Chapter 1 EMS Systems

Chapter 1 1 Chapter 1 – EMS Systems 1 - Define emergency medical services (EMS) systems . (p 5) System contains of a team of health care professionals who are responsible for and provide emergency care and transportation to the sick and injured. 2. Name the four levels of EMT training and licensure. (pp 6–8) EMR – Emergency medical responder EMT – Emergency medical technician AEMT – Advanced EMT Paramedic 3. Describe EMT licensure criteria; include how the Americans with Disabilities Act (ADA) applies to employment as an EMT. (p 8) High school diploma or equivalent Proof of immunization against certain communicable diseases Successful completion of a background check and drug screening Valid driver's license Successful completion of a recognized health care provider basic life support (BLS)/cardiopulmonary resuscitation (CPR) course Successful completion of a state-approved EMT course Successful completion of a state-recognized written certification examination Successful completion of a state-recognized practical certification examination Demonstration of the mental and physical ability necessary to safely and properly perform all the tasks and functions described in the defined role of an EMT Compliance with other state, local, and employer provisions 4. Discuss the historical background of the development of the EMS system. (pp 9–10) WWI – Volunteer ambulances were organized and personnel went to overseas to provide care for the wounded. WWII – The military trained special corpsmen to provide care in the field and bring casualties to aid stations staffed by nurses and physicians. Korean Conflict #1 – Evolution of the field medic and rapid helicopter evacuation to Mobile Army Surgical units where immediate surgical intervention could be performed. #2 – Advances in the immediate care of trauma pts. Domestic emergency care-pre 1970s #1 – As recently as the 1960s and early 1970s, emergency ambulance service and care varied widely across the US. #2 – In most cases, emergency vehicles were staffed with a driver and an attendant who had some basic first aid training. Chapter 1 2 Origins of modern EMS – EMS as we know it today had its origins in 1966 with the publication of ACCIDENTAL DEATH and DISABILITY: The Neglected Disease of Modern Society (Known as the THE WHITE PAPER), which revealed the serious inadequacy of prehospital emergency care and transportation in many areas. #2 – Congress mandated two federal agencies to create funding sources and programs to develop improved systems of prehospital emergency care: 1. The NHTSA of the DOT, through the highway Safety Act of 1966 2. The Department of Health, Education, and Welfare (now known as the Department of Health and Human Services), through the Emergency Medical Services Development Act of 1973 1970s #1 – DOT developed and published the first curriculum to serve as the guideline for EMT training. #2 – The American Academy of Orthopedic Surgeons prepared and published the first EMT textbook “Emergency Care and Transportation of the Sick and Injured” in 1971 (often called the Orange Book) #3 – Each state developed legislation, and the EMS system expanded throughout the US. #4 – Emergency medicine became a recognized medical specialty, and fully staffed EDs became the accepted standard of care. #5 – DOT developed a recommended National Standard Curriculum for the training of paramedics and identified a part of the course to serve as training for EMTs. 1980s #1 – Advanced levels of training were introduced to provide key components of advanced life support (ALS) care and advanced lifesaving procedures. #2 – With the evolution in training and technology, the EMT and advanced EMT can now perform important advanced skills in the field that were formerly reserved for only the paramedic. 1990s – NHTSA created the EMS Agenda for the Future, a plan to standardize the levels of EMS education and EMS providers to ensure a more seamless delivery of EMS care across the country. 5. Describe the levels of EMT training in terms of skill sets needed for each of the following: EMR, EMT, AEMT, and paramedic. (pp 10–14) Public BLS and immediate aide 1. Millions of laypeople have been trained in BLS. 2. Many people take first aid courses that include bleeding control and other simple skills that may be required to provide immediate essential care. 3. Many people who regularly accompany groups in situations where the arrival of EM may be delayed are trained in advanced first aid. 4. One if the most dramatic recent developments in prehospital emergency care is the use of an AED. These deices detect treatable life-threatening cardiac arrhythmias and deliver the appropriate electrical shock to the pt. Emergency medical responder (EMR) Chapter 1 3 1. The EMS system includes immediate care by EMRs, such as law enforcement officers, firefighters, park rangers, ski patrollers, or other organized rescuers who often arrive at the scene before the EMTs. 2. EMR training provides skills necessary to initiate immediate care and assist the EMTs on their arrival. Focuses on providing immediate BLS and urgent care with limited equipment. Familiarizes students with additional procedures, equipment and packaging techniques that EMTs may use, and with which the EMR may be called on to assist. EMT An individual who has training in BLS, including automated external defibrillation, use of a definitive airway adjunct, and assisting pts wit certain medications. 