jvencius
Member
A couple nights ago I was talking with a friend who's one of the instructors in the local college's EMS education program and they said it would be nice if I was to speak in class as a guest about EMS from an ED nurse's perspective and what they could do to prep their patient for handoff/transfer to definitive care. That seemed like a fine idea so I'm starting to think of points to discuss, even before the exact format of my presentation is still up in the air, i.e. Q/A, prepared lecture with PP slides, free-form discussion, etc...
Here are a couple of my ideas so far but I'd welcome other suggestions:
* Calling report--please do it, even a simple "heads up--we're inbound emergent with a STEMI" since nobody likes the surprise amberlamps (misspelling very much on purpose), especially if they're bringing someone who's actually sick
* Focusing their report--VS, relevant demographics (age/gender/race), and history as it relates to their current condition, not a complete health history that doesn't directly or even indirectly relate to why they called the ambulance this time. A couple of the EMS agencies around here tend to tie up the radio giving a five-minute radio report and, usually, 90% of what they yak about is irrelevant...
* Take care of themselves physically, ie eat right, stay in shape, etc--too many times I've seen 350 lb+ EMS personnel wheezing a pt into my ED and I've gotten concerned that they're going to code before the patient does* IV access--if the patient needs fluid resuscitation or might need blood/large volumes of fluid, see if they can go with a large bore catheter (18/16/14) vs bringing in a septic patient with a 24 ga that for our purposes isn't very useful and might be occupying the pt's one good peripheral vein into which we might have been able to get a larger catheter, albeit in better working conditions.
* Take ownership of their patients--even if they're "just" transferring a patient, get vitals, do their own assessment (however abbreviated), and be prepared to give report when they arrive at the receiving facility. Seeing a senior Attending surgeon verbally destroy an EMS crew who, literally, said "I don't know--they just said to bring him here" when they delivered a trauma transfer patient and were asked for report was one of the more stunning moments of my career--schadenfreude doesn't even come close...
Here are a couple of my ideas so far but I'd welcome other suggestions:
* Calling report--please do it, even a simple "heads up--we're inbound emergent with a STEMI" since nobody likes the surprise amberlamps (misspelling very much on purpose), especially if they're bringing someone who's actually sick
* Focusing their report--VS, relevant demographics (age/gender/race), and history as it relates to their current condition, not a complete health history that doesn't directly or even indirectly relate to why they called the ambulance this time. A couple of the EMS agencies around here tend to tie up the radio giving a five-minute radio report and, usually, 90% of what they yak about is irrelevant...
* Take care of themselves physically, ie eat right, stay in shape, etc--too many times I've seen 350 lb+ EMS personnel wheezing a pt into my ED and I've gotten concerned that they're going to code before the patient does* IV access--if the patient needs fluid resuscitation or might need blood/large volumes of fluid, see if they can go with a large bore catheter (18/16/14) vs bringing in a septic patient with a 24 ga that for our purposes isn't very useful and might be occupying the pt's one good peripheral vein into which we might have been able to get a larger catheter, albeit in better working conditions.
* Take ownership of their patients--even if they're "just" transferring a patient, get vitals, do their own assessment (however abbreviated), and be prepared to give report when they arrive at the receiving facility. Seeing a senior Attending surgeon verbally destroy an EMS crew who, literally, said "I don't know--they just said to bring him here" when they delivered a trauma transfer patient and were asked for report was one of the more stunning moments of my career--schadenfreude doesn't even come close...
