Introduction to Emergency Medical Care 1 Advance Preparation Invite state/regional EMS official to class. Invite state/regional medical director to class. Prepare examples of EMS research.

Lesson Topics 1.1 Define key terms introduced in this chapter. Slides 16-18, 26–27, 42–44 1.2 Give an overview of the historical events leading to the development of modern emergency medical services (EMS). Slides 10–13, 19 1.3 Describe the importance of each of the National Highway Traffic Safety Administration standards for assessing EMS systems. Slides 14–18 1.4 Describe the components of an EMS system that must be in place for a patient to receive emergency medical care. Slides 21–27 continued

Lesson Topics 1.5 Compare and contrast the training and responsibilities of EMRs, EMTs, AEMTs, and Paramedics. Slides 28–33 1.6 Explain each of the specific areas of responsibility for the EMT. Slides 28–29, 31–33 1.7 Give examples of the physical and personality traits that are desirable for EMTs. Slides 34–39 1.8 Describe various job settings that may be available to EMTs. Slide 40 1.9 Describe the purpose of the National Registry of Emergency Medical Technicians. Slide 41 continued

Lesson Topics 1.10 Explain the purpose of quality improvement programs in EMS programs. Slides 42–43 1.11 Explain EMTs’ role in the quality improvement process. Slides 42–43 1.12 Explain medical direction as it relates to EMS systems. Slide 44 1.13 List ways in which research may influence EMT practice. Slide 45 continued

Lesson Topics 1.14 Give examples of how EMS providers can play a role in public health. Slide 46 1.15 Given scenarios, decide how an EMT may demonstrate professional behavior. Slides 29, 32– 33, 47

CORE CONCEPTS The chain of human resources that forms the EMS system How the public activates the EMS system Roles and responsibilities as an EMT The process of EMS quality improvement (QI)

The Emergency Medical Services System Teaching Time: 20 minutes Teaching Tips: This is an important introductory lesson for a new EMT. It provides context for the EMT’s “place in the world” and lays the foundation for future growth within the system. As an instructor, it is your opportunity to lay a strong foundation and teach a positive future outlook. EMS is a relatively new profession. Many of those who built the system are still actively involved at the state level. Contact your local state office and invite such people to class.

State Standard 1) Compare and contrast the types of Emergency Medical Services (EMS) systems and operations, including ground, water, and air services. For each type of service, discuss how the public accesses EMS systems, the advantages and disadvantages, special considerations, and safety issues. Discuss the roles played by the state departments of EMS and the National Highway Traffic Safety Administration.

Lesson Objective Students will be able to… Describe the history of EMS and major milestones in EMS systems through creation of a EMS timeline.

How It Began 1790s—Napoleonic Wars Civil War World War I—Volunteer ambulance corps Korea/Vietnam—MASH-type units and helicopter transport from battlefield Point to Emphasize: Modern emergency medical systems have their roots in battlefield casualty care. Talking Points: During the Napoleonic Wars, injured soldiers were transported from the battlefield to be cared for by physicians. The Civil War saw the beginning of organized medical care with people like Clara Barton, who went on to establish the American Red Cross. Immediate care in field hospitals with transport to hospitals behind the lines by train was also pioneered. In World War I, volunteer ambulance personnel assisted in the transport of the wounded to hospitals. In the Korean War, Mobile Army Surgical Hospital (MASH) units were used, and in both Korea and Vietnam, helicopter transport was used for the wounded. These wars also brought about the development of civilian hospitals specializing in the treatment of trauma. Discussion Topic: Discuss the history of EMS. Describe the roots of modern EMS systems. continued

(Bettmann/CORBIS.)

How It Began Non-military ambulance services began operating in early 1900s in U.S. Often operated by hospitals, fire departments, or funeral homes No requirements or standards for equipment, crew training, or ambulance design “You call, we haul, that’s all!”

