Hello, everyone. I am Callie Kalina, and welcome to our session entitled Take Your EMS Hospital Relationship to the Next Level. It's not a date, it's a marriage. Our presenters for this session have extensive backgrounds in emergency health care from both the EMS and hospital perspectives. Wayne Rupert is the Regional Director of Clinical Outreach and Cardiovascular Accreditations for Bayfront Health Hospitals in Florida. He's also a paramedic and auxiliary police officer with the Pasco County Florida Sheriff's Office and is the author of several textbooks on emergency care. Mick Gunderson has worked in EMS and emergency health care for over 45 years in various leadership, managerial, and clinical roles. Currently, he's the president of the Center for Systems Improvement, specializing in EMS and systems of care for high-risk, time-sensitive conditions, and works closely with the ACC on EMS and systems of care-related programs and projects. Mick is also the editor-in-chief of a new peer-reviewed publication, the International Journal of Paramedicine, which will premiere later this year. This session is going to use a slightly different format in which Wayne and Mick will ask each other questions about EMS, hospital relationships, with Wayne speaking mostly from the hospital perspective and Mick responding from an EMS perspective. But they may also switch it up as they both have worked with EMS and hospitals in different capacities during their many respective decades of experience in emergency health care. I'll turn it over to Mick to get things started. Thanks so much for those introductions, Kelly. Really appreciate it. I appreciate the opportunity to present here at the conference. There's just so many reasons why hospitals and EMS need to collaborate and make sure that their relationships run smoothly from a clinical perspective, an operational perspective, a financial perspective, political perspective. There's just all the reasons in the world to try to make this work. But to try to get things going, let me start out with asking you a question, Wayne. From a hospital perspective, what do you feel are some of the reasons why hospitals need to improve these operational and political relationships they have with the EMS providers in their area? Why is this important? Well, I guess probably the best answer is to start with the patient. If we're looking at the continuity of care from the patient's perspective, we want to make sure that when an EMS unit arrives here at the hospital that we are anticipating the patient. EMS is called report. There's a good handoff between the EMS crew and our hospital staff. In the case of a cardiac patient or a STEMI, that is critical. Having EMS notify us in advance, us being able to activate our cath lab, in some cases 30 minutes or so before the patient gets here in the middle of the night, if our team is not here in-house. There's a lot of dynamics that are involved in getting the cath lab team here. My goal is that EMS goes to the patient's home, they do their assessment, they do the quick EKG, they identify that the patient's having a heart attack. They issue the STEMI alert and that, on our end, our ER physician initiates that. The cath lab teams are being woken up by their phones or their devices at home. If all works well, which it often does, by the time the patient arrives here at the hospital, the cath lab team is here, the interventional cardiologist is here, and the patient really doesn't spend any time in the emergency department. They go straight to the cath lab and we begin the procedure. Starting with the patient first, because we're all centering or focusing on the patient, that's my primary goal. If we have our act together really well for the most acute patient in a cardiac condition, which would be a STEMI, then everything else should fall into place rather well. That's for starters. We can certainly elaborate on that. Yeah. I think this is just as valid, not just for STEMI, but for strokes, trauma, sepsis, all of the time sensitive conditions, I think the same rationale applies. One of the other things that I think plays into this with that notification is the whole issue of trying to decide which hospital the patient should go to. Could you elaborate a little bit on that dimension of things, Wayne, with trying to have the hospital help inform that decision by EMS? Sometimes maybe the hospital they're calling isn't the right hospital to go to, or maybe the lab's busy. How do you deal with those issues? That's an excellent question. Obviously, if you have a bad trauma patient, that patient goes to a trauma center. If you have a patient who's having a heart attack, they should go to a hospital with a 24-hour cardiac cath lab. That's our position here. Our hospitals, two of our three Bayfront hospitals have 24-7 cardiac cath lab teams. If a patient wants to go to our third hospital because they live in that town and they're having chest pain, they're having a heart attack, and EMS sees that it's a STEMI, the patient will want to go to their hometown hospital, but the