About interdisciplinary teamwork at different types of scenes, communication and preparation, you can read here:
1. Teamwork at a Scene Involves Various Disciplines
The tasks during a rescue operation cannot always be fulfilled by EMS personnel alone. Therefore, we often work with other teams from several fields of expertise. We will succeed together if we all bring our specific knowledge and skills, but also a professional attitude to the scene.
Constructive collaboration, precise communication and constant coordination between all the professional teams involved are crucial.
In this article, we will also shed light on potential difficulties stemming from differences in the work culture, hierarchy, and communication. We will explore, what helps us to overcome these differences, how to prepare for the interdisciplinary teamwork and how to facilitate it at the scene.
1.1. A Short Repetition of Different Types of Scenes
Before we take a closer look at the teams which help the patients or victims, we will recapitulate the various types of scenes briefly. As we have elucidated in the first article of this series , emergencies can happen anywhere, including the patients´ homes, or workplaces, on roads, and at construction sites. At all times, we should establish the best possible scene safety.
1.2. What Teams Do EMS Professionals Encounter During a Call?
The figure below shows you the specialist teams with whom we may work in all phases of a call.
EMS Teams Communicate With Dispatch Throughout a Call
After we have received the call, the dispatcher can provide us with first pieces of information. He or she may gather more of those whilst we are en route to the scene. We usually contact the dispatcher immediately when we discover that we need help at the scene. We also call him or her to provide a first report from a crash site (number of vehicles and persons involved, severity of the injuries, and more). Our status, for example "en route to the hospital", will be transmitted to the coordination centre throughout the call, as will be any other necessary message.
In Many Situations, We Benefit Greatly From the Help of the Following Professionals
As it is the purpose of this article to highlight the principles and techniques that facilitate the collaboration, we will concentrate on the teams, which EMS personnel encounter most often, namely the police, the fire brigade, and crisis intervention teams. Depending on the geographical location, EMS will also work with the mountain rescue service, the water rescue, and the sea rescue service.
In Case of Major Catastrophes, the Interdisciplinary Teamwork Comprises Highly Specialised Teams
In the next article, in which we will deal with more complex emergencies, we will introduce further rescue services. These will comprise the German Agency for Technical Relief (Technisches Hilfswerk, THW), rapid response teams (German: Schnelleinsatzgruppe, SEG), and rescue dog squats. In case of a train crash, the railway operators will send dedicated emergency teams to the site to help with the particular technical issues caused by such an accident. The military usually helps in the event of a natural disaster. After an attack, a SWAT unit will subdue the perpetrator if that is possible.
When and How to Make Contact With the Hospital
As soon as an EMS team has made a diagnosis, it has to contact the next suitable hospital that offers the department or unit which the patient needs. This may be the cardiac catheter laboratory, the emergency room, a stroke unit, or an ordinary ward.
According to the respective procedures, we talk to the doctor in charge, or a nurse. Our information includes the patient´s age and sex and current condition, our working diagnosis, any relevant secondary diagnoses, and the treatment, which we have initiated up until this point. We always call the hospital again if anything changes. For example, the patient´s condition may deteriorate rapidly. Then, measures like general anaesthesia, intubation, and artificial ventilation sometimes become necessary.
2. Potential Difficulties With the Interdisciplinary Teamwork
2.1. Work Cultures, Tasks, and Technical Terms
These difficulties with the interdisciplinary teamwork are partly due to the differences in the chains of command and hierarchies. Different teams carry out different tasks using their professional equipment which requires specialist knowledge. The professionals use their own technical terms amongst themselves, which is necessary if they want to communicate clearly and efficiently. Depending on the country, EMS and the fire brigade may use the same radio frequency, whereas the police has its own.
2.2. The Importance of Reports and Summaries
Unfortunately, it may also happen that a higher qualified team, that has just entered the scene, wishes to start working quickly and does not listen concentratedly to the summary, which the team that had been tending to a patient earlier, has prepared for them. This mistake is made by higher qualified paramedics, as well as emergency physicians, including those who arrive at the scene in their helicopter. In order to mitigate this, every single one of us can only work on his or her professional attitude.
Listening to reports and summaries carefully is crucial if we aim at preventing the loss of vital pieces of information.
3. How to Prepare for Interdisciplinary Teamwork
In this subchapter, we will highlight how we overcome the potential difficulties by approaching and getting to know one another.
3.1. Paying Visits to One Another and Gathering Information
Such visits are meant to learn about the tasks, the equipment, and the technical terms, which other professional teams use. For instance, the dispatchers can sometimes be visited in their coordination centre.
Prehospital emergency physicians, who come to work as freelancers in Sassnitz on the island of Rügen in the northeast of Germany, usually visit the local station of the German Maritime Search and Rescue Service (Deutsche Gesellschaft zur Rettung Schiffbrüchiger, DGzRS). There, they meet the local crew and are invited to perambulate their rescue vessel, because joint rescue operations occur from time to time.
3.2. Attending Training Courses
In Germany and Austria, a classic example of a comprehensive training course is the "head emergency physician" training course, in which participants learn how to coordinate rescue operations executed by several different teams in case of a major catastrophe. Of course, a head emergency physician does not do the work alone, but in close coordination with the paramedic who acts as the so-called organisational manager and with the commander of the fire brigade, as well as the police in the event of an attack.
