How to Achieve Effective Teamwork in EMS

Jim and Tom, in Ambulance 5, are dispatched by the sheriff’s department to the scene of an auto accident along with the Bear Creek Volunteer Fire Department. Jim is driving and Tom is the crew paramedic and ambulance leader. The fire department arrives first and lets the ambulance crew know they have one individual injured due to a truck overturning on a gravel road. Tom asks the firefighters the extent of the injuries. The fire chief relates that the patient is complaining of neck and back pain; however, there appears to be no other injuries. Tom instructs the firefighters to stabilize the patient, including securing his neck with an emergency neck collar, placing the patient on a backboard and securing the patient to the backboard.

Jim and Tom arrive on scene approximately seven minutes after the call went out, just as firefighters finish placing the patient on the backboard. Tom begins checking the patient’s airway, breathing and circulation, and assesses all vital signs. Jim palpates the patient starting with the head and working down to the feet. So far there’s no bleeding and the only major injuries identified are pain in the neck and back. With the assistance of firefighters the patient is loaded into the ambulance. Tom thanks the firefighters and he and Jim begin the patient transport to the hospital. The patient’s vitals are checked every five minutes and the hospital is informed of the patient’s neck and back pain. Tom also applies the appropriate pain medication. Jim and Tom arrive at the hospital and provide a brief description of the accident and the patient’s complaints, including neck and back pain.

After an hour at the hospital the hospital staff let Jim and Tom know that everything is going well and there are no major injuries. The hospital thanks the ambulance crew for their outstanding work. As usual, Jim and Tom worked well together and did everything they could to ensure appropriate patient care. Teamwork and leadership were vital to ensuring success.

Defining Teamwork in EMS

Teams are defined as two or more individuals who interact and coordinate their EMS work to accomplish a shared goal or purpose. Teams are EMS organizational groups composed of individuals or members of the team who share common goals and who coordinate their activities to accomplish the goals and response requirements. Additionally, the EMS team shares mission requirements and collective responsibilities.

Research on the effectiveness of organizational teams has suggested that the use of teams leads to greater productivity, more effective use of resources, better decisions and problem solving, better services, and increased innovation and creativity.¹ In an EMS team, leadership is shared between individuals of the crew to ensure effective response to critical EMS-related situations.

Further research data from numerous teams show that effective leaders keep the team focused on the goals.² Additionally, trust is based on honesty, openness, consistency and respect, which is essential to building a collaborative climate so EMS team members can stay focused, be open with one another, listen to each other, feel free to take appropriate risks and be willing to compensate for each other.

The team leadership model has three aspects³. The first decision for EMS leaders should be whether specific actions are the most appropriate to ensure the success of the team. The second strategic decision facing EMS leaders involves determining which team needs must be addressed to ensure tasks are accomplished so that team dynamics aren’t negatively affected. The third decision for EMS leaders is determining the most appropriate function or skill required to address performance in all emergency situations.

Team development is very important to ensure successful EMS response and treatment of patients. It goes through four distinct stages: forming, storming, norming and performing.⁴ These stages are very important to establishing a productive response team.

During the forming stage of team development there is a period of orientation and getting acquainted with one another. Team members concentrate on figuring out which behavior is acceptable to others, explore friendship possibilities and determine task orientation. It’s important to work as a team to establish behavior that supports the mission, including establishing a constructive and effective relationships with patients. It’s also important to identify and establish friendly partnerships, which ensure the EMS team works together and gets along in the field during stressful moments. Task orientation includes such things as who is driving the ambulance and which individual is working in the back to treat the patient. These tasks can also be interchangeable, as well as establish an environment of learning to enhance current and future skills.

The storming stage showcases individual personalities in greater detail. There may be conflict, disagreement regarding leadership roles and differences about team participation during this stage. But the team and its leader must move past these conflicts that would otherwise prove detrimental to critical EMS responses. The team leader works with team members to encourage participation and assist them in finding a common team vision so the team can successfully respond in emergencies.

During the norming stage, conflicts, disagreements and differences are resolved and the team becomes unified. Consensus develops to ensure the team works together and understands the diverse roles of EMS providers. Basically, the EMS team members come to understand and accept each other. The team leader emphasizes openness within the team and continues to facilitate constructive and cooperative communications.

The final stage is performing. Here the team works together seamlessly to provide exemplary patient care. The team works interactively, coordinates its actions, handles disagreements in a mature manner, and supports each member.

Team effectiveness is defined as achieving four performance outcomes: innovation/adaptation, efficiency, quality and team member satisfaction.⁴ Innovation/adaptation is the degree to which EMS team members effectively respond to operational needs and changes. Efficiency relates to whether the team helps the organization achieve goals using appropriate resources and providing the right treatment for the patients. Quality refers to achieving fewer defective issues and treating the patient responsively and effectively. EMS team member satisfaction pertains to the team’s ability to maintain appropriate emergency and patient care commitments, as well as enthusiasm in meeting mission operational requirements.

Team cohesiveness is defined as the extent to which EMS members stick together and remain united in the pursuit of common goals and the operational mission. The EMS team members feel they are responsively and significantly involved in ensuring the team is working together. Team cohesiveness includes team interaction, sharing mission and goals, and ensuring the team finds their common ground and has similar attitudes and values including enjoying working together. These are important aspects to achieving team cohesiveness and sustaining a cooperative and effective EMS support environment.

The information presented above is a summary of items for consideration to establish a responsive, effective and efficient EMS team. Providing successful and appropriate teaming and leadership skills is vitally important to ensuring the success of any EMS organization.

References

1. Parker GM. Team players and team work. San Francisco: Jossey Bass, 1990.

2. Lafasto FMJ, Larson CE. Teamwork: What must go right/what can go wrong. Newbury Park, CA: Sage Publications, 2001.

3. Northouse PG. Leadership theory and practice. Thousand Oaks, CA: Sage Publications, 2004.

4. Daft RL. The leadership experience. Canada: Thomson Southwestern, 2005.

Paul Breaux has a PhD in leadership studies. He conducts research in EMS, firefighting, law enforcement and military leadership environments and his dissertation is on emergency medical leadership in five surrounding counties in Texas. He has been a volunteer licensed paramedic (LP) for Bandera County Texas EMS for the past 12 years. He is also an adjunct professor at Our Lady of the Lake University in leadership studies.