EMS crew will say, no, we've got to take you to Brooksville because that's where the cardiac cath lab is. Obviously, specialty services, same would be the case with stroke. A bad trauma with my hospitals would not come here because we're not a trauma center. We also, my role when it comes to cardiac patients is to be as transparent and honest as possible with the patient, again, being the primary focus. There are even some patients that are not appropriate to come to a hospital with a cath lab. They may not want to come straight to a hospital that has open-heart surgery. That's based on the interpretation of the EKG. There have been cases where EMS and our hospital collaboratively has said that the patient should go to a competitor because of the EKG finding being suggestive of the patient having triple vessel or a left main occlusion. The biggest thing we can do as a hospital is be honest with our capability and give the education to our crews. I think in doing so, and that example that I gave where the patient would need open-heart is extremely rare. I would say 99.5% out of 100 STEMIs are fine coming to a community hospital that has a cardiac cath lab and no open-heart surgery. When the hospitals are transparent and open, in those cases where our for-profit hospitals are saying, take the patient to our competitor, we don't want to do that. Our focus is what's the patient's best interest. In those cases, that's what we do. In turn, we earn the respect of the EMS crews as well as the patients. That all sounds pretty straightforward, Wayne, but let's talk a little bit about the real world of things. Trying to establish that trust in those relationships, at least in my experience, hasn't always been very smooth. Sometimes the hospitals are reluctant to share patient-level information with EMS. That's something that's plagued EMS ever since the modern era of EMS started in the 70s, where we were actually providing care rather than horizontal taxi service, if you will. We've always wanted to get information on how those patients did so that we can calibrate our assessment skills. Without that feedback to EMS, I've always felt like I was trying to shoot arrows in the dark. I felt like next time I needed to go a little bit more to the right or left or up or down. You just don't know how close you came to the target and what the issues were. What's the holdup on the hospital side for sharing the data? What do you think the solutions are for hospitals and EMS to have that better communication? How does that look from where you're sitting, Wayne? Sharing the accurate data is 100% on target. It certainly does help them when they see, for example, what the door-to-balloon times are. They can compare our facility with other facilities. Fortunately, all the numbers are comparative. There's not a big difference between door-to-balloon times in our facility and competitors. In that regard, if I were still in EMS, if there was a big difference in one hospital's performance in getting the patient into the cath lab and getting them on the table and getting the blockage open, I would be picking the hospital with the better time. Sharing the data right there gives them those numbers. That definitely is very important. I recall from my days being in the field that I wanted to learn myself not only how did my patient do, because obviously when I go on the call and take care of the patient, I've got a vested interest in did he or she do well and what was the outcome? But then I want to be able to learn, again, going back to the cath lab type setting. I saw a certain finding on the EKG and the patient presented clinically in a certain manner what artery was blocked and how did everything work out. That helps me to determine if my care was appropriate. Getting back to the data question, I think it's critical that we share data with EMS using a tool. Now, obviously, with the American College of Cardiology, we want them to use the chest pain MI registry, but if they're using another tool, as long as they're using something that's able to input information about each case and provide some type of a spreadsheet with scores giving them outcome information, that's critical, and that we get the information to them in a timely manner. Our goal here is within 30 days to try to get feedback about each STEMI to the crew that took care of them. You bring up an interesting issue, Wayne, because there's feedback that can happen on two levels. One is to the individual crew that cared for that particular STEMI patient. It's great to get the summary of the case with which vessel was occluded, what the ultimate outcome was, some of the times, et cetera, so that that crew can calibrate their responses and get the feedback. As actionable data and more of a macro level, that's where I think that spreadsheet you're referring to comes in with. In aggregate, the medical director, the quality manager, the clinical manager, they're going to want to know, overall, how well are the medics in my organization doing in correctly identifying STEMI? What was their over calls