What to teach in EMS class?

Lemon00 · Sep 13, 2015

I was in EMS for several years prior to becoming a nurse. I now work in the ER. Although, I know you are coming from a good place, some of your points seem a little bias. They could be good points but you are treading on thin ice with some of them... The weight one... leave that off. It sounds VERY offensive. Everyone knows they should take care of themselves. It's their choice to do it or not. You should take into account how certain aspects of working as a EMS professional can lend to poor weight management. First of all they are usually in a vehicle and only have a short time to eat, making it easy to eat convinces/fast food on a regular basis. They have short bursts of activity followed by sitting in a vehicle for prolonged periods. Two, about the IVs.... I'm wondering if you have ever started an IV in a moving vehicle. While I agree with what you said, I hope you have an understanding of the difficult and unique challenges of EMS. You seem to have the attitude I encountered many many times in my career and still see today, an attitude of "the high and mighty nurse" a good paramedic does what you do, except in the back of an ambulance traveling at high rates of speed with no one to back them up. Some nurses complain because the Paramedic doesn't have an EKG, large bore IV, meds given, a detailed head to toe assessment, and past medical history when they had a travel time of 8 minutes. Thing is most of the time... they do have all of that but when they don't... they'll get eye rolling and snarky remarks from the nurse. Its wrong. Maybe it would also be good for you as the ER nurse to ride a few times with them and learn a few things yourself.

Anna Flaxis, BSN, RN · Sep 13, 2015

Seems as if you're focusing an awful lot on negative experiences you've had. That would be really off-putting to me were I in the class listening to you.

How about talking about the things that your EMS crews do that work really well from your perspective? Talk about what works- what's good- what makes a great medic from where you stand, not the failures, bad calls, lapses in judgment, etc. that we are ALL guilty of occasionally.

Remember, we're all on the same team- we just have a little different focus, area of responsibility, and training backgrounds. But we're all in it together, and promoting teamwork and camaraderie is probably going to be your best bet.

And who doesn't love a good "war story"? Maybe talk about some good calls the medics made in the field and how you couldn't have provided the care the patient needed without their efforts prehospital....

I'm really reflecting now on the stuff I do that probably rubs the medics the wrong way when they bring me a patient, like not even looking at their EKGs (because we're going to get our own anyway, plus I'm busy hooking the patient up to the monitor and getting VS and typing notes and and and...). I'm sure they often get the feeling I'm not even paying attention to their report, but really I am. I'm just multitasking. That's what I wish I could impart to medic students- that my behavior as the receiving RN might be easy to misinterpret. If I'm quiet, it's probably because I'm listening or concentrating. If I'm frowning, it probably has nothing to do with the medic. If I take forever to get to the room to receive the patient, it's probably not because I'm slacking. I have the utmost respect for prehospital medics and my behaviors are more natural and less controlled because I feel comfortable with them, like they are part of my extended work "family", so I don't need to be all formal and official around them.

I'm going to start working on that. Thanks for brining this up. It's really thought provoking.

But back to your question. For me, a good solid radio report that I can take to the bank is priceless. Nothing like getting surprised by a report that doesn't paint the real picture. I've been caught off guard by enough of those that I tend to take radio reports with a grain of salt and save my assessment of the situation for when I actually lay eyes on the person.

akulahawkRN, ADN, RN, EMT-P · Sep 13, 2015

From my own prehospital experience, I would suggest that you focus on those things you'd like to know when they bring you a patient. Sometimes they cannot escape the ABC's part of the assessment as they're either too close to the hospital OR the patient is so sick that that's all that the crew can focus on. Remember that usually the ambulance crew is but 2 or 3 people, not an entire team like you have available in the ED. They have to focus on the high priority stuff. So, because of that, suggest that they do as good of an assessment as they possibly can, do a focused assessment, and from there, develop a somewhat standardized patient presentation format that takes about 60 seconds to complete.

As nurses, we know that using the smallest IV catheter that will flow an appropriate volume is appropriate and will damage the vein least. With sick patients, sometimes we need to sacrifice something to get an appropriate volume delivered reasonably fast. Just remind them that while they may get an 'eye roll' or two if they bring in a sick patient with a 22 or 24ga in place, if that's all that will work, then that'll have to do.

As to calling in a report, take the time to get to know the EMS system where you're at. It could very well be that their EMS policies do NOT generally permit an ambulance to do a radio report unless they're requesting orders. I'm generally very much a fan of getting at least some kind of report, and since I'm a paramedic too, I really don't want much beyond ETA, age, sex, (possibly) race, chief complaint, focused assessment, protocol that is being followed for that patient.

Also, it is good to teach them to always do their own assessment of every patient they get, even if it's "just" an interfacility transfer. Sometimes their assessment reveals that the patient exceeds their capability, and if that occurs, to NOT accept the patient. I have had to refuse transport of a patient and call for a higher level of care to complete the transport. Also, teach them to read the provided H&P on those transports. That, along with their own assessment, can help improve their own skill.

Lastly, I would suggest that you include the idea that they must do continuing education, and to seek out both quality providers of that education and to continually improve their own knowledge of medicine.