW to the head)? Medics have rules to follow just likes nurses.

paccookie · Oct 10, 2009

Well I have now seen this from both sides. I worked as a paramedic from 1992 to about a month ago, in that time I have given many radio reports and to be honest, most were pretty pointless. Unless I was calling in to speak to an MD for orders beyond protocol I thought reports should be done away with other than for notification on codes, or higher acuity that will require more resources. After being in the ED since June, I still feel this way, most reports are pointless. The ED I work in is almost always packed (19 beds and room for 7 hall beds). So really if EMS calls in with anything other than codes or high acuity nothing is done with it other than telling triage they can't have the bed for the random ailment they are about to use it for that should have been handled by a primary care MD. The system I am originally from I think did it best, Methodist in Indianapolis had a nurse assigned to ambulance triage. When a unit came in there was only a radio call for orders, and advanced warning of codes, cardiac alerts, and trauma alerts. It removed a lot of wasted time of going through a radio report (on both sides of the microphone).

This is the way Grady in Atlanta does it and it works really well. Every patient that isn't critical goes through triage. Some are sent to the medical side, some to the trauma side and many to the waiting room. It's simple and effective. We call for orders or to notify the ED of a CPR in progress, a very critical medical pt or a major trauma. That's it.

jhoefen · Oct 10, 2009

I have worked as a paramedic and i can tell you if a patient is dying in the back of my ambulance, i don't care what level your hospital is or if you want to "divert" me, i'm coming anyways. In the hospital you have many nurses, doctors and equipment i dont in the back of the rig. Stabilize the patient, then i'll transport them. Thats what i would want done to me. As far as a report is concerned, i consider them a courtesy, i, as a general rule do. That being said, i have had nurses ask stupid questions (pt. age? did you get an IV, What do you see on monitor, ect). In my opinion, radio reports are only to give the hospital a heads up, 50 year old patient, chest pain, be there in 5 minutes. I've got my hands full in the back of the rig, don't come back and ask a million questions you can figure out when i get there. I've done many clinicals in the ER and know how difficult the job can be, How much ride time have nurses done on an ambulance? I bet if they did some they would understand why sometimes we dont give a radio report. Medics are expected to do a lot in a very short time, most of the time with very little info ( pt. history, ect) and very little help if any and sometimes being very close to a hospital. I'm not going to sit on scene for 10 minutes figuring stuff out and give a radio report if i'm 5 minutes from the hospital. I load and go and do what i can for the patient in the meantime. I have no problem walking into an ER without calling if time didn't allow.

Larry77, RN · Oct 11, 2009

That being said, i have had nurses ask stupid questions (pt. age? did you get an IV, What do you see on monitor, ect). In my opinion, radio reports are only to give the hospital a heads up, 50 year old patient, chest pain, be there in 5 minutes. I've got my hands full in the back of the rig, don't come back and ask a million questions you can figure out when i get there.

I agree totally...the only time I ask a question is for bed placement (ie confused goes closer to the desk).

PostOpPrincess, BSN, RN · Oct 11, 2009

I've known critical care nurses to voice similar complaints about ED nurses who bring patients to the unit with little notice and/or incomplete reports. But y'know what, it happens man. The ED can get a little crazy and they can't always wrap my patients with a pretty bow on top. Sometimes the work environment sucks and prevents us from performing ideally. That goes for both nurses and EMTs.

Yup. Guys, the ED is the ED--things come in through the door and that is the way of life sometimes.

nurseladyk · Oct 14, 2009

This only happens occasionally in my department. Of course it only seems to happen when we are slammed, and have no place to put a patient. Even a 1-2 minute warning is so helpful and really gives us the opportunity to shuffle if necessary. We give the EMS crew a pretty hard time for it though. Out protocol is to receive a radio call for every ambulance and I really can't think of a reason why a call couldn't happen. If they are capable of calling when they are in the middle of a cardiac arrest, all out of breath and busy as hell, I can't think of any reason why they are not able to call for your average run.

**canoehead, BSN, RN** · Oct 16, 2009

I simple "here I come!" is much appreciated in a critical situation.

Otherwise complaint, vitals, and ETA. I'll never forget as a new nurse I asked for a temp on someone pulled out of an icey lake. They politely answered, but when they got to the ED "effing COLD!" was the actual reply. Never lived it down.

OldnurseRN · Oct 26, 2009

From most of the posts it's easy to see that most of you are in big EDs. We are a critical access hospital with 2 ED beds and 2 PACU beds that we can fill and 1 procedure room. We have 3 nurses on duty, 2 may be LPNs and we are also the floor nurses, the registration people, the RT techs and everything else ... we are IT! Fortunately, we hear the page go out to the county dispatch and have a heads up before the EMS calls with report and if needed can get the physician, radiology tech, and lab person on the way. (They are "on-call). I guess we all have our own trials.

Larry77, RN · Oct 27, 2009

From most of the posts it's easy to see that most of you are in big EDs. We are a critical access hospital with 2 ED beds and 2 PACU beds that we can fill and 1 procedure room. We have 3 nurses on duty, 2 may be LPNs and we are also the floor nurses, the registration people, the RT techs and everything else ... we are IT!

I did some agency shifts in a 8 bed ER once and i thought that was strange and they always had a doc, secretary/tech and 2 nurses. The hospital only had 22 beds--you walked around the corner to give report to the "ICU" which was basically a telemetry floor or the other hall was med/surg. I was used to either a 40 or 80 bed trauma center...quite the culture shock. It must be tough in a whole different way for you.

BTW, I have yet to receive an apology from the crew I complained about but I'm pretty sure they hate me...but hey, the have called report every time! Now if I could just get them to start lines and give more adequate care...:-)

EMTYankeeFan · Dec 4, 2009

Im dont meant for this to be hostile just stating my point of view. until your in the situation of a EMS provider you may not understand our position. At times we take patient to a ER and the staff tells us its the wrong facility.... and often times we know its not the best facility but at the end of the day if the patient needs to be stabilized the closest facility is better than the most appropriate one. lets be honest most facilities can stabilize a trauma victim in most cases.

IllinoisCCEMT-P · Dec 5, 2009

Ok i might ruffle some feathers with this one. First off the EMT probably shouldnt of said that to you. He or she should of been able to read your body language and knew it or he might of been trying to cheer you up. Second regarding the report the ambulance crew might not of been told that you were expecting the pt 2.5 hours ago. It not there fault. EMS only gets a H&P from the nursing home we dont get anything that resembles a report most of the time not all of the time. Third They should of given you a heads up but sometimes we just cant do it. Where i come from we had some nurses saying this and they did some ride time with us. When we are not on a critical care transport sometimes i am only partnered with a basic. You are intubating starting lines and pushing drugs with a fireman or maybe if your luck a basic in the back doing compressions. Its a lot. I usually have the driver call ahead but it could slip my mind especially if i am real close. Last but not least (this is not directed at you Larry) sometimes things change in the back of the rig and the pt has to go to the nearest hospital. you know and I know that you cant handle it but my medical control wont let me by-pass you so I have gotta go there. I am on a critical care truck and we have almost every drug imaginable but not everything. Sometimes things change and ohhh well i am acting on the pts behalf and If i have already done everything and this pt is gonna code your gonna get him. Isnt it an emergency room. Sorry if i came off bitter but its comments like those that make some EMS agencies dreading going to some facilities. How would you feel if everytime you brought a pt up to the unit. They questioned everything you did. Talked to you that way and were snotty to you the way you sometimes act to these guys and girls. We are all a team working together. Like it or not