I'd like you to think about a scenario that could take place on any given day in your community where a paramedic is with a patient with a suspected STEMI. The paramedic explains to the patient that on the basis of their EKG, their signs and symptoms, etc., that he believes they're having a serious heart attack and that they're going to need to take them to a hospital that can perform a cardiac catheterization. The patient doesn't have a family physician or a cardiologist, and the paramedic asks if the patient has any particular preference on one of those three PCI-capable hospitals, and the patient doesn't express any preference. Now at this particular time of day, they're all about the same drive distance away, so it's really going to be up to the paramedic to decide which of those three hospitals the patient will be taken to. And that's what I want you to start thinking about, is what do you think is going to be factored into the mind of that field paramedic on which hospital they're going to take that patient to given those types of circumstances. And let's even take that a step further. What if the EMS medical director or the administrator or the quality manager also happened to be on scene at that particular type of call in that type of scenario? What might go through the mind of that EMS medical director or the administrator or clinical quality manager on which hospital that they would like to see that patient go to? This scenario illustrates how the policies and behavior of your hospital and staff can influence not only destination decisions and frankly many other types of decisions by EMS at administrative and field level. Upon completion of this course, you should be able to, among other things, recall the roles of the different types of organizations that are generally considered to be a part of EMS. Discuss the impact that EMS agency relationships can have on hospitals clinically, operationally, politically, and financially. Recall things that hospitals can do to support field crews. Recall things that hospitals can do to support EMS administration medical directors. And recall things that EMS can do to better support hospitals. And to be aware of anti-kickback laws on how hospitals and EMS agencies support each other. I hope you'll find this information useful for strengthening the relationships between your hospitals and the EMS agencies in your area for the ultimate benefit of the patients and communities we all serve. If you have any questions about this course along the way, please contact ncdrmail at acc.org. I'll see you in Module 2 where we'll talk about the different organizations that comprise an EMS system.

paramedic decision-making

hospital selection

patient preference

hospital policies

EMS agency relationships