1. A Team Approach to Health Care
Chapter 41
A Team Approach to Health Care
Chapter 41: A Team Approach to Health Care

2. Introduction
You are a critical member of the emergency health care team.
By working as a team, emergency health care providers can improve patient and provider safety and delivery better emergency care.
Lecture Outline
I. Introduction
A. 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 will help care for your patient throughout the duration of his or her injury or illness.
B. You must learn to be an effective team member.
C. By working as a team, emergency health care providers can improve patient and provider safety and deliver better emergency care.

3. An Era of Team Health Care
Community paramedicine and mobile integrated healthcare (MIH) teams may be the best examples of the team concept of continuum of care.
The structure and effectiveness of emergency health care teams differs from system to system.
Lecture Outline
II. An Era of Team Health Care
A. Previous models of emergency care often consisted of providers who worked separately, passing the patient from one individual or group to the next.
1. In time, emergency health care providers recognized that by working as a unified team from first patient contact to patient discharge, it was possible to improve individual and team performance, patient and provider safety, and, patient outcome.
2. This concept is the continuum of care.
B. Community paramedicine and mobile integrated healthcare (MIH) teams may be the best example of the team concept of continuum of care.
C. The structure and effectiveness of emergency health care teams differ from system to system.

4. Types of Teams (1 of 2) Regular teams Temporary teams
EMTs consistently interact with the same partner or team.
Temporary teams
EMTs work with providers with whom they do not regularly interact or may not even know.
Lecture Outline
III. Types of Teams
A. Regular teams
1. EMTs consistently interact with the same partner or team.
2. Team members who frequently train and work together are more likely to move smoothly from one step in the procedure to the next.
B. Temporary teams
1. EMTs work with providers with whom they do not regularly interact or may not even know.
a. Providers must work within an environment that supports and promotes collaboration rather than competition.
b. It is crucial to have a clear understanding of the roles, responsibilities, and capabilities of each team member.

5. Types of Teams (2 of 2) Special teams
Possess specific knowledge, skills, abilities, equipment, and/or training
Examples include
Hazardous Material Team
Tactical EMS Team
Special Event EMS Team
EMS Bike Team
Lecture Outline
C. Special teams
1. Fire Team
2. Rescue Team
3. Hazardous materials (HazMat) Team
4. Tactical EMS Team
5. Special event EMS Team
6. EMS bike Team
7. In-hospital patient care technicians
8. MIH technicians

6. Groups Versus Teams (1 of 3)
A group consists of individual health care providers working independently to help the patient.
Triage
Treatment
Transport
Lecture Outline
IV. Groups Versus Teams
A. The National Incident Management System (NIMS) defines a group as “The organization level that divides the incident according to functional levels of operation. Groups perform special functions, often across geographic boundaries.”
1. A group consists of individual health care providers working independently to help the patient.
a. Triage
b. Treatment
c. Transport

7. Groups Versus Teams (2 of 3)
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.
Lecture Outline
2. 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.

8. Groups Versus Teams (3 of 3)
Five essential elements of a group
A common goal
An image of themselves as a “group”
A sense of continuity of the group
A set of shared values
Different roles within the group
Lecture Outline
3. The five essential elements of a group include:
a. A common goal
b. An image of themselves as a “group”
c. A sense of continuity of the group
d. A set of shared values
e. Different roles within the group

9. Dependent, Independent, and Interdependent 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.
Interdependent groups
Function as a true team
Lecture Outline
V. Dependent, Independent, and Interdependent Groups
A. In dependent groups, each individual is told what to do, and often how to do it, by his or her supervisor or group leader.
B. In independent groups, each individual is responsible for his or her own area (either a physical space or set of tasks).
C. In interdependent groups, everyone works together with shared responsibilities, accountability, and a common goal.

10. Effective Team Performance (1 of 2)
A shared goal
Clear roles and responsibilities
Diverse and competent skill sets
Effective collaboration and communication
Supportive and coordinated leadership
Lecture Outline
VI. Effective Team Performance
A. A shared goal
1. Every health care provider on the team must be committed to a common goal.
B. Clear roles and responsibilities
1. Each provider must know what needs to be done and what is expected of him or her.
C. Diverse and competent skill sets
1. 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.
D. Effective collaboration and communication
1. Four important elements of team communication include:
a. A clear message
b. Closed loop communication
c. Courtesy
d. Constructive intervention
E. Supportive and coordinated leadership
1. The team leader provides role assignments, coordination, oversight, centralized decision making, and support for the team to accomplish their goals and achieve desired results.

