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How Paramedics Could Improve Patient Care and Emergency Department Efficiency

Posted on by Blog Administrator

Emergency Department Design

By Kristyna Culp, MBA

In hospitals around the country, paramedics are often viewed as outsiders to emergency departments’ processes. But does this tendency obscure opportunities to improve patient outcomes? Today, some researchers are seeking to streamline communication between paramedics and nurses to explore new opportunities to deliver better care.

A Shared Instrument

The Medical Director of the Winnipeg Fire and Paramedics Service, Dr. Rob Grierson, has led exploratory work on the topic. Grierson hypothesized that educating the city’s paramedics on a standardized triage instrument might help them communicate more effectively with nurses.

After instructing Winnipeg first responders in the use of the Canadian Triage and Acuity Scale (CTAS), Grierson found that they were able to apply the instrument effectively, and more consistently assess and communicate patient acuity levels. Based on this success, Grierson has continued the experiment with an expanded project encompassing thousands of patients. And he has inspired research along the same lines in the United States.

More Collaboration

A one-time paramedic and Ph.D. candidate at the University of Virginia School of Nursing, Todd Smith, is exploring whether first responders in the United States could use the Emergency Severity Index (ESI)—or the CTAS—in a way similar to Winnipeg paramedics. The goal? More collaboration in the ED.

“I’ve seen significant amounts of wasted time and duplicated efforts,” says Smith. “I think it’s often caused by the fact that nurses and paramedics aren’t always able to communicate well with each other.”

Communication between first responders and nurses is subject to a range of challenges. Nurses might not take information from paramedics seriously, or paramedics might deliver inadequate reports. Whatever the cause, the result of such communication breakdowns can be serious for patients. Wasted and doubled efforts or muddled communications can significantly impact the quality of care. And these preventable problems occur even as all parties work to deliver the best outcomes possible. “In my experience,” Smith says, “this type of disconnect generally lengthens the patient’s stay unnecessarily.”

Shared Education

The first stage of this work involves establishing baselines, testing paramedics’ ability to use the ESI and CTAS without comprehensive education in the tools. Smith found that his subjects could make accurate assessments of critical patients, but struggled with more nonspecific complaints like abdominal pain.

Kristyna Culp, MBA Managing Principal and Director of Operations at FreemanWhite.
Author Kristyna Culp, MBA.

Now it’s time for the next step, and the big question: How will the situation change when paramedics are given the proper training? Smith contends that the common language of shared education – and shared tools — could lead to more effective emergency departments around the country.

“My hope,” says Smith, “is to show that paramedics in the U.S. are willing and able to be trained up to a higher standard of care, so they can work more collaboratively with nurses, nurse practitioners, and physicians.” And with further research, patients may reap the benefits of this education.

Kristyna Culp, MBA is a Managing Principal and Director of Operations at FreemanWhite. She specializes in transforming complex operations into manageable, efficient systems.

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26 comments on “How Paramedics Could Improve Patient Care and Emergency Department Efficiency”

Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this site is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy ».

    Identifying first responders as paramedics is the equivalent of referring to all hospital workers as doctors. The author of this article has an admiral goal in trying to improve patient outcome but has lost sight of who her audience truly is.

    I have often wondered if there was a disconnect or lack of communication between hospital workers and paramedic and this article simply verified my suspicion. My dad experienced a series of seizures last year and I noticed that many of the tests that the paramedic administered as well as the questions that they asked him were repeated in the emergency room. Is it that the paramedic need to be trained to a higher standard of care or is the real problem maybe the lack of trust between the two?

    To improve patient care/outcome would be great. However, not all first responders are paramedics. Some companies use dual EMT’s to run calls. Their knowledge of certain signs and symptons are not as vast as a paramedic’s would be and their ability to call in a run report to a nurse may not paint the entire picture of the patient. Is there a standard that can be arranged for EMT’s as well?

    I think that communication between first responders and nurses can be the factor that determines life and death. Coming up with a uniform way of assessing the patient and transferring the information in a quick time frame is a great idea. My mother has had multiple heart attacks and also gastric bypass which doesnt allow her to have sugar. If the paramedics weren’t able to asses and transfer that information they would have given her the wrong treatment. How long would it take to have a set of guidelines like this to be established?

    I did not know that this communication barrier existed between paramedics and hospital staff. I would have thought that because the paramedic is the first person in contact with the patient that they would of been a person of interest to speak to, someone who may have different insight to what is wrong with the patient. I have never had an experience with paramedics, but if I do I will observe the paramedics interaction with the person they are handing me off to. Have they thought of using technology as a means of communication to the hospitals ?

