Chapter 9 – The Team Approach to Health Care: Comprehensive Study Notes

National EMS Education Standard Competencies

  • Fundamental knowledge requirements
    • Patient safety principles and application during emergency care
    • Transferring patient care
    • Team interaction, communication, and dynamics

Introduction

  • Role of the EMT
    • Critical member of the emergency health-care team
    • Charged with minimizing exposure to injury, infection, illness, stress
  • Vision statement
    • EMS Agenda 2050 advocates systems that are inherently safe
  • Culture of safety concepts
    • “Just culture” → balances system accountability with individual accountability
    • Encourages reporting of errors without fear of punishment to improve processes

An Era of Team Health Care

  • Community Paramedicine (CP) & Mobile Integrated Health (MIH)
    • Exemplify the continuum-of-care team concept (care begins at the patient’s side and continues through disposition)
  • System variability
    • Team structure and effectiveness differ between geographic regions and agencies

Types of Teams

  • Regular teams
    • Members (e.g., two EMT partners) consistently work together
    • Advantage: seamless coordination due to familiarity
  • Temporary teams
    • Formed ad-hoc; members may not know one another
    • Common in volunteer or rural systems
  • Special teams (mission-focused)
    • Fire, Rescue, Hazardous Materials, Tactical EMS, Special Event EMS, EMS Bike, In-hospital patient-care techs, MIH techs

Groups Versus Teams

  • Group
    • Individuals work independently toward patient benefit (e.g., triage, treatment, transport groups)
  • Team
    • Individuals have assigned roles, work interdependently under a designated leader
  • Five essential elements of a functional group
    • Common goal
    • Group self-identity
    • Sense of continuity (expectation of future cooperation)
    • Shared values
    • Role differentiation

Dependent, Independent, and Interdependent Groups

  • Dependent group
    • Members await direction; limited adaptability
  • Independent group
    • Members self-manage their tasks; focus on individual area goals
  • Interdependent group (ideal team model)
    • Members share responsibility, accountability, and a common goal

Effective Team Performance

  • Core requirements
    • Shared goal & mission clarity
    • Clearly defined roles/responsibilities
    • Diverse yet competent skill sets
    • Effective collaboration & communication
    • Supportive, coordinated leadership
  • Crew Resource Management (CRM) & Situational Awareness
    • Promote open communication, flattened hierarchy when patient safety is at stake
    • PACE mnemonic for graded assertiveness
    • P – Probe (subtle inquiry)
    • A – Alert (express concern)
    • C – Challenge (assert need for action/change)
    • E – Emergency (take decisive action)

Transfer of Patient Care

  • Transfer moments are high-risk for errors
  • Guidelines for a smooth/ safe hand-off
    • Uninterrupted critical care
    • Minimal interference environment
    • Respectful interaction among providers
    • Common priorities (patient outcome centered)
    • Shared language / standardized format (e.g., SBAR, MIST)

BLS and ALS Providers Working Together

  • Interdependence: ALS relies on continuous BLS support (airway, CPR, etc.)
  • Skill scope varies by jurisdiction; what is “paramedic-only” in one area may be EMT-level elsewhere

Assisting With ALS Skills (4-Step Model)

  1. Patient preparation (positioning, explaining, oxygenation)
  2. Equipment preparation (gather, check, assemble)
  3. Performing the procedure (anticipate next steps, hand over devices, maintain sterility)
  4. Continuing care (monitor, secure devices, document)

Critical Thinking & Decision Making in EMS

  • Sound decisions rely on
    • Up-to-date medical knowledge
    • Patient-provided information
    • History & physical exam findings
  • Decision-making stages
    1. Pre-arrival (dispatch information, gear readiness)
    2. Arrival (scene size-up, initial impression)
    3. During the call (ongoing assessment, treatment adjustments)
    4. After the call (debrief, documentation, QI)
  • Decision traps
    • Bias (personal beliefs skewing interpretation)
    • Anchoring (fixating on initial impression)
    • Overconfidence (underestimating complexity, ignoring input)

Troubleshooting Team Conflicts

  • Primary rule: Patient comes first
  • Strategies
    • Do not engage in conflict on scene; maintain composure
    • Separate person from issue; address behavior, not character
    • “Choose your battles” – defer non-critical disagreements until after call

Review Concepts (Sample Q&A Integrated for Reinforcement)

  • Regular team characteristic → consistent partner interaction
  • Group essential element → shared values
  • Interdependent group → shared responsibility/accountability
  • Closed-loop communication → repeating message back to sender to confirm
  • Team leader role → coordination, oversight, helps members work together; often policy-defined
  • Respect during hand-off → every member honors each other’s role; lifesaving care handed off, minimal interference
  • Managing fatigue-related partner conflict → comply temporarily if not endangering patient, discuss post-call, avoid confronting in front of patient

Ethical, Philosophical, and Practical Implications

  • Just culture → ethical obligation to report errors for system improvement, balancing responsibility without punitive fear
  • Interdependence vs. Hierarchy → philosophical shift from authoritarian command to collaborative leadership to enhance safety
  • Continuous professional development → EMTs must keep skills/knowledge current to support sound decision making and team effectiveness

Numerical & Statistical References (formatted)

  • Vision year: 2050 (EMS Agenda safety goals)
  • Partner fatigue scenario: 48-hour shift (demonstrates human factors in team dynamics)

Key Take-Home Messages

  • Team-based care enhances safety and patient outcomes when guided by clear communication, defined roles, and supportive leadership.
  • CRM tools like PACE and closed-loop communication translate aviation safety successes to EMS.
  • Conflict resolution and a just culture protect both provider well-being and patient welfare.
  • Continuous BLS support is indispensable even in ALS-level interventions, underscoring seamless teamwork across certification levels.