CHAPTER 1

Introduction to Emergency Medical Care

Overview of the EMS System

Emergency Medical Services System

• Developed to provide what is known as “pre-hospital” or “out of hospital” care. Its purpose is to get trained personnel to the patient as quickly as possible and to provide emergency care on the scene, en route to the hospital, and at the hospital

Regulation and Policy

Resource Management

Human Resources

and Training

Transportation

Facilities

Communications

Public Information and Education

Medical Direction

Trauma Systems

Evaluation

NHTSA Standards for EMS Systems

•Regulation and Policy – must have in place enabling legislation (laws that allow the EMS system to exist), a lead EMS agency, a funding mechanism,

regulations, policies, and procedures

•Resource Management – centralized coordination of resources so that all victims of trauma or medical emergencies have equal access to basic emergency care and transport by certified personnel, in a licensed and equipped

ambulance, to an appropriate facility

•Human Resources and Training – at a minimum, all transporting prehospital personnel (on ambulance) should be trained to the EMT-Basic level using a standardized curriculum

•Transportation – safe, reliable ambulance transportation is a critical component; most patients are effectively transported by ground ambulance, but some may need helicopter or airplane

•Facilities – seriously ill or injured patient must by delivered in a timely manner to the closest facility

Components of an EMS System contd…

Components of an EMS System contd…

• Communications – there must be an effective communication system, beginning with the universal system access number (9- 1-1), dispatch-to-ambulance, ambulance-to-ambulance, ambulance-to-hospital, and hospital-to-hospital

• Public Information and Education – EMS personnel may participate in efforts to educate the public about their role in the system, their ability to access the system, and the prevention of injuries

• Medical Direction – must have a physician as a Medical Director accountable for the activities of EMS personnel within that system

• Trauma Systems – enabling legislation must exist to develop a trauma system including one or more trauma centers, triage & transfer guidelines for patients, rehabilitation programs, data collection, mandatory autopsies, and means for managing & assuring the quality of the system

• Evaluation – must have a program for evaluating and improving the effectiveness of the EMS system, QI (Quality Improvement), QA (Quality Assurance), or TQM (Total Quality Management)

Accessing the EMS System

9-1-1 (Regular versus Enhanced)

Enhanced has the additional capacity of automatically identifying the caller’s phone number and location

Regular is a system for telephone access to report emergencies. A dispatcher takes the information and alerts EMS, fire or police departments as needed

Communities without 9-1-1

Some communities do not have 9-1-1 systems, so there is a 10-digit number that must be dialed to reach ambulance, fire or police services

Levels of EMS Training

Certified First Responder (designed for the person who is first at the scene – police officers, fire fighters, industrial health personnel, etc… - emphasis is on activating the EMS system, providing immediate care for life-threatening injuries, controlling the scene, and preparing for the arrival of the ambulance)

EMT–Basic (considered the minimum certification level for ambulance personnel curriculum deals with the assessment and care of the ill or injured patient)

EMT–Intermediate (provides some level of advanced life support, such as the initiation of intravenous lines, advanced airway techniques, and the administration of some medications beyond the EMT-B level)

EMT – Critical Care (provides same care as EMT-Intermediate, but can also administer first-line cardiac drugs)

EMT–Paramedic (can perform relatively invasive field care, including insertion of endotracheal tubes, initiation of IV lines, administration of a variety of medications, interpretations of electrocardiograms and cardiac defibrillation)

The chain of human resources that make up the EMS system:

Components of theEmergency Medical System

Prehospital Care – Care provided by people on the scene of an illness or injury (CFR’s, EMT’s, etc…)

Emergency Departments – The sick or injured patient is taken to a local or specialty hospital and admitted through the emergency department

