1. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 1 Introduction to EMS Systems

2. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Outline EMS System –Activities –Access –Levels of Providers –In-hospital Care EMS System –Activities –Access –Levels of Providers –In-hospital Care First Responder –Roles –Responsibilities Medical Oversight

3. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. The Emergency Medical Services System

4. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Suggested Photo: Rescue squad leaving base for a call

5. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. An EMS System: is a network of resources to provide emergency care and transportation of the sick and injured.

6. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. The Activities of an EMS System

7. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

8. Prevention of injury through public education Occurrence of an emergency illness or injury Bystander recognition of the emergency Activation of the EMS system Initial care of the victim by bystanders Prevention of injury through public education Occurrence of an emergency illness or injury Bystander recognition of the emergency Activation of the EMS system Initial care of the victim by bystanders EMS System Activities

9. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Arrival of First Responders, who may be: –Fire/Rescue personnel (paid or volunteer) –Law enforcement personnel –Industrial response teams Arrival of First Responders, who may be: –Fire/Rescue personnel (paid or volunteer) –Law enforcement personnel –Industrial response teams EMS System Activities

10. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

11. Arrival of additional EMS resources, who may be: –EMT-Basics –EMT-Intermediates –Paramedics Arrival of additional EMS resources, who may be: –EMT-Basics –EMT-Intermediates –Paramedics EMS System Activities

12. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Emergency care at the scene Transportation to the hospital Care of the patient in the hospital Emergency care at the scene Transportation to the hospital Care of the patient in the hospital EMS System Activities

13. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. To carry out these activities, an EMS System has 10 components To carry out these activities, an EMS System has 10 components

14. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Regulation and Policies Resource Management Personnel and Training Transportation Health Facilities Regulation and Policies Resource Management Personnel and Training Transportation Health Facilities Communications System Public Information and Education Medical Oversight Trauma Systems Evaluation (Quality Improvement Process)

15. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Access to the EMS System

16. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. The public must be able to notify the EMS system of an emergency in a timely manner for the EMS system to be of value. The most efficient way to do this is through a 9-1-1 system. 9-1-19-1-1

17. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Suggested Photo: Dispatch Center

18. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Non-9-1-1: Does not have a universally recognized access number Basic 9-1-1: Has a universally recognized number for all emergencies Enhanced 9-1-1 (E9-1-1): Displays information about the caller’s location on the dispatcher’s computer screen Non-9-1-1: Does not have a universally recognized access number Basic 9-1-1: Has a universally recognized number for all emergencies Enhanced 9-1-1 (E9-1-1): Displays information about the caller’s location on the dispatcher’s computer screen Types of EMS Access Systems

19. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Levels of EMS Providers

20. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. First Responder Provides very basic medical care on the scene

21. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. EMT-Basic Performs basic life- support measures at the scene and during transport

22. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. EMT-I and EMT-Paramedic EMT-Intermediate –Performs advanced life- support measures EMT-Paramedic –The most highly trained provider. Has a wider understanding of disease processes EMT-Intermediate –Performs advanced life- support measures EMT-Paramedic –The most highly trained provider. Has a wider understanding of disease processes

23. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. The In-Hospital Care System

24. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

25. Emergency Departments Emergency Departments (EDs) have varying levels of service available, depending on resources and staffing levels.

26. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Specialty Services Trauma Centers Burn Centers Pediatric Hospitals Perinatal Centers Poison Control Centers Trauma Centers Burn Centers Pediatric Hospitals Perinatal Centers Poison Control Centers

27. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Personnel Physicians –Varying types of specialists Nurses –Many are certified in specialty areas Physicians –Varying types of specialists Nurses –Many are certified in specialty areas

28. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Other Allied Health Professionals Such as? Other Allied Health Professionals Such as? Personnel

29. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. What is Your EMS System Like?

30. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Access and dispatching system Agencies providing EMS response and the level of care provided Area emergency departments and their capabilities Access and dispatching system Agencies providing EMS response and the level of care provided Area emergency departments and their capabilities Describe:

31. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Local or regional specialty facilities – Trauma Centers – Burn Centers – Poison Control – Pediatric Resources – Perinatal Resources Local or regional specialty facilities – Trauma Centers – Burn Centers – Poison Control – Pediatric Resources – Perinatal Resources Describe:

32. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Roles of the First Responder

33. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

34. Safety of self, patient, bystanders Gaining access to the patient Patient assessment to determine life- threatening problems Initial care of the ill or injured patient Transfer of patient to additional EMS resources for ongoing care Safety of self, patient, bystanders Gaining access to the patient Patient assessment to determine life- threatening problems Initial care of the ill or injured patient Transfer of patient to additional EMS resources for ongoing care

35. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Assisting the EMS crew with ongoing care Record keeping Cooperation with other public safety agencies –Law enforcement –Fire service –EMS providers Assisting the EMS crew with ongoing care Record keeping Cooperation with other public safety agencies –Law enforcement –Fire service –EMS providers

36. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Responsibilities of the First Responder

37. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Personal health and safety Having a caring, non-judgmental attitude Maintaining composure in stressful situations Neat, clean professional appearance Having up-to-date knowledge and skills Personal health and safety Having a caring, non-judgmental attitude Maintaining composure in stressful situations Neat, clean professional appearance Having up-to-date knowledge and skills

38. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Prioritize patient care with safety of self as the first priority Knowledge of local, state and national issues and trends in EMS Prioritize patient care with safety of self as the first priority Knowledge of local, state and national issues and trends in EMS

39. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Medical Oversight

40. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Medical Oversight Also called medical control 2 components –Indirect –Direct Also called medical control 2 components –Indirect –Direct

41. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Indirect Medical Control Does not involve direct communication between the physician and the care provider during patient care Also called: –Offline –Retrospective –Prospective Does not involve direct communication between the physician and the care provider during patient care Also called: –Offline –Retrospective –Prospective

42. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. System design Protocol development Education Quality management System design Protocol development Education Quality management Indirect Medical Control

43. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

44. Direct Medical Control Communication between a physician and care provider during patient care Also called: –Online –Immediate Communication between a physician and care provider during patient care Also called: –Online –Immediate

45. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Communication Must be: Concise Accurate Organized Pertinent Must be: Concise Accurate Organized Pertinent

46. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. The First Responder may act as the designated agent of the physician medical director. In this respect, the physician delegates responsibility to the First Responder in performing patient care.

47. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. An EMS system is a network of resources to provide emergency medical care and transportation. A variety of events take place in an EMS system, from injury prevention to EMS response to in-hospital care. An EMS system is a network of resources to provide emergency medical care and transportation. A variety of events take place in an EMS system, from injury prevention to EMS response to in-hospital care. Summary

48. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. There are 10 components of an EMS system. EMS access is most efficient in a 9-1-1 system. There are 4 nationally recognized levels of EMS providers. There are 10 components of an EMS system. EMS access is most efficient in a 9-1-1 system. There are 4 nationally recognized levels of EMS providers. Summary

49. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. The in-hospital care system continues care started in the field and provides special resources for patients. In-hospital care is continued by nurses, physicians, and other allied health professionals. The First Responder’s first responsibility is for his or her own safety while performing his or her other responsibilities. The in-hospital care system continues care started in the field and provides special resources for patients. In-hospital care is continued by nurses, physicians, and other allied health professionals. The First Responder’s first responsibility is for his or her own safety while performing his or her other responsibilities. Summary

50. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Medical oversight, also called medical control or medical direction, is required of all EMS systems. Medical oversight may be indirect or direct. The First Responder acts under the delegated authority of the physician medical director. Medical oversight, also called medical control or medical direction, is required of all EMS systems. Medical oversight may be indirect or direct. The First Responder acts under the delegated authority of the physician medical director. Summary

51. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Any Questions?