Transport Nurses On Board With Interdisciplinary Ambulance Services
Tuesday June 1, 2004
Print This- Select Text Size:
Comments
advertisement
It's not difficult for emergency nurses to imagine such a scenario and understand what typically happens next. Nurses have been obligated to relinquish their patient assignments within the hospital to transport critically ill or injured patients to other facilities. These nurses have been expected to function comfortably aboard the unfamiliar work environment of private ambulances alongside equally unfamiliar crews. Of course, such situations place added stress on already overworked staff nurses; but they also commonly strain hospital staffing assignments.
A relatively new role for nurses can help alleviate that strain. Experienced emergency, critical care, and pediatrics nurses can put their expertise to work as critical care transport nurses within the private ambulance sector of Illinois' Emergency Medical Services (EMS).
Of course, RNs' providing patient care while on ambulances is really not a new concept. In fact, nursing professionals have been riding aboard hospital-based ambulances for years. When aeromedical programs experience restricted flights due to adverse weather conditions or other warranted circumstances, such as aircraft breakdown, ground transportation represents the only option for patient relocation. Also, in rural areas RNs have long been employed by fire departments, operating as either field nurses or firefighters who respond to local emergencies aboard ambulances and fire rescue vehicles.
The current nursing crunch, however, has opened opportunities for RNs to take their specialized skills out of traditional health care settings and into the private ambulance industry. The numbers of critical care transport nurses - often called ground or surface transport specialists - are growing as more and more patients are relocated from facility to facility for insurance purposes, at physicians' requests, or for higher levels of care.
It's a win-win situation for hospitals and private ambulance companies alike.
"Working on a critical care transport team has been a great experience for me," says Jeanne Boecher, RN, BSN, a critical care transport nurse for Superior Air-Ground Ambulance Service in Elmhurst, Ill. "I think the strengths and knowledge base of both paramedicine and nursing dovetail to create an environment in which excellent patient care can be provided."
Lawrence Grandt, EMT-P, a retired senior firefighter for the Countryside Fire Protection District in Vernon Hills, Ill., agrees. "Licensed paramedics and RNs working together on an interdisciplin-
ary transport team is actually one of the best things that could be done for patients," says Grandt, who currently works as a critical care transport paramedic with Superior Air-Ground. "Both areas of critical care training literally become united to achieve a common goal - to provide the best possible patient care during transport."
Ground transport RNs work collaboratively with licensed paramedics who are specially trained in critical care aboard private ambulances. The vehicles are loaded with the latest high-tech emergency medical equipment designed to meet the specific needs of high-complexity patients during both local and long-distance transports. Typical equipment aboard the ambulances include state-of-the-art mechanical ventilators, IV pumps, cardiac defibrillators, and ECG monitors.
Some critical care transport nurses have bachelor's degrees, while others hold advanced practice nursing certifications. Once employed, these nurses receive specialized, advanced EMS education for prehospital providers, including -
· 12-lead ECG analysis
· neonatal, pediatric, adult, and geriatric trauma/cardiac life support
· practical applications of intraaortic balloon pumps
· endotracheal intubation techniques
· mechanical ventilation
These specialized skills enable RNs to provide safe, cost-effective, high quality nursing care to critically ill patients of all ages during transport.
"Working as a critical care transport nurse aboard an ambulance has challenged me both professionally and clinically," says Brian Mercer, RN, BSN, who works alongside Boecher and Grandt. "My patient assessment and critical-thinking skills are razor sharp. I don't have the comfort of merely paging the physician on call to obtain an order to titrate a drip or initiate a treatment modality on a critical patient as I would in the hospital setting. I must rely on my own critical care knowledge base, specialized training, and work experience in both the ED and the ICU to appropriately treat a compromised patient aboard the ambulance."
Most nursing treatment modalities within health care facilities exceed the typical scope of paramedics' practice in the field. RNs are, therefore, required for patient transports. Nurses provide not only a higher level of care in the field, but they also act as long-arm extensions of nursing care from one health care institution to the next.
On board RNs also bridge the gap between health care facilities and EMS by answering the question of who is licensed to give what drug in the prehospital setting. Essentially, any treatment that can be practiced by an RN within a health care facility can also be performed safely, comfortably, and cost-effectively on board a private ambulance.
"With a nurse on board an ambulance as a critical care team member, patients can get the continuing care they deserve," says Mark Denning, RN, also at Superior Air-Ground.
"Incorporating RNs into EMS on private ambulances is a wonderful idea," agrees Denning's colleague, Lonnie Williams IV, EMT-P. "There have been so many times in my career as a paramedic when I've had to transport patients accompanied by nurses. Many nurses were pulled from busy EDs and ICUs and typically complained about having to leave the hospital. Once on board the ambulance, the nurses didn't know where any equipment or medications were kept and they weren't sure what role they played in an emergency situation.
"Now all that has changed," says Williams. "Critical care transport nurses seem very comfortable in the ambulance environment, and each team member has a specific role that is clearly defined."
With critical care transport nurses, it is no longer necessary to decide which nurse from a staff-strapped ED or ICU to send on a patient transport nor which staff nurse will have to care for that nurses' patients. Nursing transport positions within the private ambulance sector allow staff nurses who may be unfamiliar with patient transport to remain inside their health care facility where their skills are needed. At the same time, transport nurses can provide the continuity of patient care not available under EMS licensure.
"It's a unique, team approach to patient care," says Williams. "And I really enjoy working with the nurses."
William G. Zic, RN, BSN, is a critical care transport nurse employed by Superior Air-Ground Ambulance Service in Elmhurst, Ill.
Reader Comments
Login