Chapter 1 Introduction to Emergency Medical Care FGTC 2010 EMT-I

Overview of the EMS System History of EMS (1 of 4) World War I: motor vehicles and volunteer ambulance squads were used. World War II: trained corpsmen brought casualties to aid stations. Korean conflict: further development of the field medic; casualties transported to Mobile Army Surgical Hospitals via helicopter. Domestic emergency care lagged behind. FGTC 2010 EMT-I

History of EMS (2 of 4) Into the 1960s, prehospital care could range from interns to individuals without training. The sick and injured were often transported by private vehicle. Staffed emergency departments were often limited to large urban areas. Accidental Death and Disability (a.k.a. The White Paper) was published in 1966. Reported the inadequacies of prehospital care. Recommended: Development of training Development of federal guidelines and policies Adoption of the means to provide emergency care and transport Establishment of staffed emergency departments FGTC 2010 EMT-I

History of EMS (3 of 4) The Highway Safety Act and the Emergency Medical Act created funding sources and development programs. Early 1970s: DOT developed the first national standard curriculum for the training of EMTs. Late 1970s to early 1980s: DOT developed a recommended national standard curriculum for the training of paramedics. FGTC 2010 EMT-I

History of EMS (4 of 4) Circa 1980: EMS established in most of the United States. Responsibility of municipalities to provide prehospital care Recognized standards developed for training and equipment FGTC 2010 EMT-I

National Highway Traffic Safety Administration (NHTSA) Technical Assistance Program Assessment Standards 1996 10-point assessment criteria include: Regulation and policy Resource management Human resources and training Transportation equipment and system Medical and support facilities Communications system Public information and education Medical direction Trauma system and development Evaluation FGTC 2010 EMT-I

Levels of Training (1 of 4) Basic First Aid Trains individuals in the workplace, teachers, coaches, babysitters, and others. Individuals trained in basic first aid are taught to provide necessary critical care prior to arrival of EMTs. First Responder Trains individuals to initiate immediate care and to assist the EMTs when they arrive. Focuses on providing immediate basic life support and urgent care with limited equipment. FGTC 2010 EMT-I

Levels of Training (2 of 4) EMT-Basic (EMT-B) Requires approximately 110 hours of training (more in some states) in the essential knowledge and skills required for providing basic emergency care in the field. Includes skills for automated defibrillation, definitive airway adjuncts, and assisting patients with certain medications. FGTC 2010 EMT-I

Levels of Training (3 of 4) EMT-Intermediate (EMT-I) Designed to increase knowledge and add skills in specific aspects of advanced life support (ALS). Additional skills include IV therapy, interpretation of cardiac rhythms and defibrillation, orotracheal intubation, and administration of certain prescribed drugs. FGTC 2010 EMT-I

Levels of Training (4 of 4) EMT-Paramedic (EMT-P) An EMT-P has completed an extensive course of training that significantly increases knowledge and mastery of basic skills and covers a wide range of ALS skills. Skills include IV therapy, pharmacology, and cardiac monitoring. FGTC 2010 EMT-I

Components of an EMS System Access to the System (1 of 2) Easy access to necessary help in an emergency is essential. 9-1-1 9-1-1 system provides immediate access to central emergency dispatch service. Enhanced 9-1-1 system also displays address of the phone making the call. Non 9-1-1 In some areas, a different special published emergency number may be used to call for EMS. FGTC 2010 EMT-I

Access to the System (2 of 2) Discuss the emergency number in your area; training the public how to access 9-1-1 is important. Dispatcher may have Emergency Medical Dispatcher training and be able to give pre-arrival instructions. Describe the local access and dispatch system. FGTC 2010 EMT-I

Administration and Policy Policies and procedures are essential. An EMS service provider generally operates in specific areas called primary service areas (PSAs). Senior EMS personnel generally administer daily operations. Administrators perform administrative tasks such as scheduling, personnel budgeting, and purchasing. FGTC 2010 EMT-I

Medical Direction and Control (1 of 4) Each EMS service has a physician medical director who authorizes the EMTs in that service to provide medical care in the field. The appropriate care for each injury, condition, or illness encountered in the field is determined by the medical director and is described in a set of written standing orders or protocols. Medical director A physician responsible for the clinical and patient care aspects of an EMS system Required for every ambulance service/ rescue squad FGTC 2010 EMT-I

Medical Direction and Control (2 of 4) Online Emergency service personnel can reach a medical director for medical direction while on a call; also known as direct medical control. Telephone Radio FGTC 2010 EMT-I

Medical Direction and Control (3 of 4) Off-line The medical director functions as the ongoing working liaison between the medical community, hospitals, and the EMTs in the service. Protocols Standing orders FGTC 2010 EMT-I

Medical Direction and Control (4 of 4) The relationship of the EMT-I to medical direction The EMT-I is the designated agent of the physician. Care rendered by an EMT-I is considered an extension of the medical director's authority (varies by state law). FGTC 2010 EMT-I

Quality Control and Improvement (1 of 2) The medical director is responsible for ensuring that all staff involved in patient care meet appropriate medical care standards on each call. Each written patient run report must be reviewed. Continuous quality improvement (CQI) is a circular system of continuous internal and external reviews and audits of all aspects of an EMS call. The medical director also ensures that appropriate continuing education and training is available. FGTC 2010 EMT-I

