Copyright (c) The McGraw-Hill Companies, Inc. Permission required for reproduction or display. 1-1 Chapter 1 EMS Systems and Research

1-2 Course Overview

1-3 Objectives

The Emergency Medical Technician Emergency Medical Technician (EMT) –A member of the Emergency Medical Services (EMS) team who Responds to emergency calls Provides efficient emergency care to ill or injured patients Transports the patient to a medical facility 1-4

1-5 The Emergency Medical Technician Emergency Medical Technicians –May be paid or volunteer personnel

1-6 Goals of EMT Training Recognize the nature and seriousness of a patient’s condition or extent of injuries to determine the emergency medical care the patient requires Safely and efficiently provide appropriate emergency medical care based on your assessment findings of the patient's condition Lift, move, position, and otherwise handle the patient to minimize discomfort and prevent further injury Safely and effectively perform the expectations of the job description

1-7 Origins of Emergency Medical Services (EMS)

Origins of EMS Emergency –An unexpected illness or injury that requires immediate action to avoid risking the life or health of the person being treated 1-8

1-9 Origins of EMS

1-10 Origins of EMS: 1900–1960 Civilian ambulance services began in Cincinnati and New York City Mid-1940s –Rural communities recognized need for local fire protection and first aid 1950s –Mobile Army Surgical Hospital (MASH) units used helicopters for evacuation in Korean War 1960 –Cardiopulmonary resuscitation shown to be useful

1-11 Origins of EMS: 1960–1970 Before 1966 –Volunteers untrained in emergency care –Minimal stabilization at emergency scene –Transport to nearest hospital often provided by Funeral homes Taxis Automobile-towing companies

1-12 Origins of EMS 1966 –Accidental Death and Disability: The Neglected Disease of Modern Society “The White Paper” –Exposed inadequacies of prehospital services –Beginning of modern EMS

1-13 Origins of EMS Highway Safety Act of 1966 Charged National Highway Traffic Safety Administration (NHTSA) with responsibility for improving EMS Provided funding for programs to reduce highway-accident- related deaths Established national standards

1-14 Origins of EMS 1988 – 10 EMS System Components 1.Regulation and policy 2.Resource management 3.Human resources and training 4.Communications 5.Transportation 6. Medical oversight 7. Trauma systems 8. Facilities 9. Public information and education 10. Evaluation

Origins of EMS – 1996 EMS Agenda for the Future –Proposed continued integration of EMS into the healthcare system 1-15

Origins of EMS-2006 National EMS Scope of Practice Model which confirmed the new label for the second level of Emergency Medical Technician—Basic (EMT-B) to EMT. Increases uniformity in EMS practice nationwide and facilitates reciprocity between states. 1-16

Origins of EMS NHTSA National EMS Education Standards –Outlines the minimum objectives to be covered by each level of EMS provider 1-17

1-18 The Emergency Medical Services System

1-19 The Emergency Medical Services System EMS system –Coordinated network of resources –Provides emergency care and transportation to victims of sudden illness or injury Healthcare system –A network of people, facilities, and equipment designed to provide for the general medical needs of the population EMS is a part of the healthcare system

1-20 EMS System Components Legislation & Regulation Each state must have laws in place that govern its EMS system

1-21 EMS System Components Communications An EMS system must –Provide a means by which a citizen can reliably access the EMS system (usually by dialing 9-1-1) –Allow contact between different agencies, vehicles, and personnel

1-22 EMS System Components Communications –Official national emergency number in the United States and Canada Enhanced (E9-1-1) –Routes call to center closest to caller –Automatically displays caller’s phone number and address –Most systems today are Enhanced systems

1-23 EMS System Components Human Resources & Education Persons working in an EMS system are expected to be trained to a minimum standard National EMS Scope of Practice Model –Defines four levels of EMS professionals 1.Emergency Medical Responder (EMR) 2.Emergency Medical Technician (EMT) 3.Advanced Emergency Medical Technician (AEMT) 4.Paramedic

1-24 EMS System Components Human Resources & Education Emergency Medical Responder (EMR) –A person who has the basic knowledge and skills necessary to provide lifesaving emergency care while waiting for the arrival of additional EMS help –Trained to assist other EMS professionals

1-25 EMS System Components Human Resources & Education Emergency Medical Technician (EMT) –More skilled than an EMR –Responds to emergency calls –Provides efficient emergency care to ill or injured patients –Transports the patient to a medical facility

1-26 EMS System Components Human Resources & Education Advanced EMT (AEMT) –More skilled than an EMT –Has additional training in skills including the following: Patient assessment Giving intravenous (IV) fluids and medications Performing advanced airway procedures

1-27 EMS System Components Human Resources & Education Paramedic –Can perform the skills of an Advanced EMT –Has had additional instruction in pathophysiology, physical examination techniques, assessing abnormal heart rhythms using a heart monitor, and invasive procedures

Right to Practice Statutes Certification Licensure Scope of practice Credentialing 1-28

