The e-mail that came from one of my most conscientious paramedics was similar to many others I have received as EMS Medical Director of a busy fire-based urban EMS system. It went something like this: “I am writing to give you a heads-up about a couple of runs to Generic Hospital. This doctor had a very condescending tone as he spoke to us when we brought in a victim of a shooting. After we had taken the patient to the trauma room and the trauma team had stabilized the patient, I tried to ask the doctor what his impression of the patient’s injuries was, but he had turned his back toward me and started talking to another doctor. He completely ignored me and my question. He also seemed to doubt our evaluation of the patient and whether our patient actually had a pulse when we got to the ED. I felt humiliated and embarrassed after we tried to do our best in caring for this patient in the field. I just wanted you to know about this situation.”

After corresponding with the medic and the hospital staff (who were very apologetic over the incident), we were able to resolve the situation and move on. But it made me think about the many times these situations come up and how they might be avoided by applying the “Road House” rules of engagement for hospital staff in their interactions with EMS personnel. You all remember that classic cinema production where Patrick Swayze as the intrepid hero Dalton took care of business in a small-town entertainment establishment where the customers could get somewhat rowdy. His mantra to his bouncers was: “Be nice.” And so in honor of Dalton and in the spirit of improving ED-EMS relations across this fruited plain, here are my Top Ten “Road House Rules” for interfacing with our EMS colleagues and partners:

1. They are your health care colleagues and partners. Hey, didn’t I just say that? But you really can’t say it enough times. As hospital staff, we often forget that patient care really started when the EMS personnel arrived, and we are merely part of the continuum of that care. What the EMS providers did in the field is very important for us in the ED to be aware of so we can make sure that our care is consistent with their care. Many times ED personnel routinely dismiss anything to do with the prehospital treatment that the patient received; 12-lead EKGs are ignored, initial blood results are dismissed, and EMS run reports are filed in the circular receptacle. But the smart and seasoned ED physician knows that the EMS providers can be of tremendous help in the evaluation and treatment of that patient in the ED, and that their insight and perspective can lead the ED physician down the correct pathway to the right diagnosis and treatment. So treating them as our partners – much like we do any consulting physician we may call down to the ED – makes sense and is in the best interest of the patient.