    I’ve noticed the RN’s and Paramedics at the hospital I work at have a pretty good rapport with each other. Both professions seem to trust each other and rely equally on one another. What would be a reason for the lack of teamwork/rapport between the two scopes? Is it a “rank” issue? Is it a trust issue? Is it the rivalry that exist between the two scopes?

    I did not realize there was a significant lack of communication between paramedics and nurses. Why are paramedics deemed outsiders to emergency departments?

    As a nursing student, and a friend of a paramedic I have heard from both sides that the lack of trust leads to unintended worsening of care. The nurses feel that with less education and the nurses jobs and medical reputation on the line; that information from paramedics is not trustworthy but rather a good guess. Paramedics, sensing this, are offended defensive and more than often dislike the nurses and feel under appreciated. If there was a way to educate them together i.e. nurse-paramedic communication course lives would be saved, care would improve and overall job satisfaction would improve for both the nurses and paramedics. But who needs convincing to fund this? Does it come from the state? Or the hospital? Who’s hands does this ultimately lye in?

    Very interesting article. I was not aware that there is a disconnect between the communication between a paramedic and the nurse. But what kind of “duplicate efforts” are we talking about? The paramedics drop off the patient and all the responsibility falls into the admitting nurse/provider, right?

    This was a very interesting post because it showed a dynamic in the hospital that i never knew was an issue or existed. This problem should be discussed more because this can lead to many complications and hiccups. When I was a driver for a company there were times that i received the wrong information and it caused some confusion for both the buyer and my employers, fortunately the problem were about automotive parts but if this was dealing with people’s lives it could cause more problems than financial issues. I was curious on how different is the curve on education between nurses and paramedics? I always assumed that the medical know how was pretty similar.

    I found this article to be intriguing because a lot of the time people don’t think about how the first responders are a lot of the time paramedics. It sounds like the communication between nurses and paramedics are very poor and that needs to improve because people’s lives are in their hands. One cannot think they are better than the other because it all comes down to one thing; the patient. If I was a patient and I had to be rushed to the ER by a paramedic and information about me was poorly communicated and someone messed up I would be extremely worried about my well-being. One question I do have though is, what are some changes that could be made to improve the communication?

    I agree with this article. I really like how it is pointed out the lack in communication skills between the nurses and paramedics is a problem. My mom is a nurse and has expressed how this is a probelm in the past, and with me going into the nursing field I feel like this is a problem. I think that giving the paramedics more training would be very beneficial, not only for the nurses and them, but for the patients as well. What are some of the big problems that are predicted can be fixed if the lack of communication between paramedics and nurses were to be fixed?

    I agree that improving the communication between nurses and paramedics will definitely improve patient care. Paramedics are the first responders, they have critical information and history of the patient in need of care that can be helpful for the nurses to make quicker decisions. I work at a psychiatric hospital and on occassion we have to call 911 since we are not a medical facility. If one of our patients is having a seizure or is dehydrated we depend on the paramedics to safely transport our patient to the emergency room to get the help they need, and depend on them to translate the history and report of our patient to the nurse’s in the emergency department. I’ve noticed that the paramedics that frequent certain emergency rooms have gained a rapport with the staff at the hospital, even if a new set of guidelines and rules were made, what would happen to ensure that the paramedics and nurses are communicating up to standard?

    This article is very interesting and I really do think that communication between nurses and paramedics would can be useful because things would be able to get figured out and done quicker and so you can get what the patient needs ASAP. The paramedics are the first responders and if they weren’t able to give the nurses the information they need, I would probably be in the hospital longer than I have to and during that time, other patients could be getting treated. There is also that risk of being given the wrong treatment. My question is, when would the guidelines and such be established?

    Communication between paramedics and nurses are so critical. Paramedics are the first on the scene and need to be able to observe what is going on, what the situation was, how was the individual injured or sick in the first place and be able to relay this information to the nurses. Not being able to do so will only hurt the patient especially if incoherent because nurses can not read minds!
    So should first responders be required to have another certification or degree of education before licensed to practice? Or maybe they should attend a class held by nurses so they can let them know exactly what is to be expected of them.
    As a clinical care extender at the hospital i assist nurses in most of the things they do. And I often hear them say side comments because the paramedic did not give full/adequate information. But who’s fault is it? The nurse for not letting them know? Or the paramedic for not knowing?

    I never thought about how there could be a communication barrier between nurses and paramedics. As a future nurse I am going to have to talk to paramedics because they will be the first responders, and then I will have to take into account all of the information they have given me. I never thought about how nurses might not take the information given to them by paramedics seriously, if they do not take the information seriously they will waste crucial time instead of immediately treating them. It reminds me of an LVN versus an RN, now that they are doing away with LVN’s and expect all nurses to have bachelors degrees. Do you think that paramedics being trained up to a higher standard of care will do away with EMT’s?