and under calls, their time intervals, all that stuff in aggregate so that the folks on the EMS side of the equation can then decide, well, it seems we've been missing a fair number of these and drill down and say, oh, those all seem to be early repolarization or whatever the case may be. Then they can calibrate their CME activities accordingly to try to correct that. You can't do that if the only feedback the hospitals are providing EMS is to the individual crews. We need to have that aggregate data to be able to do that. That's a great point. Just an FYI to everybody, the ACC is actually going to be releasing a tool to try to help make that a little bit easier. It's called eReports EMS. It's coming from MCDR. What will happen is EMS will be able to get their own login to the MCDR database, to the Chesapeake MI Registry. It will allow EMS to look at data from all of the hospitals that are on the Chesapeake MI Registry, pull those numbers all together and give them aggregate feedback across multiple hospitals. The last I heard is that this will be coming out a little bit later this calendar year. Just a heads up to be watching out for that to make that whole task a little bit easier. From your perspective, Wayne, does EMS need to do a better job? From your position as a hospital person, what do you want to tell EMS? What can they do better? I can look at it from the cardiac perspective. If we talk to the cardiologist, they would like to see STEMI alerts being called on patients that are real STEMIs and not a right bundle branch block per se. I get feedback from in the hospital, we got out of bed or the team was activated and it wasn't a STEMI. I look at it from the perspective of if in doubt, make the call. I would rather get out of bed many nights and be turned around halfway to the hospital because the patient got there and the ER physician said, no, it's just a bundle branch block or it's just early repolarization. Then have it go in the other direction where they're afraid to make the call and the patient gets there and it really is something that needs to cap lab. At the end of the day, in an ideal world, our EMS crews would be perfect clinicians and they would be able to diagnose with pinpoint accuracy and only ever call a STEMI when it really is, but that's not real. Even physicians are sometimes making the call and the cardiologist, we get the patient on the table and there's no blockage. My biggest thing is making sure because there's always going to be a margin for misdiagnosis that it'd be in favor of the patient. I would rather, like I said, get the patient on the table and find there's no blockage and patient goes to recovery and we all go home. Then the other way around, the patient arrives and they need the cap lab and we're not there. You bring up the time issue. This is something that I've been frustrated a little bit by as I look at data from these cases is even if you're in town and you're a short distance from the hospital, waiting until the crew gets in the ambulance to make the notification to the hospital, I think that that's a easily correctable problem, but shame on EMS when they do that. Call while you're still with the patient so you give the hospital a little bit more lead time, I think is something that would be really helpful. I think to the extent that the hospitals try to put their best foot forward on giving timely, actionable feedback to EMS, I think that makes it a little bit easier than for the hospitals when they've got to up their game. That's a relationship that needs to build some trust because I don't know, I get the impression sometimes that hospitals are afraid to sometimes to give any negative feedback to EMS for fear of aggravating the cruise and so maybe they won't bring the patient to their hospital next time. Am I just imagining this dynamic plane or is this part of the psychological calculation that hospitals are doing on these cases and influencing the feedback they give? I think you're right there. I don't think people like to tackle a negative situation. The way that I work is I celebrate the victory. When they have a great save, they save a life, they make a great stemming call or call on other type diagnosis, we reward that. We go to the stations. We have citations and meritorious performance. We celebrate in a big way those saves. Up until COVID, we had an annual Lifesavers Award banquet. We would bring in crews, every single save that we had, whether it was cardiac or other, and we would bring in the patient. Imagine this huge banquet hall and the patients there, in many cases with their family, every single EMT and paramedic, ER nurse, ER physician, cath lab team, if it was a cardiac cath patient. It's quite a, we'll put it this way, we hand out a lot of these at those events. It's quite emotional in a good way. But then when you get that negative thing, we can't let those go. But then we take each situation where let's say a mistake was made. And it goes back to the days when you and I used to work together a long time ago in the Pinellas County EMS system, where