CHH. 41: A Team Approach to Healthcare

12. Explain the importance of ensuring patient comfort during a vascular access procedure. (pp 1500, 1502)

You must ensure the patient is comfortable and calm so that he or she is less likely to move during the procedure.

9. Discuss the importance of preoxygenation when performing endotracheal (ET) intubation. (p 1496)

the more oxygen that is available in the alveoli, the longer the pt can maintain adequate gas exchange in the lungs while the intubation procedure is being performed

2. List the five essential elements of a group. (p 1491)

- a common goal - an image of themselves as "a group" - a sense of continuity of the group (an understanding that the group may work together more than once, even in a slightly different configuration) - a set of shared values (how the group wants to get things done) - different roles within the group (often self-assigned)

8. Describe the four-step process of assisting with advanced life support (ALS) skills. (p 1495)

1. patient preparation -preoxygenation -Good oxygenation often includes bag-valve mask (BVM) ventilation (including the use of an oral or nasal airway) and ensuring a proper seal, ventilation rate, volume of ventilation, and time for patient exhalation. 2. equipment setup -Direct laryngoscopy is visualization of the vocal cords with a laryngoscope. -Video laryngoscopy is visualization of the vocal cords using a video camera and monitor. 3. performing the procedures -You can remember the six typical steps in performing endotracheal intubation using the BE MAGIC mnemonic, which stands for: B Perform BVM preoxygenation. E Evaluate for airway difficulties. M Manipulate the patient. A Attempt first-pass intubation. GI Use a supraGlottic or Intermediate airway if unable to intubate. C Confirm successful intubation/Correct any issues.

13. Describe the steps EMTs can take to troubleshoot interpersonal conflicts. (pp 1503-1504)

5 techniques: The patient comes first. Regardless of interpersonal conflicts that may arise, the patient's needs must always come first. Do not engage. If the problem causing the conflict does not directly and immediately impact patient care, do not engage. Keep your cool. If you feel that the conflict is over a critical component of patient care, follow the PACE mnemonic. Separate the person from the issue. If the conflict arises from the behavior of another team member and the conflict cannot be delayed or avoided, focus on the behavior itself rather than the individual. Choose your battles. Remember, there is strength in the diversity of team members.

4. List the five essential elements of a team. (pp 1491-1493)

A shared goal -goal = the best pt outcome Clear roles and responsibilities -An excellent example of this is the pit crew approach to CPR for cardiac arrest situations. Diverse and competent skill sets -Think of these diverse backgrounds and skill sets as opportunities to fill roles and responsibilities within a high-performing team. Effective collaboration and communication -Four important elements of team communication include: --a clear message --closed loop communication --courtesy --constructive intervention Supportive and coordinated leadership -A key differentiation between a team leader and a group leader is that a team leader helps the individual team members to not only do their jobs (provides support) but also to work together (facilitates coordination).

11. Describe the signs that indicate a complication with an intubated patient. (p 1500)

Absence of an end-tidal CO2 level Alert team members if the end-tidal CO2 waveform suddenly disappears. Decreasing SpO2 level Alert team members if the SpO2 level begins to drop, especially below 94%. Increasing resistance when ventilating Increasing resistance could indicate a critical airway or breathing problem that must be addressed, such as the advanced airway device has been mistakenly placed into the esophagus rather than into the trachea, referred to as esophageal intubation. Other physical signs of poor ventilation and perfusion Physical signs include pale skin and cyanosis. Improper positioning or dislodgement of the ET tube ensure: Breath sounds are present Gastric sounds are absent An end-tidal CO2 waveform is visible during ventilation SpO2 values are stable or rising The ET tube is secured at the proper depth marking

10. Describe the six steps of the BE MAGIC intubation procedure. (pp 1497-1499)

B Perform BVM preoxygenation. E Evaluate for airway difficulties. M Manipulate the patient. The ideal position is achieved when the patient's ear canal is on the same horizontal plane as his or her sternal notch, known as the sniffing position. A Attempt first-pass intubation. When the ALS provider is ready to begin the intubation attempt, remove the oral airway and disconnect the mask from the bag in preparation for connecting the bag to the ET tube. GI Use a supraGlottic or Intermediate airway if unable to intubate. C Confirm successful intubation/Correct any issues. An ALS provider may place an oral airway back into the patient's mouth after a successful intubation attempt to prevent the patient from biting down on the ET tube.

7. List the five steps a receiving health care provider should perform when taking a patient care report (PCR). (p 1495)

Eye Contact. Make eye contact with the individual giving a report. This helps both providers to stop other noncritical work and focus on the transfer of information and patient care. Environment. The very nature of EMS means we do not have the level of control over the environment that we would like. However, when taking a report, make every effort to create or move to an environment that is quieter and less distracting. Ensure Understanding. Ask any questions to ensure you understand what was reported. Sum up. Quickly summarize the critical components of the handoff to allow the reporting team member to correct any misunderstandings and to reinforce the information to the new team members taking over patient care. Supplement. Obtain any relevant paperwork or other materials that will be helpful for communicating information to the next set of health care providers.

6. List the five critical elements necessary to ensure effective transfer of patient care from one provider to another. (pp 1494-1495)

Uninterrupted critical care Whenever possible, the team member giving the report and the team member taking the report should hand off lifesaving care (such as performing chest compressions) to another team member, allowing them to focus on the transfer of care. Minimal interference The transfer of patient care should occur in a location with the least interference possible. Respectful interaction Each team member involved in the transfer must be respectful of members' different roles and recognize the importance of each role. Common priorities Both the team member giving the report and the team member taking the report must focus on their common priorities (critical assessment findings and patient care) vital for the best possible patient outcome. Common language or system Whenever possible, a mutually agreed-upon and standardized patient handoff format should be used.

1. Define continuum of care. (p 1489)

continuum of care The concept of consistent patient care across the entire health care team from first patient contact to patient discharge; working together with a unified goal results in improved individual and team performance, better patient and provider safety, and improved patient outcome.

5. Explain how crew resource management (CRM) can be useful in the prehospital environment. (pp 1493-1494)

crew resource management (CRM) A set of procedures for use in environments where human error can have disastrous consequences. It empowers people within a team to communicate effectively with one another with a goal of improving team situational awareness, patient and crew safety, and overall communication. when a priblem arrises, CRM recommends use of the PACE mnemonic: P Probe. Look or ask to confirm the problem. A Alert. Communicate the problem to the team leader. C Challenge. If the issue is not corrected, then clearly challenge the team's present course of action that is leading to the problem. For example, "Lieutenant, I think this additional action should be taken. Do you agree?" E Emergency. If the problem is clear and critical (such as an immediate safety issue), then immediately communicate the emergency to the entire team. CRM empowers people to speak clearly and concisely when they detect a problem or potential problem.

3. Explain the advantages of a team over a group; include the advantages of regularly training and practicing together. (pp 1490-1491)

group In the context of EMS, a collection of individual health care providers working independently to help the patient. team In the context of EMS, a group of health care providers who are assigned specific roles and are working interdependently in a coordinated manner under a designated leader