Prehospital Care Providers

Prehospital care providers are typically the first caregivers that patients see before transport to the ED by an ambulance or helicopter (Fig. 10-1). Local protocols define the skill level of the EMS responders dispatched to provide assistance. Emergency medical technicians (EMTs) offer basic life support (BLS) interventions such as oxygen, basic wound care, splinting, spinal immobilization, and monitoring of vital signs. Some units carry automatic external defibrillators (AEDs) and may be authorized to administer selected drugs such as an EpiPen or nitroglycerin based on established medical protocols. For patients who require care that exceeds BLS resources, paramedics are usually dispatched. Paramedics are advanced life support (ALS) providers who can perform advanced techniques, which may include cardiac monitoring, advanced airway management and intubation, establishing IV access, and administering drugs en route to the ED (Fig. 10-2).

FIG. 10-1 Advanced life support helicopter arriving at emergency department landing zone. Helicopters are used to rapidly transport critically ill and injured patients to the hospital for emergent care.

FIG. 10-2 Prehospital providers take a patient from the ambulance to be brought into the emergency department.

The prehospital provider is a key source for valuable patient data. Emergency nurses rely on these providers to be the “eyes and ears” of the health care team in the prehospital setting and to communicate this information to other staff members for continuity of care.

Physicians and Other Health Care Providers

Another integral member of the emergency health care team is the emergency medicine physician. These medical professionals receive specialized education and training in emergency patient management. In the past, physicians of all types of skills rotated through the ED. As emergency care became increasingly complex and specialized, emergency medicine became a recognized physician specialty practice, complete with board certification requirements.

The emergency nurse interacts with a number of staff and community physicians involved in patient care but works most closely with emergency medicine physicians. Even though other physician specialists may be involved in ED patient treatment, the emergency medicine physician typically directs the overall care in the department. Many EDs also employ nurse practitioners (NPs) and physician assistants (PAs) to assume designated roles in patient assessment and treatment. Teaching hospitals also have resident physicians who train in the ED. They act in collaboration with or under the supervision of the emergency medicine physician to assist with emergency care delivery.

Support Staff

The emergency nurse interacts on a regular basis with professional and ancillary staff who function in support roles. These personnel include radiology and ultrasound technicians, respiratory therapists, laboratory technicians, social workers, nursing assistants, and clerical staff. Each support staff member is essential to the success of the emergency health care team. The ED nurse is accountable for communicating pertinent staff considerations, patient needs, and restrictions to support staff (e.g., physical limitations, isolation precautions) to ensure that ongoing patient and staff safety issues are addressed. For example, the respiratory therapist can assist the nurse to troubleshoot mechanical ventilator issues. Laboratory technicians can offer advice regarding best practice techniques for specimen collection. During the discharge planning process, social workers or case managers can be tremendous patient advocates in locating community resources, including temporary housing, durable medical equipment (DME), drug and alcohol counseling, health insurance information, and prescription services.

Inpatient Unit Staff

The emergency nurse’s interactions extend beyond the walls of the ED. Communication with staff nurses from the inpatient units is necessary to ensure continuity of patient care. Providing a concise but comprehensive report of the patient’s ED experience is essential for the hand-off communication process and patient safety (Mascioli et al., 2009). Information should include the patient’s:

The Joint Commission’s National Patient Safety Goals (NPSGs) (2010) require hospitals and other health care agencies to use a standardized approach to hand-off communications to prevent errors that are caused by poor or inadequate communication. Many agencies use the SBAR method (situation, background, assessment, response) or some variation of that method to ensure complete and clearly understood communication. Chapter 1 discusses the SBAR technique in more detail.

Both emergency nurses and nurses on inpatient units need to understand the unique aspects of their two practice environments to prevent conflicts. For example, nurses on inpatient units may be critical of the push to move patients out of the ED setting quickly, particularly when the unit activity is high. Similarly, the emergency nurse may be critical of the inpatient unit’s lack of understanding or enthusiasm for accepting admissions rapidly. Effective interpersonal communication skills and respectful negotiation can optimize teamwork between the emergency nurse and the inpatient unit nurse. For instance, when ED patient volume or acuity is overwhelming, the unit nurse can volunteer to assist the ED nurse by moving a monitored patient to the hospital bed. The emergency nurse may decide to delay sending admitted patients to inpatient units during change of shift or crisis periods such as a cardiac arrest on the unit, whenever possible.