Chapter 1 Preparatory

National EMS Education Standard (1 of 3) Preparatory Applies fundamental knowledge of the emergency medical services (EMS) system, safety/well-being of the emergency medical technician (EMT), medical/legal, and ethical issues to the provision of emergency care.

National EMS Education Standard (2 of 3) Public Health Uses simple knowledge of the principles of illness and injury prevention.

National EMS Education Standard (3 of 3) Pharmacology Applies fundamental knowledge of the medications that the EMT may assist/administer to a patient during an emergency.

Introduction EMS is an integrated system of care. This chapter discusses the changes and improvements made in the EMS system in recent years.

New Levels of EMS Training (1 of 7) National EMS Scope of Practice Model –Created by the National Highway Traffic Safety Administration (NHTSA) –Outlines the skills performed by various EMS providers Source:© Corbis

New Levels of EMS Training (2 of 7) EMR has very basic training. –Provides care before ambulance arrives –May assist within ambulance

New Levels of EMS Training (3 of 7) EMT has training in basic life support (BLS), including: –Automated external defibrillation –Airway adjuncts –Medication assistance

New Levels of EMS Training (4 of 7) AEMT has training in advanced life support (ALS), including: –Intravenous (IV) therapy –Administration of certain emergency medications

New Levels of EMS Training (5 of 7) Paramedic has extensive ALS training, including: –Endotracheal intubation –Emergency pharmacology –Cardiac monitoring

New Levels of EMS Training (6 of 7) Certification and licensure of EMTs remains a state function. –Varies state-to-state –National guidelines create a more consistent delivery of EMS across the United States.

New Levels of EMS Training (7 of 7) An EMT may perform a skill only if the state has approved that skill as part of the EMT’s scope of practice. –The medical director can limit the scope of practice, but he or she cannot expand it beyond the boundaries set by law.

Public BLS and Immediate Aid Millions of laypeople are trained in BLS/CPR. Many individuals have taken first aid courses to provide immediate essential care. Automated external defibrillators (AEDs) are used by laypeople.

Components of the EMS System (1 of 2) 1.Public access 2.Clinical care 3.Medical direction 4.Integration of health services 5.Information systems 6.Prevention 7.EMS research 8.Communication systems 9.Human resources 10.Legislation and regulation

Components of the EMS System (2 of 2) 11.Evaluation 12.System finance 13.Public education 14.Education systems

Information Systems Technology has improved. –Allows EMS to document care –Data can be analyzed to improve care. Use of information varies.

Public Health, Disease Prevention and Education (1 of 2) Public health examines the health needs of entire populations with the goal of preventing health problems.

Public Health, Disease Prevention and Education (2 of 2) EMS works with public health agencies on: –Primary prevention –Secondary prevention

EMS Research (1 of 2) Helps determine the shape and impact of EMS on community EMTs may be involved in research through gathering data. The results can then be shared with the rest of the EMS community.

EMS Research (2 of 2) Evidence-based decision making is based on research. It is important for EMS providers to stay up- to-date on the latest advances in medicine. Be skeptical: Ask questions and conduct your own research.

Wellness of the EMT (1 of 2) Nutrition –Eat well-balanced meals. Exercise and relaxation –Exercise regularly to handle stress more easily. Safe lifting practices Sleep –Should be regular and uninterrupted Source: Courtesy of USDA

Wellness of the EMT (2 of 2) Disease prevention –Know family health history –Adjust lifestyle –Smoking Harmful to your health and to the health of those around you Balancing work, family, and health –Take time to relax with family and friends.

Workplace Issues (1 of 3) Cultural diversity on the job –Communicate respectfully. –Use cultural diversity as a resource. –Learn how to relate to and communicate with people from different cultures.

Workplace Issues (2 of 3) Sexual harassment –Two types Quid pro quo: request for sexual favors Hostile work environment: jokes, touching, etc. –Most complaints are of the second type. –Such behavior is unacceptable. –Report harassment to supervisor immediately and keep notes.

Workplace Issues (3 of 3) Substance abuse –May result in the revocation of driving privileges and/or loss of licensure –Seek help, or find a way to confront an addicted coworker. –Employee assistance programs (EAPs) are often available.

Emotional Aspects of Emergency Care Even experienced health care providers have difficulty overcoming personal reactions. The struggle to remain calm contributes to the emotional stress of the job. © James Schaffer/PhotoEdit, Inc.

Dealing with the Death of a Child Help the family in any way you can. Provide information about follow-up counseling and support services.

Helping the Family Acknowledge the death in a private place. Let the parents hold the child if possible. If the parents want to see the child, prepare them for what they will see. Nonverbal communication may be valuable.

Emotional Care During Stressful Situations (1 of 2) Use extreme care in words and actions. Present a professional demeanor. Bring a sense of order and stability to the situation. Explain your plan of action. Inform the patient that you need his or her help.

Emotional Care During Stressful Situations (2 of 2) Be compassionate but allow professional judgment to take priority. Allow patients to express fears/concerns. Be discreet and diplomatic. Transport parents with their children. Try to accommodate requests regarding religious customs.

Emergency Pharmacology (1 of 2) Many departments have strict controls on when an EMT is allowed to administer a medication. –Peer-assisted –Patient-assisted –EMT-administered

Emergency Pharmacology (2 of 2) The list of medications that may be administered by EMTs has changed over the years. –The exact list of medications that is allowed is controlled by the state government, the public safety department, and the medical director. –Always follow local protocols.

Credits Unless otherwise indicated, all photographs and illustrations are under copyright of Jones & Bartlett Learning, courtesy of Maryland Institute for Emergency Medical Services Systems, or have been provided by the author(s).