1. Chapter 1 Emergency Medical Care Systems, Research, and Public Health Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren

2. Objectives 1.Define key terms introduced in this chapter. 2.Describe the key historical events that have shaped the development of the emergency medical services (EMS) system, including (slides 17-19):slides 17-19 a.Lessons learned in trauma care from experiences in the Korean and Vietnam conflicts b.Publication of Accidental Death and Disability: The Neglected Disease of Modern Society c.Highway Safety Act of 1966 d.Emergency Medical Services System Act of 1973 e.Public CPR courses f.Publication of the National Emergency Medical Services Education and Practice Blueprint

3. Objectives 2.Describe the key historical events that have shaped the development of the emergency medical services (EMS) system, including (slides 17-19):slides 17-19 g.Publication of EMS Agenda for the Future and The EMS Education Agenda for the Future: A Systems Approach h.Development of National EMS Core Content, National EMS Scope of Practice Model, and National EMS Education Standards i.The Institute of Medicine report The Future of EMS Care: EMS at the Crossroads

4. Objectives 3.Briefly explain each of the components of the Technical Assistance Program Assessment Standards (slides 20-21):slides 20-21 a.Regulation and policy b.Resource management c.Human resources and training d.Transportation e.Facilities f.Communications g.Public information and education h.Medical direction i.Trauma systems j.Evaluation

5. Objectives 4.Discuss the differences between 911 and non-911 EMS access systems, including the features and benefits of 911 systems (slides 23-24).slides 23-24 5.Compare and contrast the scopes of practice of the following levels of EMS providers (slides 25-26):slides 25-26 a.Emergency Medical Responder (EMR) b.Emergency Medical Technician (EMT) c.Advanced Emergency Medical Technician (AEMT) d.Paramedic 6.Explain the importance of the EMT’s understanding of the health care resources available in the community (slides 27-29).slides 27-29

6. Objectives 7.Give examples of how EMTs can carry out each of the following roles and responsibilities (slides 31-43):slides 31-43 a.Personal safety and the safety of others b.Patient assessment and emergency care c.Safe lifting and moving d.Transport and transfer of care e.Record keeping and data collection f.Patient advocacy

7. Objectives 8.Describe the expectations of EMTs in terms of each of the following professional attributes (slides 44-53):slides 44-53 a.Appearance b.Knowledge and skills c.Physical demands d.Personal traits e.Maintaining certification and licensure

8. Objectives 9.Discuss the purposes of medical direction/oversight in the EMS system (slides 54-55).slides 54-55 10.Describe the purpose of quality improvement/continuous quality improvement programs in EMS (slide 56).slide 56 11.Explain the EMT’s roles and responsibilities in quality improvement (slide 57).slide 57 12.Identify activities in EMS that pose a high risk of mistakes and injuries (slides 59-60).slides 59-60 13.Discuss steps that you can take to minimize mistakes and injuries in EMS (slides 59-60).slides 59-60

9. Objectives 14.Discuss the steps of evidence-based decision making (slides 60-61).slides 60-61 15.Explain the limitations of evidence-based decision making in EMS (slide 60).slide 60 16.Describe the relationship between EMS and public health (slides 62-63).slides 62-63 17.List the ten greatest public health achievements in the United States in the 20th century.

10. Multimedia Directory Slide 29EMS and the Community Video Slide 64Healthy People 2010 Video

11. Topics The Emergency Medical Services System The EMT Research and EMS Care Public Health

12. CASE STUDY Dispatch

13. EMS Unit 121 Respond to 10915 Pine Lake Road in Perry Township for an elderly male who has fallen. Perry Township Fire Department is also en route. Time out 1032

14. Upon Arrival 65-year-old male fell approximately 30 feet down embankment Conscious; states injured right arm and leg Rescue preparing to extricate patient

15. How would you proceed?

16. Back to Topics The Emergency Medical Services System

17. A Brief History Back to Objectives

18. A Brief History Korean and Vietnam War “White paper” Highway Safety Act of 1966 Emergency Medical Services System Act of 1973 American Heart Association CPR

19. A Brief History National Emergency Medical Services Education and Practice Blueprint in 1993 EMS Agenda for the Future EMS Education Agenda for the Future National EMS Core Content in 2005 National EMS Scope of Practice Model The Future of EMS Care: EMS at the Crossroads National EMS Education Standards