Development of Today’s EMS 1966—Department of Transportation charged with developing EMS standards 1970—Founding of National Registry of EMTs (NREMT) 1973—National Emergency Medical Service Systems Act (NEMSSA) Point to Emphasize: In 1966, the National Highway Safety Act developed EMS standards and assisted states in upgrading the quality of their prehospital emergency care. Talking Points: The establishment of EMS standards was spurred by the 1966 government white paper “Trauma: The Neglected Disease of Modern Society.” It dealt with the high number of deaths from traffic collisions due to inadequate emergency medical care. Since this was considered a highway safety issue at the time, EMS is regulated by the National Highway Traffic Safety Administration. The NREMT established national standards for testing and certifying EMS personnel. The NEMSSA made funds available to establish and upgrade EMS systems nationwide. Discussion Topic: Discuss the federal and local agencies involved in the oversight of EMS systems.

NHTSA Standards for EMS Systems Regulation and Policy Each state establishes laws, policies, and regulations Resource Management Centralized coordination of emergency treatment and transport resources Point to Emphasize: The National Highway Traffic Safety Administration (NHTSA) Technical Assistance Program established an assessment standard that includes regulation, resource management, and trauma systems. Knowledge Application: Have students research specific examples of NHTSA standards for EMS systems as the standards apply to their local system. Ask students to present their examples to the class. Discussion Topic: List and describe the components of the NHTSA standards for EMS systems. continued

NHTSA Standards for EMS Systems Human Resources and Training Assure EMS personnel are trained and certified to minimum standard by qualified instructors Transportation Provide safe, reliable transportation—ground, air, or other means continued

NHTSA Standards for EMS Systems Facilities Must be transported to closest appropriate facility Communications Universal access number (911), dispatch to ambulance, ambulance to ambulance, ambulance to hospital, hospital to hospital continued

NHTSA Standards for EMS Systems Trauma Systems Develop trauma triage, transport, and treatment protocols Evaluation Establish program for assessing and improving quality of care provided (QI, QA, TQM) Talking Points: QI = Quality Improvement, QA = Quality Assurance, TQM = Total Quality Management. These are interchangeable terms used to assure that quality is incorporated into all phases of the operation. continued

NHTSA Standards for EMS Systems Public Information and Education Educate public about role of EMS, increase public awareness, participate in injury prevention programs Medical Direction Medical director oversees, is accountable for EMS personnel within system Critical Thinking: Consider your own EMS system compared to the NHTSA standards. Are there areas in which your system might improve? In what areas is your system exceptional?

The Long and Winding Road of Ambulance Service Video https://www Video Clip The Long and Winding Road of Ambulance Service Discuss the progression of EMS throughout history. What is the purpose of the Emergency Medical Services system? What agency developed the standard for the assessment and care of prehospital patients? Discuss possible future advancements in EMS. . Back to Directory

Activity You will be creating a timeline that outlines the history of Emergency medical Services through today’s modern systems. Reference this sample timeline http://www.angelfire.com/co/fantasyfigures/710history.html Make sure to include important information such as the first ambulance, the first EMS helicopter/airplane, first water rescue devices etc. Choose 2 events that you believe to be the most important and write a summary detailing why?

Components of the EMS System Teaching Time: 20 minutes Teaching Tips: Describe components of the EMS system in local terms. Use specific local examples to demonstrate larger concepts. Use actual EMS providers to discuss the various levels of training. Use a discussion format to review important traits of a good EMT. Allow students to formulate their own ideas of what the important elements are.

State Standard 1) Compare and contrast the types of Emergency Medical Services (EMS) systems and operations, including ground, water, and air services. For each type of service, discuss how the public accesses EMS systems, the advantages and disadvantages, special considerations, and safety issues. Discuss the roles played by the state departments of EMS and the National Highway Traffic Safety Administration.