11. Effective Team Performance (2 of 2)
Communication and team dynamics fostered from crew resource management and team situational awareness
CRM recommends the use of the PACE mnemonic:
Probe
Alert
Challenge
Emergency
Lecture Outline
2. Team leaders foster communication and team dynamics using concepts such as crew resource management and team situational awareness.
3. Crew resource management (CRM) is a way for team members to work together with the team leader to develop and maintain a shared understanding of the emergency situation.
a. CRM recommends use of the PACE mnemonic:
i. Probe
ii. Alert
iii. Challenge
iv. Emergency

12. Transfer of Patient Care
Transfers introduce the possibility of patient care errors.
General guidelines for a smooth transfer:
Uninterrupted critical care
Minimal interference
Respectful interaction
Common priorities
Common language or system
Lecture Outline
VII. Transfer of Patient Care
A. At several points along the continuum, the patient’s care will be transferred, or “handed off,” from one unit of providers on the team to another.
1. These transfers introduce the possibility of critical patient care errors, especially when they occur several times and in different settings along the continuum of care.
2. Effective teams minimize the number of transfers during patient care and adhere to strict and careful guidelines when such transfers are unavoidable.
3. Whenever the verbal transfer of care occurs, all team members should do their best to ensure the following:
a. Uninterrupted critical care
b. Minimal interference
c. Respectful interaction
d. Common priorities
e. Common language or system
B. See Chapter 4, “Communications and Documentation,” for information on PCRs.

13. BLS and ALS Providers Working Together
BLS and ALS care cannot exist without each other.
BLS efforts must continue throughout the continuum of care.
What may be a “paramedic only” skill in your EMS system may be common for an EMT to perform in another.
Lecture Outline
VIII. BLS and ALS Providers Working Together
A. BLS and ALS care cannot exist without each other.
B. BLS efforts must continue throughout the continuum of care.
1. You must carefully coordinate your efforts with the advanced tools and techniques used by ALS providers.
C. What may be a “paramedic only” skill in your EMS system may be common for an EMT to perform in another.
1. It is your responsibility to understand what is allowed by the scope of practice, standard of care, and local protocols where you work.

14. Assisting with ALS Skills
Assisting follows a four-step process:
Patient preparation
Equipment
Performing the procedure
Continuing care
Lecture Outline
IX. Assisting with ALS Skills
A. Assisting follows a four-step process:
1. Patient preparation
2. Equipment setup
3. Performing the procedure
4. Continuing care

15. Advanced Airways (1 of 3) Patient preparation Equipment setup
Preoxygenation
Apenic oxygenation
Equipment setup
Lecture Outline
B. Assisting with placement of advanced airways
1. Patient preparation
a. Preoxygenation
b. Apneic oxygenation
2. Equipment setup

16. Advanced Airways (2 of 3) Performing the procedure
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
Lecture Outline
3. Performing the procedure
a. BE MAGIC
i. B—Perform BVM preoxygenation.
ii. E—Evaluate for airway difficulties
iii. M—Manipulate the patient
iv. A—Attempt first-pass intubation
v. GI—Use a supraGlottic or Intermediate airway if unable to intubate
vi. C—Confirm successful intubation

17. Advanced Airways (3 of 3) Continuing care
Observe all of the patient’s monitor readings
Monitor for signs of potential complications
Lecture Outline
4. Continuing care
a. Continue to observe all of the patient’s monitor readings, as well as monitor for signs of potential complications.

18. Vascular Access (1 of 2) Patient preparation Equipment setup
Position the patient and equipment.
Explain the procedure and the reason for it.
Ensure the patient is comfortable and calm.
Equipment setup
Lecture Outline
C. Vascular access
1. Patient preparation
a. Positioning the patient and equipment
b. Explaining the procedure and the reason for it
c. Ensuring the patient is comfortable and calm.
2. Equipment setup
a. While vascular access may involve either IV or intraosseous (IO) access, the procedure and equipment list will be generally the same.

