Improving Professional Working Relationships in Emergency Medical Services

Emergency medical services (EMS) providers are placed in any number of situations on a daily basis, often with no two calls being alike. Providers must constantly maintain their composure as they try to restore some semblance of order in the midst of what is often very chaotic. Navigating congested traffic while driving lights and sirens to the scene, making critical decisions within seconds, and rendering patient care without haste are just a few of the things that keep stress levels high.

All of these things are important parts of providing efficient emergency care to the critically ill and injured. Probably one of the most important things an EMS provider does on a daily basis though is communication with others. Communication with dispatch allows providers to find the incident scene, communication with medical direction allows appropriate emergency care to be delivered, and communication with the nursing staff and physicians at the emergency department typically allows for a smooth transfer of patient care.

While good communication sounds pretty simple, experience has shown that there can be a breakdown in communication at any number of levels throughout the course of an incident, and unfortunately when this happens patient care may suffer. One factor that may lead to that breakdown in communication is poor interprofessional and interagency working relationships. Firefighters, law enforcement officers, emergency dispatchers, nurses, physicians, hospital clerical staff, and other EMS providers are just some examples of the types of people encountered by EMS providers on a daily basis. Striving to develop good working relationships with all of these groups of people can go a long way toward not only improving the EMS providers' ability to communicate and do their job, but also toward improving the overall quality and morale of the EMS workplace.

While the concept sounds simple, it is important for providers to realize that developing these working relationships does not happen overnight. It takes time and effort on the part of the EMS provider in order for these positive working relationships to become a reality. While it would be impossible to cover every scenario EMS providers might encounter when communicating and interacting with others, the purpose of this article is to provide suggestions for EMS providers on ways to improve both interprofessional and interagency working relationships with those persons and agencies that EMS providers most commonly interact with.

Due to the nature of EMS, providers probably interact with members of the emergency department (ED) staff and other public safety personnel more than any other group(s) of people. In many cases this interaction is positive, however, there are certainly more than a handful of times when this interaction does not go well. One way to improve or enhance relations between the ER staff and the EMS provider is to simply get to know members of the ED staff. The ED is typically a very busy place, and often times ED nurses and physicians barely have time to take a full report from the EMS provider before having to move on to their next patient. If it does not interfere with the EMS providers' job duties and/or ED policy, it may be possible for EMS providers to agree to help out the ED staff during these busy times by assisting with patient care (ie, assisting with cardiac arrest, splint application prior to interfacility transport, taking vital signs, etc.) or simply running errands within the hospital such as taking recently drawn blood to the lab for processing. When the ED isn't quite so busy, EMS providers should take advantage of the opportunity to spend some time interacting with the ED staff, rather than just "dumping" their patient, completing necessary paperwork, and returning to station. Learning who people are and what they do, asking questions to improve one's own knowledge and skills, taking the time to explain what goes on in the world of EMS, and even talking about things unrelated to emergency medicine and healthcare can go a long way toward gaining respect and developing positive working relationships with the ED staff.

In looking at relationships with other public safety personnel it is important to consider that many emergency incidents require multiagency response, and how well the personnel from each of those responding agencies work together can play a big role in how smoothly on scene operations flow. While most public safety agencies do work well together, there are cases where problems do arise from poor working relationships either between a few individuals or between two agencies as a whole.

Possibly one of the worst scenarios that an EMS provider can encounter on scene of an incident is when there is an argument between fire, police, and/or EMS over command of the scene, direction of extrication, flow of traffic, etc. In an arena where seconds often count, spending time arguing on scene only serves to negatively affect the quality of patient care provided. While many fire and EMS personnel are trained in both disciplines, there are equally as many personnel who only function in one role or the other. Those personnel that are not cross-trained may not have an understanding, or may have a misunderstanding, of what each other's roles and responsibilities are on scene. One way in which EMS providers can help to prevent this situation is to spend some time around fire and law enforcement personnel in a less stressful environment than the incident scene. While on duty it is often beneficial for EMS providers to take the time to stop by the fire station or police department and interact with these colleagues in the field of public safety. This should allow EMS providers to gain a better understanding of policies, procedures, and protocols in each associated public safety discipline. In addition, it often provides the right time and atmosphere to discuss and find resolution to issues that have arisen at incidents in the past.

A second way in which EMS personnel can improve interagency relations is to schedule and attend training sessions that involve personnel from various public safety agencies. Simple examples of this could include holding in-services where fire personnel provide instruction for how EMS providers can assist with rescue/extrication, while EMS providers provide instruction in techniques to utilize when assisting EMS such as operation of equipment utilized by EMS (ie, c-collars, backboards and straps, or stair chair use). An EMS agency might also ask law enforcement to provide instruction on how to preserve evidence and document accurately what is seen and heard at a potential crime scene.

On a larger scale, staging mock incidents such as an accident scene involving patient care and extrication (Figure 1), or mass casualty incident drills provide personnel the opportunity to "test" almost all aspects of response and on scene operations. These mock incidents can be tailored to fit the types of incidents most commonly seen in a particular area (ie, Hazmat, motor vehicle accidents, rural area extrications, etc.). In addition the realism of the incidents can be enhanced through obtaining actual vehicles to practice extrication, utilizing moulage to provide realistic looking injuries, staging the incidents in the location they would typically occur, etc. These types of training exercises provide the opportunity for collaboration between agencies during the planning, operations, and debriefing portions of the mock incident. While debriefing following the incident, personnel from all agencies involved can discuss what went right, what we wrong, and what changes can be made to operational policies and procedures so that when the real thing occurs, all personnel are as prepared as possible to carry out their roles on scene.

Communicating successfully with others is a critical component to ensuring that EMS providers render the highest possible level of patient care. Working under the unique umbrella of public safety that also includes fire and law enforcement personnel, EMS providers interact with a variety of different people on a daily basis, including others in public safety and healthcare. Developing good working relationships with other healthcare providers and members of the public safety team can go a long way toward helping EMS providers render the best possible care to patients. This article has presented just a few suggestions of ways in which EMS providers can strengthen their working relationships with both individuals in other healthcare professions and also between the various public safety agencies. Good working relationships between all those working in public safety can go a long way toward achieving the overall goal of providing a high quality of emergency care to the public.

Brian Potter, MS, ATC, EMT-B is a member of the Upshur County Emergency Squad and a West Virginia Emergency Medical Services Instructor.