Lesson Objective Students will be able to… Compare and Contrast ground, water, and air EMS services by creation of a Venn diagram. Formulate and support an opinion of whether our local EMS systems are adequate for our location and community needs. Students will defend their opinion in a debate during the next class period. Students need to be able to explain why or why not as well as provide suggestions for improvement.

Components of the EMS System Dispatch Emergency medical responders Police, Fire, Ambulance etc. Emergency Department/Hospital Doctors, nurses, allied health personnel Point to Emphasize: It is important to consider the EMS system from the viewpoint of the patient. Class Activity: Visit a state or regional EMS office. Use this opportunity to discuss the organization of your local system. continued

Components of the EMS System Other specialized care facilities Trauma centers Burn centers Stroke centers Cardiac centers Labor and delivery/ pediatrics Poison control Knowledge Application: Have groups of students build a mock EMS system. Discuss the key components and compare these components to existing systems. Discussion Topic: Describe the components of the EMS system from access to delivery at the hospital. Consider the viewpoint of the patient.

Think Pair Share answer the following questions What medical services are available in your community? How important is it that EMS personnel know the capabilities of community medical facilities? What are the possible consequences of transporting a patient to a facility not equipped to handle the problem? Talking Points: Have students list medical services available; add others that are not obvious. Discuss with students their responsibility to know this essential information.

Chain of Human Resources in EMS System Class Activity: Have students work in groups to research examples of EMS systems that pertain to services in their area. Assign various topics including local, regional, state, and federal systems. Have groups present their findings to the class.

Accessing EMS System 911 telephone access Enhanced 911 Cell phones Available in most but not all areas Enhanced 911 Provides caller number and location for landline phones Cell phones Newer models may provide location in some areas Point to Emphasize: The 911 and enhanced 911 telephone systems are common methods of accessing the EMS system.

Emergency Medical Dispatchers Can provide instructions to callers on how to provide emergency care until EMS personnel arrive EMD certification required in some jurisdictions

Types of EMS Operations https://www.youtube.com/watch?v=HlJ4V8rFz08 As you watch pay careful attention to the different types of EMS operations shown in the video. Write down as many types as you can.

Types of EMS operations Ground Water Air What types of geographical locations would each of these types of EMS operations would be needed in. What do we have locally? What specific equipment is needed in each EMS system/operation?

Critical Decision Making is Key in every EMS system/operation Critical decision making is very important in EMS Information must be gathered, patients assessed, and determination made on treatment and transport options Decisions often time-critical

Examples of Critical Decisions Is it better to take patient to closest hospital or to one farther away but more appropriate for the condition? Is patient stable enough for further evaluation on scene, or should patient be transported immediately? Will this treatment make patient better or worse? Talking Points: Every situation is different, and transport decisions are often based on local protocols. This list should initiate discussion.

Activity Create a Venn diagram comparing and contrasting ground, water, and air EMS systems. Make sure to include the geographical location each is needed, the special equipment used, and special training needed. Research what local EMS systems we have and write a paragraph stating whether you do, or do not think that they are adequate for our community.

EMS Careers and Training

State Standard 3) Differentiate between the careers in various types of EMS. Research and document educational requirements as well as state and national guidelines governing practicing professionals (such as licensing, initial certifications, re-certifications, training, and compliance). Identify personal and physical characteristics required of an EMS professional in a career portfolio.

Objective Students will be able to… Differentiate between the careers in EMS through research of guidelines, education, and mental and physical characteristics. Students will display information in a career portfolio.