19. Vascular Access (2 of 2) Spiking the bag Performing the procedure
Stabilize the patient’s limbs.
Provide comfort to the patient.
Continuing care
Observe the access site for swelling, bleeding, discoloration, and leaking
Lecture Outline
3. Spiking the bag
4. Performing the procedure
a. While the ALS provider is establishing IV or IO access, you may help to stabilize the patient’s limbs or provide him or her comfort.
5. Continuing care
a. Continue patient care by observing the access site for swelling, bleeding, discoloration, or leaking.
b. Observe the IV tubing to see if it is improperly blocked, clamped, or kinked, or if the bag of IV solution is empty.

20. Troubleshooting Team Conflicts
The patient comes first.
Do not engage.
Keep your cool.
Separate the person from the issue.
Choose your battles.
Lecture Outline
X. Troubleshooting Team Conflicts
A. When conflict occurs, keep in the mind the following five techniques:
1. The patient comes first.
2. Do not engage.
3. Keep your cool.
4. Separate the person from the issue.
5. Choose your battles.

21. Review Which of the following is a characteristic of a regular team?
They serve a specialized role within the larger emergency health care system.
Members consistently interact with the same partner.
The team performs special functions across geographic boundaries.
Regular teams are more common in volunteer EMS systems.

22. Review
Answer: B
Rationale: Members of a regular team consistently interact with the same partner. This allows them to perform as a seamless unit. Special teams serve a specialized role within the larger emergency health care team. Groups perform special functions across geographic boundaries. Temporary teams are common in volunteer EMT systems.

23. Review Which of the following is a characteristic of a regular team?
They serve a specialized role within the larger emergency health care system.
Rationale: Special teams serve a specialized role within the larger health care system.
Members consistently interact with the same partner.
Rationale: Correct answer

24. Review Which of the following is a characteristic of a regular team?
The team performs special functions across geographic boundaries.
Rationale: Groups perform special functions across geographic boundaries.
Regular teams are more common in volunteer EMS systems.
Rationale: Temporary teams are more common in volunteer systems.

25. Review Essential elements of a group that people must share include:
focusing on individual goals.
placing emphasis on one way of accomplishing a task.
working with a set of shared values.
promoting a personal identity.

26. Review
Answer: C
Rationale: It is important for groups to have a set of shared values (how the group wants to get things done). In a group the focus needs to be on a common goal. Group members must have a sense of continuity and remember that the group may work together more than once in a different configuration. Finally, a group member should put forth an image of the group as a whole, not one person.

27. Review Essential elements of a group that people must share include:
focusing on individual goals.
Rationale: Groups are focused on a common goal.
placing emphasis on one way of accomplishing a task.
Rationale: Group members must have a sense of continuity and remember that the group may work together more than once in a different configuration.

28. Review Essential elements of a group that people must share include:
working with a set of shared values.
Rationale: Correct answer
promoting a personal identity.
Rationale: A group member should put forth an image of the group as a whole, not one person.

29. Review Members of an interdependent group:
focus on the goals of their own individual areas.
rely on the group leader for task assignments.
have limited ability to adapt and deliver critical care medical care in an uncontrolled field environment.
work together with shared responsibilities, accountability, and a common goal.

30. Review
Answer: D
Rationale: Members of an interdependent group work together with shared responsibilities, accountability, and a common goal. People who are part of a independent group focus on the goals of their own individual area. Individuals who are part of a dependent group rely on the leader for task assignments and have limited ability to adapt and deliver critical medical care in an uncontrolled field environment.

31. Review Members of an interdependent group:
focus on the goals of their own individual areas.
Rationale: People who are part of an independent group focus on the goals of their own individual areas.
rely on the group leader for task assignments.
Rationale: People who are members of a dependent group rely on the group leader for task assignments.