3.3. Practising for a Mass Casualty Incident
These large-scale exercises require extensive preparation as they not only involve various professions, but also actors who will mime the victims, along with many vehicles and a huge amount of different materials. It is expensive to stage such an event, which is another reason why they are not organised very often. However, such exercises provide invaluable lessons to be learned.
3.4. A Joint Structured Debriefing Session After the Rescue Operation
When several teams work together during a major rescue operation, not everything will run smoothly. The debriefing session after such an event is meant to elucidate what went well and to identify the areas that need improvement. The atmosphere should be calm, friendly and constructive. At the end, the key learning points should be summarised and steps towards ameliorations should be derived from them.
4. Collaborating, Communicating, and Coordinating
It is paramount that the teams cooperate well when they are planning and executing all the actions during a rescue operation. This will help them to work safely and efficiently.
4.1. Collaborating Without Airs and Graces
An important aspect of the interdisciplinary teamwork is the mutual respect that the teams show towards one another. No one at the scene should feel superior to other specialists.
We will enjoy a greater success if do not try to be the outstanding hero, but collaborate with every team on a level playing field.
It is vital that everyone understands, why a team is present at the scene, and what team will help to accomplish what task. Using the knowledge that we acquired during our preparations, will help us with our teamwork.
Especially at chaotic scenes with many casualties, hazards like leaking petrol from crashed cars, and many rescuers tending to their respective patients, cleary labelled clothing and helmets help us to identify the person to which we want to convey vital information.
4.2. How to Communicate All Relevant Information
As you know, communication techniques, such as closed communication loops, are used whenever CRM principles are applied. Below, we will explore, what needs to be communicated at the site of an emergency.
All Professional Rescuers Should Introduce Themselves
Let us look at emergency physicians as an example. When they arrive at a scene, they will introduce themselves to the ambulance team, which has treated the patient up until this point. In case of a major crash, they will first go to the commander of the fire brigade in order to introduce themselves (mentioning their name and role) and obtain first pieces of information. Following that, fire fighters, paramedics, and the doctor can coordinate the next steps together.
How to Continue the Communication
A rescue operation often comprises several phases, such as administering medication and applying wound dressings, before a patient can be carried to the stretcher. During all these steps, it is vital that every team member who is involved in a certain action, knows exactly what is being planned. Everyone should know the overall objective. We will use the example in the next subchapter to highlight the role of communication in the coordination of the teamwork.
When the EMS team is ready to leave the scene and take the patient to the hospital, the members will ask other teams at the scene whether they need any further information. For instance, the police usually needs to talk to a patient whenever he or she is conscious. Normally, the officers also ask the emergency physician or paramedic about the severity of the injuries.
Before we leave a scene, we always thank other teams for their contribution.
After a major incident and whenever time allows, we try to hold a joint debriefing session once the rescue operation is completed.
4.3. How Collaboration and Communication Facilitate Coordination
Let´s take a look at a situation, which is quite common.
The Staircase of the House Is too Narrow, and the Turntable Ladder Is Required
Imagine a patient with a broken hip lying on the floor of an upper storey in a building with a narrow staircase. Now, we need the fire brigade to help us to bring the patient from one of the windows to the ground outside safely using their turntable ladder.
Two Teams, the EMS Personnel and the Fire Fighters, Communicate the Task at Hand
Our communication includes the following aspects, amongst others:
- medical interventions before the patient is ready to be transported
- who will carry the patient in what manner to the open window
- what equipment will be needed during the ride towards the ground (e. g. monitoring devices after the adminstration of certain analgesics)
- who will accompany the patient (Is there enough space for a paramedic or the emergency physician in addition to one of the fire fighters?)
Coordinating the Interdisciplinary Teamwork During the Rescue Operation
Whilst the emergency physician and the paramedics are treating the patient, the fire fighters position their turntable ladder. In addition, they have to secure the scene outside on the street. Especially if the patient is overweight, the EMS team and the fire fighters carry him or her together. During all these activities, one of the paramedics prepares the stretcher on the street outside so that everything is ready when the patient arrives on the ground.
5. In the Need of a Crisis Intervention Team
Whenever someone has just lost a loved one, or a family member has just been severely injured, we always ask the relatives if they want a crisis intervention team to help them through the first hours after the tragic event. Sometimes, the presence of close family members or friends is enough, but in some cases, people accept our offer gratefully.
A crisis intervention team usually consists of two persons, but sometimes and at some places, there may only be one. In some areas the members of such teams are pastors, in others they may also be paramedics or volunteers who have attended the required training courses.
When we call a crisis intervention team to the scene, it will take some time until it arrives. Whether we meet the team in person or not, we always try to make contact and tell the team members what we know about the incident. This information does not only include what happened, but also what type of relationship there is between the victim and the persons concerned. In addition, we mention any circumstances that may aggravate the situation, such as a recent loss of a family member.
6. In August, We Will Look at Truly Hazardous Scenes
Even though the members of rescue teams are prepared to work at atrocious types of scenes, no one wants a major catastrophe to happen. However, how can we maximise safety if we are dispatched to a major crash, or even a vicious attack? Which of the teams will take on what tasks in order to try to help as many victims as possible in the best possible way?
Author: Eva-Maria Schottdorf
Date: July 30th, 2024
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