Continued…

Components of theEmergency Medical System

Specialty Facilities

Trauma centers

Burn centers

Pediatric centers

Poison control centers

Other specialty centers

Emergency DepartmentHospital Personnel

Physicians

Nurses

Other Health Professionals

Liaison with OtherPublic Safety Workers

Local Law Enforcement

State and Federal Law Enforcement

Overview of the Local EMS System

Dispatch

Emergency Medical Dispatcher

Types of Agencies

Hospital Resources

Other Resources

Roles and Roles and Responsibilities Responsibilities

of the EMTof the EMT––BB

Roles and Responsibilities

Personal safety

Safety of crew, patient, and bystanders

Patient assessment

Patient care based on assessment findings

Lifting and moving patients safely

Transport/transfer of care

Record-keeping/ data collection

Patient advocacy/Patient Rights

ProfessionalProfessionalAttributesAttributesand Traitsand Traits

Professional Attributesand Traits

Appearance

Keeps knowledge and skills up to date

Puts patient’s needs as a priority without endangering self

Continued…

Professional Attributesand Traits

Maintains current knowledge of local, state, and national issues affecting EMS

Quality Quality ImprovementImprovement

Continuous self-review to identify and correct aspects of the system that require improvement.

Quality Improvement

Quality Improvement

If a problem is identified, a plan is developed and implemented to prevent further occurrences of the same problem. Helps to assure that the public receives the highest quality of pre-hospital care.

Role of the EMT–B

Careful documentation

Become involved in the QI process – Run Reviews and Audits

Obtain feedback from hospital staff and Patients

Continued…

Role of the EMT–B (cont.)

Maintain equipment/Conducting Preventative Maintenance

Continuing education

Skill maintenance

MedicalMedicalDirectionDirection

Medical Direction

Oversight of the Oversight of the patient care aspects of patient care aspects of an EMS System by the an EMS System by the Medical DirectorMedical Director

Medical Director

Assumes ultimate responsibility for Assumes ultimate responsibility for the patient care aspects of the EMS the patient care aspects of the EMS System System

Oversees training

Develops protocols

Develops standing orders

Integral part of QI process

Types of Medical Direction

On-line

Telephone

Radio

Off-line

Protocols

Standing orders

On-line Medical Direction

Consists of orders from the on-duty Consists of orders from the on-duty physician given directly to the EMT-physician given directly to the EMT-B in the field by radio or telephoneB in the field by radio or telephone

You should take name and number You should take name and number of the physician that you speak toof the physician that you speak to

You must contact on-line medical You must contact on-line medical direction to sign off a minor even in direction to sign off a minor even in the presence of a parentthe presence of a parent

Off-line Medical Direction

Protocols are lists of steps, such as Protocols are lists of steps, such as assessments or intervention, to be assessments or intervention, to be taken in different situations – taken in different situations – developed by the Medical Directordeveloped by the Medical Director

Standing Orders are policies or Standing Orders are policies or protocols issued by a Medical protocols issued by a Medical Director that authorizes EMT-B’s Director that authorizes EMT-B’s and others to perform particular and others to perform particular skills in certain situationsskills in certain situations

EMT–B Relationship withMedical Direction

Designated agent of the physician.

Care rendered is considered an extension of the medical director’s authority (varies by state law).

EMT–B Relationship withMedical Direction

Designated agent is an EMT or other person authorized by a Medical Director to give medications and provide emergency care.

The transfer of such authorization is an extension of the Medical Director’s license to practice medicine.

Specific Statutes and Regulations regarding EMS in

NYS• Public Health Law Article 30 – law that

governs EMS and public health law; discusses “Good Samaritan Law”, Public Access Defibrillation, Epinephrine, Resuscitation Equipment and the establishment of EMS agencies

Specific Statutes and Regulations regarding EMS in

NYS cont’d…

• Part 800 – document that includes the state emergency medical services code; covers general topics and topics specific to emergency medical services personnel and certified ambulance services requirements

Specific Statutes and Regulations regarding EMS in

NYS cont’d…• Local Regulations and Protocols – there

is a book of protocols that each EMT should have that lists the steps to take while performing patient care. If there are any changes or updates, you should receive the updated information from your local EMS agency

Specific Statutes and Regulations regarding EMS in

NYS cont’d…• Vehicle and Traffic Law Concerning

Emergency Vehicles – describes legal requirements in NYS for driving ambulances and other EMS response vehicles; establish a standard in NYS for EMS response vehicles emergency operations; create a climate to help reduce the number of crashes and accidents and thereby reduce the injuries and property damage associated with EMS response vehicle emergency operations, and to provide information to develop educational programs for EMS emergency vehicle operators