Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Paramedic Care: Principles & Practice Volume 1 Introduction to Advanced Prehospital Care

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Chapter 3 EMS Systems

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Topics History of EMS Today’s EMS Systems

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Introduction An EMS system is a comprehensive network of personnel, equipment, and resources established to deliver aid and emergency medical care to the community.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Components of an EMS System Members of the community EMS providers Communication system Public utilities Fire, rescue, hazmat Poison control centers Out-of-Hospital Elements

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Components of an EMS System Emergency nurses Emergency and specialty physicians Ancillary services Rehabilitative services In-Hospital Elements

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Types of EMS Response Basic Life Support Advanced Life Support Tiered Response

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ History of EMS

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ History of EMS Ancient times –A “good Samaritan” provided care to a wounded traveler by the side of a road –Ancient tablets provided healers with step-by- step instructions for patient care –Code of Hammurabi One particular section of the code was devoted to the regulation of medical fees and penalties

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ History of EMS 18th and 19th Century –Napoleonic Wars First efforts of field care developed. Triage, a method of sorting patients by severity, developed. –U.S. Civil War Triage and transport of wounded soldiers Improvised hospitals in houses, barns, and churches –First civilian ambulance service Cincinnati, Ohio (1865) New York City Health Department Ambulance Service (1869)

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ History of EMS 20th Century –World War II Transportation to appropriate facilities Battlefield ambulances –Vietnam and Korean conflicts Soldiers treated in battlefield Evacuation by helicopter Until the late 1960s, few areas of the United States provided adequate civilian prehospital emergency care.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ History of EMS Post-1960s Developments –Mortician-operated ambulances withdrew due to costs and demand for additional services. –Fire and police departments began providing EMS. –There was growth of volunteer and independent local EMS provider agencies.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ History of EMS In 1966, the publication of “Accidental Death and Disability: The Neglected Disease of Modern Society” addressed EMS –Highlighted deficiencies in prehospital emergency care –Set guidelines for development of EMS systems, training, ambulances, equipment

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Federal and Private Initiatives 1966-National Highway Safety Act –Established the U.S. Department of Transportation (DOT) –Provided matching grants to states for emergency medical services –Funds were also provided for the development of educational programs In 1969 the EMT–A program developed First paramedic curriculum followed in 1977

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Federal and Private Initiatives 1971 –White House issued $9 million in EMS grants for EMS demonstration projects –Designed to be models for subsequent system development 1972 –The Department of Health, Education, and Welfare funded a $16 million five-state initiative for the development of regional EMS systems

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Federal and Private Initiatives EMS Systems Act of 1973 –Provided funding for a series of trauma projects –$300 million allocated to study EMS planning, operations, expansion, and research –Amended in 1976 and 1979 to continue funding for regional EMS systems

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Federal and Private Initiatives Two Items the Legislation Omitted: –System finance Federal funding was significantly reduced in the early 1980s –Medical direction Many services were operating without medical direction

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Federal and Private Initiatives 1981 –The Consolidated Omnibus Budget Reconciliation Act (COBRA) wiped out federal EMS funding Funding that remained was placed into state preventive-health and health-services block grants –The National Highway Traffic Safety Administration (NHTSA) attempted to sustain the efforts

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Federal and Private Initiatives 1988 –Statewide EMS Technical Assessment Program was established Defines elements necessary to all EMS systems

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Statewide EMS Technical Assessment Program Regulation Resources management Human resources/training Transportation Facilities Communications Trauma systems Public information Medical direction Evaluation Elements necessary for an EMS System

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Federal and Private Initiatives EMS Agenda for the Future –Published in 1996 as a comprehensive evaluation of the history of EMS –Focuses on aspects of EMS related to emergency care outside of traditional health care facilities –Casts a vision for the future of EMS in the United States

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Federal and Private Initiatives 2005 –The National EMS Scope of Practice Model Supports a system of EMS personnel licensure A guide for States in developing their Scope of Practice legislation, rules, and regulation Will increase the consistency of the nomenclature and competencies of EMS personnel nationwide

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ History of EMS 21st Century EMS –The terrorist attacks on the World Trade Center in New York City and the Pentagon on September 11, 2001 forever changed EMS and the world © Reuters/Corbis