we basically, and I collaborate with the EMS chief, and that chief may be interviewing his or her crew to learn what the specific factors were on that case. I give them the hospital's input. And at the end of the day, we want it to be an educational experience and not a punitive or a disciplinary one. So if we ignore those bad cases, who's going to suffer is the patient the next time a 911 call comes in. So if a mistake is made, let's say a clinical error, clinical judgment, if the crew gets positive education and it makes them better, then we all win. And every great once in a while, I mean, there are just in any profession, there are people, unfortunately, that it's disciplinary. So but that's not my fault. That's the EMS chief. We present the case and the information to the EMS chief and that person and the medical director, and they review the case. But in most cases, it's education. And I'd say a very small percentage are really in need of discipline. In need of discipline, it's education and making them better providers. Yeah, and I think that that's key is, you know, start off from the premise that it wasn't an intentional error. You know, no one comes to work with the idea of providing bad care and people can make a mistake. But, you know, as we both have a deep appreciation for a lot of times, most of the time, 95% plus, if not more, it can be traced back to a process problem. And so, you know, I think if the way that EMS approaches issues they have with the hospital and where hospitals approach issues they have with EMS, if we begin from a standpoint of assuming that there is an underlying process issue, whether it was related to the education, whether it was related to the lack of feedback, or, you know, other things that may, you know, cause that to happen. And this is where the transmission of the 12-lead, I think, starts to play in. I think some EMS agencies are really pushing back a lot from being asked to transmit the 12-lead with kind of the assumption, what, you don't trust us? You're not confident in our interpretation skills? They get kind of defensive about that. But on the other hand, emergency physicians get consults from cardiologists on, you know, this one's really throwing me. I just want another set of eyes or a different opinion on this, and there's no shame in that. And I think that kind of puts a lot of noise in the signal there. Let me just mention the 12-lead EKG and EMS being offended that their interpretation skills weren't, quote, trusted, unquote. I can tell you that most interventional cardiologists won't even necessarily trust the ER physician's interpretation. They, the cardiologist, wants to see the EKG, period. So it's not just EMS who could be potentially offended. It's the ER physician, the ER staff. So one of the things that we should communicate to EMS and fire rescue is that, you know, it's not your skills, it's not mine, it's not even ER doctors. The cardiologist who's getting out of bed in the middle of the night to come in and take care of the patient, that's who wants to see the EKG. You're sending it for that person. So that kind of eliminates all the, you know, trust or lack of trust issues. Yeah, and it's amazing how quickly all that could be destroyed by a cardiologist or an emergency physician kind of coming off the rails and unloading on the crew in front of other staff, especially, and that can have long lasting damaging consequences to the relationships. Yeah, I just wanted to touch on something you had alluded to a moment ago. And, you know, it goes back to the, you know, when you were talking about aggregate feedback versus individual feedback and, you know, the NCDRs registries, the American College of Cardiology's Accreditation Conformance Database, the ACD, Mission Lifeline. I don't even know if they're still, the American Heart Association, I know that they still have a tool, but I know all of those tools look at aggregate feedback. And I think that's what drives like decisions about, you know, what should be our CME topic for next month? Where is system-wide are we having issues where we can identify, you know, a topic for education that we need to hit? So you need the aggregates for that level of feedback, whether it's education or throughput, looking at throughput issues, which would bring us to COVID, which is a whole different thing that if we have a couple of minutes, I'd like to address that as well. COVID's been a major wrench, but yeah, and that's changed all the rules right now, but keeping on this track here with the feedback, you know, you need both, you need the aggregate and you need the individual. And, you know, and I know Mick, you and I've discussed in the past, you know, my role is a cardiovascular coordinator, you know, and putting data into these registries and looking at these monthly reports and looking at aggregates. And I remember when we first started this back in 2012 at my first hospital and we were doing, it was the first accreditation process. And we looked at door to EKG and it could be any metric. I mean, in this case