1. The EMT course requires approx. 150 hours and provides the essential knowledge and skills required to provide emergency care in the field. 2. On arrival at the scene, you and any other EMTs who have responded should assume responsibility for the assessment and care of the pt and follow the proper packaging and transport of the pt to the ED if appropriate. AEMT 1. AEMT training is designed to add knowledge and skills in specific aspects of ALS to providers who have been trained and have experience in providing emergency care 2. Additional skills include:  IV therapy  Use of advanced airway adjuncts  The knowledge and skills necessary to administer a limited number of meds 3. The AEMT course ranges between 200-400 hours. 4. The purpose is to deliver an expanded range of skills beyond the EMT 5. In some parts of the US, the availability of paramedics is limited and AEMTs help to fill the gap by providing limited ALS care to regions where paramedics are not available. Paramedic 1. The paramedic completes an extensive course of training the significantly increases knowledge and mastery of basic skills and covers a wide range of ALS skills. 2. This course ranges from 1,000 to more than 1,300 hours, divided between classroom and internship training. This training is often within the context of an associate’s degree or bachelor’s degree college program. 6. Recognize the possible presence of other first responders at a scene with EMR training, some knowledge of first aid, or merely good intentions, and their need for direction. (pp 13–14) People such as teachers, coaches, child care providers and others training in CPR. Law enforcement officers, firefighters, park rangers, ski patrollers and other organized rescuers. 7. Name the 14 components of the EMS system. (pp 15–26) 1. Public Access  Emergency communication centers (or public safety access points) can be reached by dialing 9-11 Chapter 1 4  Enhanced 9-1-1 systems identify the cell phone number and the exact geographic coordinates through global positioning system (GPS) technology.  Emergency medical dispatch (EMD) was developed to assist dispatchers in providing callers with instructions to help them deal with a medical emergency until EMS crews arrive. 2.    Clinical Care As an EMT, you will use a wide range of different emergency equipment. Familiarize yourself with the roads in your primary service area (PSA) or sector. Check all the equipment and supplies and communication equipment that the ambulance carries.  It is your responsibility to ensure the ambulance is fully fueled, has sufficient fluids, and that the tires are in good condition. 3. Medical Direction  A medical director authorizes EMTs to provide medical care in the field.  The medical director: Determines appropriate care in a set of written standing orders and protocols Is the ongoing working liaison among the medical community, hospitals, and the EMTs in the service Determines and approves the continuing education and training required of each EMT in the service  Medical control is provided either off-line (indirect) or online (direct). o Online medical control consists of direction given over the phone or radio directly from the medical director or designated physician. o Off-line medical control consists of standing orders, training, and supervision authorized by the medical director.  Protocols identify an EMS physician, usually at a local hospital, who can be reached for medical control during a call.  Once the ambulance crew initiates any immediate urgent care and gives its radio report, the online medical control physician may either confirm or modify the proposed treatment plan or prescribe additional special orders that the EMTs are to follow. 4. Integration of Health Services  The prehospital care you administer is coordinated with the care administered at the hospital.  Some EMS systems collaborate with local hospitals to improve patient outcomes associated with time-sensitive treatment like heart attacks, trauma, and stroke. o Key personnel are ready to begin critical treatments as soon as the patient arrives at the hospital. 5.     Information Systems An information system allows EMS providers to document the care delivered. Information is used for constructing educational sessions for the department. Data from ambulance activity logs are used to justify hiring more personnel. Examining the types of patients and their frequency can provide the foundation for the purchase of new equipment and guide continuing education sessions. 6. Prevention Chapter 1 5 EMS is able to work with public health agencies on both primary and secondary prevention strategies. Primary Prevention Efforts to prevent an injury or illness from ever occurring.  Primary prevention focuses on strategies that will prevent the event from ever happening.  Example: Polio was a devastating disease that caused death and disability for thousands of Americans in the early 1900s. A vaccine was developed to prevent the disease. In the span of one generation, the disease was virtually eliminated. Vaccinations are a good example of primary prevention within public health. o If a major outbreak were to occur in the United States, EMTs may be called on to assist in the administration of vaccinations.  