EMS Systems

Emergency Medical Services (EMS) Systems  Define EMS systems.  Describe History of EMS.  Describe Roles/responsibilities of EMS personnel.  Discuss the purpose of the EMS Quality improvement

 System consists of a team of health care professionals who in each area,are responsible for and provide emergency care and transportation to the sick and injured patients

 1485 ◦ First use of an ambulance ◦ Transport only  1800s ◦ First use of ambulance/ attendant to care for injuries on site  1926 ◦ Service started ◦ similar to present day  1940s ◦ EMS turned over to fire and police departments

 Certification examination: ◦ Ensures all health care providers have the same basic level of knowledge and skill ◦ Once you pass certification you can apply for state licensure.

 Licensure:  Also known as certification  Unlawful to practice without licensure  Holding a license shows you:  Completed initial education  Met the requirements to achieve the license  Paramedics are required to receive medical direction.

1. EMT-B (Basic) EMT-B 2. EMT-I/85 (Intermediate) EMT-I/85 3. EMT-I/99 (Intermediate or Advanced) EMT-I/99 4. EMT-P (Paramedic ) EMT-P

 As a paramedic, you must: ◦ Develop care plan ◦ Decide on transport method ◦ Determine receiving facility ◦ Be active in your community.

1/ First Responder ♦ Scene assessment ♦ Patient assessment ♦ CPR ♦ Oxygen therapy ♦ Patient stabilization and movement ♦ Splinting ♦ Bandaging 2/ Emergency Medical Technician- Basic ♦ Non-visualized airways ♦ Spinal immobilization ♦ Medications patient assisted medications (inhalers)) ♦ Intravenous line mainten

3/ Emergency Medical Technician – Intermediate ♦ Endotracheal intubation ♦ Intravenous and nebulizer medications (limited to 23) ♦ Expanded 3-lead ECG interpretations ♦ External cardiac pacing ♦ Needle chest decompression ♦ Cardioversion 4/Emergency Medical Technician – Basic Advanced ♦ Intravenous therapy initiation ♦ Automated or manual defibrillation ♦ ECG interpretation ( ventricular tachycardia, ventricular fibrillation, pulseless electrical activity)

5/ Paramedic ♦ Expanded anatomy and physiology ♦ Intravenous therapy ♦ Injectable and narcotic analgesic medications as trained and approved by physician medical director ♦ Surgical airway ♦ Cardiac monitoring and external pacing ♦ Chest decompression ♦ 12-lead ECG interpretation

 Public safety agents ◦ Some have EMS training  Can better perform certain functions than you ◦ Interagency cooperation benefits patient © Mark C. Ide

© Dan Myers

 Teach the community about prevention of injury and illness. ◦ Appropriate use of EMS ◦ CPR training Courtesy of Captain David Jackson, Saginaw Township Fire Department

 A-Preparation -physical, mental,emotional -Knowledge and skill abilities -equipment appropriate and in working order B- Response -timely -safe C- Scene management -safety of you and your team -assessing situation -personal protective equipment

Patient assessment and care - appropriate,organized assessment -recognize and prioritize patient need Patient transfer and report -give brief,concise,hand –off report -protect patient privacy Documentation -fill out patient care report Return to service Restock and prepare unit

 Continuous quality improvement (CQI) ◦ Tool to continually evaluate care ◦ Quality control ◦ Process of assessing current practices, looking for ways to improve ◦ Dynamic process

 Review ambulance runs when possible.  Focus of CQI is improving care  CQI can be a peer review. ◦ Be professional ◦ Should be a constructive process

 CQI programs help prevent problems by: ◦ Evaluating day-to- day operations ◦ Identifying possible stress points  Look for ways to eliminate human error. ◦ Ensure adequate lighting ◦ Limit interruptions ◦ Store medications properly

 Ways to eliminate human error ◦ Be careful when handing patients off. ◦ Three main sources of errors:  Rules-based failure  Knowledge-based failure  Skills-based failure

 Ways to eliminate human error ◦ Agencies need clear protocols. ◦ Be aware of your environment. ◦ Ask yourself “Why am I doing this?” ◦ Use cheat sheets. ◦ Be conscientious of protocols.