EMT Certification To be certified as an EMT, state agencies require successful completion of an approved EMT course –National Registry of EMTs (NREMT) requirements –Maintenance of current status is a personal responsibility –Participation in CE courses or an EMT Refresher Course is required for recertification 1-29

Maintaining Knowledge and Skills An EMT’s education does not end with completing the EMT course Must keep knowledge and skills current –Continuing education (CE) courses –Refresher courses 1-30

1-31 EMS System Components Transportation Safe transport Appropriately staffed and equipped vehicle –Ground ambulance –Air medical service

1-32 EMS System Components Medical Oversight Medical Oversight –Process by which a physician directs emergency patient care provided by EMS personnel –Every EMS system must have medical oversight –Physician who provides medical oversight is called the medical director –Also referred to as medical control or medical direction

1-33 EMS System Components Medical Oversight On-line medical direction –Also called direct or concurrent medical direction –Direct communication with a physician Radio Telephone Face-to-face communication at the scene

1-34 EMS System Components Medical Oversight Off-line medical direction –Also called indirect, prospective, or retrospective medical direction –Medical supervision through the use of: Policies Treatment protocols Standing orders Education Quality management reviews

1-35 EMS System Components Medical Oversight Prospective medical direction –Activities performed by a physician medical director before an emergency call Treatment protocols Standing orders Retrospective medical direction –Actions performed by a physician after an emergency call

1-36 EMS System Components Medical Oversight Treatment protocols –List of steps to be followed during provision of emergency care to an ill or injured patient Standing orders –Written orders authorizing EMS personnel to perform certain medical procedures before establishing direct communication with a physician

1-37 EMS System Components Facilities An ill or injured patient receives definitive care in the hospital Examples of specialty centers –Trauma centers –Burn centers –Heart/cardiovascular centers –Hyperbaric centers –Pediatric centers –Perinatal centers –Poison centers –Spinal cord injury centers –Stroke centers

1-38 EMS System Components Public Health & Injury Prevention Public health –The science and practice of protecting and improving the health of a community as a whole. Healthcare professionals have a responsibility to educate the public. –Public education and injury prevention programs often lead to more appropriate use of EMS resources.

1-39 EMS System Components Evaluation Quality management –A system of internal and external reviews and audits of all aspects of an EMS system –Used to identify areas of the EMS system needing improvement and ensure that patients receive the highest quality medical care

1-40 Your Role in the Quality Management Process Quality management includes: –Obtaining information from the patient, other EMS professionals, and facility personnel about the quality and appropriateness of the medical care you provided –Reviewing and evaluating your documentation of an emergency call

1-41 Your Role in the Quality Management Process Quality management includes evaluating: –Your ability to perform skills properly –Your professionalism during interactions with the patient, EMS professionals, and other healthcare personnel –Your ability to follow policies and protocols –Your participation in continuing education opportunities

1-42 Phases of a Typical EMS Response

1-43 Phases of a Typical EMS Response 1.Detection of the emergency 2.Reporting –Call made for assistance

1-44 Phases of a Typical EMS Response 3.Dispatch/Response –Medical resources sent to the scene

1-45 Phases of a Typical EMS Response On arrival at the scene, perform scene size-up –Look for hazards or potential hazards

1-46 Phases of a Typical EMS Response 4.On-scene care

1-47 Phases of a Typical EMS Response 5.Care during transport

1-48 Phases of a Typical EMS Response 6.Transfer to definitive care

Characteristics of Professional Behavior 1-49

Professional Behavior: Integrity Integrity –Honesty, sincerity, truthfulness –Assumed by public –Single, most important behavior –Integrity in all actions 1-50

Professional Behavior: Empathy Empathy –Identifying with and understanding the feelings, situations, and motives of others –Demonstrate empathy to patients, families, and other healthcare professionals 1-51

Professional Behavior: Self-Motivation Self-Motivation –Internal drive for excellence –Must also be self-directed 1-52

1-53 Professional Behavior: Appearance “You never get a second chance to make a good first impression.” Presenting a neat, clean, professional appearance: –Invites trust –Instills confidence –Enhances cooperation –Brings a sense of order to an emergency

1-54 Professional Behavior: Hygiene Good personal hygiene –Bathing daily –Using a deodorant or an antiperspirant –Making sure hair, nails, and teeth are clean Good grooming –Uniform that is clean, mended, and fits well –Shoes that are clean, comfortable, provide support, fit properly –Wear a watch that displays seconds –Fragrances should not be worn –Tattoos and piercings should not be visible

Professional Behavior: Self-Confidence You will encounter situations involving: –Minor injuries –Life-threatening injuries –Patients and family members who are upset Others will look to you as the person in control You must be able to: –Adapt to these situations –Remain calm –Display confidence 1-55

Professional Behavior: Communication Communication –The exchange of thoughts, messages, and information –You must be able to convey information to others verbally and in writing. –You must also be able to understand and interpret verbal and written messages. 1-56

Professional Behavior: Respect Feeling and showing polite regard, consideration, and appreciation for others Introduce yourself to your patient –“Hello. My name is ______, and I am an Emergency Medical Technician. I am here to help you. What is your name?” 1-57

Professional Behavior: Time Management You must be able to prioritize tasks, while simultaneously providing patient care, and work quickly to accomplish those tasks. 1-58

Professional Behavior: Teamwork / Diplomacy Teamwork –Ability to work with others to achieve a common goal Diplomacy –Tact and skill in dealing with people 1-59

1-60 Professional Behavior: Patient Advocacy An advocate is a person who supports another. –You must protect the patient from further injury. –If the patient is unable to speak, you must be his voice and act in his best interests. –You must protect the patient’s rights, privacy, and dignity.

