1. Introduction to Emergency Medical Care
Chapter 1
Introduction to Emergency Medical Care

2. Case History
You respond to a call for a patient in cardiac arrest. On arrival, you find a 52-year-old male who is pulseless and not breathing. A family member is performing CPR. The family states that he collapsed 4 minutes before your arrival.

3. Historical Perspective Battlefields Lay the Foundation
Napoleonic Wars – Ambulance volantes
Civil War – Horse-drawn ambulances
World War I – Motorized ambulances

4. Historical Perspective Battlefields Lay the Foundation
Korean War – Helicopters and MASH units
Death rates from battle casualties
8% WW I
4.5% Korea
2% Vietnam

5. Historical Perspective Civilian Evolution
Civilian evolution varied from region to region in U.S.
Rural areas – Undertakers
Fire departments and volunteer ambulance replaced funeral directors
Urban areas
Hospital-based
Fire departments
Police departments
Independent ambulance companies

6. Historical Perspective Civilian Evolution
Mid-1860s – First hospital-based ambulance services
Cincinnati General and Bellevue Hospitals
1899 – The first motorized ambulance
Michael Reese Hospital of Chicago

7. Trauma as an Impetus for EMS Development
Preventable injury
Leading cause of death in ages 1 to 45
Automobile caused surge in trauma deaths
1900 – 7th leading cause of death
2000 – 4th leading cause of death
Automobiles account for 50%

8. Knowledge and Technology
1960 – CPR developed
1960s – Portable defibrillators
First ALS units
Belfast, Ireland
St. Vincent’s Hospital (New York City)
Only physicians provided advanced care

9. Knowledge and Technology
Late 1960s – Biotelemetry developed
Allowed EMS providers to deliver ALS
Defibrillation
Advanced airway procedures
Drug therapy
“Johnny and Roy”
popularized paramedics
on TV show Emergency!

10. The Physician and EMS Physician societies organized early EMS programs
American Academy of Orthopaedic Surgeons (AAOS)
American College of Surgeons (ACS)
Worked with National Highway and Traffic Safety Administration (NHTSA)

11. The Physician and EMS Physician groups still involved
American College of Emergency Physicians (ACEP)
National Association of EMS Physicians (NAEMSP)
National Association of State EMS Medical Directors (NAEMSD)

12. The Landmark Paper – 1966
“Accidental Death and Disability: The Neglected Disease of Modern Society”
Prompted federal money to develop EMS in 1973
“Provide safe handling and transportation of ill or injured.”
Provided impetus for rapid proliferation

13. EMS Agenda for the Future: 14 Components
Integration of health services
EMS research
Legislation and regulation
System finance
Human resources
Medical direction
Education systems
Public education
Prevention
Public access
Communication systems
Clinical care
Information systems
Evaluation

14. Elements of a Communications System
The dispatch system – Enhanced 911
Formal national program to train dispatchers
Emergency Medical Dispatch (EMD)
Ambulance-to-hospital
Radio
Cell phone
Landline

15. Levels of Training Lay rescuer First responder EMT-Basic
EMT-Intermediate
EMT-Paramedic

16. Lay Rescuer Carry little or no equipment
Recognize life-threatening illness or injuries
Provide lifesaving care until EMS arrives
CPR
Relief of airway obstruction
Use of an AED
Bleeding control

17. First Responders Equipped with
Oxygen
AEDs
Airway equipment
Provide lifesaving care until EMS arrives

18. EMT-Basic Provide basic, noninvasive skills Patient assessment CPR
Airway adjuncts
AED use
Childbirth
Splinting
Spinal immobilization
Administration and assistance with medications
Activated charcoal, metered-dose inhaler, nitroglycerin, epinephrine
Use variety of transport devices

19. EMT-Intermediate Provide same skills as EMT-B
Provide additional advanced skills, including
Advanced airway techniques
ECG recognition
Intravenous fluid therapy
Administration of multiple medications

20. EMT-Paramedic Expanded scope of practice beyond EMT-B and EMT-I
Provides advanced techniques, such as
ECG interpretation
Drug therapy
Invasive airway techniques
Defibrillation
Often have more standing orders in protocols than EMT-I

21. Chain of Survival
Early Access Early CPR Early Defibrillation Early Advanced Care

22. The Health Care System Emergency departments
Specialty referral centers
Hospital personnel

23. Liaison with Other Public Safety Workers
Conflicts may occur when overlaps with other public safety personnel
Police take charge at crime scene, traffic and crowd control issues
Fire take charge at fire scene
EMS responsible for patient care
Cooperation is essential
Incident command system should be in place

24. Professional Attributes
Demonstrate skill and knowledge for the good of the patient
Promote high standards of behavior
Add to your body of knowledge to continue to advance in the profession

25. Professional Attributes
Appearance
A professional appearance and attitude help evoke a sense of confidence in patients and family members.
Clean and appropriate clothing
Attitude more important than outer appearance
Show an interest in your job
Possess a sensitive awareness of environment and needs others
Putting patient/family needs ahead of your own will protect and preserve safety

26. EMT-Basic Primary Responsibilities
Patient assessment
Personal safety and safety of others
Patient care
Lifting and moving patients safely
Transport/transfer of care

27. Other Responsibilities
Record keeping
Patient advocacy
Extrication
Communications
Vehicle and equipment maintenance

28. Local, State, and National Issues
National Registry of Emergency Medical Technicians
National Association of Emergency Medical Technicians
The American Heart Association
Continuing education
Refresher courses
Record keeping/Data Collection

29. Quality Improvement: Definition
A system of internal/external reviews and audits of all aspects of an emergency medical services system that identifies aspects that need improvement to ensure that the public receives the highest quality of prehospital care

30. Role of the EMT-Basic in Quality Improvement
Documentation
Run reviews and audits
Gathering feedback from patients/hospital staff
Conducting preventive maintenance
Continuing education
Skills maintenance

31. Medical Direction
Accountability for the medical conduct of EMS personnel by a physician knowledgeable in patient care
Online medical direction
Direct real-time contact via telephone or radio
Offline medical direction
Written protocols, policies, procedures

32. Summary EMT-Basic plays a key role in EMS system
Teamwork with other providers is essential for effective patient care
Quality assurance is an important role of the EMT-Basic