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Introduction to the EMS System

Lesson 1

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Introduction

• First Responders are essential part of EMS system

• First trained persons to reach ill/injured patient• Individual summoned to provide care in an

emergency• Professional duty to respond/provide emergency

care• Usually have access to supplies/equipment for

providing initial care

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Examples of Occupations of First Responders

• Law enforcement personnel

• Firefighters • Industrial safety

officers• Prison guards• Lifeguards

• Daycare attendants• Athletic trainers• Ski patrol members• Civil defense

personnel• Disaster team

members

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Medical Emergencies• Situation where person suddenly needs medical care• Often person is injured or experiences sudden illness• May be life-threatening

U.S. Medical Emergency Statistics• 40 million visits made to emergency departments• 2 million people are hospitalized• 140,000 die from injuries• 180,000 die from heart attacks• 162,000 die from strokes

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Sudden Illness• Medical conditions that occur suddenly • Person with non-emergency chronic illness

Common Causes of Injuries Treated in Emergency Departments

• Examples of annual cases in U.S.: – Falls - 7,989,000 – Motor vehicle crashes - 4,582,000– Struck by or against object - 4,209,000– Cut or pierced by object - 2,544,000– Poisoning - 750,000– Burns - 516,000

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Injuries Causing Deaths

• Motor vehicle crashes, injuries at home, public places, and work

• Injuries may strike at any time• First Responders provide care until patient

receives advanced help

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Emergency Medical Services System (EMS)

• EMS Act of 1973 established nationwide system• Sophisticated network of services• Single call for help initiates responses to rush care to

patient

Accessing EMS• Activated when someone calls 911 or another local

number• Most communities have a centralized 911 system• 911 calls reach dispatcher who then sends resources to

scene

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911 Systems• Callers identify name,

location, and phone number

• Enhanced 911 systems automatically provide dispatcher with caller’s phone number/location for land lines

• Caller may need to specify exact location

• With cellular calls, caller’s location is unknown

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Steps of EMS Response to Emergencies

1. Medical emergency occurs2. Emergency recognized/EMS is activated3. Citizen responder may give first aid/CPR on the scene if

trained4. First Responders arrive5. EMTs/Paramedics arrive and assume care6. EMTs continue care measures begun by First

Responders7. Following stabilization and care, patient transported to

hospital8. Patient transferred to in-hospital care system

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Response of First Responders

• Sent to scene by dispatcher after a citizen has activated EMS

• If on-scene, initiates call to dispatcher to activate EMS.

• “Ensure that EMS has been activated” to cover all situations

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Types of Facilities Receiving Patients

• Hospital emergency departments• Specialty facilities:

– Trauma centers– Burn centers– Pediatric centers– Perinatal centers

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Preparation of First Responders

• Equipment used must be clean, complete, and readily available for use

• Frequent checks of equipment /supplies:– All equipment safe and in good working order– Dated supplies checked and replaced before

expiration– Oxygen cylinders kept full– Dressings/bandages replaced as soon as they are

used

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Preplanning• Preparing a plan in anticipation of different

emergencies• Many industrial plants have plans for response

that identify:– key personnel, – locations of supplies– mechanism for notifying EMS– evacuation routes

• Fire departments/EMS systems preplan responses to areas of potential hazards

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First Responder Preparation

• Preparation begins with training• First Responders should strive to keep

skills/knowledge up to date• Infrequently used skills should be practiced• Continuing education also essential

Notification of Medical Emergencies

• Police department, fire department, and EMS receive the call

• Lifeguards, ski patrol members, and athletic trainers are already at scene

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Responding to the Call• Gather medical

equipment and go to scene

• Respond in the appropriate vehicle

• Fire, police, and rescue personnel have vehicles equipped with the necessary warning equipment

• If private vehicle, obey all traffic laws/signs

Ten Components of EMS Systems

• Regulation and policy• Resource management• Human resources and training• Transportation• Facilities

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• Communications• Public information and education• Medical oversight• Trauma systems• Evaluation

Ten Components of EMS Systems Continued

• Dispatcher• First Responder• Emergency Medical

Technician (EMT)• Medical Director

EMS Professionals

Dispatcher

• Called an emergency medical dispatcher (EMD) or dispatch

• Receives most 911 calls• Located in law enforcement

agency, fire station, or other site

• Trained to obtain information/determine what personnel/equipment are needed

• Sends appropriate EMS unit(s) to the scene

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First Responder• Sometimes called an

emergency medical responder • Usually first person to arrive at

emergency • Takes over care of victim from

those giving first aid• Gathers information

concerning the victim• Controls scene• Prepares for arrival of an

ambulance• Provides care until more

advanced professionals arrive

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Emergency Medical Technician (EMT)

• Arrive in ambulance equipped for Basic or Advanced Life Support

• Take over care/transport patient for definitive medical care

• EMTs with different levels of training perform different medical treatments– EMT-Basic (EMT-B) – EMT-Intermediate (EMT-I)– EMT-Paramedic (EMT-P)

Medical Director

• Physician within EMS system who oversees First Responders/EMTs

• Establishes protocols for medical care • Available for consultation by radio or telephone

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Categories of First Responders’ Responsibilities

• General responsibilities• Patient care responsibilities• Responsibilities at the scene• Personal responsibilities and characteristics

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General Responsibilities

1. Respond in safe/rapid manner

2.Maintain personal safety

3. If emergency requires special personnel/equipment, contact EMS

4.Gain access to patient

5.Give care to the patient

6.Document emergency/actions to meet local recordkeeping requirements

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Patient Care Responsibilities

1. Give care needed for life-threatening problems2. Activate EMS system3. Further assess patient to detect medical

problems/life threats4. Provide care/remain with patient5. Assist other EMS personnel as needed6. Maintain the patient’s privacy and confidentiality

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Responsibilities at the Scene

1. Identify safety issues, determine number of patients, determine resources needed

2. It may be necessary to access the patient

3. Maintain safety of self, patient and others at scene

4. Assist personnel as required /requested

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Responsibilities at the Scene Continued

5.Cooperate with other public safety workers

6.Other responsibilities may include:– Assist in directing traffic – Summon other appropriate help – Control, direct, or ask bystanders for help– Other responsibilities as dictated by your job

or specific EMS system

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Training Responsibilities

• Keep your skills/ knowledge up to date• Attend continuing education programs and

refresher training• Read professional publications• Maintain current knowledge of issues affecting

EMS

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Personal Responsibilities and Characteristics

• Maintain a caring and professional attitude • Respect all patients, family• Maintain composure• Maintain a professional appearance• Maintain personal fitness and health

Medical Oversight

• Responsibility of physician overseeing out-of-hospital emergency care

• Medical director leads response team and decides how care is delivered

• Includes direct/indirect medical control

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Direct Medical Control

• Medical director involved by instructing prehospital care providers

• Medical director stays in contact with care providers

• Medical director can authorize specific patient treatment outside of standard protocols

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Indirect Medical Control

• Refers to offline direction provided by the medical director

• Medical director responsible for developing protocols

• Includes EMS system design, standards of training, quality assurance programs

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Legal Responsibility of Medical Director

• First Responders function under guidance/control of medical director

• First Responders generally considered agents of the medical director