Another great year of the JEMS Games competition is in the books. A big shout out goes to the Cumberland County EMS/Duplin County (N.C.) for winning the gold at the annual event during the EMS Today Conference & Exposition. The competition gets closer and closer each year. With newcomers and veteran teams alike continuing to demonstrate the highest level of clinical care around, event organizers and judges learn something new each year.
The competition spans two days, starting with a preliminary competition. The preliminary round is an obstacle course with a series of stations that test the participants’ efficiency in performing skills. The top three teams go on to the final competition, in which the teams are immersed in a scenario designed to push them to their limits.
One of the principal purposes of the competition is to provide an alternative and exciting method to teach providers how to improve the care provided on the streets. Those who compete often spend significant time leading up to the competition thinking of ways and practicing techniques to maximize the efficiency of their care. In the final competition, providers discover personal strengths and weaknesses while testing the soundness of the simulation, promoting improvement not just for participants’ skills but for the next competition. Spectators also benefit from the chance to observe top-notch care and perhaps walk away with some ideas they would like to implement in their day-to-day jobs. Despite the fact that the focus is on winning, the strategies employed by the teams—as well as the mistakes they make—can easily carry over to the streets.
Analysis of the 2010 Games
The participants did countless things well with this year, the first of which is airway management. Each provider had a slightly different approach to this station, the second of the preliminary event, but all aproaches were effective. Most teams demonstrated accurate ventilatory technique, which is vital to patient outcomes. The judges saw a lot of skill and grace when teams performed the intubation.
The cardiac station also always proves interesting, and this year was no exception. There are as many approaches to this station as there are competing teams. The teams that stood out the most on this skill were the teams who decided ahead of time exactly which responsibilities would be handled by each team member. In the finest example of this, one person immediately took and kept control of the cardiac monitor, another team member went directly to the IV, and so on. Using this approach, nobody has to guess what the other team members are doing.
Experience tells us this is a great way to maximize patient care on the streets as well. Have you and your partner ever specifically assigned task responsibilities? Even if you’re working with a new partner for a day, it’s best to converse first thing and be on the same page about what the other will do in the first several minutes of a particular call.
For every 10 skills performed well, there was at least one mistake that would adversely affect patient care in the real world. As you might imagine, the mistakes primarily occurred in areas of our practice we don’t use very often. For instance, we saw a handful of teams struggle with the Emergency Response Guidebook. A teaching point from this is that any item in the book that’s highlighted is toxic when inhaled. Because of this, providers must immediately turn to the green section of the book and follow the directions. Several teams skipped the green section and utilized only the orange section.
This next suggestion can, at least in part, be chalked up to the collective competition mentality, but still warrants a reminder. It’s really quite simple: BLS before ALS. Of all the teams participating in the competition, only a very small percentage actually performed BLS foreign body airway obstruction techniques while preparing for laryngoscopy. Whether it’s the street or competition, we know that BLS techniques are vital to effective care.
We also consistently see a large number of incidents in which a patient would have suffered dental trauma as a result of laryngoscopy techniques. Proper technique with the laryngoscope on an average adult should allow enough space to fit a pencil between your blade and the patient’s teeth. Don’t be afraid to ask your partner to help stabilize the head, both in training and on patients, so you can minimize dental trauma.
Invariably we run into roadblocks and challenges. It’s a great idea to have a systematic approach to unanticipated problems. It doesn’t have to be as long a process as if we were flying to the moon, but a couple quick steps to help identify and eliminate the problem will go a long way. With endotracheal tube problems, we sometimes refer to the acronym DOPE (displacement, obstruction, pneumothorax, equipment issues) to try to identify the issue before just pulling the tube. Have a similar approach to problems when they arise and always include an thorough equipment check.
I specifically recall an instance when a team was attempting to infuse dopamine for their hypotensive patient. The provider piggybacked the medication line to the port closest to the normal saline bag, then closed the clamp on the main IV tubing. In doing this, the provider unknowingly shut off his dopamine! The team spent a great deal of time trying to figure out the problem when a systematic troubleshooting approach that included simply taking a step back and looking at the equipment may have solved the problem in no time.
All things considered, there’s little debate about the biggest learning point to come out of the competition, and it’s virtually the same year after year—communication. The teams that communicate the best routinely perform well in both competition and in real life. Many of us are not the greatest communicators in the first place. Add the stress of a large quantity of critical patients, and communication takes a back seat. Every post-incident review I’ve ever attended involved communications on some level or another as a needs-improvement area. It’s not just a matter of communicating more, but communicating more efficiently and effectively. Think you’re a good communicator? Convinced you and your partner excel at communicating? I challenge you this: Put a blindfold on your partner and direct them to complete a patient scenario using only your words. Spend an entire training session specifically devoted to communication. Not radio traffic communication, but the true interpersonal communications. Communication is the key to any relationship in existence.
So much of what we do on the streets is just plain old habit—and it has to be. Even the less common skills and techniques need to be habit, but that’s not always the case. Don’t let apathy or complacency get in the way of your ability to continually improve. If you think you have what it takes, then we look forward to seeing you at the 2011 JEMS Games. We have already started dreaming up the final scenario, and we’re confident you will enjoy it.