EMS Interaction/Feedback

[emtcsmith]

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During my field time In paramedic school I trained in a hospital based system that allowed the chance to speak to the ED Doc's easily. Also gave the chance to follow up on patients and get feed back with relative ease.

Now working as a new Paramedic I've tried to make the effort to follow up on some critical patients with the hospitals I brought them to. I work for a service separate from the hospital so the feedback and information varies by hospital and doctor. How often are you and or willing to take a second and provide information and feedback to EMS providers that you may interact with? Typically critical patient’s charts make there way through the QA world between squad mgt and hospitals but I can say that it goes along way to have a little information the next day on somebody I treated.

Also, to those that are "Medical Command" docs at your ED what type of training did you get in that area? I'm sure it varies by area but I would be interested to know anything you could offer on that.

 

[southerndoc]

I not only tell paramedics info on patients they treated and are asking about, but I will often tell them about patients they bring in without them even asking. Well, that's if I remember who brought in the patient. Sometimes I will see a crew the same day after bringing in a critical patient or a "regular" patient that had an interesting diagnosis, and I will definitely mention it to them.

 

[docB]

Also, to those that are "Medical Command" docs at your ED what type of training did you get in that area? I'm sure it varies by area but I would be interested to know anything you could offer on that.

Generally docs get no formal training on being medical command. Most do an EMS block in med school but that's about it.

 

[roja]

I definately take time to talk to EMS that are interested in follow up

 

[EMCC]

Generally docs get no formal training on being medical command. Most do an EMS block in med school but that's about it.

I am guessing you guys are talking about taking command on the 2way radio? If so, in Pennsylvania you HAVE to have command training in order to answer the radio. Each doctor who gets trained (6 hours? of useless lectures) gets a command number that is on file with PA MedComm. Basically, residents can only take medcomm calls starting at the end of 2nd year...

 

[Jeff698]

I'm always more than happy to talk to our EMS crews about patients. In fact, I enjoy it and appreciate when they come talk to me. I'll often go track them down to let them know how interesting patients turn out.

I'll admit to a wee bit of bias about this though. I worked as a paramedic in a hospital based system where I got lots of spontaneous feedback and real-time education and loved it. I also worked in systems where I never heard anything back.

As for medical control training, our residency assigns each new resident to an EMS system (we're the hub for a regional medical control system) to act as assistant medical director. At the beginning of your PGY2 year, you go through an in-service and then began wearing the EMS phone. We always have a PGY2 on duty and they are the ones to answer the phone. If they're tied up with a procedure/patient, it rings over to the PGY3 who is also carrying a backup.

As a 3, I've missed talking with EMS on the phone. Sniff, sniff.

Take care,
Jeff

 

[emtcsmith]

Had an intersting call resulting in a medical command contact that I thought worked rather well and worth a mention in this thread.

I'm about two weeks into working alone as a paramedic and no longer precepting. Called for chest pain outside a bowling ally we arrive to find a 55 year old caucasian male with a CC of 2/10 sternal chest pain. That is his only complaint mind you. 12 Lead shows huge inferior and lateral elevations, at that point another medic unit near by squirred the call and arrived to help me out.

We are about 5-7 min from a hospital we frequent and you could consider a "local" hospital and about 15min away from the county trauma center. (Sounds like the registry oral station now). I make the call to medical command at the trauma center and explain the situation "travel time, massive MI" and ask him if the closer hospital has a cath lab, he is unsure and contacts that hospital to verify they do and can recieve this patient. The medical command doc speaking with the "local hospital" gives them a heads up and en route I call the "local hospital" en route and give my report.

Normally medical command contact wasn't required for anything on the call but helped alot. The last thing I wanted to do was arrive with this patient in desprate need of cath lab an hour ago and have to wait an hour to get to one.

 

[leviathan]

I'm about two weeks into working alone as a paramedic and no longer precepting. Called for chest pain outside a bowling ally we arrive to find a 55 year old caucasian male with a CC of 2/10 sternal chest pain. That is his only complaint mind you. 12 Lead shows huge inferior and lateral elevations, at that point another medic unit near by squirred the call and arrived to help me out.