Professional Behavior: Careful Delivery of Service Deliver the highest quality of patient care with careful attention to detail Critically evaluate performance and attitude 1-61

1-62 Duties as an Emergency Medical Technician

1-63 Standard of Care No matter where they work, EMTs are expected to provide the same standard of care in an emergency Standard of care –Minimum level of care expected of similarly trained healthcare professionals

1-64 Your Obligations as an EMS Professional Respect each patient as an individual Provide emergency medical care to every patient to the best of your ability Listen attentively to your patients Provide clear explanations Provide patients with emotional support Preserve each patient’s dignity during examinations

1-65 Your Obligations as an EMS Professional The emergency medical care you provide must be based on need and without regard to the patient’s: –Race –Ethnicity –National origin –Religion –Gender –Age –Mental or physical disability –Sexual orientation –Ability to pay for the care provided

1-66 Primary Duties: Preparation and Safety Physical demands –Stamina and endurance –Walking, standing, and assisting in lifting and carrying ill or injured patients –Climbing and balancing may be required –Patients may be accessible only if you stoop, kneel, crouch, or crawl

1-67 Primary Duties: Preparation and Safety Maintain your health by exercising regularly –Improves muscle tone and circulation –Provides physical release for stress Get adequate sleep and rest Practice good nutrition and keep immunizations up to date

Primary Duties: Preparation and Safety Appropriate equipment and supplies Adequate knowledge and skill maintenance 1-68

1-69 Primary Duties: Preparation and Safety Safety 1.Personal 2.Crew 3.Patient 4.Bystanders

Primary Duties: Response Safety Timeliness 1-70

Primary Duties: Scene Assessment Size up the scene before initiating patient care –Determine if the scene is safe –Identify the mechanism of injury or the nature of the illness –Identify the total number of patients –Request additional help if necessary Put on appropriate personal protective equipment before approaching the patient 1-71

1-72 Primary Duties: Gaining Access Additional resources may be needed –Law enforcement personnel –Fire department –Utility company –Special rescue team Notify dispatch if resources are needed

1-73 Primary Duties: Patient Assessment Perform a systematic patient assessment Obtain vital signs Gather information about the emergency

Primary Duties: Emergency Care Give emergency medical care based on your assessment findings 1-74

Primary Duties: Emergency Care Lifting and moving patients safely –You must know the following: Body mechanics Lifting and carrying techniques Principles of moving patients –You must be also familiar with equipment used for lifting and moving 1-75

1-76 Primary Duties: Emergency Care Once you begin emergency care, you must continue that care until: –An individual with medical training equal to or greater than your own assumes responsibility for the patient, or –You are physically unable to continue providing care because of exhaustion, or –There is a change in the scene that weakens or endangers your physical well-being or –When an adult patient, of adequate mental capabilities and fully informed of the risks and benefits of treatment, elects to terminate care

Primary Duties: Transport/Transfer of Care Identify yourself as an EMT Report the patient’s age, gender, primary problem, and current condition Describe what happened and the position in which the patient was found Describe pertinent assessment findings, including vital signs Report any medical history obtained Describe the emergency medical care that you gave Describe the patient’s response to the treatment given 1-77

1-78 Verbal Report Remember “The Four Cs” when giving a verbal report: 1.C ourteous 2.C lear 3.C omplete 4.C oncise

Primary Duties: Documentation Documentation is an important part of prehospital care Documentation must be: –Accurate –Complete –Concise Documentation should reflect: –What you saw and heard at the scene –The emergency care you gave –The patient’s response to that care 1-79

Primary Duties: Returning to Service Rapidly prepare for the next call –Clean equipment as needed –Restock any disposable equipment used –Return equipment to its storage area Know policies regarding restocking of supplies 1-80

Primary Duties: Community Involvement Become actively involved in public education –How to access the EMS system –Injury prevention programs Bicycle safety Use of child safety seats Poisoning prevention Drowning prevention CPR and first aid programs 1-81

Primary Duties: Personal Professional Development Healthcare professionals are responsible for their personal professional development. Examples: –Participating in continuing education activities –Mentoring –Getting involved in professional organizations –Supporting and participating in research activities 1-82

EMS Research Research is the foundation for medical practice decisions and changes in patient management. If you are asked to participate: –Approach this responsibility seriously –Complete the task assigned to the best of your ability 1-83

1-84 Questions?