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Chapter 41 - Team Approach to Health Care (Effective Team Performance (CRM…
Chapter 41 - Team Approach to Health Care
Types of Teams
Regular teams
EMTs consistently interact with the same partner or team
Team members who frequently train and work together are more likely to move smoothly from one step in the procedure to the next
Temporary teams
EMTs work with providers with whom they do not regularly interact or may not even know
it is key to have a clear understanding of the roles, responsibilities and capabilities of each team member
Special teams
Fire team
Hazardous materials (HazMat) team
Rescue team
Tactical EMS team
EMS bike team
In-hospital patient care techs
Special event EMS team
Mobile Integrated healthcare (MIH) technicians
Groups vs.Teams
NIMS define a group as, "the organizational level that divides the incident according to functional levels of operation groups perform special functions, often across geographic boundaries."
EMS group: consists of individual health care providers working independently to help the patient.
Treatment
Transport
Triage
a team consists of a group of health care providers who are assigned specific roles and are working interdependently in a coordinated manner under a designated leader
5 essential elements of a group
a sense of continuity of the group
a set of shared values
an image of themselves as a "group"
different roles within the group
a common goal
Dependent, Independent, & Interdependent Groups
Dependent groups
each individual is told what to do, and often how to do it, by his or her supervisor or group leader
Independent groups
each individual is responsible for his or her own area
do not have to wait for an assignment before taking action
Interdependent
function as a true team
each provider may be assigned to a particular area/task, but everyone works together with shared responsibilities, accountability, and a common goal
Effective Team Performance
effective collaboration and communication
supportive and coordinated leadership
clear roles and responsibilities
a shared goal
diverse and competent skill sets
Communication and team dynamics fostered from crew resource management and team situational awreness
CRM recommends the use of the PACE mnemonic:
Alert - communicate the problem to the team
Challenge - if the issue is not corrected, then clearly challenge the team's present course of action that is leading to the problem
Probe - look or ask to confirm the problem
Emergency - if the problem is clear and critical, then immediately communicate the emergency to the entire team
Transfer of Patient Care
Transfers introduce the possibility of patient care errors
General guidelines for a smooth transfer:
respectful interaction
common language or system
common priorities
minimal interference
uninterrupted critical care
BLS and ALS Providers Working Together
cannot exist without each other
BLS efforts must continue throughout the continuum of care
carefully coordinate your efforts with the advanced tools and techniques used by ALS providers
what may be a "paramedic-only" skill your EMS system may be common for an EMT to perform in another
it is your responsibility to understand what is allowed by the scope of practice, standard of care and local protocols where you work
working outside these bounds can be a legal liability
There are many ways in which you can assist paramedics and other ALS providers with advanced procedures
Advanced Airways
Endotracheal Intubation
Insertion of a tube into the trachea to maintain and protect the airway
Patient preparation
preoxygenation
apenic oxygenation
Equipment
suction unit with rigid and nonrigid catheters
laryngoscope
PPE
magill forceps
stylette or tube introducer
ET tube
10-mL syringe
commercial ET tube securing device
water-soluble lubricant
confirmation device
alternate airway management devices
Performing the procedure
GI - use a supraglottic or intermediate airway if unable to intubate
C - confirm successful intubation
A - attempt first-pass intubation
E - evaluate for airway difficulties
Manipulate the patient
B - Perform BVM preoxygenation
attempt intubation
manipulate the patient
BVM preoxygenation
evaluate for airway difficulties
correct issues
confirm intubation