Chapter 1 EMS Systems

Emergency Medical Services = system

After completion of course à certification (exam used to make sure all healthcare providers have same basic level of knowledge à Licensure (State tests applicant’s competency in examination setting). Process of granting authority to act as an EMT = licensure, certification, credentialing (differs based on state).

General requirements prior to licensing:

1.      HS diploma/GED

2.      Proof of immunization

3.      Successful background check

4.      Valid driver’s license

5.      Successful completion of BLS/CPR

6.      Successful completion of state written cert exam

7.      Successful completion of state practical cert exam

8.      Demonstration of mental & physical abilities necessary to safely and properly perform all EMT tasks

9.      Compliance with other state, local, and employer provisions

4 Training and Licensure Levels (most follow National Highway Traffic Safety Administration):

v  Emergency Medical Responder (EMR) – Courses offered to basic level folks expecting some issues.

Ø  Very basic training.

Ø  Provides care before ambulance arrives.

Ø  Assistant role in ambulance.

v  Emergency Medical Technician (EMT) ~ 150 hrs of course training

Ø  Basic Life Support (BLS)

§  Automated external defib

§  Using airway adjuncts

§  Assisting patients w/ certain medications

v  Advanced EMT ~ 200 – 400 hrs of course training

Ø  Some training in Advanced Life Support (ALS)

§  IV therapy

§  Administration of some emergency medications

v  Paramedic ~ 1000 – 1300 hrs of course training (usually an associates or bachelor’s)

Ø  Extensive training in ALS

§  Intubation

§  Emergency pharmacology

§  Cardiac monitoring

Roles determined by National EMS Scope of Practice Model (Federal) à State EMS office à Medical director

4 types of learning activities:

v  Reading assignments

v  Step-by-step demonstrations

v  Summary skills sheets

v  Case Presentations

Components of EMS system

Based on EMS Agenda for the Future (14 components of EMS system):

1.      Public Access: Easy access to help via 911.

a.      Public Safety access point – call communication center

b.      Emergency medical dispatch (EMD) – system developed to handle medical calls, gives callers vital instructions to help w/ medical emergency until EMS arrives.

2.      Clinical Care: Various pieces of equipment and the scope of practice for using that equipment.

a.      Prior to duty, check all equipment à responsibility of EMT to ensure ambulance if stocked, fueled, and properly maintained.

b.      Primary Service Area – Main area in which an EMS agency operates.

c.       Training with ambulance controls.

3.      Medical Direction

a.      Medical director (MD) authorizes EMTs to provide medical care.

b.      Appropriate care = standing orders and protocols

                                                              i.      Protocols: comprehensive guide detailed EMT scope of practice.

                                                            ii.      Standing orders: Part of protocols that designate what EMT is required to do for a specific complaint/condition. (Offline)

c.       Medical control is offline or online

                                                              i.      Offline (indirect)

1.      Standing orders

2.      Training

3.      Supervision

                                                            ii.      Online (direct)

1.      Physicians directions given over the phone/radio

4.      Integration of Health Services

a.      Prehospital care by EMT coordinated w/ care at admitting hospital

b.      Ambulance à ED

5.      Information Systems

a.      Used to document care done

b.      Stored electronically à can be referred back to later for improvement

6.      Prevention

a.      EMS focus on public health.

b.      Public health examines needs of entire population à goal of preventing health issues before they emerge

c.       EMS work w/ public health in 2 ways:

                                                              i.      Primary prevention – focusing on prevent the emergency from happening

                                                            ii.      Secondary prevention – focusing on how to prevent the event after it has already occurred.

7.      EMS Research

a.      Application of evidenced based practice à also improves treatment

b.      Needed to advance care

c.       Skepticism, questions, and self-research necessary to improvement of EMS field

8.      Communication Systems: Using information from caller dispatch forwards location to appropriate responders.

9.      Human Resources: Management of human “resource”, organizing people and their skills toward EMS.

10.  Legislation and regulation

a.      EMS systems MUST follow state legislation, rules, regulations, and guidelines.

b.      Senior EMS official usually in charge of administrative tasks (~ police chief/fire chief)

11.  Evaluation

a.      Medical director responsible for quality control EMS system (QA)

b.      continuous quality improvement (CQI) à aims through reviews and audits to ID areas of improvement.

c.       CME needed due to rapid changes in medicine.

d.      Goal of minimizing errors

12.  System Finance

a.      Financing varies depending on type of organization

b.      Personnel – Paid, volunteer OR mixed

c.       EMT in regards to $$$

                                                              i.      Gather insurance info on patient

                                                             ii.      Secure signatures on documents like HIPAA

                                                           iii.      Obtain written permission from patient to bill health insurance company

13.  Public Education

14.  Education Systems

a.      Most EMS edu must adhere to standards set by Committee on Accreditation of Educational Programs for the Emergency Medical Services (CoAEMSP) OR Commission on Accreditation of Allied Health Education Programs (CAAHEP)

b.      EMS instructors – licensed

c.       ALS instructors & directors need 4 yr degree (bachelors)

Roles and Responsibilities of EMT

EMTs are healthcare professionals – will be held to a standard

Responsibilities:

·       Keep vehicles and equipment ready for emergency.

·       Ensure safety of self and partner.

·       Familiarize with ambulance operation.

·       On-scene leader

·       Perform an evaluation of the scene.

·       Call for additional resources when needed.

·       Gain patient access.

·       Patient assessment

·       Medical care

·       Emotional support to patient and others

·       Maintain a continuity of care w/ other medical professionals.

·       Resolve possible emergency incidents (to the best of your ability)

·       Uphold medical & legal standard

·       Ensure patient privacy

·       Give admin support

·       Continue professional development

·       Cultivate and sustain community relations

·       Give back to profession

Attributes needed:

·       Integrity

·       Empathy

·       Self-motivation

·       Appearance and hygiene

·       Self-confidence

·       Time management

·       Communications

·       Teamwork and diplomacy

·       Respect

·       Patient advocacy

·       Care delivery of care

*** Treat all patients with respect despite appearance and behavior.

History of EMS

1.      Volunteer ambulances during WW1

2.      WW2 Military trained special corpsmen to transport casualties to aid stations w/ RNs and MDs

3.      Korea and Vietnam – Field medic and rapid hospital evacuation to nearest surgical hospital

Unfortunately, Emergency care of ill or injured not as advanced.

1.      Previously emergency care varied depending on organization of neighborhood.

2.      Most first aid provided by those 1^st available on site (police, funeral homes, interns, fire dept)

3.      1966 Accidental Death and Disability: The Neglected Disease of Modern Society (white paper) à Congress formed 2 federal agencies (National Highway Traffic Safety Administration (NHTSA) – 1966 Highway Safety Act & Department of Health and Human Services (HHS) – 1973 Emergency Medical Services Development Act) à EMS is administrated at federal level, NOT the DOH.

4.      1970s 1^st EMT textbook (orange book) + ED medicine specialty development.

5.      1980s enhanced EMT training by developing EMT and AEMT procedures for key parts of ALS.

6.      EMS DEF depends on state

7.      1990s standardize EMS education