EMTs can contribute to primary prevention efforts by: o Becoming involved in programs that educate the community o Teaching first aid and CPR Secondary Prevention  In a secondary prevention strategy, the event has already happened. The question is, how can we decrease the effects of the event?  Example: There have been significant changes in guardrail construction over the years as more information has become available on what happens during a vehicle collision. 7. EMS Research  Evidence-based practice focuses patient care on procedures that have proven useful in improving outcomes.  All aspects of the EMT role are currently being researched within the academic community and in the practitioner community.  EMTs gather data. o High-quality patient care should focus on procedures useful in improving patient outcomes through sound research.  The International Liaison Committee on Resuscitation (ILCOR), along with its member the American Heart Association, documents guidelines based on large amounts of evidence. These guidelines are an excellent example of evidence-based medical decision making in progress.  Stay current on the latest advances in health care. 8. Communication System Using the information provided by the caller, the dispatcher will select the appropriate parts of the emergency system that need to be activated. 9. Human Resources  The obligation of providing for and protecting citizens has led to the creation of EMS levels that are unique to a particular state. EMS levels can make movement from one state to another complicated.  A key function of the National EMS Scope of Practice Model is to encourage a more consistent definition of "what is an EMT" so providers can move more freely about the country.  The EMS Agenda for the Future encourages the creation of systems that help to protect the wellbeing of EMS providers. o It also encourages systems to develop career ladders. Chapter 1 6 10. Legislation and Regulation  The state EMS office is responsible for authorizing, auditing, and regulating all emergency medical services, training institutions, courses, instructors, and providers within the state.  In most states, the state EMS office obtains input from an advisory committee made up of: o Representatives of the services o Service medical directors o Medical associations o Hospitals o Training programs o Instructors' associations o EMT associations o The public  Daily operations and overall direction are provided by an appointed chief executive officer and several other officers. o When EMS is a part of a fire or police department, the department chief delegates the responsibility for directing EMS to an assistant chief or other officer whose sole responsibility is to manage the EMS activities of the department.  The chief executive is in charge of: o Administrative tasks (e.g., scheduling, personnel, budgets, purchasing, vehicle maintenance) o Daily operations of the ambulances and crews 11. Evaluation Quality Control  To provide the necessary quality control, the medical director and other involved staff: o Review patient care reports (PCRs) o Audit administrative records o Survey patients Continuous Quality Improvement (CQI) A system of internal and external reviews and audits of all aspects of an EMS system.  The continuous quality control (CQI) process is designed to identify areas of improvement and, if necessary, assign remedial training or develop some other educational activity.  The medical director is also responsible for ensuring that appropriate continuing education and training are available. Refresher Training and Continuing Education  When you have not used a particular procedure for some time, skill decay may occur. Your medical director may establish a training program to correct the deficit. Eliminating Human Error  Errors occur from: o A rules-based failure o A knowledge-based failure o A skills-based failure  Limiting errors requires the efforts of both the EMS agency and EMS personnel.  Agencies need to have clear protocols, which need to be understood by all EMTs within the service. Eliminating Environmental Error Chapter 1 7     Are there ways to limit distractions? How do we improve lighting so EMTs can see well? How organized is the equipment? Can the EMT find what he or she needs in a timely manner? Trying to reduce environmental factors regarding errors means having the people with the right equipment in place. Other Means of Eliminating Errors  Knowing the reason for your actions gives you time to reflect and make a more informed decision.  If you cannot come up with a solution, ask for help. Talk with your partner, contact medical control, or call your EMS supervisor.  Use "cheat sheets."  Discussing the events of a call provides an excellent avenue for learning. Such discussions can help lead to changes in: o Protocol o How equipment is stocked o The purchase of new equipment 12. System Finance  EMS departments may have: o Paid personnel o Volunteer personnel o A mix of both  Financial resources are available through: o Taxation o Fee for service o Paid subscription o Donations o Federal/state/local grants o Fund-raisers o Combinations of these  The financial system used depends on the needs and makeup of each EMS department.  EMTs may be asked to: o Gather insurance information o Secure signatures on documents such as HIPAA notifications o Obtain written permission from patients to bill their health insurance company o Regardless of the type of system in which you work, you will help the department secure its financial resources. 