Improving EMS and ED Relations

There is no argument that having strong interdisciplinary relationships can be the silver bullet to any industry’s success. The reality is that professions don’t operate in silos. This is true in any industry but particularly true in emergency medical services. The thing that we all have to appreciate is the fact that we are all specialists in a given area. As much as a clinician would like to think of themselves as a “jack of all trades” we cannot fool ourselves to think that we can do it all on our own. This is why we need to think how we can foster positive relationships that are sustainable.

While this article is written from the perspective of a paramedic regarding emergency department and EMS relations, these principals can be applied in any area of medicine. If you are reading this it probably means you are interested on how you can improve your relations as an emergency department with your local EMS service. In my humble opinion, researching this topic already means that you have identified that there is room for improvement and you are heading in the right direction. In brief, the three categories where an ED can have the greatest impact are: communication, education and acknowledgement. Let’s break down each category and how your ED can implement each one…

Communication: With the exception of EMS crews that already have excellent relationships with their local emergency departments, most paramedics interact with physicians and nurses in the ED briefly during patient transfer. While some emergency medicine clinicians may look at this as a benign action, this is a huge opportunity to foster positive relations with EMS. The goal with patient transfer should be undivided attention on what the paramedic is saying. Paramedics are skilled prehospital clinicians that can take undifferentiated patients, perform comprehensive physical exams, provide resuscitative care and have a significant impact on patient morbidity and mortality. When you consider those points, you begin to realize how important their perspective is in guiding emergency department care. If you are not paying attention to the prehospital report, you are providing poor quality emergency care. Respecting paramedics and what they have to say is the first step towards improving your relationship with EMS. If that isn’t convincing enough, here is another reason you should do it… It is low cost and yields a high reward. If you are the emergency department in the area that is known for respecting paramedics, you will attract more ambulance transports.

Education: This is often an overlooked area of improvement for hospitals. Providing continuing education for prehospital providers is a great way to not only improve relations but also influence the quality of prehospital care of the patients arriving at your ED. Education is a great way to have additional face-time with your local paramedic service beyond patient transfers. Continuing education is a great way to engage the motivated prehospital provider and create meaningful clinical dialogue. In addition, continuing education can be customized to fit a facility’s needs. In other words, if you have an ongoing issue with an area of prehospital care and you feel that the reason is misinformation, you can identify that teachable opportunity and create a lecture, skill lab or simulation around that specific issue. In addition to these points you are providing a service to the EMS community. As with any other health profession, paramedics are responsible for completing a specific number of continuing education credits each year. They are always looking for a class or a conference to attend. As a hospital, you should consider taking the initiative and start providing CE’s and help out the healthcare professionals that care for your patients during transport to your facility. If you need more information on how to start a CE program at your facility, check out the CAPCE website. CAPCE is the accrediting agency that oversees continuing education for prehospital providers in the United States.

Acknowledgement: Lastly is the concept of acknowledgement. The job of a paramedic can be extremely thankless. In a lot of cases, paramedics are usually placed in the back of the line when it comes to both of their domains (public safety and healthcare). As mentioned in the “communication” section, respect is the key word here as well. Paramedics desire respect from their colleagues in both public safety and healthcare. Even if you disagree, paramedics often view themselves as equals when comparing themselves to registered nurses, physician assistants, nurse practitioners and physicians. If you are one of those professionals and you find that sentence offensive, that may be your first challenge in improving relations with EMS. The reality is we all need to check our egos at the door and work together to improve patient care. Paramedics are the professionals of the prehospital domain. When it comes to acknowledging the hard work of these prehospital professionals it is important to not be patronizing about it. We have all seen it, the hospital puts up a “Happy EMS Week” sign that has a subtitle that reads “Thank you for all that you do” but the attitude on the inside of the emergency department reads differently. If you accept a pro-EMS culture at your Emergency Department you need to have buy-in from everyone that paramedics are indeed prehospital professionals. You need to have the same respect that they have for you. You need to understand that they put just as much care into their craft as you do. You have to understand that they are placed in impossible situations, with limited resources, can critically think their way through any prehospital call and do it all with unparalleled professionalism. If you need further convincing that paramedics are truly clinicians and not “ambulance drivers” I urge you to seek out a ride-along and come to an objective conclusion.

You may already implement all three of these areas and still be having issues with your prehospital partners. The thing to remember is as with all relationships, it often takes time to make things better. If you are starting off with an unfortunate impression from EMS, you will need to work extra hard in these given areas. Be persistent, come up with creative ways to engage, be consistent and remain sincere in everything you say and do.