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ History of EMS 21st Century EMS (cont.) –Attacks pointed out the problems and inefficiencies with the United States emergency response system Fragmented and uncoordinated oversight of emergency response 2006 –National Academies of Science Emergency Medical Services: At the Crossroads

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Emergency Medical Services: At the Crossroads Study found that there were significant problems at the federal, state, and local level –Government leadership in emergency care is fragmented and inconsistent Hospital-based emergency and trauma care is scattered across multiple agencies and departments

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Other Identified Problems Insufficient coordination Coordination of transport within regions is limited Disparities in response times Uncertain quality of care Lack of readiness for disasters Divided professional identity Limited evidence base

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Today’s EMS Systems

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Today’s EMS Systems Every EMS system must develop a system that best meets its needs. Certain elements are essential to ensure the best possible patient care.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Today’s EMS Systems Local and State-Level Agencies –The first step in developing a comprehensive EMS system is to establish an administrative agency. Manages the local system’s resources, develops operational protocols, and establishes standards and guidelines –The agency designates who may function within the system and develops policies consistent with existing state requirements.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Today’s EMS Systems Medical Direction –The Medical Director is a physician who is legally responsible for all clinical and patient-care aspects of the system. © Ken Kerr

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Medical Direction Role of the Medical Director –Educate and train personnel –Participate in equipment and personnel selection –Develop clinical protocols –Participate in problem resolution and quality improvement –Provide direct input into patient care –Interface with the EMS system –Advocate within the medical community –Serve as the “medical conscience” of the EMS system

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Medical Direction On-line Medical Direction –A qualified physician gives direct orders to a prehospital care provider –May be delegated to qualified personnel Mobile intensive care nurse (MICN), a physician assistant (PA), or a paramedic

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Medical Direction Off-Line Medical Direction –Policies, procedures, and practices that a system physician has set up in advance Prospective Retrospective –Use of Protocols

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Public Education An essential and often overlooked component of EMS is the public. Educate the public –Recognizing an emergency –Accessing the system –Initiating BLS procedures Public involvement may include bystander defibrillation.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Communications A coordinated, flexible communications plan should include: – Citizen access – Single control center – Operation communication capabilities – Medical communication capabilities – Communications hardware – Communications software

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Emergency Medical Dispatcher (EMD) The activities of an EMD are crucial to the efficient operation of EMS. EMDs must be medically and technically trained.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ EMS Dispatch The means of assigning and directing appropriate medical care to patients –Includes interrogation protocols, response configurations, system status management, and prearrival caller instructions An effective EMS dispatching system places the first responding units on scene within 4 minutes.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Education and Certification Two kinds of EMS education are initial and continuing education. –Initial education is the original training course for prehospital providers. –Continuing education programs include refresher courses for recertification and periodic in-service training sessions.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Initial Education Based on the EMT-Paramedic: National Standard Curriculum published by the U.S. DOT –Establishes the minimum content for the course –Divided into 3 specific learning domains Cognitive Affective Psychomotor

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Education and Certification Certification –The process by which an agency grants recognition to an individual who has met its qualifications Licensure –The process of occupational regulation Registration –Is entering your name and essential information within a particular record Reciprocity –An agency grants automatic certification or licensure to an individual who has comparable certification or licensure from another agency

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Certification Levels First Responder Emergency Medical Technician-Basic Emergency Medical Technician- Intermediate Emergency Medical Technician-Paramedic

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ First Responder The First Responder is usually the first EMS-trained provider to arrive on the scene. Emergency Medical Responder (EMR)

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Emergency Medical Technician-Basic The EMT-Basic is trained to do all that a First Responder can do, plus other complex skills.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Emergency Medical Technician- Intermediate The EMT-I should possess all the skills of an EMT-B and be competent in advanced airway, IV therapy, and other skills. Advanced EMT (AEMT)

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Emergency Medical Technician- Paramedic The EMT-P is the most advanced EMS provider.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Expanding Roles Critical care transport –Paramedics manage complicated interhospital transports Industrial or occupational EMS –Used to staff construction sites, oil rigs, and other facilities Tactical EMS –Accompany specially trained law enforcement officers on tactical operations Primary care –Triaging and directing patients to the proper nonhospital facilities

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ National Registry of EMTs (NREMT) Prepares and administers standardized tests for EMS responders Establishes the qualifications for registration and re-registration, and establishing a minimal standard of competency Serves as a major tool for reciprocity by providing a process for EMTs

