hello and welcome to the emergency care and transportation of the sick and injured chapter 9 the team approach to healthcare after you complete this chapter and the related coursework you will understand the significance and characteristics of a team approach to health care and the impact of this approach on positive patient outcomes you will also be able to list and describe the steps an emt should follow to assist with advanced life support skills including placement of advanced airways and vascular access alright so let's begin as an emt you are a critical member of the emergency health care team that includes not only first responders paramedics and other emts but also physicians nurses and other personnel who help your patient throughout the duration of his or her injury or illness a key goal of the ems agenda 2050 is ems systems that are designed to be inherently safe minimize exposure to injury infections illness and stress the culture of safety so there's data collection culture coordinated support and resources ems education initiatives ems safety standards reporting and investigating of errors and near misses and then there is just culture so that's an approach to leadership in organizations that balances fairness and accountability and encourages people to report errors and near misses and it focuses on risk management an error of team health care so previous models of emergency care often consisted of providers who work separately passing the patient from one individual or group to the next in time emergency health care providers recognize that working as a uniform team for first patient contact to patient discharge it was possible to improve individual and team performance patience and patient safety and patient outcome this concept is the continuum of care community paramedicine and mobile integrated health care mih teams may be the best example of this team concept of continuum of care health care is provided within the community rather than at the physician's office the structure and effectiveness of community healthcare teams differ from one system to system okay so let's talk about types of teams you have regular teams and temporary teams okay so regular teams consist of emts who constantly interact with the same partner team team members who frequently train and work together are more likely to move smoothly from one step in the procedure to the next and then you have temporary teams and these are emts who work with providers with whom they do not regularly interact or may not even know so providers must work within an environment that supports and promotes collaboration rather than competition it is crucial to have a clear understanding of the roles responsibilities and capabilities of each team member so special teams um these are type is another type of team and you have fire teams rescue teams hazmat tactical special event ems teams ems bike teams in hospital patient care techs and then mih technicians okay and then you have group versus teams so groups versus teams the national incident management system which is nims defines a group as the organization level that divides the incident according to functional level of operation groups perform special functions often across gra geographic boundaries so a group consists of individual healthcare providers working independently to help the patient and this could be a group could consist of triage transport or treatment group a team consists of a group of healthcare providers who are assigned specific roles and who are working interdependently in a coordinated manner under a design leader the five essential elements of a group include a common goal an image of themselves as a group a sense of community of the group a set of shared values in different roles within the group dependent independent and intra-dependent groups okay so a dependent group independent group each individual is told what to do and often how to do it by his or her supervisor or group leader okay in independent groups each individual is responsible for his or her own area his or her own area and in interdependent groups everyone works together with shared responsibilities accountability and a common goal all right so effective team performance so to have effective team performance you have to have a shared goal and that means that every healthcare provider on the team must be committed to that goal you have to have clear rules and responsibilities and this means each provider must know what he or she needs to do and what is expected of him or her you have to have a diverse and competent skill set so practice with one another and become familiar with each other's tools techniques capabilities and preferences so that each team member is competent before the call comes in and then to be an effective team performance you have to have effective collaboration and communication so there are important elements of team communication and they include a clear message close-loop communication courtesy and constructive intervention and then to have an effective team performance you have to have supportative and coordinated leadership the team leader provides role assignments coordination oversight centralized decision making and a support and the support for the team to accomplish the goals and achieve desired results the team leaders foster communication and team dynamics using concepts such as crew resource management and team situational awareness good team members communicate effectively accepts feedback our good followers have confidence compassion and maturity maintain situational awareness and use appreciative or positive inquiry to approach organizational change crew resource management which is crm is a way for team members to work together with a team leader to develop and maintain a shared understanding of the emergency situation so crm recommends the use of pace mnemonic and a pace mnemonic stands for probe alert challenge emergency all right so transferring of patient care at several points along the continuum the patient care will be transferred or handed off from one unit of providers to another team these transfers introduce the possibility of critical patient care errors especially when they occur several times and in different changes along the continuum of care so effective teams minimize the number of transfers during patient care and adhere to strict and careful guidelines when such transfers are unavoidable whenever the not whenever the verbal transfer of care occurs all team members should do their best to ensure the following uninterrupted critical care minimal interference respectable interaction common priorities and common language systems so see chapter four communication and documentation for information on the patient care reports all right so basic life support and advanced life support providers working together so basic life support efforts must continue throughout the consumer of care you must carefully coordinate your efforts with the advanced tools and techniques used by advanced life support providers what may be a paramedic-only skill in 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 the next thing we're going to talk about is assisting with advanced life support skills so assisting follows a four-step process and this is the patient preparation equipment setup performing the procedure and then continuing care effective decisions are based on sound up-to-date knowledge and information provided from the patient the patient's history and physical examination there are stages of a decision-making process okay and so when you talk about critical decision making and critical thinking there's a pre-arrival arrival during the call and after the call stages of the decision-making process okay so pre-arrival is when the decision-making process begins when the initial dispatch information is received mentally rehearse the steps in care that may be needed so designate a leader crew members discuss their roles in this pre-arrival decision-making process on arrival we provide the scene size up and request additional resources we assess and intervene for life threats immediately and during the call the team leader must gather information interpret the data develop a plan communicate the plan to the team and implement it and then evaluate the effect on that decision then there's after the call after the call you need to debrief and talk about what happened and listen the feedback with an open mind okay so when it comes to critical thinking and decision making there are decision traps okay so decision traps and these are traps that frequently lead to decision making errors in ems and they are bias anchoring and overconfidence okay so let's talk about those three things biases are fixed beliefs about something anchoring occurs when an emt settles on one possible cause for the patient's problem early and fails to consider other options and then overconfidence occurs when an emt overestimates his or her abilities all right so we need to talk about nexus troubleshooting team conflicts and when conflict occurs keep in mind the following five techniques the patient comes first do not engage keep your cool separate the person from the issue and choose your battles all right so that concludes chapter nine uh the team approach to healthcare and now we're going to go ahead and go through some of the review questions which of the following is a characteristic of a regular team okay and what is a regular team members of regular teams consistently interact with the same partner this allows for them to perform as a seamless unit okay so regular team is going to be members is b members consistently interacting with the same partner all right essential elements of a group that people must share include i think it's c working with the same set of shared goals that's right it's important for groups to set to have a set of shared goals fun twister all right members of an interdependent group what do they do interdependent group members of an interdependent group work together with shared responsibilities accountabilities and a common goal okay so that was d when a team member asked you should repeat the message back to him or her this is an example of and that's closed loop communication okay and so a clear message is delivered you speak calmly confidently and concisely so that the information delivered or action requested is clear to the listener and then you repeat it back to them okay a team leader i think it's all of the above yes a team leader is essential part of the success of a team when verbal transfer of care occurs all team members should do their best to ensure that all right when the verbal transfer of care occurs all team members should do their best to ensure that each team member is respectful of each other okay so everyone is respectful your partner is working a 48-hour shift and has had little sleep he disagrees with you over how to position the patient and how you should drive to the hospital you should pretty sure it's a you want to um to go ahead with it and then talk about it after right okay all right so this concludes chapter nine team approach to healthcare and thank you