5. Ride time may be beneficial. One of the most productive things that any ED staff can do to better understand the challenges that EMS providers face is to take some time and actually take some calls with them. Certainly it requires a commitment of time to do so, but you might be surprised how perspectives can change when you actually witness a cardiac arrest being managed in a bathtub or the excited delirium patient who is kicking and biting everyone in sight before the administration of ketamine. Even just one ride-time experience may be enough to permanently make individuals much more sensitive to the realities of rendering prehospital care.

6. Education from you can set new standards of cooperation and good will. EMS personnel usually appreciate efforts from hospital staff to provide continuing education. For example, if you recently instituted induced hypothermia in cardiac arrest in conjunction with your EMS system, you might want to consider a periodic educational session on how that is going in your hospital. Or give an inservice about the changes in stroke care and what benefits are being realized by stroke patients. Even better, start a monthly EMS Educational Outreach Session and make it a part of the local culture of your health care community. Providing food at these sessions may be a worthwhile investment.

7. Never make disparaging remarks in front of staff or patients. See #2 above. But it can’t be said enough. If you do have a concern about any care being given by EMS providers, take your concerns in a productive direction. It is understood that in times of stress and tension, we all can lose control and let slip comments that we wished we could take back. But the potential destruction of the “loose lips” can definitely “sink ships” in regards to lost credibility, hard feelings, established biases, and, more seriously, litigation against EMS systems. There is a way to direct your concerns that will result in a change for the better.

8. Direct your care concerns to the EMS Medical Director. When an ED nurse or physician has observed a situation in which they feel EMS care was either inappropriate, inadequate, or just plain wrong, that issue should be forwarded to the EMS Medical Director. If you don’t know who the EMS Medical Director is … well, shame on you. You should have posted in your emergency department the names and contact information for all of the EMS Medical Directors of every EMS system that transports patients to your ED. In many cases, there is a form that you can fill out and submit online that will be sent confidentially to the EMS Medical Director for their review and disposition. They should contact you to let you know the ultimate resolution of the problem. Our ED staff members in our community are critical and valuable components of our continuous quality improvement process. They let us know about the great cases where the care was exemplary, as well as the ones that are opportunities for improvement. Without feedback from the institutions that receive our patients, our ability to improve the system would be greatly handicapped. So taking the time to bring areas of concern to the EMS Medical Director results in a healthy and effective local EMS system.