FEATURE
Florida Emergency Nurses Travel Overseas to Learn about Emergency Care By Terri Repasky,
APRN, MSN, CNS, CEN, EMT-P Before COVID-19 changed our world, five emergency nurses — three from Northwest Florida and two from Northcentral Florida — joined other emergency department RNs from around the country on a cultural exchange trip to the Netherlands and Stockholm, Sweden to learn about emergency care in those countries. They visited three different hospitals and learned about pre-hospital emergency medical systems. The trip was organized by the national Emergency Nurses’ Association (ENA). The nurses spent 10 days observing, learning, sharing and comparing their practices in the USA with nurses and medical staff in the two countries. ENA international member and current board member, Joop Breuer RN, CEN, CCRN, FAEN, is a staff nurse and educator at Leiden University Medical Centre in Leiden, Netherlands, and served as host. Leiden University Medical Centre was founded in 1575 and the medical school in 1636. It is said that Albert Einstein studied there. The emergency nurses were able to compare the health care systems with that of the U.S. One notable difference in EMS is the make-up and education level of the EMS teams. Ambulances are staffed by a critical care nurse and are driven by 46
By Christie Jandora, BSN, RN
a driver with basic training. Helicopters are staffed by physicians. They may respond to a scene and provide care, but not transport the patient. Ambulances are well dispersed throughout the country and can respond to any location within about 20 minutes. EMS nurses treat the patients on scene and make a decision of whether or not to transport to a hospital. Nurses work with protocols and can contact the hospital ED for assistance if needed. Unlike the U.S, there is only one ambulance company for the entire country, so there is consistency in training, protocols and processes. First responders may respond to a motorcycle (see photo to right) as opposed to an ambulance. U.S nurses were impressed with the large, enclosed ambulance bay at the hospital. They noted that many hospital EMS receiving areas in the U.S. are drive-through, open areas, while this one was more “garage like” and extremely clean (see photo above). Emergency departments may be “open or closed,” and patients are transported or assigned to either depending on their condition. Even if it means bypassing multiple hospitals, a patient with a fracture is transported to the hospital specializing in orthopedics. Academic/Teaching hospitals often receive the more complex patients. Low-acuity patients or EMpulse Summer 2020
By Lauren Sanguinetti, BSN, RN, CEN
those needing minor surgery may be transferred out of the academic centers to other hospitals. There is no such thing as EMTALA. Triage nurses may refer to a nearby urgent care or to a primary provider if the patient’s condition does not warrant an emergency department visit. The most used ED triage system is the Manchester Triage System (MTS). The MTS is a 5-level, color-coded system similar to ESI used in the U.S. Another difference noted was the lack of routine security with medications. U.S. medical personnel are used to medications being behind locked doors or in locked distribution systems like a pyxis. They noted, in at least one hospital, that medications were not locked. Staff in that particular hospital reported that they did not have an opiate crisis there. Staff also reported a very low rate of mental illness, especially patients requiring admission, but they are well prepared for it. Under the socialized medical model, access to care is readily available to the homeless population, and the homeless appear to be well managed and cared for. It was noted that this most likely contributes to the low volume of mentally ill in the EDs. Physician/nurse working relation-
