Invest in EMS
August 1, 1998
Invest in EMS
Hospital administrators should not hesitate to make capital investments in EMS, stresses James Augustine, MD, FACEP, CEO of Premier Health Services in Dayton, OH, and chair of the department of emergency medicine at Miami Valley Hospital. "They bring us the patients that keep the doors open," he says. "They are also true members of the healthcare team, who do 'access management' through the 911 system."
Investing in EMS should be a broad-based effort, says Augustine. "This includes making their job productive, treating them as healthcare partners, communicating with them in a professional manner, offering food and drink when they come into the ED, providing quality assurance feedback, and participating in their education and operational planning," he explains.
Several capital investments to make in EMS are:
Offer inservicing. Inservicing for staff on EMS should be done as part of orientation, says Robert Suter, DO, MHA, FACEP, regional medical director for Questcare Emergency Services in Dallas, TX. "The key is creating a culture where EMS people are seen as members of the team," he says. "You need to get somebody who believes in the team concept to go over the issues." EMS should be included in staff parties, he notes.
Suter created a video for inservicing staff. "It shows the same scenario twice. In one case, there is a good relationship and good communication between paramedics and the ED and the patient does well. In the other case, the paramedics are treated poorly and, as a result of breakdown in communication, the patient dies," he says. This video is currently in use at the 14 hospitals in Suter's region.
Add a paramedic lounge. "Space is an issue in most EDs, so you really have to make it a priority," says Suter. "Usually, you can find someplace where you can give them desk space. It's important for them to have a place to go, even if it's a small area or shelf with a phone. Having a separate lounge sends a clear message that they're important, basically saying you're important enough to us, that we are going to give you your own space."
If you don't have room for a separate paramedic lounge area, you should be willing to share the ED staff lounge. "If a paramedic comes in and needs a cup of coffee or to heat something up in microwave, they should get the feeling that this is their lounge too-that they are part of a team. They shouldn't feel like they are barging into'our' staff lounge," says Suter.
At Summit Medical Center in Nashville, TN, the paramedic lounge offers a view of the ambulance bay. "When you come in the trauma doors, the room to the left has a huge window so EMS can clearly see their ambulance," notes Ellen Roll, RN, director of the ED.
Celebrate EMS week. The third week in May is "EMS Week." "One thing you can do is buy sweatshirts or caps that have hospital and agency's name together," says Suter. "One hospital had sweatshirts made up saying'Partners for Life' underneath, with the names of the hospital and the fire department. It was approved as a uniform shirt for nurses and paramedics, so staff can wear the same shirt to work as the EMS crews.
Purchase needed supplies. "The EMS crew might need a defibrillator or a radio, so you might want to consider donating that to them," says Suter. Having the local newspaper take a picture of the gift giving is a good idea, he adds.
Summit Medical Center purchased two 12-lead EKGs for one county EMS to carry on the ambulance. "We also provided a 12-lead course at no cost to the ambulance service," says Roll.
The purchase benefited patient care. "They might have a 20 minute ETA, but our door to needle time is very short because we can get a 12-lead from them in advance, so we already know what's going on," says Roll. "It benefits everybody, so it's a win-win situation."
Have food on hand. "One of the best things you can do is allow paramedics to eat in your cafeteria for free when they come to your ED," recommends Suter. "Often, they may get several calls in a row. The firefighters who don't take the EMS calls may have eaten lunch at noon, but it's after 2:00 in the afternoon, and the EMS guys haven't made it back to the station. This way, they can grab something to eat."
Paramedics will be appreciative of the offer, says Suter. "Even if it generates one more admission a month, it pays for itself," he says. EMS crews can be given a house account number, such as 911, to check out at electronic cash registers, he suggests.
Summit's ED budget allots for EMS refreshments. "We run $900 a month strictly for nourishment for EMS, including food, ice cream, and juices," Roll reports.
Hire paramedics to work in the ED. Paramedics work every shift in the Summit ED, and a full time paramedic supervisor acts as the liaison for EMS. "Two years ago, we started out small, but paramedics have evolved into a major part of our staffing," says Roll. What started out as just a PRN turned into a full-time paramedic supervisor, working hand in hand with nurses.
Mutual learning took place. "We teach each other. It helped us see their needs out in the field, and it helped them to follow patients through the process who just don't feel good and find out if it was an aneurysm, helped them to find out that a lot of patients who they thought weren't as serious turned out to be very serious," says Roll.
Paramedics can shed light on communication problems. "We learned from them how they have problems getting bad attitude when coming inside, and they helped us break down those barriers," says Roll. Sine we are serviced by multiple EMS squads, it helped us to communicate and problem solve."
The paramedics also assist on in-house codes and transport critical care patients to the floors, she notes. "They are well qualified to assist on code teams in-house, and this enables people in the house to get used to them and know their qualifications," says Roll.
The arrangement also helps with staffing in the ED. "We have a high acuity level and staffing is tight, so we took two nurses out of the ED to transport to CCU, which is not close-that was a real stretch," reports Roll. "This way, a paramedic can go transport the patient, and it has worked out really well."
Previously, if a patient was injured on hospital grounds, the operator would call the ED. "Now, we've developed a first responder system in which operators notify someone of a problem, security and one of our paramedics go out and assess the situation-do they need to call an ambulance or bring the patient to the ED?" says Roll.
Paramedics are also used in triage. "They are great because they simply triage, don't try to diagnose them, and they do good assessment," says Roll. "They are right to the point, and do an outstanding job."
Training of paramedics. All of Summit's paramedics are critical care paramedic certified. "That validated their knowledge with ICU and gave them more experience," says Roll. "We provide part of the instructors and facility and make no profit."
Require new employees to ride along with paramedics. At Providence, an eight-hour ride along with paramedics is part of orientation. "New staff always spent eight hours with the fire department, and we added another eight hours with a private EMS agency," says Linda Honeycutt, EMT-P, EMS programs coordinator for Providence Hospital and Medical Centers in Novi, MI. "Whether it's a new tech or physician, it's important for them to get some perspective on what goes on outside the hospital."
As a result, ED staff have a better understanding for the uncontrolled environment in which EMS operates. "Let's say EMS wanted to put an IV line in the patient, but it's in the middle of the night and pouring out, so they can hardly see-it would have entailed perhaps pulling over to the side of road," says Honeycutt. "They may have felt it was a secondary issue and choose not to take the extra time. If the ED staff sees how fast time goes by, how you just don't hear that well in the back of the ambulance to take a patient's blood pressure, they may be more understanding."
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