"Aren't you the cot monkey who brought me three drunks in a row last month?"
About a month ago, a colleague from our local emergency department asked me to present a station at their ER Skills Fair. Instruct nurses? Me? Immediately my mental “worst-case scenario video player” was running in my mind’s eye. I could clearly imagine the veteran ER nurses who would love a chance crucify the newbie EMS educator. I have had my share of the garden-variety EMS/ER conflicts in the past, and work much harder now to avoid them. Needless to say, I was apprehensive about the request, and asked what skill they would possibly want me to demonstrate.
“Oh, we really just want the nurses to see some of the EMS equipment before they have to figure it out on the fly,” she said.
“Hmm… likely story,” I thought. My Spidey-sense still told me I was walking into a trap, but I agreed and put the date in my planner.
"Greetings, Honored Provider of Healthcare! Please, partake of my deli trays and tell me of your organizational purchasing authority."
The date rolled around this week, and I arrived at the hospital loaded with gear. With me I had all of our newest equipment (and a hidden bag of emergency chocolate; in case things turned ugly and I needed a diversion for my escape). As I got off the elevator and entered their education area, a polite young nurse welcomed me and showed me to the room that would be mine to use. I had expected to be assigned to a dark hallway near the loading dock for the whole day, so a room with table and chairs was a welcomed surprise. The morning got even better when I learned of a special guest down the hall. This dapper gentleman was known as a “Product Rep.” I’m still not sure what they do, but he provided me with a lot of tasty food. My only guess is that they are traveling missionaries on a holy crusade to feed all healthcare providers, with generous sponsorship from Men’s Wearhouse. Shortly after I finished laying out my display of EMS knick-knacks and prehospital herbs & spices, the first wave of nurses came rushing in. I quickly realized that I was not equipped with nearly enough chocolate if events turned south. Luckily, they were quite happy to see a new face and try out the EMS equipment they “only got to see that one time.”
The first wave of nurses flowed on through, giving way to the second, third, and fourth waves. After a few hours I was comfortable enough to put down the emergency chocolate throw-bag. There wasn’t going to be a lynching of the EMS guy. In fact, all the nurses were very pleasant. They were genuinely thankful to have someone from outside the ER come in to show them equipment on which they wouldn’t otherwise be trained.
After reflecting on this for a while, I realized how many stressful (and incredibly similar) “on the job training” equipment experiences nurses and paramedics will have. I remember the first time I took an interfacility transfer with one of the hospital’s shiny new multi-line IV infusion pumps. The thing started alarming about 5 minutes into our 45-minute transport, and I had no idea how to backprime the new pumps and clear the alarm. I eventually figured it out, but the patient was convinced it was my first day on the job by the time I was done (in my own defense, it was my second day on the job, thank you very much)! About 30 seconds of training from an ER nurse beforehand would’ve saved my credibility with the patient, but it never crossed my mind to ask. I just assumed it would work similarly to the old pumps.
One of these LMA's offers a chance for ER staff to taste the lunch your post-resuscitation patient was enjoying. They might appreciate the heads-up tip during a brief ER staff training or even an informational flyer.
Likewise, nurses may be forced to learn our equipment on the spot, under circumstances that are already stressful. Let’s use the laryngeal mask airway (LMA) as an example. Our field LMA’s have a gastric drain tube, a feature some of our local nurses had not before seen in an LMA. The take-home point I offered at the ER Skills Fair was to be mindful of the potential for projectile vomiting through this port. And that, my friends, is a quick tip anyone can appreciate.
So now it’s your turn. Have you helped provide EMS education to ER staff? Have you invited ER staff (other than physicians) to guest lecture to your EMS personnel? If so, how did it turn out?