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2. EMS Past, Present, Future In Tennessee

3. EMS Emergency Medical Services When did EMS begin in the in the USA?

4. EMS What is EMS? Many components – Fire Departments – County Services – Hospital based – Private Services – Volunteer – Rescue Squads Emergency Rooms

5. EMS When did EMS begin? – Officially or Unofficially? – Officially- 1966 was the birth of modern EMS – Unofficially- Belleview Hospital started operating ambulances soon after it opened in 1736 18th and early 19th Charity Hospital operated its own ambulances. During and after the Civil War- local ambulances with no standards

6. EMS Who is EMS? – First Responders – Ambulance Drivers – EMR – EMT – AEMT – Paramedics – RN/NP/PA – Doctors

7. EMS What do we do in EMS? – Healthcare Provider Mental health, Dietician, Physical Therapist – Educators – Public Safety FF, LEO, Park Rangers, Safety Officers – Social Worker – Repairman?

8. EMS Modern EMS-Past – September 1966 “White Paper”- Accidental Death and Disability: The Neglected Disease of Modern Society Adequate ambulance services are as much a municipal responsibility as firefighting and police services.

9. EMS Modern EMS-Regulatory – What did that mean for Tennessee was created by state legislation in 1972 ( Memphis Fire Dept., Maury County, Hardin County) – the training of Emergency Medical Technicians (EMTs) – mandated the creation of standards for ambulances and medical equipment The Office of EMS was formed – coordinate training and certification of EMTs – implement ambulance licensing standards – vehicle inspection and permitting

10. EMS Modern EMS-Regulatory – What did that mean for Tennessee, cont. In 1973 legislation mandated the training and certification of Paramedics In 1977 legislation authorized the creation and management of a statewide system of EMS radio communications In 1983 the EMS Advisory Council and the Department of Health sponsored legislation to create the state EMS Board

11. EMS Modern EMS-Regulatory – What did that mean for Tennessee, cont. The Emergency Medical Services Board consists of 13 board members who are appointed by the Governor: Four from each Grand Division and one that can be from any of the three divisions – Two physicians, – One registered nurse, – One hospital administrator, – One member licensed as an EMT, EMT-P, registered nurse, or physician (who is affiliated with a volunteer ambulance service), – Two operators of ambulance services (licensed as an EMT or EMT-P), – One rescue squad member (licensed as an EMT or EMT-P), – One professional firefighter (licensed as an EMT-Paramedic), – One member affiliated with emergency management (licensed as an EMT or EMT-P), – Two officials of local governments that operate ambulance services, and – One paramedic instructor from an accredited paramedic program in Tennessee.

12. EMS Modern EMS-Regulatory – What did that mean for Tennessee, cont. EMS Board’s is empowered to: – approve schools and prescribe courses – promulgate regulations governing licenses and permits, – establish standards for the activities and operation of emergency medical and ambulance services. – conducts hearings to review and decide disciplinary matters – may suspend, revoke or otherwise discipline any authorization required for emergency medical personnel and ambulance services.

13. EMS Modern EMS-Regulatory – What did that mean for Tennessee, cont. Today the EMS Office, – operating under the rules of the EMS Board, – oversees a statewide EMS system comprised of thousands of Paramedics and EMTs – 210 ambulance services – 1,300 ambulances – 40 Air Ambulances – 1,000,000 patient transports annually.

14. EMS Modern EMS=Regulatory – What did that mean for Tennessee, cont. Since 1983 the Board has regulated the EMS system – involving several standing and ad hoc committees. – This gives Providers input into the rules that govern EMS.

15. EMS Modern EMS-Regulatory – What did that mean for Tennessee, cont. Today the EMS Office, – operating under the rules of the EMS Board, – oversees a statewide EMS system comprised of thousands of Paramedics and EMTs (licensing numbers is in the 40,000) » 14 EMT training sites Community College and Fire Departments » 10 Paramedics schools Most Nationally Accredited

16. EMS Modern EMS-Regulatory – What did that mean for Tennessee, cont. Today the EMS Office, – Coordinates effective and rapid delivery of emergency medical services to the general population – operational radio communications between ambulances and hospitals. – maintains liaison with emergency service agencies and the Tennessee Emergency Communications Board concerning 911 access

