NASHVILLE — A pharmacist can collaborate with EMS to improve patient outcomes and deliver education to paramedics to avoid drug administration mistakes and errors. A pharmacist, as a pharmacology subject matter expert, can also participate in protocol development, EMS research investigations and quality management committees.
Kevin Collopy, clinical outcomes manager for NHRMC AirLink/VitaLink Critical Care Transport; and Daniel Hu, emergency department pharmacist at Providence St. Peter Hospital, described how a pharmacist can work closely with EMS personnel in a session at EMS World Expo.
Memorable quotes on an EMS pharmacist
Here are memorable quotes from Collopy and Hu on pharmacist education, responsibilities and EMS interactions.
When working together, “we can all see the patient as a whole person and see what each caregiver is seeing.”
“My job is to make sure medications are used safely and effectively. I can catch mistakes that you [paramedics] make and help make corrections to avoid mistakes.”
— Daniel Hu, BA, PharmD
“I am expert in prehospital care. It’s OK for me to not be an expert in pharmacy or neuro-surgical intervention for stroke. I am not an expert, but let’s go find one.”
“It’s a really neat relationship when we combine paramedics with emergency medicine physicians and pharmacists.”
“Every protocol we update, our pharmacist reviews. He looks to make sure the drugs we are selecting are going to be continued and used in the hospital. Maybe the hospital needs to update [its pharmacy].”
— Kevin Collopy
Top takeaways on how a pharmacist can improve EMS patient care
A pharmacist collaborating with EMS and educating paramedics is a novel idea. Most of the session attendees had little regular or no interaction with a pharmacist. Hu and Collopy provided many examples of how a pharmacist can impact EMS. Here are four top takeaways.
1. Protocol improvement
Prehospital medications continue to impact patient care after hand-off at the emergency department. Because paramedics can administer many medications, a pharmacist can assist in protocol development and improvement. Hu shared specific conversations he’s had with paramedics about succinylcholine versus rocuronium and ketamine administration.
Collopy shared several examples of collaborating with an emergency department pharmacist to improve protocols, including:
- Increasing dose of a prehospital administered antibiotic
- Making fentanyl doses consistent across different protocols
- Ensuring hospital staff understand the reason tranexamic acid was administered to a patient before hospital arrival
Collopy’s pharmacist participates in preparing and delivering training related to drugs added to new or updated protocols.
2. Pharmacology education
Pharmacists bring deep, expert knowledge about pharmacokinetics and can provide instruction to paramedics on absorption, distribution, metabolism and excretion. A pharmacist can also describe and discuss a drug’s mechanisms, interactions with other drugs, and indications/contraindications. Hu, an emergency department pharmacist, described providing just-in-time education to paramedics as they deliver patients to the emergency department.
“Do you think we gave the right medications?,” Hu said is the question paramedics ask him most frequently. Hu is also regularly asked, “Was there anything we should have done differently?”
Hu is also able to bring evidence-based, recent research knowledge to discussions between paramedics and physicians about whether a medication was correctly given.
3. Pharmacists are not pill counters
The modern pharmacist does much more than move pills from big bottles to little brown containers.
“Pharmacists have demonstrated a positive impact on patient-specific outcomes, timely medication administration, optimization of therapy, medication safety and cost of care,” Hu said.
Collopy and Hu shared many examples of collaboration between pharmacists and physicians, nurses, respiratory therapists and paramedics. They even suggested an ambulance ride-a-long for pharmacy students, and paramedics spending a portion of their clinical time with an emergency department or intensive care unit pharmacist.
4. EMS and pharmacy research collaboration
Finally, doctor of pharmacy residents have a research requirement, and every EMS agency has thousands of patient care reports. NHRMC has completed two pharmacist-supported research projects and a third project, a randomized clinical trial is currently enrolling patients:
- Cefazolin administration in prehospital trauma patients
- Prehospital RSI induction via ketamine or etomidate
- Ketamine versus etomidate in RSI (ED versus EMS) a randomized clinical trial
Learn more about pharmacology
Here are some other articles from EMS1 on EMS-administered drugs and learning pharmacology.
- Drug Whys: Common Medications Explained column by Mike McEvoy
- 4 steps to prepare for prehospital antibiotic administration
- 10 tips for learning pharmacology
- 6 pharmacology study tips for paramedic students
- 5 ways to eliminate dosing errors
- Strategies to reduce medication errors
- Ketamine a safer option for agitated patients and providers
