It is often said a chain is only a strong as its weakest link. When we speak about Out-of-Hospital-Cardiac-Arrest we often speak of the “Chain of Survival” as coined by our own Dr. Paul Pepe, coordinator of the Gathering of Eagles program.
A chain is often likened to teamwork and we know that teamwork saves lives.
Both paramedics and ED nurses work together to provide the best care for the patient. They form two critical links in the patient care chain. However, the transition of care from the prehospital setting to the ED can present certain challenges. In this blog, we will explore the interface between paramedics and ED nurses and the steps that can be taken to bridge the gap during a patient transfer.
Improving the Paramedic-ED Nurse Interface
The critical contact point in the patient care chain is the Prehospital-ED interface. The communications that occur during these few moments can make a difference in patient outcomes, long term.
Paramedics and ED nurses have different clinical backgrounds and experiences. Where a paramedic is trained to manage a case within the first few minutes, nursing training encompasses long-term, health restoration and recovery. The different backgrounds can sometimes lead to unique perspectives. For example, when obtaining a patient’s medical history, the paramedic may seek cursory information needed to determine an immediate course of action or the patient may be a poor historian. Nursing assessments will go much deeper. An ED nurse, receiving a patient, may be frustrated that the information provided to a paramedic may be incomplete or inaccurate requiring a more detailed or accurate history.
Another challenge is the difference in scope of practice. Paramedics are trained to provide emergency medical treatment, but their scope of practice is limited compared to that of the ED nurse. The ED nurse is responsible for a broader range of tasks, such as administering a wider variety of medications, applying a greater array of treatment modalities, and coordinating care with other healthcare providers.
Finally, the contrasting work environments can present different challenges. The paramedic’s world customarily encompasses the first 15 to 30 minutes of a patient’s event. Details may be sparse, and the treatment provided is only meant to bridge the gap between the field and the ED. The paramedic may also be facing challenges unknown to the ED nurse such as patient entrapment, poor lighting, or cramped working conditions.
Similarly, it may not be within the paramedic’s scope to assemble a complete patient history, devise a comprehensive treatment plan, or provide the attending physician with as much detail as needed.
Understanding these differences and seeking opportunities to close these gaps builds strong Prehospital-ED relationships, creates a better patient care experience, and strengthens that teamwork chain.
Bridging the Gap
The 2014 theme of the First There First Care Conference was “Bridging the Gap: From the Streets to the ED.” That year ED nurses were invited to attend the conference and many of the principles discussed here were presented.
Standardized Handoff Process
Conversations should be had between paramedics and nursing staff on what is needed and what can reasonably be provided during a patient transfer. A formalized protocol can be developed and followed with each case, similar to a stroke assessment. The consistency in the information provided will create a level of comfort and reasonable expectations with each other.
Training
The First There First Care & Gathering of Eagles Conference provides the ideal environment for prehospital and clinical personnel to interact, share concepts and ideas, and learn from each other. The cross training provided at FTFC & GOE gives each a perspective on the other’s responsibilities and how they can work together to create a seamless process.
Mutual Respect
Both paramedics and ED nurses have come a long way in respecting and appreciating each other’s roles. First There First Care encourages interaction between the two disciplines and introduces each to the other’s methodologies, helping to create that level of respect.
Collaborative Care
Paramedics rarely get to see patient outcomes; what was done right and what could have been done better. A patient follow-up process or joint case reviews provide the paramedic with a deeper insight into the long-term recovery process and the paramedic’s role in making that process better as well as provide the nurse with a perspective in the situations the paramedic faced.
Know your team members
Nurses and paramedics interface regularly. Get to know each other on a first-name basis. Learn to appreciate each other’s needs and limitations. Discuss ways to meet those needs and overcome obstacles.
It’s a team sport
The interface between paramedics and ED nurses is a critical aspect of patient care. It is essential that both professions work together, to provide the best care for the patient.
By improving communication, understanding, and collaborating, the gap between the two professions can be bridged, resulting in improved patient outcomes and a more efficient and effective healthcare system.