Levels of EMS Training Emergency Medical Responder (formerly First Responder) Emergency Medical Technician (formerly EMT Basic) Advanced EMT (formerly EMT Intermediate) Paramedic (formerly EMT Paramedic) Talking Points: There are four general levels of EMS training and certification. They vary from place to place. Emergency Medical Responder (EMR): This is designed for the person who is often first at the scene, such as police, firefighters, and industrial health personnel. The emphasis is on activating the EMS system and providing immediate care for life-threatening injuries, controlling the scene, and preparing for the arrival of the ambulance. Emergency Medical Technician (EMT): In most areas, this is considered the minimum level of certification for ambulance personnel. EMTs provide basic-level medical and trauma care and transportation to a medical facility. Advanced Emergency Medical Technician (AEMT): The AEMT provides basic-level care and transportation as well as some advanced-level care, including using advanced airway devices, monitoring blood glucose levels, and administering some medications, which may include intravenous and intraosseous administration. Paramedic: The paramedic performs all of the skills of the EMT and AEMT plus advanced-level skills. The paramedic provides the most advanced level of prehospital care, such as advanced assessment, drug therapy, EKG interpretation, and additional lifesaving skills.

Roles and Responsibilities of EMTs Personal safety Safety of crew, patient, and bystanders Patient assessment Patient care Lifting and moving Transport Transfer of care Patient advocacy Talking Points: It is not possible to help a patient if you are injured, so your first responsibility is to keep yourself safe. The same dangers you face will also be faced by others at the scene. You must be concerned with their safety as well as your own. One of the EMT’s most important functions is patient assessment, or finding out enough about the patient to provide appropriate emergency care. Based on your assessment findings, patient care is an action or series of actions that your training will prepare you to take in order to help the patient deal with and survive the illness or injury. Since EMTs are usually involved in transporting patients to the hospital, lifting and moving patients are important tasks. It is a serious responsibility to operate an ambulance at any time, but even more so when there is a patient on board. Upon arrival at the hospital, you will transfer care of the patient to hospital personnel. You must never abandon care of the patient until transfer has been properly completed. As an EMT, you are an advocate, the person who speaks up for your patient and pleads her cause. In your role as advocate you may perform a task as important as reporting information that will enable the hospital staff to save the patient’s life—or as simple as making sure a relative of the patient is notified. Discussion Topic: Discuss the roles and responsibilities of an EMT. What are the most important traits of a good EMT?

Think About It How would it impact elderly patient if transported to the hospital without glasses, hearing aid, or dentures? On a routine call, would taking the time to gather these items have a negative effect on the patient’s care? How about assuring the home is secure and locked before leaving? continued

Think About It Could the concept of patient advocacy also extend to the community (fall prevention programs for elderly, poisoning awareness, pool and water safety programs for children)?

Physical Traits of a Good EMT Ability to lift and carry equipment and patients Good eyesight (distance and reading) and color vision Good communication skills (oral and written) Talking Points: You should be fit to carry out your duties. If you are physically unable to provide needed care, then all your training may be worthless to the patient. Practice with other EMTs is essential so that you can carry your share of the combined weight of the patient and all equipment. Coordination and dexterity are needed, as well. You will have to perform basic rescue procedures, lower stretchers and patients from upper levels, and negotiate fire escapes and stairways. You must be able to see distant objects as well as those close at hand. Color vision is important to driving as well as patient assessment. Color of the skin, lips, and nail beds often provides valuable clues to the patient’s condition. You have to give and receive oral and written instructions and communicate with patients, bystanders, and other members of the EMS system. Eyesight, hearing, and speech are important; any problems must be corrected.

Personal Traits of a Good EMT Pleasant Sincere Cooperative Resourceful Talking Points: Pleasant to inspire confidence and help calm the sick and injured. Sincere to convey an understanding of the situation and the patient’s feelings. Cooperative to allow for faster and better care, establish better coordination with other members of the EMS system, and bolster the confidence of patients and bystanders. Resourceful to be able to adapt a tool or technique to fit an unusual situation. continued

