1. LT: I understand what paramedics do.
BR: What is a radiologist?

2. What do you think paramedics do?

3. Group work – 2-3 no more!!
Grab a poster and some markers
Brainstorm what paramedics do
We will do a gallery walk afterwards!!

4. Hang your posters around the room.
Now that you know what a paramedic does walk around the room and make comments on each others papers
Comment if it is an accurate portrayal of a paramedic

5. EMS Systems

6. National EMS Education Standard Competencies
Preparatory Integrates comprehensive knowledge of the EMS system, safety/well-being of the paramedic, and medical/legal and ethical issues, which is intended to improve the health of EMS personnel, patients, and the community.

7. National EMS Education Standard Competencies
Emergency Medical Services (EMS) Systems
EMS systems
History of EMS
Roles/responsibilities/professionalism of EMS personnel
Quality improvement
Patient safety

8. Introduction The EMS system is constantly evolving.
Originally, the primary role was transportation.
As a paramedic, you will encounter many different situations.
© Mark C. Ide

9. Introduction The public’s perception of the EMS is based on:
TV and articles
Your treatment of their loved ones
Continued education is a must.
Treat everyone with respect and dignity.

10. The History of EMS 1485 1800s 1926 1940s First use of an ambulance
Transport only
1800s
First use of ambulance/ attendant to care for injuries on site
1926
Service started similar to present day
1940s
EMS turned over to fire and police departments
No standards set

11. The 20th Century and Modern Technology
EMS made major strides after WWII.
Bringing hospital to field gave patients a better chance for survival
Korean War
First use of a helicopter
M*A*S*H units
© National Library of Medicine

12. The 20th Century and Modern Technology
1956
Mouth-to-mouth resuscitation developed
Late 1950s/early 1960s
Focus shifted to bringing hospital to patients
MICUs developed

13. The 20th Century and Modern Technology
1965: “The White Paper” released
Findings included:
Lack of uniform laws and standards
Poor-quality equipment
Lack of communication
Lack of training

14. The 20th Century and Modern Technology
“The White Paper” findings outlined 10 critical points for EMS system
Led to National Highway Safety Act
Created US Department of Transportation
1968
Training standards implemented
9-1-1 created

15. The 20th Century and Modern Technology
1969
First true paramedic program
Standards for ambulance design and equipment
1970s
NREMT began
Courtesy of Eugene L. Nagel and the Miami Fire Department

16. The 20th Century and Modern Technology
1970s (cont’d)
1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS
1973: Emergency Medical Services System Act
1977: First National Standard Curriculum for Paramedics developed by US DOT

17. The 20th Century and Modern Technology
1980s/1990s
Number of trained personnel grew
NHTSA developed 10 system elements to help sustain EMS system
Responsibility for EMS transferred to the states
Major legislative initiatives

18. Licensure, Certification, and Registration
Certification examination:
Ensures all health care providers have the same basic level of knowledge and skill
Once you pass certification you can apply for state licensure.

19. Licensure, Certification, and Registration
Reciprocity
Certification granted from another state/agency
Requirements:
Hold a current state certification.
Be in good standing.
National Registry certification.

20. The EMS System
A complex network of coordinated services that provides care to the community
The public needs to be taught how to:
Recognize emergencies.
Activate the EMS system.
Provide basic care.

21. The EMS System Patient outcomes determined by: Bystander care
Transportation
Dispatch
Emergency department care
Response
Definitive care
Prehospital care
Rehabilitation

22. The EMS System As a paramedic, you must: Develop care plan
Decide on transport method
Determine receiving facility
Be active in your community.

23. Levels of Education EMS system functions from a federal to local level
Federal: National EMS Scope of Practice Model
State: Licensure
Local: Medical director decides day-to-day limits

24. Levels of Education
The national guidelines designed to create more consistent delivery of EMS nationally
Medical director can only limit scope of practice
2009: National EMS Education Standards
NREMT provides a national standard for testing and certification

25. Different levels First responder Dispatcher EMT-basic EMT-intermediate
EMT-paramedic
You can get certified by the Erlanger Fire Department

26. Emergency Medical Responder (EMR)
Formerly “first responder”
Requirements vary by state
Should be able to:
Recognize seriousness of condition.
Provide basic care.
Relay information.
Can include firefighters and law enforcement as well as private citizens
© Matt Dunham/AP Photosages

27. The EMS System Dispatchers
Usually the public’s first contact
Training level varies by state
Scene may differ from what dispatcher relays

28. © Peter Casolino/Alamy Images
The Dispatcher
Plays a critical role
Receives and enters information
Interprets it
Relays it to appropriate service
Some locations train EMDs
Give prearrival instructions
© Peter Casolino/Alamy Images

29. EMT Formerly EMT-B (basic) Primary provider level in many EMS systems
EMT certification precedes paramedic education
Most populous level in the system
© Amanda Herron, The Jackson Sun/AP Photos

30. Advanced EMT (AEMT) Formerly EMT-I Initially developed in 1985
Major revision in 1999
Trained in:
IV lines
Airway techniques (clear them)
Interpret ECG
Use of Defibrillators
Administer certain medications

31. Paramedic Highest level to be nationally certified
1999: Major revisions to curriculum greatly increased level of training and skills
Even if independently licensed, you must:
Function under guidance of physicians.
Be affiliated with a paramedic-level service.

