Introduction to Emergency Medical Care Chapter 1 Introduction to Emergency Medical Care

Case History You respond to a call for a patient in cardiac arrest. On arrival, you find a 52-year-old male who is pulseless and not breathing. A family member is performing CPR. The family states that he collapsed 4 minutes before your arrival.

Historical Perspective Battlefields Lay the Foundation Napoleonic Wars – Ambulance volantes Civil War – Horse-drawn ambulances World War I – Motorized ambulances

Historical Perspective Battlefields Lay the Foundation Korean War – Helicopters and MASH units Death rates from battle casualties 8% WW I 4.5% Korea 2% Vietnam

Historical Perspective Civilian Evolution Civilian evolution varied from region to region in U.S. Rural areas – Undertakers Fire departments and volunteer ambulance replaced funeral directors Urban areas Hospital-based Fire departments Police departments Independent ambulance companies

Historical Perspective Civilian Evolution Mid-1860s – First hospital-based ambulance services Cincinnati General and Bellevue Hospitals 1899 – The first motorized ambulance Michael Reese Hospital of Chicago

Trauma as an Impetus for EMS Development Preventable injury Leading cause of death in ages 1 to 45 Automobile caused surge in trauma deaths 1900 – 7th leading cause of death 2000 – 4th leading cause of death Automobiles account for 50%

Knowledge and Technology 1960 – CPR developed 1960s – Portable defibrillators First ALS units Belfast, Ireland St. Vincent’s Hospital (New York City) Only physicians provided advanced care

Knowledge and Technology Late 1960s – Biotelemetry developed Allowed EMS providers to deliver ALS Defibrillation Advanced airway procedures Drug therapy “Johnny and Roy” popularized paramedics on TV show Emergency!

The Physician and EMS Physician societies organized early EMS programs American Academy of Orthopaedic Surgeons (AAOS) American College of Surgeons (ACS) Worked with National Highway and Traffic Safety Administration (NHTSA)

The Physician and EMS Physician groups still involved American College of Emergency Physicians (ACEP) National Association of EMS Physicians (NAEMSP) National Association of State EMS Medical Directors (NAEMSD)

The Landmark Paper – 1966 “Accidental Death and Disability: The Neglected Disease of Modern Society” Prompted federal money to develop EMS in 1973 “Provide safe handling and transportation of ill or injured.” Provided impetus for rapid proliferation

EMS Agenda for the Future: 14 Components Integration of health services EMS research Legislation and regulation System finance Human resources Medical direction Education systems Public education Prevention Public access Communication systems Clinical care Information systems Evaluation

Elements of a Communications System The dispatch system – Enhanced 911 Formal national program to train dispatchers Emergency Medical Dispatch (EMD) Ambulance-to-hospital Radio Cell phone Landline

Levels of Training Lay rescuer First responder EMT-Basic EMT-Intermediate EMT-Paramedic

Lay Rescuer Carry little or no equipment Recognize life-threatening illness or injuries Provide lifesaving care until EMS arrives CPR Relief of airway obstruction Use of an AED Bleeding control

First Responders Equipped with Oxygen AEDs Airway equipment Provide lifesaving care until EMS arrives

EMT-Basic Provide basic, noninvasive skills Patient assessment CPR Airway adjuncts AED use Childbirth Splinting Spinal immobilization Administration and assistance with medications Activated charcoal, metered-dose inhaler, nitroglycerin, epinephrine Use variety of transport devices

EMT-Intermediate Provide same skills as EMT-B Provide additional advanced skills, including Advanced airway techniques ECG recognition Intravenous fluid therapy Administration of multiple medications

EMT-Paramedic Expanded scope of practice beyond EMT-B and EMT-I Provides advanced techniques, such as ECG interpretation Drug therapy Invasive airway techniques Defibrillation Often have more standing orders in protocols than EMT-I

Chain of Survival Early Access Early CPR Early Defibrillation Early Advanced Care

The Health Care System Emergency departments Specialty referral centers Hospital personnel

Liaison with Other Public Safety Workers Conflicts may occur when overlaps with other public safety personnel Police take charge at crime scene, traffic and crowd control issues Fire take charge at fire scene EMS responsible for patient care Cooperation is essential Incident command system should be in place

Professional Attributes Demonstrate skill and knowledge for the good of the patient Promote high standards of behavior Add to your body of knowledge to continue to advance in the profession

Professional Attributes Appearance A professional appearance and attitude help evoke a sense of confidence in patients and family members. Clean and appropriate clothing Attitude more important than outer appearance Show an interest in your job Possess a sensitive awareness of environment and needs others Putting patient/family needs ahead of your own will protect and preserve safety

EMT-Basic Primary Responsibilities Patient assessment Personal safety and safety of others Patient care Lifting and moving patients safely Transport/transfer of care

Other Responsibilities Record keeping Patient advocacy Extrication Communications Vehicle and equipment maintenance

Local, State, and National Issues National Registry of Emergency Medical Technicians National Association of Emergency Medical Technicians The American Heart Association Continuing education Refresher courses Record keeping/Data Collection

Quality Improvement: Definition A system of internal/external reviews and audits of all aspects of an emergency medical services system that identifies aspects that need improvement to ensure that the public receives the highest quality of prehospital care

Role of the EMT-Basic in Quality Improvement Documentation Run reviews and audits Gathering feedback from patients/hospital staff Conducting preventive maintenance Continuing education Skills maintenance

Medical Direction Accountability for the medical conduct of EMS personnel by a physician knowledgeable in patient care Online medical direction Direct real-time contact via telephone or radio Offline medical direction Written protocols, policies, procedures

Summary EMT-Basic plays a key role in EMS system Teamwork with other providers is essential for effective patient care Quality assurance is an important role of the EMT-Basic