By Emily Peters, MA, EMT, CIC; Michael Doyle, DO, NRP
You’re the paramedic standing at the foot of a stretcher in a crowded ED code room, staring down at the patient. His wife called 911 2 hours ago, screaming after she found him slumped next to the toilet, covered in vomit. You’re sweating after carrying him down the narrow staircase, loading him into the rig and struggling for an IV — too few hands, too much to do.
You’re the doctor, listening to the paramedic’s report.You just walked out of another room where you told a patient they’ll need more testing, but the CT scan “is concerning” for cancer.You aren’t sure they understood.You’re trying to focus, but your other patients pull for your attention. You can’t remember what the paramedic just said.
The paramedic pauses, “Anything else you need from me?” and heaves a sigh of relief after walking out of the room.
This high-stakes scenario occurs countless times, every day and night, in emergency departments across the country, in situations often wrought with anxiety, criticism and alienation.Patient turnover is a fragile moment in prehospital care.Healthcare workers from EMS and ED teams operate under different systems, in unique environments, with complex pressures and treatment pathways. Yet, they care for the same patients with the same pathologies.
How do you unify two teams with vastly different jobs — yet the same patients — around best practices and evidence-based medicine? Can you do so while building camaraderie among these teams? Can it be done in an engaging and cost-effective manner?
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How journal clubs can bridge the gap between healthcare disciplines
We think an EMS-focused journal club is the perfect constellation of these goals. In 2024, Albany Medical Center launched a regional EMS Journal Club. The success and flexibility of this program is easily replicated in any region, regardless of available resources.We found that the journal club has successfully engaged prehospital clinicians in academic discussions and models a framework for critically appraising literature.
Paramedics and EMTs come excited to explore and deeply engage with their practice on core themes, such as intubation, antiarrhythmics, fluid resuscitation, immobilization, and other regionally relevant topics.
The cost? Free. You can’t beat that, especially in the often financially neglected EMS community.
The format of a journal club is casual and relaxed.We pick two or three articles to review, usually one landmark study and another more recent publication. The invitation to participate is broad, and personnel from local EMS training programs, municipal, commercial and volunteer EMS agencies sit alongside ED residents, fellows, attendings and nurses.Initially, the articles were presented by local ED residents or fellows; however, as our community of practice grew, we integrated presentations from local EMS clinicians as well.
To emphasize inclusivity, the location varies with each quarterly meeting, as events are hosted by different EMS agencies. This further builds camaraderie and draws engagement from wide-ranging service areas, not only forming bonds between EMS and ED teams, but also fostering interagency affiliations. After the main event, the group often congregates at a local venue for a drink and appetizers. Scholarly (nerdy) discussions usually follow.
One challenge we faced was finding ways to effectively communicate the concept of a journal club to EMS clinicians. The name itself carries a strong academic undertone — which could be daunting to prehospital clinicians who feel unqualified to participate in the discussion. We changed the name to “EMS Evidence Review” and welcomed clinicians from multiple educational backgrounds and varying levels of certification.Regardless of the content covered, we encouraged questions and discussion from all participants and at any level of academic rigor.We found this approach successful in encouraging new attendance and participation.
The attendees ask excellent questions. They challenge the practice patterns of the most experienced clinicians and ask the most important question: why? Moreover, we’ve witnessed growth in the regular attendees. They’ve come to future sessions more poised to pick apart flaws or find areas of strength in the papers. This positions them with the desire and skills to foster continued academic inquiry and bring these new skills back to their communities and agencies, broadening the reach of our impact. We felt clinicians leave our conversations with a deeper understanding of the importance of effectively integrating prehospital practice with emergency department evidence-based medicine, leading to a streamlined patient care trajectory.
This model is easy to implement and replicate. We want a journal club in your community. Let us know your thoughts, questions or challenges. We would love to help this be a successful new norm. Let’s bring evidence-based medicine to the streets. Let’s equip our field clinicians with the skills, desire and knowledge to drive their academic growth and bridge the gap between paramedics and physicians.
| MORE: Understanding research and its impact on patient care. David Page, MS; Hezedean Smith, DM; and Ayanna Walker, MD, share best practices for evaluating and interpreting prehospital research
ABOUT THE AUTHORS
Emily Peters is an EMT with over a decade of experience both in the field and in the classroom. She is a passionate educator, leading local EMT classes and teaching composition and rhetoric at a regional community college. Her work focuses on cultivating inquiry, expanding academic accessibility, and exploring rhetorical practice.
Michael Doyle is an enthusiastic EMS physician. He started his medical education at the University of New England College of Osteopathic Medicine. He continued his training at Albany Medical Center where he completed his emergency medicine residency followed by an EMS fellowship. As a recent graduate, he is starting his career at Southwestern Vermont Medical Center emergency department and serving as the local district medical advisor. In his free time, he enjoys the outdoors, DIY home and auto projects, and broadening his skills. He enjoys his time in the EMS community and is looking forward to advancing the field through his role as an EMS physician.