20. Technical Assistance Program Assessment Standards Back to Objectives

21. Standards Regulation and Policy Resource Management Human Resources and Training Transportation Facilities

22. Standards Communications Public Information and Education Medical Direction Trauma Systems Evaluation

23. Technical Assistance Program Assessment Standards Access to the EMS system Back to Objectives

24. E911 Cell phones

25. Technical Assistance Program Assessment Standards Levels of Training Back to Objectives

26. Emergency Medical Responder Emergency Medical Technician Advanced Emergency Medical Technician Paramedic

27. Technical Assistance Program Assessment Standards The Health Care System Back to Objectives

28. Specialty Facilities Pediatric Stroke Spine Burn Trauma Cardiac Poison Hyperbaric Psychiatric Obstetric

29. EMS and Community Video Return to Directory Click here to view a video on the topic of EMS, the Community, and Children.here

30. Back to Topics The EMT

31. Roles and Responsibilities Back to Objectives

32. Personal safety Safety of others Patient assessment Emergency care Safe lifting and moving Transport and transfer of care Record keeping and data collection Patient advocacy

33. Roles and Responsibilities Personal Safety and the Safety of Others

34. Remember You cannot help the patient, other rescuers, or yourself if you are injured.

35. Driving safety Patient safety Scene safety Personal safety

36. Roles and Responsibilities Patient Assessment and Emergency Care

37. Primary assessment Secondary assessment Beware of changing conditions

38. Roles and Responsibilities Safe Lifting and Moving

39. Safety in movement and equipment Proper body mechanics

40. Roles and Responsibilities Transport and Transfer of Care

41. Transport Facility determination Transport code Drive safely Report to hospital staff

42. Roles and Responsibilities Record Keeping, Data Collection, and Patient Advocacy

43. Completereport Become apatientadvocate – Be truthful – Protectprivacy

44. Professional Attributes Appearance Back to Objectives

45. Appearance Groomed Neat, clean appearance In uniform Prepared

46. Professional Attributes Knowledge and Skills

47. Safety Traffic laws Territory Cleaning of equipment Use of equipment Medications

48. Professional Attributes Physical Demands

49. Must be able tolift 125 pounds Good vision Communicationskills Hearing (© Craig Jackson/In the Dark Photography)

50. Professional Attributes Personal Traits

51. Calm and reassuring Leadership Good judgment Good moral character Stability and adaptability Ability to listen Resourcefulness Cooperativeness

52. Professional Attributes Maintenance of Certification and Licensure

53. Continuingeducation Skill competency Avoiding criminalor unethicalbehavior Submitting allfees

54. Medical Direction and Oversight Back to Objectives

55. Medical director Protocols Off-line medical direction On-line medical direction Standing orders Medical oversight

56. Quality Improvement Back to Objectives

58. Issues in Patient Safety

59. High-Risk Activities Transfer ofcare Medical errors Carryingpatients Ambulancecrashes Lack of spineimmobilization Back to Objectives

60. Back to Topics Research and EMS Care

61. Evidence-Based Medicine Formulate a question Search medical literature Appraise the evidence for validity and reliability If the evidence supports it, change protocols Back to Objectives

62. Back to Topics Public Health

63. Roles of EMS in Public Health Healthpreventionandpromotion Diseasesurveillance Injuryprevention Back to Objectives

64. Healthy People 2010 Click here to view a video on the Healthy People 2010 initiative.here Return to Directory

65. CASE STUDY Follow-Up

66. Primary Assessment 65-year-old male, Edgar Robinson Chief complaint: right wrist and right thigh pain Respiration: 24 per minute Pulse: 90 beats per minute Skin warm and dry CASE STUDY

67. Secondary Assessment S: –Abrasions to arms –Pain and deformity of right wrist –Deformity, swelling, abrasions, pain in right thigh No feeling or movement of right toes Pulses present in foot –Denies losing consciousness CASE STUDY

68. Secondary Assessment A: Sulfa drugs M: Metroprolol P: HBP CASE STUDY

69. Treatment and Reassessment O 2 via nonrebreather mask Traction splint right leg Wheeled stretcher Reassess patient every five minutes Transfer care without incident CASE STUDY

70. 78-year-old male patient who appears to be suffering a stroke Patient is unable to speak and appears agitated The patient’s niece requests transport to a small local hospital near his residence A designated stroke center is 20 minutes from your location Critical Thinking Scenario

71. 1.What are your responsibilities while on this call? 2.How can you serve as the patient’s advocate? 3.How can you use medical direction in this situation? Critical Thinking Questions

72. Reinforce and Review Please visit www.bradybooks.com www.bradybooks.com and follow the myBradykit links to access content for the text.