1. Slide 1 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Introduction to Emergency Medical Care Chapter 1

2. Slide 2 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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. 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. Slide 3 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Historical Perspective Battlefields Lay the Foundation  Napoleonic Wars – Ambulance volantes  Civil War – Horse-drawn ambulances  World War I – Motorized ambulances

4. Slide 4 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Historical Perspective Battlefields Lay the Foundation  Korean War – Helicopters and MASH units  Mobile Army Surgical Hospital  Death rates from battle casualties  8% WW I  4.5% Korea  2% Vietnam

5. Slide 5 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Historical Perspective Civilian Evolution Civilian evolution varied from region to region in U.S.Civilian evolution varied from region to region in U.S. Rural areas – UndertakersRural areas – Undertakers  Fire departments and volunteer ambulance replaced funeral directors

6. Slide 6 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Historical Perspective Civilian Evolution Civilian evolution varied from region to region in U.S.Civilian evolution varied from region to region in U.S. Rural areas – UndertakersRural areas – Undertakers  Fire departments and volunteer ambulance replaced funeral directors Urban areasUrban areas  Hospital-based  Fire departments  Police departments  Independent ambulance companies

7. Slide 7 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Historical Perspective Civilian Evolution Mid-1860s – First hospital-based ambulance servicesMid-1860s – First hospital-based ambulance services  Cincinnati General and Bellevue Hospitals 1899 – The first motorized ambulance1899 – The first motorized ambulance  Michael Reese Hospital of Chicago

8. Slide 8 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Trauma as an Impetus for EMS Development Preventable injuryPreventable injury  Leading cause of death in ages 1 to 45 Automobile caused surge in trauma deathsAutomobile caused surge in trauma deaths  1900 – 7th leading cause of death  2000 – 4th leading cause of death  Automobiles account for 50%

9. Slide 9 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Knowledge and Technology 1960 – CPR developed1960 – CPR developed  Cardiopulmonary Resuscitation 1960s – Portable defibrillators1960s – Portable defibrillators First ALS units (Advanced Life Support)First ALS units (Advanced Life Support)  Belfast, Ireland  St. Vincent’s Hospital (New York City)  Only physicians provided advanced care

10. Slide 10 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Knowledge and Technology Late 1960s – Biotelemetry developedLate 1960s – Biotelemetry developed  Space race Allowed EMS providers to deliver ALSAllowed EMS providers to deliver ALS  Defibrillation  Advanced airway procedures  Drug therapy “Johnny and Roy”“Johnny and Roy” popularized paramedics on TV show Emergency!

11. Slide 11 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. The Physician and EMS Physician societies organized early EMS programsPhysician 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)Worked with National Highway and Traffic Safety Administration (NHTSA)

12. Slide 12 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. The Physician and EMS Physician groups still involved Physician groups still involved  American College of Emergency Physicians (ACEP)  National Association of EMS Physicians (NAEMSP)  National Association of State EMS Medical Directors (NAEMSD)

13. Slide 13 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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

14. Slide 14 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. EMS Agenda for the Future: 14 Components 1. Integration of health services 2. EMS research 3. Legislation and regulation 4. System finance 5. Human resources 6. Medical direction 7. Education systems 8. Public education 9. Prevention 10. Public access 11. Communication systems 12. Clinical care 13. Information systems 14. Evaluation

15. Slide 15 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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

16. Slide 16 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Levels of Training  Lay rescuer  First responder  EMT-Basic  EMT-Intermediate  EMT-Paramedic

17. Slide 17 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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

18. Slide 18 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. First Responders  Equipped with  Oxygen  AEDs  Airway equipment  Provide lifesaving care until EMS arrives

19. Slide 19 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.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 Activated charcoal, metered-dose inhaler, nitroglycerin, epinephrine  Use variety of transport devices

20. Slide 20 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.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

21. Slide 21 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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

22. Slide 22 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Chain of Survival Early Early CPREarly Defibrillation Early Advanced Care Early Access Early CPREarly Defibrillation Early Advanced Care

23. Slide 23 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. The Health Care System  Emergency departments  Specialty referral centers  Hospital personnel

24. Slide 24 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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

25. Slide 25 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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

26. Slide 26 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Professional Attributes  Appearance  A professional appearance and attitude help evoke a sense of confidence in patients and family members. Clean and appropriate clothing Clean and appropriate clothing  Attitude more important than outer appearance Show an interest in your job Show an interest in your job Possess a sensitive awareness of environment and needs others Possess a sensitive awareness of environment and needs others Putting patient/family needs ahead of your own will protect and preserve safety Putting patient/family needs ahead of your own will protect and preserve safety

27. Slide 27 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. EMT-Basic Primary Responsibilities  Patient assessment  Personal safety and safety of others  Patient care  Lifting and moving patients safely  Transport/transfer of care

28. Slide 28 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Other Responsibilities  Record keeping  Patient advocacy  Extrication  Communications  Vehicle and equipment maintenance

29. Slide 29 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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

30. Slide 30 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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 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

31. Slide 31 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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

32. Slide 32 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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

33. Slide 33 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 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

34. Slide 34 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Basic or Advanced?  Basic life support called BLS describes the care given by First Responders and EMT- Basics  Advanced life support, called ALS, is the higher level of care performed by EMT- Intermediates and Paramedics  Permitted to perform invasive procedures Procedures that introduce foreign substances or equipment into the patient’s body Procedures that introduce foreign substances or equipment into the patient’s body

35. Slide 35 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Training  The EMS provider is legally prohibited from performing skills that are beyond his or her level of training  Each group of skills requires the proper certification  The length of time required for learning the advanced skills is considerable

36. Slide 36 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. First Responder Training  Prerequisite: Health Care Professional level CPR  8 hours  24-hour class  Three-year certification period  Certification is maintained with a refresher course 12 hours 12 hours

37. Slide 37 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. EMT Basic Training  Prerequisite: Health Care Professional level CPR  8 hours  110-hour class plus  Five patient contacts  State certification application and fee  $150.00  Two-year certification period  24-hour refresher course  28 hours of continuing education  $150.00 recertification fee

38. Slide 38 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. EMT Intermediate Training  Prerequisite: Health Care Professional level CPR  8 hours  180-hour class plus  100 hours of clinical observations and skills 30 i.v. starts 30 i.v. starts 10 intubations 10 intubations  100 hours of field observations and skills 10 i.v. starts 10 i.v. starts 1 intubation 1 intubation

39. Slide 39 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. EMT Intermediate Training  State certification application and fee  $150.00  State administered exam  Minimum passing grade: 70%  Two-year certification period  24-hour refresher course  28 hours of continuing education  $150.00 recertification fee

40. Slide 40 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. EMT Paramedic Training  Prerequisite: Health Care Professional level CPR & EMT-B certification  X contact hours as an EMT-B  400-hour class plus  200 hours of clinical observations and skills 60 i.v. starts 60 i.v. starts 10 intubations 10 intubations  200 hours of field observations and skills 30 i.v. starts 30 i.v. starts 1 intubation 1 intubation

41. Slide 41 Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. EMT Paramedic Training  State certification application and fee  $150.00  State administered exam  Minimum passing grade: 70%  Two-year certification period  24-hour refresher course  28 hours of continuing education  $150.00 recertification fee