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Professional Organizations Belonging to a professional organization is a good way to keep informed about the latest technology. Organizations assist in the development of educational programs, operational policies and procedures, and the implementation of EMS.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Professional Organizations Include: National Association of EMTs National Association of Search and Rescue National Association of State EMS Directors National Association of EMS Physicians National Flight Paramedics Association National Council of State EMS Training Coordinators

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Professional Journals A variety of journals are available Journals provide an abundant source of continuing-education material

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ These Professional Journals Include: Annals of Emergency Medicine Emergency Medical Services Prehospital Emergency Care Journal of Emergency Medical Services Journal of Emergency Medicine

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Patient Transportation In general, patients should be taken to the nearest facility whenever possible. Medical direction should designate the facility –Based on patient need and availability of resources Patients may be transported by ground or air.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Patient Transportation All transport vehicles must be licensed and meet local and state EMS requirements. Regional standardization of equipment and supplies is most effective in facilitating interagency efforts during disaster operations.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Patient Transportation The helicopter has become an integral part of prehospital care. Trauma care systems use law enforcement, municipal, hospital- based, private, and military helicopter transport services.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Patient Transportation KKK-A-1822 Federal Specifications for Ambulances were developed in It identified 3 types of standardized ambulances. Revisions in the standards have improved overall features.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Type I Ambulance Conventional cab and chassis on which a module ambulance body is mounted, with no passageway between the driver’s and patient’s compartments © Jeff Forster

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Type II Ambulance A standard van, body, and cab form an integral unit © Jeff Forster

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Type III Ambulance A specialty van with forward cab and integral body. It has a passageway from the driver’s compartment to the patient’s compartment © Jeff Forster

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Receiving Facilities Hospitals are placed into categories that identify their readiness and capability. All receiving facilities should have the following capabilities: –Emergency department with an emergency physician on duty, surgical facilities, a lab and blood bank, x-ray capabilities, and critical and intensive care units

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Receiving Facilities Emergency facilities should have: –A documented commitment to participate in the EMS system –A willingness to receive all emergency patients in transport –Medical audit procedures to ensure quality care and medical accountability

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Mutual Aid and Mass Casualty Preparation A formalized mutual aid agreement ensures that help is available when needed. Agreements should be between neighboring departments, municipalities, systems, or states. Each system should also put a disaster plan in place for catastrophes that can overwhelm available resources.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Quality Assurance and Improvement The only acceptable quality is excellence. Quality assurance and improvement programs must be dynamic and comprehensive.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Quality Assurance and Improvement Quality Assurance is designed to maintain continuous monitoring and measurement of the quality of clinical care. –A problem with QA programs is that they tend to identify only the problems and therefore focus only on punitive corrective action.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Quality Assurance and Improvement Continuous Quality Improvement (CQI) is designed to refine and improve an EMS system, emphasizing customer satisfaction. –Evaluations of such aspects as billing and maintenance CQI focuses on recognizing, rewarding, and reinforcing good performance.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Research A formal, ongoing research program is an essential component of the EMS system. An area that will rely heavily on research is funding. –Managed care will force EMS systems to scientifically validate their effectiveness and necessity.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Research EMS research must address the following issues: –Which prehospital interventions actually reduce morbidity and mortality? –Are the benefits of certain field procedures worth the potential risks? –What is the cost-benefit ratio of sophisticated prehospital equipment and procedures? –Is field stabilization possible, or should paramedics begin immediate transport in every case?

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Components of a Research Program Identify a problem Identify the body of knowledge on the subject Select the best design for the study Begin the study and collect raw data

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Components of a Research Program Analyze and correlate your data in a statistical application Assess and evaluate the results against the original hypothesis or question Write a concise, comprehensive description of the study for publication in a medical journal

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Evidence-Based Medicine (EBM) Current standards accepted by physicians and other health care providers in clinical medicine Conscientious, explicit, and judicious use of the current best evidence in making decisions about the care of individual patients Combines clinical expertise with the best available clinical evidence from systematic research

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ System Financing EMS funding can come from a variety of sources. Fee-for-service from Medicare, Medicaid, private insurance companies, or private paying patients is common. Public Utility Models are becoming increasingly popular.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Summary History of EMS Today's EMS Systems