Video 3: Understanding Emergency Department Protocols

Dr. Nelson (00:03):

I’m Dr. Nelson. We are using Full Code, the software that allows us to care for virtual emergency department patients as an emergency department physician, and we are taking care of Randy Sherman today, the 29-year-old male who is found by EMS to be somnolent, hypoventilating, and hypoxemic. 

Now, let’s talk about what happens before the emergency department physician starts seeing the patient [and] start evaluating things. Well, it really depends on how critically ill or injured that patient is. Sometimes if a patient is very ill, I will escort the patient from the ambulance bay into the area of the emergency department. We are going to care for them. Usually a critical care area, if you work at a facility that has a helicopter pad, sometimes we’ll even escort patients from the helicopter if they’re critically ill or injured. A “hot offload” means we will take a patient from the helicopter before the helicopter blades stop spinning.

Dr. Nelson (01:17):

Now, we don’t like doing that because that’s dangerous, but if a patient is critical enough, we’ll often have to do that. A cold offload means that the patient is stable enough that we can wait for the helicopter blades to stop spinning. 

Most patients do not arrive to the emergency department though via EMS. They arrive by private vehicle on their own or with family, and in that case, a triage nurse will be the first person they interact with and the triage nurse will gather information such as the chief complaint, which is the concern that the patient has that brought them there, whether that’s abdominal pain, chest pain, arm injury, cut finger, and so forth. 

In addition, the triage nurse will obtain a set of vital signs including a temperature, pulse, blood pressure, and respiratory rate. They’ll then obtain some background medical history or past medical history and any medications or medication allergies the patient will have.

Dr. Nelson (02:25):

Then, the triage nurse will triage that patient in what line to be seen by the emergency department physician. A critical patient will be seen before a non-critical patient. That brings us to another one of our AAMC Premed Competencies. Let’s look and see what competency, what we can work on as pre-meds in order to establish that skill to work as a team in the emergency department. 

It takes a team to do this teamwork and collaboration where you collaborate with others, shares information with team members, and encourages this behavior in others and gives and accepts feedback to improve team performance.

I want you to stop the video now and talk amongst yourselves about what did it be like to work amongst a team and how that team then decides who is seen first in the emergency department.

• What responsibilities would you like to take on as a member of the emergency department?
  
  
  
• How would you support your peers (nurses, EMTs, lab technicians, physician assistants, social workers, and many others)?
  
  
  
• How does a healthcare team decide who is seen first in the emergency department?