1. EMERGENCY MEDICAL SERVICES

2. LECTURE OBJECTIVES
Describe the historical development of the National Emergency Medical Services system
Describe the organizational structure of the State EMS System
Review the types of emergencies that prehospital personnel typically respond to within the school setting
Discuss the ways that the school nurse and local EMS can work together to better meet the emergency care needs of students

3. EMERGENCY MEDICAL SERVICES
Network of services coordinated to provide aid and medical assistance from primary response to definitive care
Personnel trained in rescue, stabilization, transportation, and advanced treatment of traumatic or medical emergencies.
Linked by a communication system that operates on both a local and a regional level
Tiered system of care, typically initiated by citizen action in the form of a telephone call to an emergency number

4. HISTORY OF EMS Early 1800s: Napoleonic Wars Baron Dominque Jean Larrey
Baron Dominique Jean Larrey – First modern military surgeon who introduced army ambulance corps
French army used horse-drawn “ambulances” to remove injured soldiers from the battlefield
Baron Dominque Jean Larrey

5. History of EMS 1860s: U.S. Civil War
Use of field ambulances and medics to treat trauma in the field
Surgeon General Hammond
Organized field care and transport of injured
One ambulance for every 150 soldiers
Two medical supply wagons for each regimental corps

6. History of EMS 1870: First air medical transport of patients
Franco-Prussian War
Wounded French soldiers evacuated from the battlefront and transported by hot air balloons

7. History of EMS
1865: First known hospital based ambulance – Commercial Hospital, Cincinnati, Ohio
1899: First motorized ambulance purchased by local businessmen for Michael Reese Hospital, Chicago
1900: Interns dispatched with ambulances to provide care en route
1940s: Funeral-home hearses and commercial vehicles deployed as ambulances
Early motorized ambulance
Funeral home-owned hearse ambulance

8. EMS Evolution in Wartime
World War I ( )
Evacuation time: hours
Mortality rate: >20%
World War II ( )
Evacuation time: 4-6 hours
Mortality rate: 3.3%
World War I Ambulance

9. History of EMS
Early 1950s: Helicopter evacuation of wounded begins during Korean War

10. EMS Evolution in Wartime
Korean War
( )
Evacuation time: 2-4 hours
Mortality rate: 2.4%
Vietnam War ( )
Evacuation time: 35 minutes
Mortality rate: 1.8%
Vietnam War-era Medevac helicopter

11. Early emergency care issues
1950s and 1960s
“Scoop and run” approach
Lack of uniformity
None/inadequate federal, state, local laws and/or standards
Personnel – little/no emergency care training
Emergency room physicians – largely part-time/ moonlighting who didn’t necessarily have experience in emergency/trauma care
Ambulances/equip/supplies – no standards/little consistency
Lack of radio communication with hospitals
1960: President John F. Kennedy
Declared “Traffic accidents constitute one of the greatest, perhaps the greatest, of the nation’s public health problems.”
1965: Unsafe at Any Speed, by Ralph Nader 11

12. 1966

13. 1966 National Academy of Sciences published a ground breaking paper
Accidental Death and Disability: The Neglected Disease of Modern Society
Referenced 1965 injury data. Cited accidents as
Leading cause of death between ages
Fourth leading cause of death for all ages

14. 1965 Data Accidents were responsible for: 52 million injuries
107,000 deaths
49, 000 deaths due to motor vehicle crashes (MVC)
10 million temporarily disabled
400,000 permanently impaired
Cost $18 billion
Accidents – became the impetus for federal EMS support

15. National Highway Safety Act of 1966
Federal response to the National Academy of Sciences report
States required to develop
Highway Safety Plan
EMS Plan (as related to motor vehicle incidents)
Development of uniform standards
Ambulances
Communication
Personnel training 15

16. Federal Milestones
– Federal funding provided by the Department of Transportation for EMS development
1972 – Federal Communications Commission recommends 911
1988 – National Highway Traffic Safety Administration (NHTSA) implements EMS Technical Assistance program
1990 – Trauma Systems Planning and Development Act (HHS)
1996 – EMS Agenda for the Future (NHTSA/HRSA)
2000 – EMS Education Agenda for the Future: A Systems Approach (NHTSA/HRSA)
2004 – Enhance Act (DOT/DOC)
Federal Interagency Committee on Emergency Medical Services (FICEMS) established
2006 – Institute of Medicine The Future of Emergency Care Report (
2008 – EMS Model Plan (Nat’l Assn of State EMS Officials)

17. EMERGENCY MEDICAL SERVICES IN Connecticut

18. CONNECTICUT REGIONS

19. Department of Public Health 410 Capitol Avenue, MS#12EMS
Region 1     Southwestern CT EMS Council 
Gwen Summ, Regional Coordinator 
 Walter Dadik, Council President
    (860)        
Region 2    South Central CT EMS Council  
Tom Lenart, Regional Coordinator  
 Judith Reynolds, Council President   
   (860)
 Region 3    North Central CT EMS Council 
David Bailey, Regional Coordinator 
Thomas Murphy, Council President       \
  (860)      
   Region 4    Eastern CT EMS Council  
Jonathan Lillpopp, Regional Coordinator  
Greg Allard, Council President
(860)
              
Region 5   Northwest CT EMS Council  
Jean Speck, Regional Coordinator     
Skip Gelati, Council President      
    (860)
Department of Public Health 
 410 Capitol Avenue, MS#12EMS
 P.O. Box    
Hartford, CT     

20. Provider Levels
EMR
EMT
AEMT
Paramedic

21. Division of EMS School Nurse Preparedness
Find the answers you need NOW!
Do you know the level of care of your local EMS agency, ie EMT’s or Paramedics?
Who would be your contact person at your EMS agency?
Do you have an established relationship with EMS?
What will their response time be?
Do they know which entranceway to enter?
Do you know what hospitals they transport to?

22. Division of EMS School Nurse Preparedness
Find the answers you need NOW!
Is the EMS agency aware of your students that have chronic medical conditions or special health care needs that may require emergency care intervention?
Does the EMS agency carry age appropriate equipment?
Is there equipment exchange with EMS?
Does your local EMS agency provide public education programs or injury prevention presentations?
Do you collaborate with your local EMS on preparedness planning or injury prevention initiatives?
Have you worked with your local EMS, local health department and hospital on terrorism/disaster planning?

23. Division of EMS School Nurse Preparedness
Find the answers you need NOW!
Do you have appropriate equipment/supplies for an emergency?
Are these items in an easily accessible area when they need to be obtained quickly? Do you have a portable emergency kit?
Where is your AED located?
Are routine quality checks of the AED conducted?
Who are your staff who are trained in CPR, AED use and First Aid?

24. SUMMARY
Work to ensure that a school emergency plan is developed and in place
Develop the plan with local EMS involvement
Establish a relationship with your local EMS to facilitate the emergency preparedness process

25. QUESTIONS?