13. Public Education  PUBLIC HEALTH - examines the health needs of entire populations with the goal of preventing health problems.  Health care in the United States: o Is expensive  In the United States, more than 17.9% of the gross domestic product is accounted for by health care.  May not deliver the better product o People born in the United States have an average life expectancy of 79 years. Chapter 1 8  There are 35 other countries where people are living longer.  The focus of the public health arm of health care is prevention 14. Education Systems  EMT instructors are approved and licensed by the state EMS office or agency.  EMS training programs must adhere to national standards established by: o CoAEMSP (Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions) o CAAHEP (Commission on Accreditation of Allied Health Education Programs)  To be licensed in some states, an instructor must have extensive medical and educational training and teach for a designated period while being observed and supervised by an experienced instructor. ALS  ALS-level instructors and directors must hold a four-year degree.  Training is provided either in a college, adult career center, or hospital setting.  In most states, ALS training must be approved by the state and have a medical director.  Many lectures and small-group sessions are presented by the medical director or other physicians, nurses, and EMS instructors.  In supervised practice or other in-hospital settings, students are supervised directly by physicians and nurses. Continuing Education  EMTs are required to attend a certain number of hours of continuing education each year.  The required hours are provided by the training officer and medical director.  Most EMS education programs and hospitals offer a number of regular continuing education opportunities in each region.  You may also attend state and national EMS conferences to help keep current about local, state, and national issues affecting EMS.  Because there are many levels of licensing, you should ensure that the continuing education you receive is approved for the EMT. 8. Describe how medical direction in an EMS system works, and the EMT’s role in the process. (p 18) Each EMS system has a physician (medical director) who authorizes the EMTs in the service to provide medical care in the field. 9. Define mobile integrated healthcare and community paramedicine. (p 19)  Mobile integrated health care (MIH) evolved to facilitate improved access to health care at an affordable price. o Health care is provided within the community. o An integrated team of health care professionals delivers health care services and connects patients with other resources.  In community paramedicine, experienced paramedics receive advanced training, including: HEALTH CARE MODEL: in which experienced paramedics receive advanced training to equip them to provide additional services in the prehospital environment, such as health evaluations, monitoring of chronic illnesses or conditions, and pt advocacy. Chapter 1 9 o o o o o Performing health evaluations Monitoring chronic illnesses or conditions Obtaining laboratory samples Administering immunizations Serving as a patient advocate 10. Discuss the purpose of the EMS continuous quality improvement (CQI) process. (pp 20–21)  The continuous quality control (CQI) process is designed to identify areas of improvement and, if necessary, assign remedial training or develop some other educational activity.  The medical director is also responsible for ensuring that appropriate continuing education and training are available. 11. Characterize the EMS system’s role in disease and injury prevention and public education in the community. (pp 23–24)  EMTs are also involved with: o Surveillance of illnesses and injuries  The PCRs generated by EMS personnel can be used to determine if a serious, widespread condition exists.  Educating the public on: o Injury prevention o Services EMS provides o Performing CPR o Helping a choking victim o Assisting in delivery 12. Describe the roles and responsibilities of the EMT. (p 26) Chapter 1 10 13. Describe the attributes an EMT is expected to possess. (p 27)  Personal attributes include: o o o o o Appearance Attitude and behavior Ability to perform under pressure Composure Self-confidence 14. Explain the impact of the Health Insurance Portability and Accountability Act (HIPAA) on patient privacy.  Do not discuss findings or disclosures made by the patient with anyone but those who are treating the patient or, in limited situations as required by law, the police or other social agencies.  Avoid revealing any information that might disclose the name or identity of patients you've treated.  The protection of patient privacy has drawn national attention with the passage of the Health Insurance Portability and Accountability Act (HIPAA). Extra Notes: Chapter 1 11 Emergency Medical Dispatch (EMD) – A system that assists dispatchers in selecting units to respond a particular call for assistance and provides callers with vital instructions until the arrival of EMS crews. Licensure – The process whereby a competent authority, usually the state, allows people to perform a regulated act. National EMS Scope of Practice Model – A document created by the NHTSA that outlines the skills performed by various EMS providers.