1. Roma Bhatia and Egor Buharin
Mentor: Zachary Meisel, MD

2.  Pre-hospital emergency medical services
(EMS) provide care for over 20 million
patients annually.
 Nearly all episodes of EMS care are completed
when the provider “hands off” a patient to
emergency department (ED) personnel.

3. ◦Examine attitudes, beliefs among a diverse group of
stakeholders and participants
◦Characterize perceptions of barriers to high quality
handoffs; to identify variations in these perceptions
by thematic factors.
◦Characterize perceptions of relative value of EMS
handoffs as it relates to patient safety among a
diverse group of stakeholders.

4.  Job description
 Salary
 Education/training

5.  Perform tests essential for the detection,
diagnosis, and treatment of disease.
 At times, assigned to aid nurses in the
Emergency Department when exceptionally
busy.
 $26,000 annual salary
 Bachelor of Science, majoring in clinical-
laboratory science (4 year degree)

6.  Assess injuries, administer emergency
medical care, and extricate trapped
individuals. Transport injured or sick persons
to medical facilities.
 $36,000 annual salary
 140 hours course (often completed in 3-6
months)

7.  Entirely encompasses EMTs scope of practice.
 Paramedics are trained in the use of 30-40
medications, depending on the state.
 Set-up IVs and administer advanced airway
maintenance intervention.
 $55,000 annual salary
 1400 – 1800 hours training (2 year degree)

8.  Treat patients, educate patients and the public about
various medical conditions, and provide advice and
emotional support to patients' family members. RNs
record patients' medical histories and symptoms,
help perform diagnostic tests and analyze results,
operate medical machinery, administer treatment and
medications, and help with patient follow-up and
rehabilitation.
 Mean salary: $72,000
 Bachelor's degree, an associate degree, and a
diploma from an approved nursing program (2 to 4
years)

9.  Diagnose illnesses and prescribe and administer
treatment for people suffering from injury or
disease.
 Examine patients, obtain medical histories, and
order, perform, and interpret diagnostic tests.
They counsel patients on diet, hygiene, and
preventive healthcare.
 Annual salary: $234,000
 Undergraduate (4 yrs) + medical school (4 yrs) +
residency (3 yrs) + fellowship (2 yrs) = 13 years

10. Healthcare Personel annual Salaries
$80,000
$70,000
$60,000
$50,000
Annual Salary
$40,000
$30,000
$20,000
$10,000
$0
Medical Tech EMT Paramedic Nurse
Medical Tech $26,000
EMT $36,000
Paramedic $55,000
Nurse $72,000

11. Annual Salaries of Healthcare Personel
$250,000
$200,000
$150,000
Annual Salary
$100,000
$50,000
$0
Medical Tech EMT Paramedic Nurse ER Physician
Medical Tech $26,000
EMT $36,000
Paramedic $55,000
Nurse $72,000
ER Physician $234,000

12. Years of Initial Training of Healthcare Personel
14
12
10
Years of Initial Training
8
6
4
2
0
Medical Technitians EMT Paramedics ER Nurse ER Physician
Medical Technitians 4
EMT 0.5
Paramedics 2
ER Nurse 4
ER Physician 13

13.  Dispatched to fall incident.
 Unresponsive 68 year old male.
 Relative – Claims p/t suffers from history high BP
 Show altered mental status (signs of stroke)
 Hospital choice
 Divert + Stroke Center vs Non-Divert hospital

14.  Use of focus groups vs. surveys
◦ How are points of view constructed?
◦ How are points of view expressed?

15.  7 X 1 hour focus group
transcripts
 Focus groups divided
by professional
category
 Participants offered
refreshments and $25
gift card.

16.  Annual Meeting of the National Association of
EMS Physicians (NAEMSP)
◦ Includes: Physicians, paramedics, nurses,
administrators, educators, and researchers.
 Conducted focus groups:
 EMS medical directors/physicians;
 Non physician EMS professionals;
 Nursing personnel.

17.  EMS Today/JEMS Conference and Expo
◦ Largest national convention for EMS professionals—
with over 4,000 members in attendance.
 Conducted Focus Groups:
◦ EMT paramedics-extensive training, broad scope of
practice.
◦ EMT basic/intermediate-limited training, limited
scope of practice
◦ Nursing personnel

18.  Conduct separate groups
◦ To maximize the shared experiences
◦ Known authority gradient (e.g., between medical
directors who supervise paramedics and
paramedics themselves)
 Utilized sampling model to obtain variety of
professionals in genders, races, and training
levels.
 Moderated by Dr. Zachary Meisel, MD (PI).

