Welcome to Module 3 on Supporting EMS Crews. To recap where we've been so far, Module 1 covered a discussion on why these relationships between hospitals and EMS matter, and we presented the course objectives. In Module 2, we explored the different organizations within the EMS system and the different roles that they play, and how they can impact hospitals and patients clinically, operationally, politically, and financially. Now here in Module 3, we're going to talk about ideas on how hospitals can better support EMS field crews. It's important to understand that EMS field crews have a unique set of needs and wants. First and foremost, they want to be treated with courtesy and respect. This is often not the case, unfortunately, and it seems to vary with the cultural tone of different emergency departments, or even shifts within the same emergency department. One of the biggest symptoms of this lack of professional courtesy and respect is not really paying attention to their report, which isn't helpful for patient care or safety either. EMS professionals need and want feedback on the emergency diagnosis, and they want that feedback presented to them in a constructive manner. They'll be curious about what the lab imaging and other tests showed. They'll want to know what the emergency department diagnosis was. For example, was it a STEMI or was it something else? They'll want to know what the discharge diagnosis was, and they'll be very interested and receptive to tips to consider on the field differential the next time they encounter a patient with a similar presentation. They want to learn and correct from their misses, and they want to learn and reinforce from the cases they correctly identify. The other important need field crews have is a smooth and timely patient handoff. Extended wall times are sometimes unavoidable, particularly in times of COVID-related overloads, but otherwise extended wall times are a glaring symptom of hospital administration not bringing sufficient resources to bear on staffing and managing patient flow, which forces the use of EMS resources to look after patients at the expense of EMS and at the expense of compromises to community coverage for emergency response. Legally, the patient is the hospital's once the patient is on hospital property, so it's important not to risk abusing the EMS relationship by making EMS choose between what's legal and what's ethical by giving them no real choice other than to stay with patients that are the hospital's responsibility, lest patient care be compromised by their leaving a patient unattended who should not be. Much of this is outside the control of the emergency department or the cardiovascular care team leadership. It may fall more into the purview of senior hospital administration and the hospital's board of directors, but the emergency department and cardiovascular team and leadership needs to be aware of these issues and advocate for EMS when necessary. The other thing that field crews will find helpful is resources to help them prepare for the next call. This is really helpful and appreciated when hospitals can provide some cleaning supplies and space to use them. They'll not only need to be able to clean up their unit, but also themselves and their equipment. They're also going to be appreciative of a comfortable place to do their reports and relax a little bit before going back into service. And this might be an EMS room with desks and workspaces, chairs, Wi-Fi, perhaps some refreshments, access to a restroom. And recognize that they may have back-to-back calls for hours on end, sometimes for an entire 24-hour shift on busy units. Continuing education is another way that hospitals can really help support field crews. It may be something as simple as inviting them to attend hospital CE activities, but the thing that they would really appreciate is an opportunity for experiential learning. This may be things like having the opportunity to stick around in the cath lab or the stroke lab or the trauma room between their calls to directly observe what's going on in the care of their patients after the pre-hospital phase. Now this may be operationally inconvenient for them if the system is busy, so creating an opportunity for them to come in on their days off, even if they're not being compensated for it, is something that I think the crews would still appreciate. But the ideal would be to have that all set up as an organized and official CE activity that would actually grant continuing education credits. But what's been covered so far has really been about the ambulance crews. But it's again important to realize that they're not the only ones who provide care prior to arrival at the hospital. There's the emergency medical dispatchers in the 911 communication centers that did the initial triage and pre-arrival instructions to bystanders and callers to initiate care even before the first ambulance or non-transport medical first response unit arrived on scene. They're going to be interested in feedback as well, particularly on individual cases, again to kind of refine their processes and clinical acumen. Now I also mentioned the non-transport medical first responders. These crews will be working in teamwork with the ambulance crews to do the initial field diagnosis, the initiation of appropriate treatment, and relaying information to the hospital as well as the ambulance crews in many cases. They're very much working as a team on scenes, particularly on the more severe time-sensitive emergency cases like a STEMI stroke and particularly cardiac arrest and major trauma cases. So try to become more sensitive to what field crews want and appreciate. You want your hospital to be a place where they're going to feel welcome, appreciated, and respected, and that's going to make them more likely to recommend your hospital to patients when they have the discretion to do so. So that wraps it up for Module 3. I'll see you on the next one.

EMS field crews

courtesy and respect

constructive feedback

patient handoffs

patient care