As an ED nurse in Hong Kong, I find it not uncommon to meet and receive a handover from the paramedics, either at the triage station or before the resuscitation. However, have we fully grasped what happened on the scene in that 30-second glimpse? Have we ever wondered what happened before arrival? Have we ever questioned why the Paramedics would manage the case that way? I participated in the 7th Asian EMS Competition held between 18 and 20 February, and here comes my humble thought.

As one of the activities of the 7th EMS Asia Conference held in Hua Hin, Thailand, the competition aims to enhance the ongoing exchange of knowledge and experience and build new and lifelong bonds between the Asia EMS Community. HKSEMS sent out a team with an EM doctor, an ED nurse, and 3 paramedics this year. The team, alongside 12 other teams from Hong Kong, Japan, Thailand, Taiwan, and the Philippines, competed in the Preliminary Round: Management of Out-of-Hospital Cardiac Arrest (ACLS), Management of Trauma (PHTLS) and Special Scenes/Critical Care Transport. Our team qualified for the Final Round with the New Taipei City and Tainan teams and was awarded 2nd in Asia.

My seniors always joke that we, as AED Nurses, work under air-conditioning, while the pre-hospital environment differs from our usual workplace. Besides the unexpected weather, we work with a rather big group of colleagues, and helping hands are just steps away. However, in the pre-hospital setting, it will just be you and me. While resources and staffing are limited, using bystanders plays an essential role in the pre-hospital setting: Performing CPR, Cordoning off the area, or providing guidance to the retrieval team, to name a few. "Scene Safe" is no longer just a slogan; it aims to examine the Mechanism of Injury (MOI) and safety hazards and request extra assistance if needed. If we equip this mindset, we can anticipate the challenges and problems ahead of us.

We might be familiar with intubation; we might be able to operate blood transfusion while we are entirely newbies to SKED stretchers or managing a Mass casualty incident (MCI). In this competition, we must adopt new assessment and management methods, focusing on the ACLS and using the Pre-hospital Trauma Life Support (PHTLS) algorithm developed by NAEMT. This systematic trauma management derives from ATLS principles: Airway, Breathing, Circulation, Disability, and Exposure, but also focuses on X: Management of Exsanguinating hemorrhage. Dr. R A Cowley’s “Golden Hour of Trauma” principle has taken root in the course's development. It is believed that if we could control the bleeding and maintain the perfusion in Platinum 10 minutes after the trauma happens, the mortality rate would be significantly reduced. As ED Nurses, we have encountered the TNCC training, which focuses on the principles and workflow but limited time spent on equipment usage. Through training before the competition, ED personnel learned how to apply neck collars (Just an example), while Paramedics also gained experience in diagnosing and running through those algorithms. The exchange of ideas shall not be limited to the classroom or the triage station but also to our daily encounters.

In Hong Kong, Paramedics-learners undergo 26-week intensive, skills-focused training in the Fire and Ambulance Services Academy (FASA) before they hit the road. As Nurses, we adopt a rather scholarly-based approach. The differences have shaped a distinct learning approach and expectation between us. Malcolm Knowles promoted the renowned “Adult-Learning Theory” or “Andragogy” in 1968. It draws our attention to the Self-Concept, Adult Learner Experience, Readiness to Learn, Orientation of Learning, and Motivation to Learn of an Adult Learner. Recognition of prior learning and mutual respect are key to building rapport. During the rest of the training, a phenomenon always rings my bell. We are used to administering and titrating medications according to body weight. Thus, we are usually given a range of dosages (e.g., Rocuronium 1-1.5ml/kg of Ideal Body Weight in RSI), and we double-checked with our medical colleagues after quick calculation. While for Paramedics team-mates, they usually urge for an exact dosage：

「1ml就係1ml，1.5ml就係1.5ml，即係幾多ml？唔準諗，即刻答。」

You may attribute it to “laziness," but if we could take a step back, step into their shoes, regarding the differences in their educational background, it is not difficult to relate it to their daily experiences: How could we calculate the dosage of specific medications, when someone is talking to you about their worries of the patients; your team-mate is asking for your opinion on particular adjuncts, while you are also working on managing the critically-ill? We are all trying to save lives; thus, having more understanding of each other could lead to better patient outcomes.

“It always seems impossible until it is done," a famous quote from Nelson Mandela, is always stuck in my mind. Joining this team 3-week before the departure has allowed me to reflect on my growth as a Nurse or a volunteer pre-hospital personnel member. From the 1st day of training till the moment of announcing the result, I always thought that I had greatly hindered the team's success (Well, yes, in some sense), as I am not perfect. But this experience makes me believe that working together on the same track is already the best shot we can get. Sometimes, the Paramedics called themselves “White Taxi," sometimes, the Nurses named themselves “Assistants to Doctors." But if we perceive and uphold this self-image, we are what we thought; it will be a disaster. At times when we are evolving the idea of authority to practice, let us not forget our calling and uphold professionalism. Next time we meet our Paramedics at the Triage Station, let’s take some time to understand and listen; then, we will be healthcare professionals.

Special thanks to our trainers: Dr. KL MOK, Dr. Irene LO & Mr. Bob YEUNG, as well as my teammates and their family members for unfailing support: Dr. Marcus LO; Mr. Koch YIU; Mr. Dodo TO & Mr. Roy CHEUNG