32. Review Members of an interdependent group:
have limited ability to adapt and deliver critical medical care in an uncontrolled field environment.
Rationale: People who are part of a dependent group have limited ability to adapt and deliver critical medical care in an uncontrolled environment.
work together with shared responsibilities, accountability, and a common goal.
Rationale: Correct answer

33. Review
4. When a team member speaks, you should repeat the message back to him or her. This is an example of:
closed loop communication.
a clear message.
constructive intervention.
courtesy.

34. Review
Answer: A
Rationale: Closed loop communication helps confirm that you heard and understood the message, and will act on it. A clear message is delivered when you speak calmly, confidently, and concisely so that the information delivered or the action requested is clear to the listener. Constructive intervention takes place when it is necessary for you to respectfully question or correct a team member or leader. You extend courtesy when speaking politely to members of the group.

35. Review
When a team member speaks, you should repeat the message back to him or her. This is an example of:
closed loop communication.
Rationale: Correct answer
a clear message.
Rationale: A clear message is delivered when you speak calmly, confidently, and concisely so that the information delivered or the action requested is clear to the listener.

36. Review
When a team member speaks, you should repeat the message back to him or her. This is an example of:
constructive intervention.
Rationale: Constructive intervention takes place when it is necessary for you to respectfully question or correct a team member or leader.
courtesy.
Rationale: You extend courtesy when speaking politely to members of the group.

37. Review A team leader: helps individual team members to work together.
is often defined by policy, procedure, or statute.
provides coordination, oversight, centralized decision making and support for the team.
All of the above.

38. Review
Answer: D
Rationale: A team leader is an essential part of successful team. The team leader is often defined by policy, procedure, or statute. He or she provides coordination, oversight, centralized decision making and support for the team. In addition, the team leader will help individuals to not only do their jobs, but also to work together.

39. Review A team leader: helps individual team members to work together.
Rationale: Correct answer. A team leader helps individual team members to work together.
is often defined by policy, procedure, or statute.
Rationale: Correct answer. A team leader is often defined by policy, procedure, or statute.

40. Review
A team leader:
provides coordination, oversight, centralized decision-making and support for the team.
Rationale: Correct answer. A team leader will provide coordination, oversight, centralized decision-making and support for the team.
All of the above.
Rationale: Correct answer

41. Review
The mnemonic BE MAGIC helps you remember the six typical steps of endotracheal intubation. Which of the following is not part of the mnemonic?
Performing BVM preoxygenation
Achieving venous access
Manipulating the patient
Evaluating for airway difficulties

42. Review
Answer: B
Rationale: Although a patient who requires endotracheal intubation will also require venous access, gaining venous access is not part of the BE MAGIC mnemonic. Performing BVM preoxygenation, manipulating the patient, and evaluating for airway difficulties are all components of the BE MAGIC mnemonic.

43. Review
The mnemonic BE MAGIC helps you remember the six typical steps of endotracheal intubation. Which of the following is not part of the mnemonic?
Performing BVM preoxygenation
Rationale: Performing BVM preoxygenation is part of the BE MAGIC mnemonic.
Achieving venous access
Rationale: Correct answer

44. Review
The mnemonic BE MAGIC helps you remember the six typical steps of endotracheal intubation. Which of the following is not part of the mnemonic?
Manipulating the patient
Rationale: Manipulating the patient is part of the BE MAGIC mnemonic.
Evaluating for airway difficulties
Rationale: Evaluating for airway difficulties is part of the BE MAGIC mnemonic.

45. Review
7. As you ventilate an intubated patient, which of the following observations would cause you to immediately alert the team leader?
Ventilation is creating equal chest rise.
The patient’s cyanosis is disappearing.
The oxygen saturation level is now at 94%.
The BVM is offering more resistance.

46. Review
Answer: D
Rationale: Increasing resistance while ventilating with the BVM could be indicative of a critical airway or breathing problem, such as an esophageal intubation, that needs to be addressed. Other observations that need to be immediately reported to the team leader include a decreasing SpO2 level (especially below 94%), physical signs of poor ventilation and perfusion, and improper positioning or dislodgement of the ET tube.

47. Review
As you ventilate an intubated patient, which of the following observations would cause you to immediately alert the team leader?
Ventilation is creating equal chest rise.
Rationale: Equal chest rise is a sign that the endotracheal tube is in proper position.
The patient’s cyanosis is disappearing.
Rationale: Improving cyanosis is a sign that the endotracheal tube is in proper position.