We are about 5-7 min from a hospital we frequent and you could consider a "local" hospital and about 15min away from the county trauma center. (Sounds like the registry oral station now). I make the call to medical command at the trauma center and explain the situation "travel time, massive MI" and ask him if the closer hospital has a cath lab, he is unsure and contacts that hospital to verify they do and can recieve this patient. The medical command doc speaking with the "local hospital" gives them a heads up and en route I call the "local hospital" en route and give my report.

Normally medical command contact wasn't required for anything on the call but helped alot. The last thing I wanted to do was arrive with this patient in desprate need of cath lab an hour ago and have to wait an hour to get to one.

Good to hear that everything went well! I guess something you can do proactively is find out what services are offered by the hospitals in your catchment area, so you know where to take patients. I hope everything turned out well for your patient. 🙂

 

[Flopotomist]

Had an intersting call resulting in a medical command contact that I thought worked rather well and worth a mention in this thread.

I'm about two weeks into working alone as a paramedic and no longer precepting. Called for chest pain outside a bowling ally we arrive to find a 55 year old caucasian male with a CC of 2/10 sternal chest pain. That is his only complaint mind you. 12 Lead shows huge inferior and lateral elevations, at that point another medic unit near by squirred the call and arrived to help me out.

We are about 5-7 min from a hospital we frequent and you could consider a "local" hospital and about 15min away from the county trauma center. (Sounds like the registry oral station now). I make the call to medical command at the trauma center and explain the situation "travel time, massive MI" and ask him if the closer hospital has a cath lab, he is unsure and contacts that hospital to verify they do and can recieve this patient. The medical command doc speaking with the "local hospital" gives them a heads up and en route I call the "local hospital" en route and give my report.

Normally medical command contact wasn't required for anything on the call but helped alot. The last thing I wanted to do was arrive with this patient in desprate need of cath lab an hour ago and have to wait an hour to get to one.

Great use of medical command - but how do you not know where the nearest cath labs are if you are working in the field?

 

[Greenbbs]

I love when our EMS guys ask questions about patients, etc....it helps them to be better trained so that when they see something again, they'll have more input to the situation to reflect upon.

I actually had an EMS crew ask me today about a guy they brought me 3 days ago (the crew was a 24h on/48h off crew). They brought me a guy who just slid out of bed, landed on the floor, ambulated on scene, and had a pretty bad intertrochanteric hip fracture. they wondered how he did....but it's nice to know on their end how the patients do.

We also have a box with EMS forms that the squads can put info requests on and put them in the box and we'll give em follow up when we see the forms....it's not a hipaa violation because it's considered patient follow up (so we found out).

 

[BostonEMT]

I've had nothing but positive experiences following up with ED doctors. Most are eager to share their knowledge and experience and I think they feel an obligation to keep us clued in so that our clinical care will improve. Short chats with enthusiastic MDs and PAs are one of the greatest things about my job and helps a tiny bit to make up for the terrible ratio of BS we put up with vs. how much we are paid.

I've had far more negative experiences with nurses who regard EMS personnel as a species of taxi driver and romanticize and exaggerate their role in the continuum of patient care. Far more.

 

[WallowaWanderer]

Great use of medical command - but how do you not know where the nearest cath labs are if you are working in the field?

Well, he did say he just started working as a paramedic, and Philly has a ridiculous amount of hospitals.

 

[emtcsmith]

While it would have been ideal that I was aware that "hospital x" had a cath lab, its not a facility we frequent often, is an out of county hospital and because of that we have to contact another hospital for medical command.

During the conversations not only was I able to verify they had a cath lab but that when I arrived the patient could be taken to the team and not have to wait. I also think that the conversation between myself and the two hospitals helped to ready "hospital x" to receive the patient. The ST elevations literally doubled in the time I took my first twelve lead and second when we arrived at the hospital aprox 20min later.

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Today (0715) I transport a patient with right sided weakness with an onset at 0630. No facial droop, no slurred speech, right hand is a little weaker; he has an abnormal gait and trouble writing. In other wards it was a very minimal presentation but within the time frame for treatment. Contact the hospital, actually have the doctor answer the line, and on arrival the physician is interested in the report and when the neuro doc arrived is again interested in my report.

While that doesn't sound all that abnormal I just wanted to thank doctors who are interested in our reports and interact with EMS providers as willingly as I experienced in the above.