An ER Nurse’s Experience Shadowing EMTs
Written by: Emma Doherty, RN
My clinician told me about halfway through my new grad nurse residency program in the emergency room that each nurse goes on an EMS ride-along. This is also called a third rider. Every ambulance has an EMT and paramedic. The residency program implemented ride-alongs to ensure all the nurses understood and appreciated both sides of emergency services. The hospital teamed up with our local fire station to provide us this cool experience. I still remember feeling excited and nervous in that moment.
The ride along began at one of our local fire stations that housed the ambulances. Fortunately for me, the station I was assigned to is the same one that reports to my house if I ever called 911. I was interested to see their responsiveness and get insight into “my own” local station.
About the Day
I arrived at the fire station at 0700, freezing cold might I add. First, we checked off all the medications and stocked the truck. The mini arsenal of medications available to the paramedics (including adenosine, calcium chloride, atropine, sodium bicarbonate, magnesium, and so on,) took me by surprise. I learned that while these medications were not always used on the truck, it’s crucial to have them on hand. The paramedic then showed me all the different types of airways they kept on the truck. When it comes to life-saving medications and equipment, if it’s not on the truck, it’s not happening
Throughout the day, I also witnessed how incredibly skilled the medics were at advanced care life support (ACLS) within their scope of practice. The options medics have in order to do what they need to do “out in the field”, with little to no external resources, is extremely admirable. They told me some amazing stories of starting an external jugular (EJ) IV for venous access while on the ROAD. So impressive! Especially because where I worked, only providers were allowed to start an EJ.
Finding Calm in the Chaos
I gained even more appreciation once we hit the road, and I realized just how bumpy it is in the back of an ambulance. IVs can be hard enough with a calm, non-moving environment. Imagine trying to start one going 60 MPH down the highway!
Speaking of the environment, the scene of the calls we went on kept me on my toes. Even more so when comparing it to the somewhat controlled environment of the hospital. At one of the scenes, police had to clear the area to ensure everyone’s safety before the ambulance could move on scene. At every stop, I hopped out with the “jump bag”, trauma kit, or “go kit” with my adrenaline pumping. I never knew what to expect.
The medics provided so much kindness and care to each individual involved in the call. Regardless of it being their 24th or 48th hour of their shift, they were compassionate. It didn’t matter if the patient was calling about toe pain they had for the last 18 years, or if they were calling about a heart attack.
Report: What Happened, What was Done. Forget the Rest.
Transporting back to the hospital gave me insight into what makes a good report. Some details are more important than others, and this experience really drove that home. Giving report to the ED nurse regarding the time from picking up the patient to arriving at the hospital, gave me the chance to nit pick and tailor the events. I worked at giving a clear and concise report. I found it most important to tell what occurred and what was done about it en route. The experience tailored all my reports going forward. They are still short, sweet and to the point.
I am so grateful for this eye-opening opportunity. They taught me so much about medics’ scope of practice, starting IVs, giving meds in a moving (and bumpy) vehicle, and how to give a successful/relevant report. I hope more nurses can experience EMT ride-alongs, especially those working in emergency medicine. It’s a great way to bridge the gap between expectations versus reality when it comes to patients arriving by ambulance. I have an even greater appreciation for all paramedics, EMTs, 911 operators and all individuals working in emergency medical services!
Edited by: Claire Lang, RN-BSN