    Paramedics are in great need because they transport critical patients to the hospitals as fast as they can by working at the emergency department. They might not have great communication with the staff such as nurses or doctors at the emergency department, but they do help save people lives before the time patients get to the hospitals and seen by nurses. I volunteer in the emergency department at the West Covina hospital and i have seen how paramedics work and help patients with many things. They do not just stand there and watch. They are trained professionals and they should be respected. When my father needed to go to the hospital with an ambulance, a team of 3-4 paramedics help my dad to reduce his anxiety with difficulty breathing due to his condition. I was so glad they were there because they can safely transport my father to the hospital and save his life. I am glad that i now have a chance to work with them in emergency department. What are the new training guidelines for the paramedics?

    I am a nursing student, so this is an insightful topic that I’d like to explore (especially once I start getting experience in a hospital setting). Now I am looking forward to observing paramedic-nurse interactions once I do start my clinical hours at a hospital. As a nursing student, what are some key questions I should ask the nurses who I will be working alongside in regards to their communication/interaction with paramedics?

    I think a very good and valid point is expressed in this article. Many times there is miscommunication between paramedics and nurses, especially in emergency situations, and many times a person’s life is hanging in the balance. A small mistake can be the difference between life and death.
    As a nurse, whenever we send a patient out 911 or receive a patient from the hospital, both parties need to have all the essential information in hand in order to be able to start or finish their job. It’d make jobs for nurses and paramedics easier if they were on the same page with communicating strategic information about a patient’s condition and what’s been done and what still needs to be done. I think this could help out immensely with helping a patient or even saving a patient’s life.
    Even though it’s still in the beginning stages, how has the training for paramedics been so far? Has there been significant improvement in communication between nurses and paramedics?

    good communication is always vital in every fields of work; it is what gives way to understanding the satiation at hand which results in good or bad service. This post reminds me on a lot of communication breakdown when I was in the military. Because of urgent situations, vital information are not relayed properly and the person receiving the information and doing the action ends up misinterpreting and doing the wrong actions.Does the paramedics serve different hospitals or is contracted to one hospital only? is ther a standard way of communication between the [paramedics and nurses?

    Communication is important for any career field, especially in healthcare. Being good friends with a paramedic and knowing nurses, I can see why there might be miscommunication. I think a big thing that has to do with it is that nurses feel superior to paramedics, but that shouldn’t be the case. If both jobs bit the bullet and communicated to get on the same page, then patients won’t have unnecessary stays at the hospital. Everyone’s working towards the same goal, helping the patient, so why shouldn’t there be more collaboration?

    The studies are long been overdue and should have been done before. They should consider how the Paramedics’ jobs affects the outcome of a patient. Proper communication skills and more training or more education should be required for Paramedics since they are one that first handles an emergency. If they are able to identify health problems immediately then they can relay it to the nurses in the ER. Furthermore, we should look at the first responders as important part in patient care and nurses should take their reports seriously. Don’t you think Paramedics should get more training and more education requirements? They should also get paid more because of how stressful their job is.

    I am about to graduate from a 2 year paramedic degree program (associates degree), and my wife is an RN (BSN). We have frequently had conversations about the similarities and differences in our respective training/education and she is more often than not surprised at the depth of medical knowledge we receive considering our position on the medical hierarchy. At the associates level, our level of training is comparable to an RN with an associates, and in the state of NC, our respective scopes of practice have huge overlap. There are very few skills that one role can perform that the other can’t, and only minor differences in medical knowledge, understanding of pathophysiology, etc.
    One problem with that is until fairly recently, Paramedic certification could be obtained through con-ed and a certain amount of experience, and most states don’t require graduation from an accredited college to hold a certification. Now, there are hundreds of community colleges and universities that are offering AAS degrees in Emergency Medical Science, and there are 14 universities that offer a Bachelors in EMS (I begin one this fall). There is a push nation wide to adopt higher education standards for EMS providers, and I believe until the paramedic is held to the same education requirements that other allied health professionals are, we will continue to be seen as “lesser”.