19.  Explore how the handoff usually occurs.
 Examine positive or negative experiences
associated with handoff.
 Determine important components to
communicate/know in handoffs.
 Understand barriers to high quality handoff
 Evaluate the role of trust/perceived trust in
handoffs
 Assess global and relative value of handoff
process as compared to other key aspects of
emergency care.

23. Roma

25.  To obtain
inter-rater
reliability

26.  Attitudes/judgments towards me
 Receptiveness
 Mannerisms/personality/professionalism
 Relationships/familiarity/socializing
 Competence

27. Structural Aspects
Who? Where? When? How? How long?
Attitudes and
beliefs
Process
• Training
outcomes
• Local
• Time to
culture
Antibiotics
• Trust
• Door to
• Perceived
Balloon
Trust
Patient • tPA window
Factors for stroke
• Race
• Age Patient outcomes
• Gender
• Acuity

29.  [paramedic referring to a specific hospital]
◦ “… I am pretty capable of convincing patients to not
make me take them to [Hospital X] because I don’t
want to deal with the nursing staff there.”
◦ “There’s a hospital near me that I will not go to
because of the attitude unless it’s a trauma that you
have to go there.”

30. ◦ “I now feel much better knowing that they trust my
treatment, knowing that they trust my assessments
and things of that sort and being able to
handle…like it’s a lot easier going in there.”

31.  The role of EMT’s in healthcare
 “And that we are not glorified taxi drivers.”
 “Because I think there’s so many people that don’t
understand EMS that work in the hospital setting, and
… having somebody that understands EMS and doesn’t
just look at us as ambulance drivers that brought the
patient, and realize what we can do in the field, to be
able to interact on that level I think would really help
as far as being able to relay information.”

32. Mod: So how often does that happen where you get to talk to even
a doctor when you bring the patient in?
 R: Not often enough.
 R: Not often. You talk to a nurse more than anything. And
sometimes you don’t even get a nurse. Sometimes you get a…
 R: Nursing assistant?…
 R: Or yeah, an ER tech. Now pretty much an ER tech is our
level…
 R: The same level [as EMTs] and it’s not even worth it like to
sign off because you’re not even really passing it to a person of
higher authority.

33. ◦ “Sick is sick. You’re a hospital. It doesn’t say at the
front door “We only take traumas only. Sick people go
next door.”
◦ [referring to Trauma cases] “They’re the ones you had
your business for.”

34. ◦ I came in with this lady, she was pretty bad, in her
eighties. And I came in and of course they [hospital]
were on diversion… But so I walked in and they had no
idea I was coming in and they just looked at me like a
deer in the headlights, like “What are we supposed to do
with the patient ?” They didn’t have anywhere to put it
or… And I was just like “Help please!” And the doctor
was very rude . She was just like “Why do you keep on
coming here with these sick patients? We’re on divert.” I
mean the hospital was like two blocks from her house so
I really didn’t have a choice. And it didn’t make for a
very good experience and the nursing staff was very
nasty. They just kept on telling me “Don’t come back.
Don’t come back again. Don’t come back.”

35. Mod: What do you guys do if there are…if you feel like you’re
talking past each other
I just reiterate why, my point, and then I laugh at them when they
rush right up to CAT scan when they find something. And they
come “Well oh, it was something.” Maybe next time you should
listen to the paramedic, you know.
[In response to hospital disrespect targeting EMS]
Mod: So you think that some of that is personality trait or…
 And that’s when they have a personality… And I do a little
planning or games and ok, well now you’re getting the next
fifteen patients ‘cause you ticked me off with this one. And
that’s not the right thing to do, but unfortunately I think in all
walks of life you have all… Depending on personalities…

36. Structural Aspects
Who? Where? When? How? How long?
Attitudes and
beliefs
Process
• Training
outcomes
• Local
• Time to
culture
Antibiotics
• Trust
• Door to
• Perceived
Balloon
Trust
Patient • tPA window
Factors for stroke
• Race
• Age Patient outcomes
• Gender
• Acuity

37.  Study is first evaluation of the pre-hospital to
hospital transition of care.
 Goal: inform local and large scale efforts to
improve the process.
 Next step: trials of quality improvement
informed by the results of these studies.

38.  Personality, professionalism, and mannerisms
can drive patient outcomes.
 Poor standardization of the healthcare
system.
 Modes of deriving statistical significance from
qualitative data.

39.  Job Descriptions: BLS.gov
 Salaries: specified to the Philadelphia region –
indeed.com
 Hypothetical: Egor’s experiences in EMS

40.  Dr. Zachary Meisel
 Joanne Levy
 Lissy Madden
 Meagan Pellegrino
 Hoag Levins
 Renee Zawacki
 SUMR Sponsors
 SUMR Scholars