Oregon’s EMS System

Objectives Describe the environment in which the first ‘ambulances’ responded Identify the first volunteer ambulance Identify the agency that was tasked, through Legislation, with developing the Emergency Medical Services

Objectives State when Legislation was passed to develop Oregon’s Trauma System List the Oregon Revised Statutes and Oregon Administrative Rules that outline the responsibilities of Oregon’s EMS Office List three things an EMT can do to assist the EMS Office in providing service to him/her

Objectives State the difference between Level 1, Level 2, Level 3 and Level 4 Trauma Hospitals in Oregon List three reportable actions defined in OAR 333-265-0160 Identify three functions of the Medical Director

Way Back Napoleonic War Civil War NYC 1869 Horse drawn wagons Civil War NYC 1869 1899 – The first motorized ambulance Chicago

In the beginning… 1913 – Ben C. Buck started the nation’s first private ambulance service in Portland, Oregon 1918 – Mr. Buck donated one of the few motorized ambulances used in WW-I 1920 – First volunteer ambulance service, Roanoke, Virginia 1942 – Buck Ambulance became the first to carry oxygen as standard equipment

More Recent CPR, 1960s 8% WWI, 4.5% Korea, 2% Vietnam 1966 – DOT – EMS Dr. Leonard Rose, Cardiac Tech 8% WWI, 4.5% Korea, 2% Vietnam Accidental Death & Disability, The Neglected Disease of American Society, 1966 1966 – DOT – EMS

America’s deaths from influenza were greater than the number of U. S America’s deaths from influenza were greater than the number of U.S. servicemen killed in any war Thousands Civil WWI 1918-19 WWII Korean Vietnam War Influenza War War

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

More Modern Times OHD 1973-82 Title 12 Grants June 30, 1981 $12 million to Oregon June 30, 1981 1987 Trauma System 1989 BME OHD - Now DHS-EMS

State EMS Office (DHS, Emergency Medical Services and Trauma Systems) Statutory responsibility Oregon Revised Statutes Chap. 682, 431 Oregon Administrative Rules Chap. 333-200, 250, 255, 260, 265, Chap. 847 State EMS office State EMS Committee Subcomm. EMT Cert. and Discipline STAB, ATAB

State EMS Office Charge – minimum standards Certification, CME FR EMTs Ambulance vehicles Ambulance services Trauma hospitals Certification, CME Accreditation process

State EMS Office Be nice to them Do your research Start locally Read, then follow directions Know your responsibilities Document, conduct business in writing Don’t shop for answers

Things in the works! “Certification” of First Responders Revision of Oregon EMT-Intermediate Curriculum (rethinking) ACEP/OHD-EMS Supervising Physician Course 40 Hour Oregon Version DOT National Standard EMS Instructor Course National Registry Exam Manage Grant Programs

Total of All Certification Levels as of March 17, 2006 EMT-B 4187 51.31% EMT-I 1422 17.43% EMT-P 2551 31.26% TOTAL EMTS ALL LEVELS 8160

Oregon’s EMTs All Levels by ZIP code

Oregon’s EMT-Basics by ZIP code 4075 51.23% of total EMTs

Oregon’s EMT-Intermediates by ZIP code 1472 18.51% of total EMTs

Oregon’s Paramedics by ZIP code 2407 30.16% of total EMTs

Statewide ALL EMS Agencies

Statewide Transport Agencies

Statewide Non-transport Agencies

Trauma Section State wide trauma system Hospital designation 1-4 Data gathering Triage criteria 911 System

Revised 3/20/02

TRIAGE CRITERIA AND DECISION SCHEME   TO TRAUMA HOSPITAL VITAL SIGNS & LEVEL OF CONSCIOUSNESS: Systolic blood pressure <90 mmHg; or Respiratory distress with rate<10 or >29; or Airway management required; or Glasgow Coma Scale <12 ANATOMY OF INJURY: Penetrating injury of the head, neck, torso, or groin; or Amputation above the wrist or ankle; or Spinal cord injury with limb paralysis; or Flail chest; or Two or more obvious long-bone (humerus/femur) fractures. YES → MANDATORY TRAUMA SYSTEM ENTRY MECHANISM OF INJURY: Death of a same car occupant; or Ejection of patient from an enclosed vehicle; or Heavy extrication time >20 minutes.

NO↓ YES → HIGH ENERGY TRANSFER SITUATIONS: Falls >20 feet; or   NO↓ HIGH ENERGY TRANSFER SITUATIONS: Falls >20 feet; or Pedestrian hit at 20 mph or thrown 15 feet; or Rollover; or Motorcycle, ATV or bicycle crash; or Significant impact or intrusion into occupant space of vehicle. YES → DISCRETIONARY TRAUMA SYSTEM ENTRY These criteria shall cause a high index of suspicion that a patient may have sustained a severe injury. Trauma system entry for patients meeting two or more of these criteria is strongly encouraged. CO-MORBID FACTORS: Extremes of age <5 or >55 years; or Patient with bleeding disorder or patient on anticoagulants; or Medical illness: cardiac or respiratory disease, insulin-dependent diabetes, cirrhosis, or morbid obesity; or Pregnancy; or Immunosuppressed patients; or Presence of intoxicants.

Prehospital Standards Reporting criteria (ORS 682.220(4)) Applications and recertification. Backgrounds E-4 The nasty stuff Sexual assault elderly Walking around in sox Diverting drugs to owner Convicted double homicide

Medical Directors Under BME Standing orders (protocols) Advocate, training Scope of Practice Don’t violate Only under an agency's protocols Teamwork

Questions??