    I WORK IN A ER AS A PARAMEDIC OR “TECH”AND TRANSITIONING INTO REGISTERED NURSE, I HAVE ALSO WORKED IN THE FIELD PRIOR TO MY ER EXPERIENCE AS MOST OF US HERE ARE INVOLVED IN THE MEDICAL FIELD AND SOME ARE NOT WHICH IS FINE I HAVE SEEN BOTH SIDES OF THE FENCE PERSONALLY COMMUNICATION IS KEY, YES JUST BECAUSE PARAMEDICS ARE NOT REQUIRED TO HAVE A DEGREE FOR CERTIFICATION BUT ITS THE MEDICS OWN FREE WILL TO BETTER EDUCATE THEMSELVES IN THE MEDICAL FIELD IF YOU THINK YOU KNOW IT ALL YOU DONT KNOW JACK! BUT NO MATTER WHERE YOU GO YOU WILL HAVE GOOD AND BAD PARAMEDICS AND NURSES. I AM ALWAYS LEARNING EVERYDAY I WORK WITH GREAT NURSES AND DOCTORS AND IF I HAVE A QUESTION ABOUT SOMETHING I DONT KNOW I AM NOT ASHAMED TO ASK THEY ARE ALWAYS GLAD TO SIT DOWN AND TEACH AND EXPLAIN THINGS AND THAT MAKES ME BETTER AT BEING A PARAMEDIC IN THE ER AND IN THE FIELD AS WELL AS A BETTER NURSE TO WHERE I CAN EXCEL IN KNOWLEDGE WITH PRIOR UNDERSTANDING. A PARAMEDICS ULTIMATE OUTCOME FOR FIELD TREATMENT IS IDENTIFY LIFE THREATENING INJURIES AND ILLNESSES, A WELL EXPERIENCED PARAMEDIC WILL USE WHAT HE/SHE KNOWS FROM EXPERIENCE AND THEIR DEPARTMENT PROTOCOLS TO DETERMINE THE PROPER INTERVENTIONS/TREATMENT A THOUROUGH HISTORY IS KEY TO HELPING THE PATIENTS OUTCOME I GET ASKED WHAT IS THE DIFFRENCE AND I EXPLAIN TO PEOPLE THAT THE DIFFRENCE IS PARAMEDICS ARE MORE TECHNICAL IE. INTUBATIONS,IVs,MEDICATIONS,CRICOTHIROTOMY, ETC. WITH THE SHORT COMING IN KNOWLEDGE OF DISEASE PROCESS, CAUSES, ETC. NURSES HAVE A EXTENSIVE KNOWLEDGE THAT THE MEDICS LACK WITH THE MENTIONED ABOVE AND LESS OF TECHNICAL SKILLS LIKE MEDICS HAVE BUT JUST LIKE NURSES HAVE TO LEARN CERTAIN THINGS TO WORK IN THE ER. PARAMEDICS SHOULD EDUCATE THEMSELVES MORE ON THE PROCESS OF DISEASE ETC. ITS INFORMATION THAT CANT HURT, BUT UNFORTUNATELY IN THE FIELD YOU DONT HAVE A WHOLE ER STAFF TO HELP WITH YOUR PATIENT YOU DONT HAVE LABS, AND BEDSIDE TESTING, RESPIRATORY THERAPISTS ETC. TECHNOLOGY IS A GREAT TOOL TO HAVE IN THE FIELD TO HELP THEM COMMUNICATE AND IMPROVE PATIENT OUTCOME AND THATS WHERE THE EMS FIELD ALSO LACKS BUT WITH THAT COMES TO MORE EDUCATION. SO WE SHOULD NOT SET HERE AND CRITISIZE ANYONE ABOUT WHAT THE DOWNFALLS ARE AND THE BREAK DOWNS WE CAN POINT FINGERS AND SAY THIS IS WHATS WRONG WHAT I WANT TO SEE IS HOW CAN WE COME TOGETHER AND FIX THE PROBLEM THATS THE ANSWER IS TO FIND THE SOLUTION TO THE ISSUE.

    I think paramedics play a key part in the outcome for a patient. In my past experiences I often felt they did not receive the credit or acknowledgement that they deserve. However I must also admit I was surprised it didn’t require more education and training to become a paramedic or EMT. After learning just how much training is required to become a paramedics it began to become more clear as to why the disconnect of communication existed between nurses and paramedics. I think some nurses discredit the findings provided by paramedics because they feel they aren’t adequately trained or informed enough to communicate this type of information. This type of behavior and way of thinking is unfortunate because often times paramedics are the first on the scene and can provide pertinent data that could be useful for the nurse and the doctor. I think we all need to respect each others profession and its scope of practice in the medical field and try to keep the patients best interest in the forefront of all that we do.

    To work as a paramedic is not easy especialy when someone is not realising how important you are, we do have those challenges @ the hospitals with some of the nurses that are not taking paramedic seriously when you handover, only to find out the person who is suffering is the patient.

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