32. Paramedic Education Initial education
Most states base education programs on the National EMS Education Standards.
Outline minimum knowledge needed for practice
States require varying hours of education.
National average: 1,000-1,500 hours
Training can last up to 2 years

33. Paramedic Education Continuing education
Most states require proof of hours.
Attend conferences and seminars.
Read EMS journals.
Get everyone involved in postrun critiques.
The responsibility for continuing education rests with you.

34. Paramedic Additional expertise involves More education
More administration duties
You are blamed if something goes wrong!!

35. Working With Other Professionals
Hospital staff
Become familiar with the hospital.
You may consult with staff by using the radio through established procedures.
The best patient care occurs when emergency care providers have close rapport.

36. Working With Other Professionals
Public safety agents
Some have EMS training
Can better perform certain functions than you
Interagency cooperation benefits patient
© Mark C. Ide

37. Working With Other Professionals
Continuity of care
The community has expectations of EMS
Focus on prevention
You will interact with many professional groups
Understand your role, as well as theirs.

38. National EMS Group Involvement
Many national and state organizations exist and invite paramedic membership.
Impact EMS future
Provide access to resources
Promote uniformity

39. Professionalism
You have responsibilities as a health care professional.
You will be measured by:
Standards, competencies, and education requirements
Performance parameters
Code of ethics

40. Professionalism You are in a highly visible role in your community.
You must:
Instill confidence.
Establish and maintain credibility.
Show concern for your patients.

41. Professionalism
More health care locations are using paramedic services, including:
Administering vaccinations
Serving as home health nurses
Performing special transports

42. Roles and Responsibilities
© Dan Myers

43. Roles and Responsibilities
Teach the community about prevention of injury and illness.
Appropriate use of EMS
CPR training
Influenza and pandemic issues
Campaign for EMS system
Courtesy of Captain David Jackson, Saginaw Township Fire Department

44. Summary
Ambulance corps were developed during World Wars I and II to transport and rapidly care for soldiers.
Helicopters were used to rapidly remove soldiers from the battlefield during the Korean and Vietnam Wars.

45. Summary
In 1966 the National Academy of Science and the National Research Council released “The White Paper” outlining 10 points.
The National Highway Safety Act and the US Department of Transportation were created as a result.
Paramedics must be licensed (also known as certification or credentialing) before performing any functions.

46. Summary
Standards for prehospital emergency care, and the people who provide it, are regulated under state law by a state office of EMS.
There are four levels of training: emergency medical responder, emergency medical technician, advanced emergency medical technician, and paramedic.
Paramedics may be involved in interfacility transports and transports to specialty centers.

47. Summary
Paramedics should be familiar with the roles and responsibilities of other health care providers and public safety agencies.
Continuing education programs expose paramedics to new research findings and refresh their skills and knowledge.
A physician medical director authorizes EMS providers to provide care in the field through off-line or online medical direction.

48. Summary
There are expected standards and a code of ethics for all paramedics.
There are many professional attributes that a paramedic is expected to have, including but not limited to integrity, empathy, teamwork, patient advocacy, and time management skills.

49. Summary
Some of the primary paramedic responsibilities include preparation, response, scene management, patient assessment and care, management and disposition, patient transfer and report, documentation, and return to service.
Paramedics evaluate their care through quality control and continuous quality improvement.

50. Summary
Research establishes a consensus of what EMS personnel should or should not do. Research may be quantitative or qualitative.
There are many ethical considerations when conducting research. Researchers must always obtain consent from subjects, inform them of the research parameters, and protect their rights and welfare.

51. Summary
Paramedics should know how to evaluate the quality of research, including how to recognize peer-reviewed literature and how to find quality research on the Internet.
Review medical literature as it becomes available, and stay up to date on changing guidelines.

52. Credits Chapter opener: © Mark C. Ide
Backgrounds: Purple – Courtesy of Rhonda Beck; Green – Jones & Bartlett Learning; Blue – Courtesy of Rhonda Beck; Lime – © Photodisc
Unless otherwise indicated, all photographs and illustrations are under copyright of Jones & Bartlett Learning, courtesy of Maryland Institute for Emergency Medical Services Systems, or have been provided by the American Academy of Orthopaedic Surgeons. ,

53. A day in the life When you arrive on the scene what do they do?
Size it up – is it easily accessible
Initial assessment – how serious is it
History of the patient
physical exam
Ongoing assessment
Communication
documentation

54. Scene Safety of the scene for all invovled Number of injured invovled
Possible hazards
Wrecked cars,
Fire
Atmosphere – wet, dry, heat, cold
Animals
People around – angered or beligerent

55. Client assessment Are they responsive Assess airway Assess breathing
Circulation
How bad is it?

56. Physical exam Individually check out the following Head Pelvis Eyes
Arms
Neck
Legs
Chest
Back
Abdomen
Vital signs

57. HISTORY S – signs and symptoms A - allergies M - medications
P – past medical history
L – last time eat or drink
E – event preceding

58. AED
Ventricular Fibrillation – abnormal heart rhythm. It is the most common cause of cardiac arrest.
A Defibrillator delivers an electric shock to put the heart back in rhythm “ reset button”
Automated external defibrillator – detects the heart rhythm and instructs the operator how to treat the patient

59. When to use an AED Patient does not respond to voice or touch
NO spontaneous breathing
No signs of circulation

60. Things to consider Patient is in a wet area or is themselves wet
The patient is less than 8 or less than 65 pounds
The client has a pacemaker
Lying on a metal surface
Medication patches