Integrating CCITTS With EMS

There often is a casual integration with EMS as the CCITT performs its job. This integration may range from using the same parking spaces outside of the emergency department to the use of EMS providers or vehicles as a core component of the CCITT.

• Emergency vehicle operations

• Communications

• Use of an incident command (IC) system

• Continuing education specific to the prehospital environment

• Triage of multiple patients

• Rapid and efficient on-scene triage, evaluation, and management of patients

• Consistent, effective, and outcome-driven phone triage algorithms

• Mass casualty preparedness

There also are many areas of expertise within the critical care transport environment that could be shared with EMS providers, such as the following:

• Phone direction of advanced care

• Advanced and thorough medical assessments and care provision

• Integration with hospital personnel

• Anticipation of next steps in critical care patient management

• Provision of thorough care with complete written and verbal patient care reports

• Ability to use hospital-based resources and educational opportunities

• Access to academic and tertiary medical settings and the opportunity to work with students, residents, and fellows

• Nationally standardized education, training, licensing, and certification of providers

• Consistent advanced medical control

• Implementation and use of research protocols

• Successful integration of effective quality assurance programs into medical practice

Integration between groups requires an understanding of educational backgrounds and care capabilities. The standard levels of EMS training and personnel in the prehospital environment are as follows:

• First responders: can assist with basic first aid, use an automated external defibrillator, and perform cardiopulmonary resuscitation and very basic airway support; typically have approximately 40 hours of training

• Emergency medical technician-basic (EMT-B): can perform the preceding skills and immobilization, extrication, oxygen support, and patient trans­port in an ambulance; typically have approximately 100 hours of training

• Emergency medical technician-intermediate (EMT-I): can perform pre­ceding skills and may have advanced airway skills, such as intubation, and the ability to obtain intravenous access; relatively few EMTs are trained and have wide variability in skills performed; training time, approximately 200 hours

• Emergency medical technician-paramedic (EMT-P): have advanced skills and can perform advanced airway support and administer medications in the field; training of more than 1000 hours (often closer to 2000 hours) with extensive field internships that are integral to the certification process

• “Critical care transport” EMS provider: available in some areas; training builds on the skills of an EMT-B, EMT-I, or EMT-P; courses usually pre­sented in a modular format over several months and include didactic and clinical instruction

The different levels of EMTs can be confusing. When teaming with an EMS provider, it is important to clarify professional capabilities and personal comfort level with expected involvement.

Whether it is through day-to-day casual encounters, ride-alongs (strongly encouraged as a learning opportunity), or an integrated educational and training program, the importance of sharing expertise between EMS and CCITTs cannot be overstated. This sharing should start with a better understanding of one another's modes of operations. For example, hospital transport and other medical professionals may not be aware of the educa­tion, capabilities, or scope of practice of prehospital providers. The converse is often true for EMS providers, who typically work in the field and may not regularly interact with CCITT members. Understanding one another's roles and responsibilities is especially important during high-volume and high-acuity situations or in the case of limited care availability (such as a mass casualty or evacuation with use of both resources), when the distinc­tions between EMS and CCITT may blur. Situations such as mass casualty incidents or disasters of any kind may demand that the CCITT move into a role to which it is unaccustomed. Issues such as definitions of words used can add to confusion and communication difficulties for teams work­ing together without previous training. For example, “casualty” may mean something different to an EMS-trained provider than to a transport team member (death vs an injured patient, respectively). Operational training in the aspects of EMS will be of a great benefit to the CCITT if it is needed to integrate into EMS-level care. In addition, it is always in the best interests of the CCITT and the EMS to have predesignated plans of action for these types of situations. Examples where this may be useful are described in the following section.