Recently my feathers became ruffled when my nursing staff shared with me that two EMT students decided to sleep in the nursing lounge rather than to introduce themselves and “dive right in.” Despite my nurses trying to “protect” these kids, I insisted on getting details and calling the EMT instructor to make sure hell was raised in class. I requested that these students return to perform their observation time all over again.
The two nurses who shared with me the events of that day are angels. Both were feeling incredibly guilty over “ratting out” these two kids. They saw my anger upon my hearing about the total disregard for learning that was displayed. “They aren’t learning to be fry cooks – they will be responsible for peoples lives!” I explained to my nurses that the observation time provided to these students to see what the Emergency Department staff actually does is crucial. The students need to be aware of what information we need, how we need patient histories presented, and how EMTs and Paramedics are our “eyes and ears” in the field. The rotation is more than just about “watching,” it is about honing skills and gathering a feeling of what processes proceed upon their bringing the patients through our sliding glass doors.
Many EMTs that I have seen over the recent years lack effective communication skills. The ability to communicate pertinent information in a concise and efficient manner is paramount. In no other hospital environment does rapid transmission of data in an effective matter hold such a high priority. Did the child have access to medications before he arrested? Was the accident victim’s car displaying a spidered windshield? How long ago was it that the stroke victim was last seen acting normally by his family? There have been several occasions where I personally feel like pulling my hair out trying to tease this data out of the rescue personnel bringing in patients.
I believe the solution to the effective data transmission problem is two pronged. First, the minimal observation time in the Emergency Department needs to be extended to more than the minimum of ten hours with emphasis on patient presentations. A rolling four-week rotation might make more logical sense, with students actively following a physician, physician-assistant, and nurse. Secondly, minimal standards in language skills and public speaking should also be a requirement. Testing should be mandatory to assure these skills are present prior to be entered into an EMT program. Failure to meet these standards represents a disservice to the EMT student and to the public for which they are training to serve.
I have created a lot of conversation/controversy with this piece as can be viewed in the comments. There seems to be some general themes which I would like to share based on the responses.
First off, I wish to apologies to anyone who I offended with this blog post. The intent was never to be insulting, but rather to start a conversation regarding the issue of effective patient care reporting and student education. I strongly feel that effective public speaking and communicating patient reports in an efficient manner is a paramount skill needed in the Emergency Medicine/EMS arena. As such, all comments which were submitted, both positive and negative, have been posted as of my logging in today on 1-19-11 at 1900 EST
For clarification to those who don’t follow my blog and expressed concern that I have no in-field experience, I was a New York City EMS provider. I was initially stationed out of Bedford-Stuyvesant, (Woodhall Hospital) and subsequently out of Queens General Hospital (worked a tactical unit) . I have worked in the field in EMS for years (both public and private sector), volunteer my time as a proctor for EMS examinations, actively teach EMT programs, and was a volunteer firefighter. I have worked both the suburban and urban arenas. I started this blog as an effort to promote positive change and as well as advancement of Emergency Medical Services.
Of further note, a substantial number of the nursing staff with whom I work are EMTs, flight nurses, and paramedics themselves. We all put in a great deal of effort whenever an EMT student rotates through our ER to teach. I have the students follow me on a rotating basis listening to heart sounds, breath sounds, and perform examinations. We actively discuss and teach pathology . The nurses help the students splint, take vitals, and assist in care. We take our roles with these students very seriously. We aren’t mandated to do this. We do this because of genuine concern for the education of these students and our patients. In this context, I believe it becomes obvious why I was so angry regarding these two individuals who were found sleeping in the lounge.
To address some key points which were made:
1) There are communication issues on both the hospital and prehospital side of EMS care. As was noted in one of the responses listed below, most ED personnel are overworked and there are incidences where EMS personnel are ignored. I agree that ignoring our infield colleagues is absolutely wrong. A vicious circle, however, ensues. ED staff who are met with ineffectively communicated reports tune out the prehospital provider. This, in-turn, leads to the prehospital care provider feeling unappreciated. A negative feedback loop is created.
Since this blog is intended to discuss issues in prehospital/EMS care and look for solutions, my suggestion is that if you are dealing with a hospital environment where you or your staff are being ignored, discuss this with the ED nurse manager or ED director. Find out how to correct this problem! Offer ride-alongs. Offer teaching in turn. Meanwhile, the initial premise which I was trying to convey, being that of assuring exposure to effective patient reporting to the EMT student, might be augmented by extended ED rotations and education in honing communication skills.
2) The issue of pay and salary was raised by several individuals. I agree that in many areas EMS isn’t even considered an essential service. This is absolutely wrong and does need to be changed. I have addressed this concern in a prior blog. However, pay and the responsibility inherent to accepting a job where people’s lives are involved are two separate issues. There are towns where police are paid horribly and their lives are constantly at risk. Should they, therefore not protect the public? Since the blog addressed two of my students who were caught sleeping in the nurses lounge, should police cadets who know they will be serving in poorly paid dangerous cities not bother to learn? Obviously not.
3) Someone raised the issue of difficult staffing in volunteer squads. This is a tough topic. I would argue that maintaining a standard would be of greater value than pure staffing.
4) Another individual raised the issue of how, as a medical student, he routinely has to present cases as part of his training. He referenced how little didactic coverage is included in the current EMT course work. He makes a valid point! I would argue that this should be addressed in EMT core curriculum
5) For clarification, my statement regarding the need for effective communication skills does not imply being a native English speaker. Being able to relay a concise detailed report with pertinent information is my concern.
I truly like the response from paramedic George
“It’s a skill that communication should be simultaneously efficient and effective. There are only benefits in seeking better cooperation between ER nurses and EMS. And between SNF nurses and EMS. Between any and all healthcare providers transferring care or working as a team. It’s everyone’s duty to keep improving their skills, for supervisors to support and encourage development of providers’ skills, including communication skills. Don’t wait until there’s a problem involving a patient outcome to recognize this. Thank you all.”.