9. Be discerning of the differences among EMS agencies. In some communities, there is a mix of paid and volunteer EMS providers who may be able to provide advanced life support (ALS), basic life support (BLS), or a combination of the two. ED staff should be educated to the nuances of their EMS community and, by looking at the identifying information on the shirt or jacket of the EMS provider, be able to know things like whether they can intubate, read EKGs, start IVs, or just provide transport. That way you are not taken aback when a patient arrives in cardiac arrest without an endotracheal tube when those providers are only BLS and cannot perform that procedure legally. It also is helpful when you have a volunteer service come in with a very difficult trauma patient and you know that this particular system takes only one run a day and maybe one bad trauma a year. These providers were called in from home or their jobs and were thrust from a safe and familiar world into a horrific and strange one in a matter of minutes. These EMS providers differ from the paid EMS providers who do this type of thing day in and day out and are comfortable with just about anything. Those differences are important to realize and take into account in communities with a varied tier of EMS providers.

10. Invite them to observe continuation of care on patients they bring you. Most EMS providers want to know what happened to the patients they bring to the ED. So if they can be accommodated without compromising patient care and safety and do not have to get back into service right away, invite them to observe the ongoing care of the patient (procedures, cath lab, stroke care intervention, etc.). In cases of cardiac arrest, let them watch the continuation of the code through final disposition of the patient. With a trauma patient, they could observe the surgical interventions in the trauma room until the patient is taken to the operating room. Or in the case of a patient with a STEMI, maybe invite them up to the cath lab to watch the procedure unfold. Nothing is more powerful in impressing the importance of “time is muscle” on EMS personnel than watching blood flow being restored to a portion of the heart that was deprived due to a coronary clot. Allowing EMS providers to participate as active observers costs the ED and hospital nothing but results in untold dividends of good will and partner building with EMS. It also helps to reinforce the concept of the health care team and the inclusion of EMS into that team.