here, it was our hospital door to EKG. And for the previous month, we had 38% compliance with nurses or ER staff getting the EKG obtained and getting it read by a provider within 10 minutes. So I posted those scores and 38%, I mean, that's a big F, you're failing. And the following month, the score almost doubled. It got better, it was 68%. And so, I mean, I saw that huge leap and I'm happy, well, 68% if you're in school is a D. So it's still not a good grade, but it's certainly better than it was before. And over the next several months, that score remained in the upper 60s to the low to mid 70s range and it never got better. And I kept posting scores, posting scores. And I'm thinking, okay, we're sharing aggregate information and I want us to be a 90%, an A, or at least a B, somewhere in the 80%. And we're just not getting there. And that's when I, in my mind, I'm like, okay, maybe aggregate needs to be augmented with individual. So I had to build a database using an Excel spreadsheet where we input every single case like we did previously, but on each case, we identified who was the ER doctor, who was the ER nurse. So we had individual people who were responsible for each metric with each case. And so when I did the following month, I was able to give each nurse and each doctor their profile. And I saw a trend. I saw certain nurses were 90%, 100%, door to EKG within 10 minutes. And I saw other nurses were close to zero. And I thought, that's interesting. So using those profiles and those scores. So I know earlier we were talking about individual feedback for one case, that would be like one STEMI, but now I'm talking about an individual's trend. So like last month you had 25 patients with chest pain. That's your profile. And out of this 25, you got to EKG within 10 minutes, 24 times within the guidelines. So you have an A. How do you do it? Because I wanted to take those star performers and learn their technique. Cause I'm thinking, how do you do that? And there's one particular person and a nurse comes to mind, his name is Mark. He's now a nurse practitioner. And I said, how do you get those scores? Because Wayne, when I have the chest pain rooms that I know that these rooms over here, when they're assigned to me, that's where the cardiac patients are gonna go. So I put an EKG machine in the room beside the bed. I have the sticky buttons attached to it already. The machine is on. So when a chest pain patient comes in, the patient lays down, I lift up the shirt. I get access to their skin. I put the buttons on and I print the EKG. I went, wait a minute, you don't put in the name? Because no, no, I do emergency EKG. I print it. I put a sticker on it. I take it out to the doctor and that stops the 10 minute time clock. Then I come back retrospectively and open the file and enter the name and the birth date and all the information. So I was able to take techniques from a star performer and share it across the board with other people. Then we called in one nurse comes to mind who I won't even say a name or anything, but one nurse comes to mind who is about a zero. And I remembered saying last month you had 18 patients and every single one of them took much longer than 10 minutes to get the EKG. And I literally watched a color and it was me and the ER director. And I watched a color drain from the nurse's face and she had this big deer in the headlights look. And her first question was, you can tell? Meaning out of the aggregate group which we were posting aggregate scores, you can single me out? And I said, yes. And she was in shock. And then the ER director took over and said, well, this is just informative. Right now it's not discipline. I wanna know why you're having trouble. And the next thing she said was, well, when I need an EKG done, I can't find the tech to do it. And the director said, that's not the right answer. If you need an EKG done and you can't find the tech, I suggest you do the EKG yourself because you're responsible for that metric. So, the nurse got some education during that session. The following month, her scores were a hundred percent and the aggregate scores of the entire emergency department jumped to 92%. So, you need both. You need aggregate, but you need individual. So, you need individual case-by-case review like in the case of STEMI's, but you also need a way to give the feedback to all of your providers on your team. Now, with the American College of Cardiology's NCDR registries, the cath PCI, the interventional cardiologist gets what they call the physician's dashboard, which gives that degree of feedback to the interventional cardiologist. But when you look at the care of a cardiac patient, the cardiologist is only one piece of that situation. You've got the ER physician, you've got the ER staff, you have the cath lab staff, you have EMS. So, they all need their own dashboard. So, I'm glad to hear that you just shared that, the American College of Cardiology is introducing a new tool for EMS. And I would love to see us continue developing these tools to allow us to put in our hospital team