17. EMS Modern EMS-Regulatory – What did that mean for Tennessee, cont. Today the EMS Office, – Regional Medical Communications Center (RMCC) » An RMCC is a state designated communications entity with a regional mission and » focus that coordinates hospitals, ambulance services and other medical resources, in real time

18. EMS Modern EMS-Regulatory – What did that mean for Tennessee, cont. Today the EMS Office oversees – The Regional Medical Communication Centers (RMCC), with one located in each of the Eight EMS Regions. – Johnson City Knoxville Chattanooga Cookeville Nashville Columbia Jackson Memphis

19. EMS Modern EMS-Regulatory – What did that mean for Tennessee, cont. Today the EMS Office oversees – Peer Assistance Program » The Tennessee Professional Assistance Program (TNPAP) is a voluntary program made available through the Tennessee Board of Emergency Medical Services. consultation referral monitoring For EMS Providers whose practice is impaired, or potentially impaired, due to the use of drugs or alcohol, or psychological or physiological condition.

20. EMS Modern EMS-Regulatory – What did that mean for Tennessee, cont. Today the EMS Office oversees – State Trauma System » Hospital trauma centers are designated under the rules of the Board for Licensing Health Care Facilities (BLHCF). » Over 20,000 patients are admitted to Tennessee trauma centers annually, with more than » 18,000 seen at the six level one centers located in Memphis, Nashville, Knoxville, Chattanooga, Johnson City and Kingsport. » responsible for conducting the inspection process by contracting with qualified trauma surgeons and nurses and scheduling trauma center inspections that are conducted within a three year designation period as stipulated in BLHCF rules.

21. EMS Modern EMS-Regulatory – What did that mean for Tennessee, cont. Emergency Medical Services for Children (EMSC) – 1984 — Federal Emergency Medical Services for Children Program Authorized – 1993 — EMS Board Promulgates First Rules for Pediatric Equipment

22. EMS Modern EMS-Regulatory – What did that mean for Tennessee, cont. Emergency Medical Services for Children (EMSC) – 2009 — Star of Life Ceremony – Committee on Pediatric Emergency Care (CoPEC) » CoPEC advises the Tennessee Department of Health's Board for Licensing Health Care Facilities and the EMS Board regarding pediatric emergency care.

23. EMS Modern EMS-Education – What did that mean for Tennessee, cont. – 20 hour American Red Cross Advanced First Aid level – 32 hr. Advanced Training Emergency Care Course – 81 hr. Department of Transportation (DOT) Emergency Medical Technician (EMT-A) basic curriculum – Today EMT cources range from 2 college semesters to 13 weeks of training at Fire Departments – In transition at this time from EMT-IVs to EMT-Basic, to Advanced EMTs

24. EMS Modern EMS-Education – What did that mean for Tennessee, cont. – 1973 Paramedic courses were implemented across the State » Approximately 540 Hours – Today’s courses range from 1000 to 1500 hours and can end with an Associate’s Degree – Several Bachelor and Master’s program in EMS or related

25. EMS Modern EMS- Present – Transition to new levels – Mobile Integrated Healthcare/Community Paramedicine – Elevating our profession: Bachelor Degrees and Master Programs – Partnerships with other Healthcare Providers STEMI, Stoke accreditation processes Utilization of scope of practice in ERs

26. EMS Modern EMS- Present – Transition to new levels

27. EMS Modern EMS- Present – State Organizations at work for the continuous improvement of the industry Tennessee Ambulance Service Association (TASA) Tennessee EMS Education Association (TEMSEA) Tennessee EMS for Children (TNEMSC) Rural Health Association of Tennessee (RHAT)

28. EMS Modern EMS- Present – We have to be involved at all level Local Regional State National

29. EMS Modern EMS- Present into the Future – Where are we going? We need to continue to grow our industry MIHC/Community Paramedicine Telemedicine Ultrasound Drones Star Trek innovations ???

30. EMS Modern EMS- Present into the Future – What’s happening We need to continue to grow our industry – How do we do that? » Education » Scientific Studies » Professionalism

31. EMS Modern EMS- Present into the Future – What’s happening MIHC/Community Paramedicine

32. EMS Modern EMS- Present into the Future – What’s happening Ultrasound

33. EMS Modern EMS- Present into the Future – What’s happening Telemedicine

34. EMS Modern EMS- Present into the Future – What’s happening Drones

35. EMS Modern EMS- Present into the Future – What’s happening Star Trek innovations ???

36. EMS