48. Review
As you ventilate an intubated patient, which of the following observations would cause you to immediately alert the team leader?
The oxygen saturation level is now at 94%.
Rationale: An increasing oxygenation saturation level is a sign that the endotracheal tube is in proper position.
The BVM is offering more resistance.
Rationale: Correct answer

49. Review
You are assisting the paramedic with vascular access. When you spike the IV bag, it is important for you to use __________ technique.
sterile
clean
aseptic
reduction

50. Review
Answer: A
Rationale: Sterile technique involves thorough decontamination as well as the use of sterile fields around the procedure and sterile PPE. When you assist with ALS skills such as spiking an IV bag, it is important for you to use sterile technique. Clean technique refers to minimizing the amount of pathogens or “unclean” materials that you pick up or transfer through the use of routine handwashing. Aseptic technique is often used for fast, invasive procedures such as starting an IV line and refers to techniques that help ensure that pathogens are not introduced anywhere in the procedure. There is no reduction technique.

51. Review
You are assisting the paramedic with vascular access. When you spike the IV bag, it is important for you to use __________ technique.
sterile
Rationale: Correct answer
clean
Rationale: Clean technique refers to minimizing the amount of pathogens or “unclean” materials that you pick up or transfer through the use of routine handwashing.

52. Review
You are assisting the paramedic with vascular access. When you spike the IV bag, it is important for you to use __________ technique.
aseptic
Rationale: This is often used for fast, invasive procedures such as starting an IV line and refers to techniques that help ensure that pathogens are not introduced anywhere in the procedure.
reduction
Rationale: There is no such thing as reduction technique.

53. Review
When verbal transfer of care occurs, all team members should do their best to ensure that:
the transfer of care occurs in a place where many staff members are present to hear.
lifesaving care is not interrupted if it is being performed by the person giving report.
everyone is respectful of each team member’s role.
patient care is centered around what you believe is the correct treatment.

54. Review
Answer: C
Rationale: Whenever the verbal transfer of care occurs, all team members should do their best to ensure that each team member is respectful of each other. Transfer of care should occur in a location with the least interference possible. The team member giving the report and the member receiving report should hand off lifesaving care to another team member. Finally, it is important to remember that the team members involved in the transfer of care focus on doing what provides the best care for the patient.

55. Review
When verbal transfer of care occurs, all team members should do their best to ensure that:
the transfer of care occurs in a place where many staff members are present to hear.
Rationale: The transfer of care should occur in a location with the least interference possible.
lifesaving care is not interrupted if it is being performed by the person giving report.
Rationale: Lifesaving care should be handed off to another team member.

56. Review
When verbal transfer of care occurs, all team members should do their best to ensure that:
everyone is respectful of each team member’s role.
Rationale: Correct answer
patient care is centered around what you believe is the correct treatment.
Rationale: Team members involved in the transfer of care must focus on their common priority: the best possible patient outcome.

57. Review
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:
follow your partner’s orders and discuss the call after the patient has been dropped off at the hospital.
confront your partner about his or her behavior in front of the patient.
tell your partner he or she does not know that they are talking about.
ask the patient who he or she thinks is correct.

58. Review
Answer: A
Rationale: If the problem causing the conflict does not directly and immediately impact patient care, it is best to wait until after the call to discuss the matter with your partner. It is also important to not have a heated discussion in front of the patient. Rather than contribute to a conflict, take a deep breath and count to 10. Let cooler heads prevail. Finally, do not involve the patient in a conflict- it takes the focus off of patient care.

59. Review
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:
follow your partner’s orders and discuss the call after the patient has been dropped off at the hospital.
Rationale: Correct answer
confront your partner about his or her behavior in front of the patient.
Rationale: Do not confront your partner in front of the patient. Keep the focus on providing quality patient care.

60. Review
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:
tell your partner he or she does not know that they are talking about.
Rationale: Rather than confront your partner, take a deep breath can count to 10.
ask the patient who he or she thinks is correct.
Rationale: Never involve a patient in a personal conflict. Remain focused on the goal: quality patient care.