Emergency Medical Care Chapter 1

Brief History Local funeral homes provided service EMS-allows for prehospital care Korean & Vietnam war-soldiers benefited from field care prior transport Modern EMS started about 1960’s

Accidental Death & Disability: The Neglected Disease of modern society Aka: white paper Identifies deaths & injuries r/t MVA’s Severe deficiencies in delivery of prehospital care Recommendations for ambulance systems, training requirements, & provisional prehospital care

Significant Developments Highway Safety Act of 1966 Required states establish highway safety protocols American Heart Association Teaching CPR & BLS National Registry of EMT’s Defined issues for education & training National Highway Traffic Safety Administration Very involved in EMS Developed national curriculum for EMT

Access to EMS 911 Universal number E-911 Automatic number identification Automatic location identification

Levels of Training EMR EMT AEMT Paramedic

Health Care System Closest facilities? Trauma center Burn center Obstetrical center Pediatric center Poison center Stroke center Cardiac center Hyperbaric center Spine injury center Psychiatric center Poky, Boise Salt Lake CRMC, SLMVRMC Primary Salt lake SLMVRMC, Boise, Poke Poky Poky, Boise, SLC Canyon View, Boise, Poky

Roles & Responsibilities Personal safety & safety of others Pt assessment & emergency care Safe lifting & moving Transport & transfer of care Record keeping & data collection Patient advocacy

Professional attributes Appearance Knowledge & skills Physical demands Personal traits Maintain certification & licensure

State EMS Agency Role Medical director Medical direction Protocols http://healthandwelfare.idaho.gov/Portals/0/Medical/EMS/2016-1_EMSPC_SOP.pdf Off-line direction On-line directions Standing orders Medical oversight

Quality Improvement Aka: continuous quality improvement Role: Document carefully Perform reviews & audits Obtain feedback Maintain equipment Participate in continuing education Maintain skills

Issues in patient safety High risk safety Hand-off of care Poor communication Improper body mechanics Ambulance crash Improper spinal immobilization

Preventing errors Develop clear protocols Light scene effectively Minimize interruptions Clearly mark medications Reflect on all actions Question all assumptions Use decision aids if necessary Ask for assistance

Research & public health Evidence based medicine Steps for evidence based decision making Formulate question Search medical literature Appraise the evidence for validity & reliability If evidence supports change, change protocols/implement new practice

Public health Educating public 10 greatest Health achievements Vaccinations Motor-vehicle safety Workplace safety Control of infectious disease Reduce deaths from CAD & CVA Safer & healthier foods Decline in maternal & infant deaths Contraceptive devices Fluoride in drinking water Reduction of use of tobacco products

EMT role in public health Health prevention & promotion through primary prevention (vaccines, education), secondary prevention of complications of disease, health screening Disease surveillance by identifying & reporting certain diseases Injury prevention education