Continuum of care is when you work as a team with the hospital staff from intake to discharge, which improves their outcome. An example of this is community paramedicine and mobile integrated health care teams are examples of paramedics working alongside hospitals and physician offices to provide essential care. When a new provider arrives, it is helpful to think of them joining the team as opposed to taking over.
A group consists of individual health care providers working independently to help the patient. Groups share a common goal and image of themselves as a group. There is a sense of continuity of the group and an understanding that the group may work together again under a slightly different configuration. There is a shared set of values and different roles within the group, often self-assigned. There are dependent groups where each individual is told what to do and often how to do it by their group leader. There are independent groups where each member may receive support from a leader but does not wait for assignment before taking action. A bad example of an independent group is when the group is unable to recognize other portions of the task like ABCs and ends up splinting instead of clearing an airway. In an interdependent group each provider is assigned to a particular area or task. All of the providers in an interdependent group work together with shared responsibility.
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. Important elements of a team are a clear message, speaking clearly, confidently, and concisely so that the information delivered or the action requested is clear. Closed-loop communication is also used, which is when a team member speaks, you should repeat the message back to them. All team members expect and deserve to be spoken to politely. There should also be constructive intervention where you respectfully question or correct team members. A good team needs supportive and coordinated leadership who can provide role assignments and properly communicate roles. This should be the most senior provider of the group.
When you believe there is a potential problem, use the PACE mnemonic.
P — Probe: look or ask to confirm the problem or make sense of the situation.
A — Alert: communicate the problem to the team leader.
C — Challenge: if the issue is not corrected, then clearly challenge the team’s current course of action that is leading to the problem and suggest an alternative plan.
E — Emergency: if the problem is clear and critical, then immediately communicate the emergency to the entire team.
Stages of the decision-making process. There are a few key periods where critical decisions will have to be made. They occur at the prearrival, arrival, during the call, communicate and implement the plan, evaluate the outcome, and after the call. Make sure to always rule out the worst-case scenario first. You should gather data, which begins with the dispatch information and continues when the EMT gathers the patient history and completes the physical examination. You then have to interpret the data and develop a plan. Remember communication is key and to communicate well with the team. Afterwards be sure to evaluate the effect of the decision. It is important to avoid decision traps like bias, anchoring, and overconfidence. Settling on one possible cause of the patient’s problem early and failing to consider other options can lead to many problems.
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