members so we can give each person their profile. And that's probably a conversation for a different topic or a different time. Well, let me shift it a little bit, Wayne. You know, one of the other dimensions that EMS and hospitals can interact with is more operationally and even financially. And, you know, when 12-lead technology first came on the horizon, a lot of EMS agencies were bearing the full cost and responsibility of implementing 12-lead EKGs, you know, from their budgets, but the downstream financial benefits went to the hospitals. Any thoughts about, you know, how hospitals and EMS could work together more collaboratively to share expenses, particularly when the financial benefit may be more to the hospital than it is to EMS? Interesting question, interesting topic. Now, my thoughts are at the end of the day, the beneficiary of that technology is the patient. And yeah, the hospitals may benefit from that as well. Possibly some collaborative purchasing arrangement could just be one thought that comes to mind. I mean, clearly buying in a larger system or buying and being a consumer with a bigger order, and that certainly can affect the pricing in a positive way. One other thing that occurred to me, Wayne, was I saw this happen early on when they first started introducing CPAP. So I forget which community it was, but the hospital realized that on the patients that they were seeing coming in from EMS with CPAP, they had lower rates of nosocomial infections because they weren't intubated, say like a severe congestive heart failure sort of thing. And then it seemed that it dawned on the hospital that if they went ahead and bought the equipment for EMS and provided the training for EMS and replaced the circuits, so it took the financial burden off of EMS, for every dollar that the hospital spent on that, they were saving $2, $3, $4 at the end of the day because the patients did better there. Clinical scores came out better, particularly under bundled payment arrangements. Financially, the hospitals did better. And so it just seems that there could be some more creative ways for hospitals and EMS agencies to collaborate on those sorts of things. Because there's other stuff that's coming up. I mean, if we find that a combination of mechanical CPR, thoracic impedance threshold devices and a heads up CPR is giving us dramatically improved ROSCs and neuro outcome rates, then maybe there's a financial alignment of incentives between the hospitals and EMS to pay for those not inexpensive technologies. And we could look at maybe the same things regarding sepsis identification, stroke identification, et cetera. How does that sound from your perspective on the hospital side of things? Well, it definitely sounds interesting. That's not something that I've actually thought about in the past, but I leave it to you to come up with an innovative thought. Definitely is worth digging it into and doing some research on it. Yeah, so there's obviously an awful lot of things that EMS and hospitals can do to improve their relationships with individual aggregate feedback. Aggregate feedback at an institutional level, aggregate feedback at the individual level, like you were talking about with your scenario there, because EMS could do exactly the same thing, but come at it from a process perspective. Things they can do operationally, again, with some process changes to make sure that those STEMI alert notifications or trauma alert notifications, stroke alert notifications are done as soon as possible so that the team can actually be in place by the time they hit the emergency department doors and have the opportunity to go straight to the definitive intervention rather than parking for a little bit in the emergency department, assuming this patient is stable and stable as they can be given their circumstance, but ready to go right to definitive care. Now, you mentioned something about COVID kind of changing the rules. We got a couple minutes left, Wayne, if you could maybe elaborate on that a little bit. Okay. Well, what I've seen in the last two to three weeks here at my three hospitals in Central Florida is unprecedented for my 41 year career in EMS and hospitals. I've never seen such a concentration of morbidity and mortality that I've seen in these past two to three weeks. Three weeks ago, I was going shopping without my mask because we were told if you were vaccinated, you didn't need your mask anymore. And I come to work the following Monday to find that the ER is completely filled. Patients are lining the hallways. All C-suite people were asked to go help. So after the morning management meeting, I put scrubs on and my background being cath lab technologist and paramedic, I either go to the ER or go to the cath lab. And I went into the ER and I saw every place a patient could be parked. There was a patient. I saw no less than a dozen EMS crews standing in the hallway with their patients on EMS stretchers. I heard beeping. I heard wailing and crying. It was something out of a bad movie, a disaster scene. And I'm thinking, this is