Personal Traits of a Good EMT Self starter Emotionally stable Able to lead Neat and clean Talking Points: Self starter to show initiative and accomplish what must be done without having to depend on someone else to start procedures. Emotionally stable to help overcome the unpleasant aspects of an emergency so that needed care may be rendered and any uneasy feelings that exist afterward may be resolved. Able to lead in order to take the steps necessary to control a scene, organize bystanders, deliver emergency care, and when necessary, to take charge. Neat and clean to promote confidence in both patients and bystanders and to reduce the possibility of contamination. Knowledge Application: Have students play the role of EMTs. Assign negative traits and have students demonstrate the serious impact of poor behavior. Discuss. continued

Personal Traits of a Good EMT Good moral character Respectful of others Control of personal habits Control of conversation Able to communicate properly Able to listen to others Nonjudgmental and fair Talking Points: Of good moral character and respectful of others to allow for trust in situations when the patient cannot protect his own body or valuables and so that all information relayed is truthful and reliable. In control of personal habits to reduce the possibility of rendering improper care and to prevent patient discomfort. This includes never consuming alcohol within eight hours of duty and not smoking when providing care. (Smoking can contaminate wounds and is dangerous around oxygen delivery systems.) Controlled in conversation and able to communicate properly in order to inspire confidence and avoid inappropriate conversation that may upset or anger the patient or bystanders or violate patient confidentiality. Able to listen to others to be compassionate and empathetic, to be accurate with interviews, and to inspire confidence. Nonjudgmental and fair treating all patients equally regardless of race, religion, or culture. There are many cultural differences you will encounter among patients.

Education Maintain up-to-date knowledge and skills Read EMS magazines; join EMS organizations Refresher courses for recertification Continuing education to supplement original training Talking Points: An EMT must maintain up-to-date knowledge and skills. Education is a constant process that extends long past the original EMT course. Reading professional journals and joining EMS organizations will help you keep abreast of changes in the field. Ongoing research in emergency care causes occasional changes in procedure, so some of the information you are studying to become an EMT will become outdated. Most areas require regular recertification. Refresher courses present material to the EMT who has already been through a full course but needs to receive updated information. Refresher courses are required at two- to four-year intervals. Continuing education supplements the original course. For example, you may wish to learn more about pediatric or trauma skills or driving techniques. You can obtain this education in conferences and seminars and through lectures, classes, videos, or demonstrations. continued

Education Conferences, seminars, lectures, classes, videos, and demonstrations

Job Opportunities Ambulance services Fire departments Medical facilities Rural/wilderness teams Industrial settings Talking Points: Many fire and EMS agencies are volunteers, especially in rural communities. In addition, many fire department personnel are cross-trained as firefighters and EMTs.

National Registry of EMTs (NREMT) Registration for EMRs, EMTs, AEMTs, and paramedics who successfully complete NREMT examinations May help in reciprocity (transferring to another state or region) Considered favorably when applying for employment Talking Points: NREMT exams are often used as state certification exams. If your state or region does not use the registry exam, ask your instructor how you can sit for the examination. Upon passing the exam and obtaining registry, you will be entitled to wear the NREMT patch.

Quality Improvement Continuous self-review to identify areas for improvement Develop plans to address areas Point to Emphasize: Quality assurance, research, and education ensure constant improvement for both individual providers and the EMS system in general. continued

Quality Improvement Everyone in organization has a role Prepare careful documentation Involved in quality process Get feedback from patients, hospital staff Maintain equipment Continuing education

Medical Direction Medical Director: ultimate responsibility for patient care aspects of EMS system All patient care performed under direction of Medical Director Oversees training; develops treatment protocols Off-line medical control (standing orders) On-line medical control Talking Points: Off-line medical control involves policies or protocols that authorize an EMT to perform particular skills in certain situations. On-line medical control involves requesting orders from medical control (usually by radio or phone) or getting approval by medical control before performing certain procedures. Discussion Topic: Explain how medical directors, medical research, and quality improvement impact the EMS system.

