1. Introduction to EMS For Residents Rotating in PEM

2. Goals and Objectives To understand the basic structure of EMS and the capabilities of various EMTs To gain a basic understanding of EMSC and EMTALA To gain a basic understanding about online/offline medical and disaster triage

3. Background 1869 – Used horse drawn carriages in NY 1 st Volunteer squad in Roanoke, VA in 1922, however, this became popular after WWII. 1966. Highway Safety Act – improve EMS, develop regional EMS agencies 1972 - Funding 1984 – EMS-C. Funded by MCHB and HRSA

4. EMSC Developed in 1991 Designed to ensure that all children receive appropriate care in a health emergency –Improve Pediatric Emergency Care infrastructure in the US Federally funded (HRSA)

5. EMSC 2 Resource Centers –NRC (National Resource Center) http://www.childrensnational.org/EMSC –NEDARC Data analysis resource center, Utah Funds –Competitive Targeted Issue (TI) Grants –PECARN – Which our ED is part of

6. EMTALA EMTALA, which applies to all hospitals that participate in the federal Medicare program, imposes three primary obligations on those hospitals. –First, when an individual shows up for treatment at a hospital's emergency room, "the hospital must provide for an appropriate medical screening examination... to determine whether or not an emergency medical condition" exists. –Second, if the screening examination indicates that an emergency medical condition does exist, the hospital ordinarily must "stabilize the medical condition" before transferring or discharging the patient. –Third, if the hospital is unable to stabilize the patient, the hospital must provide for an appropriate transfer to another medical facility.

7. EMTALA Failure to fulfill these obligations is considered a breach of the provider agreement and grounds for termination from the Medicare program.

8. EMS Tiered Response Level specific training and equipment First Responder First Responder EMT-B (basic) EMT-B (basic) EMT-I or EMT-D EMT-I or EMT-D EMT-P (paramedic) EMT-P (paramedic)

9. First Responder Layperson definition –“A person who happens on the scene first to provide patient aid.” Classification of providers –Between First Aid and EMT-Basic –“Certified First Responder”

10. First Responder Abilities Patient Care –Basic Life Support Opening and maintaining an airway Ventilate patients AED –Injuries Controlling hemorrhage Bandaging wounds Manual stabilization of extremities and neck –Childbirth Assist in childbirth Routine care of the infant

11. First Responders Can Not: Spinal immobilization with collar or backboard Oxygen administration Medication administration

12. BLS Equipment Stretchers Portable oxygen Portable oxygen Nasal cannulas Nasal cannulas Suction Suction Bag valve mask Bag valve mask Spine boards Spine boards Commercial fracture splints. Commercial fracture splints. Cold packs Cold packs Fire extinguisher Fire extinguisher Head-to-board immobilization device. Head-to-board immobilization device. Obstetrical kit Activated charcoal. Burn sheets Bandages or commercial slings. Trauma dressings Sterile gauze pads 20. One set of N Nasopharyngeal airways Oropharyngeal airways Occlusive dressings TapeShears Bedpan, emesis basin Distilled water or saline Flashlights Sharps containers Biohazard bags Cervical collars Blankets, Sheets, Pillows, Towels Phenol disinfectant Flares for securing scene Automatic defibrillator Blood pressure manometer stethoscope Traction splint. RadioGlucose Disposable gloves Hot packs. Personal protection equipment Biological fluid cleanup kit.

13. EMT-B PPVAED Oral and Nasal airways Home medication administration Check glucose

14. EMT-I Can do everything the EMT-B plus –Defibrillate –Typically are ACLS trained –Can do needle decompression of tension pneumo –Intubate –Diagnose and treat basic arrhythmias

15. ALS Equipment Basically – everything for PALS 1. Cardiac defibrillator with pediatric capabilities. 2. Portable radio. Rechargeable battery operated capable of reaching law enforcement and hospitals. 3. Nebulizer with tubing. 4. Endotracheal airway equipment in pediatric and adult sizes. 5. Intravenous therapy equipment. Catheters, intraosseous needles, tubing, solutions 6. Glucose measuring device. 7. Syringes and needles. 8. Alcohol swabs. Betadine swabs. 9. Electrocardiogram supplies. Rolls of electrocardiogram paper, monitor electrodes, and defibrillator pads. 10. Pediatric weight and length based drug dosage chart or tape.

16. Random Facts Enhanced 911 –Operator knows the address of the caller Online medical control –MD advising EMT to administer 2mg ativan for a seizure Offline medical control –Using protocols for management

17. Disaster Triage Sort patients with limited data Maximize the survival of greatest number of victims Treat most seriously injured if salvageable