no different than a 747 dropping out of the sky. It's a disaster. Our resources are being overtaxed. It has not let up since. And what I'm, I guess my message to, the first thing I experienced is, we're working so hard to get these patients and most of them are COVID. And what I did see is this trend where every single patient that I've seen on a ventilator, every single patient that I've seen who did not survive were unvaccinated. And I've seen patients, I saw an overweight, older gentleman, lots of comorbidities. And I know he got sent home with a couple prescriptions and instructions. And he was told he has COVID. He got monoclonal antibodies, basically drink plenty of fluid, you know, quarantine yourself and only come back if you have trouble breathing. But he was vaccinated. And under other circumstances without the vaccine, he probably would have ended up on a ventilator. So there's a big issue of education. I've gone on a drive because we're seeing with this COVID situation, it's become politicized a long time ago. And basically, if you're a Republican, you don't believe in masks, you don't believe in the vaccine. If you're a Democrat, you were, this is crazy. And I'm watching reports on television, CNN, Fox, I watch all of them. And, you know, I see what appears to be credible people presenting research. And I see it being presented on both sides. You go on social media and you see somebody who appears to be a credible person quoting a scientific paper showing where vaccines hurt people. So there's so much misinformation out there. What I'm finding is helpful is for each of us, the paramedic in the street, who is seeing the results, real life, of what this is doing to people. What I've seen in the ER, if I could have worn a body cam, like I wear when I'm on duty with the sheriff's office and played back what I've witnessed in the last two weeks, that would be more effective at educating the public in why you really should get vaccinated, why you should wear a mask than any CDC report or any politician or any other, you know, talking head person quoting statistics. Real life from first responders. So my message would be to our EMS partners out there, our hospital partners is for those of us who are on the front lines to share our story, real life with the public in any way that they can. I'm working with the sheriff's office here right now and our marketing department to put some videos together from frontline staff to do our part in trying to educate people to get vaccinated and wear a mask and wash hands and, you know, take those precautions. And the final thing that I felt, and this is me now, Nick, you know, I work EMS, you and I worked together for many years in EMS. So my initial exposure, 20 years is in an ambulance and I'm watching another ambulance crew coming through the ER doors and I'm seeing red. I'm angry at them for bringing me a patient because we have no place to put the patient. But my feelings are the same as every nurse, every doctor nationwide who's feeling what we feel now. And the paramedic came up and the first thing he did, I guess he read my facial expression and he apologized. And I said, no, no, no, no. You should not be apologizing. You're doing your job. When someone calls 911, it's your duty to act. You must go. And, you know, when you get there and the patient's having trouble breathing, which this patient was, it was a COVID patient, you can't take the patient back to the station with you. You have to bring them here. So my job is to do the best that I can to be respectful and polite to you and try to get you as quickly as possible to offload your patient. And in our break room, we have protein bars, we have drinks that will help hydrate you and get you as a person back in shape so you can go back out and answer the next 911 call. So I guess that was my COVID lecture and it's not necessarily consistent with the American College of Cardiology or data or chest pain, but it's timely. It's what we're all seeing and what we're all feeling right now. Yeah, I think illustrates the whole issue of process issues and individuals kind of getting caught up in the middle of it and dealing with the consequences. But hopefully those who are watching this session will come away with some ideas, some food for thought about things they can do to try to make all of that flow better all the way from the 911 communication center through the non-transport medical first responders, et cetera. So I'll turn it back over to you, Callie. Thanks so much to Wayne and Mick for sharing their insights with how hospitals can improve their relationships with the MS. This is such an important issue to make sure that care flows smoothly across all of the organizations that influence the outcome from the 911 communication center to the non-transport first responders, to the ambulance, to the ED and into the cardiac cath lab or other acute care specialty area. This concludes the video portion of the session.

EMS Hospital Relationship

communication

handoff

trust

feedback

patient-level data

technology

COVID-19