Research Vitally important; more needed in EMS field Care should be based on evidence-based research rather than tradition Goal is improving patient outcomes Form a hypothesis, review literature, evaluate evidence, and adopt practice if evidence supports it Talking Points: EMTs should stay abreast of ongoing EMS-related research, and should participate in the research process when possible to assure the quality of care for the patient. Critical Thinking: Once you have completed class, how will you continue to improve as an EMT? Use specific examples. Knowledge Application: Have students work in groups. Assign meaningful EMS research articles. Have the groups discuss how these articles impacted national and local EMS systems.

EMS Role in Public Health Injury prevention for geriatric patients and youth Blood pressure clinics File of life Public vaccination programs Disease surveillance Talking Points: When on call to a geriatric patient’s home the EMT can identify things that may cause falls, such as footwear or rugs. EMS may also offer methods for the elderly to present medications and medical history to EMTs in the event of emergency (e.g., file of life). EMS is frequently involved in child safety seat clinics, distribution of bicycle helmets, and other programs. More EMS providers are being trained and allowed to provide vaccination clinics for the public. Seasonal flu and variations such as H1N1 are examples of vaccinations that are frequently offered by EMS providers. Some regions are beginning to allow specially trained EMS providers to take routine vaccinations (e.g., childhood vaccinations) out to the public—especially in areas where many children do not have routine well care and are at risk. At the front lines EMS reports may serve as an indication that a trend in injury or disease is beginning. This may range from flu to violence to terrorist attacks.

Think About It How will you refresh your knowledge and stay current once you are out of the classroom? What qualities would you like to see in an EMT who is caring for you? How can you come closer to being this kind of EMT?

Activity Research the licensing, initial certifications, re-certifications, training, and compliance needed to be in each of the following EMS careers. -Emergency medical responder -Emergency medical Technician -Advanced EMT -Paramedic Write a summary over the information that you find and create a venn diagram to compare and contrast the careers visually

Emergency Medical Services for Children Video Video Clip Emergency Medical Services for Children Discuss the main purposes of EMS. Describe how most communities access EMS services. What is the role of the medical director? Describe some of the specific needs of children during an emergency. Click here to view a video on the topic of emergency medical services for children. Back to Directory

Chapter Review

Chapter Review EMS system includes 911 or other emergency access system, dispatchers, EMTs, hospital emergency department, physicians, nurses, physician’s assistants, and other health professionals. EMT’s responsibilities include safety; patient assessment and care; lifting, moving, and transporting patients; transfer of care; and patient advocacy. continued

Chapter Review EMT must have certain personal traits to ensure the ability to do the job. Education, quality improvement procedures, and medical direction are all essential to maintaining high standards of EMS care.

Remember EMS dates back to Napoleonic times. Modern EMS standards come from 1960s–1970s and National Emergency Medical Service Systems Act (NEMSSA). There is a chain of human resources involved in EMS. Critical decisions are made by each member of the chain. continued

Remember There are certain personal and physical traits that help you to be a successful EMS provider. An EMS provider should actively pursue opportunities to improve personal knowledge and abilities as well as the unit’s overall quality.

Questions to Consider What innovation was introduced in the Korean and Vietnam wars that is now common in many EMS systems? What are the four levels of EMS providers? Requesting orders from a physician by radio is an example of what kind of medical control? Talking Points: Helicopter transport EMR, EMT, AEMT, paramedic On-line medical control

Critical Thinking Your patient is hesitant to go to the hospital because she is worried about her dog. What can you do to assist in this situation? What part of your role as an EMT is this an example of? Talking Points: Help to contact a neighbor or relative that can come by and check on the dog; Patient advocate.

Please visit Resource Central on www. bradybooks Please visit Resource Central on www.bradybooks.com to view additional resources for this text. Please visit our web site at www.bradybooks.com and click on the mykit links to access content for this text. Under Instructor Resources, you will find curriculum information, lesson plans, PowerPoint slides, TestGen, and an electronic version of this instructor’s edition. Under Student Resources, you will find quizzes, critical thinking scenarios, weblinks, animations, and videos related to this chapter—and much more.