Quality Control and Improvement (2 of 2) The role of the EMT-I Refresher training Continuing education Run reviews, audits, and documentation Gather feedback from medical director and hospital staff FGTC 2010 EMT-I

Other Physician Input Local physicians and specialists may be active on the local level in the development of EMS. State and national organizations may also participate in development. State-specific statutes and regulations regarding EMS Training, protocols, and practices must conform with the EMS legislation, rules, regulations, and guidelines adopted by the state. An advisory committee made up of representatives of the EMS system, medical directors, and others provides input. FGTC 2010 EMT-I

Equipment A wide range of different emergency equipment is available. It is the responsibility of the EMT-I to know indications and contraindications of using each piece of equipment. The EMT-I should check each key piece of equipment before going on duty to ensure that it is in its assigned place and working properly, and that the EMT-I is familiar with the specific model. FGTC 2010 EMT-I

The Ambulance Before going on duty, the EMT-I should check all the equipment and supplies. Check to make sure that the ambulance is fully fueled and has sufficient oil and other key fluids, and that the tires are in good condition. Test each of the driver's controls and each built-in unit and control in the patient compartment to ensure proper functioning. FGTC 2010 EMT-I

Transport to Specialty Centers and Interfacility Transports Many EMS systems include specialty centers such as trauma, burn, poison, or psychiatric centers. Some areas have specialty centers for children. Describe resources in the local area. Interfacility transports Transportation of patients from a health care facility to home, nursing home, or other hospital. Patient may be accompanied by other health care providers (eg, respiratory therapists, nurses). FGTC 2010 EMT-I

Working With Hospital Staff EMT-Is need to understand how their care integrates into the system and affects the patient's hospital care. Many hospital staff members are willing to help the EMT-I develop in the profession. Physicians Nurses Other health professionals FGTC 2010 EMT-I

Working With Public Safety Agencies EMT-Is should understand the role of each public safety agency. Some public safety workers have EMS training. Personnel from certain agencies may be better prepared than the EMT-I to perform certain functions. EMS and public service agencies need to work together and recognize that each person has a special talent and a job to do at the scene. The most efficient patient care is achieved through cooperation among agencies. Public safety agencies may include law enforcement and state and federal agencies. FGTC 2010 EMT-I

Training Quality of care depends on training. In most states, instructors responsible for coordinating and teaching the EMT-I course are approved and certified by the state EMS office. To be certified, an instructor must have extensive medical and education training and teach under supervision. Most ALS training is done in the hospital or in a college setting. FGTC 2010 EMT-I

Providing a Coordinated Continuum of Care The first phase consists of patient assessment, initial prehospital care, proper packaging, and safe transport to the hospital (out of hospital). In the second phase, the patient receives continued assessment and stabilization in the hospital emergency department. In the third phase, the patient receives the necessary specialized definitive care. FGTC 2010 EMT-I

Roles and Responsibilities of the EMT-I Professional Attributes Personal safety Should always be the EMT-I’s top priority Determined by sizing up the scene during the approach Safety of crew, patient, and bystanders Ability to safely operate the ambulance Sizing up the scene for threats FGTC 2010 EMT-I

Patient Assessment and Care Should be thorough and accurate Include a SAMPLE history. Recognize that assessment findings will affect treatment decisions, and a poorly done assessment may lead to inappropriate treatment. Patient care based on assessment findings Reaching a clinical impression and providing care. Identifying patients who need immediate intervention and those who will benefit from a detailed assessment. FGTC 2010 EMT-I

Lifting and Moving/Transport Lifting and moving patients safely Properly packaging the patient and safely moving him or her. Using proper lifting mechanics to protect the EMT. Transport/transfer of care Transporting the patient to the destination. Giving necessary radio reports. Giving a verbal report to health care facility staff. FGTC 2010 EMT-I

Records and Patient Rights Record keeping/data collection Documenting patient care report. Completing other needed reports (eg, incident report). Patient advocacy (patient rights) Considers the patient as a whole and safeguards the patient's rights. FGTC 2010 EMT-I

Professional Attributes of the EMT-I (1 of 2) Professional attributes of an EMT-I Puts patient's needs as a priority without endangering self. Maintains a professional appearance and manner. Expected to perform under pressure with composure and self-confidence. Treats patients and families under stress with understanding, respect, and compassion. FGTC 2010 EMT-I

Professional Attributes of the EMT-I (2 of 2) Is nonjudgmental. Extends compassion, respect, and the best care possible to every patient, regardless of the patient's attitude. Respects patient confidentiality because EMS is an extension of the emergency medical care provided in the emergency department by physicians. Does not discuss findings or any disclosures made by the patient with anyone except those who are treating the patient or as required by law. FGTC 2010 EMT-I

Continuing Education An EMT-I is required to attend a certain number of hours of continuing education (CE) each year. Review state requirements for renewal. An EMT-I must also maintain a current knowledge of local, state, and national issues affecting EMS. Maintaining knowledge and skills is a substantial responsibility; the EMT-I must regularly practice or refresh seldom-used skills. FGTC 2010 EMT-I