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EMS 484

EMS management 1

Lecture 1Dr. Maha Khalid

Contents :

• Definition of EMS System .• Out-of-Hospital Components of an EMS System.• In-Hospital Components of an EMS System.• BLS.• ALS• Important milestone in the evolution of EMS• The 15 components of EMS System.• Continued Development of 14 EMS Attributes.• Medical Direction

Definition of EMS System

• A comprehensive network of personnel, equipment, and resources established to deliver aid and emergency medical care to the community.

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Out-of-Hospital Components of an EMS System

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©

Members of the Community

Communications System

EMS Providers

Public Utilities Poison Control Centers

FireRescueHazmat

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EmergencyNurses

Emergency and SpecialtyPhysicians

Ancillary Services

RehabilitationServices

In-Hospital Components of an EMS System

BLS

• Refers to the basic life-saving procedures such as artificial ventilation and cardiopulmonary resuscitation

Bledsoe et al., Essentials of Paramedic Care: Division 1

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

ALS

• Refers to advanced life-saving procedures such as intravenous therapy, drug therapy, intubation, and defibrillation

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Some systems are tiered: BLS arrives first and then, if required, ALS arrives later.

Bledsoe et al., Essentials of Paramedic Care: Division 1

Important milestone in the evolution of EMS

• EMS systems have developed from the traditional and scientific beliefs of many cultures.

Bledsoe et al., Essentials of Paramedic Care: Division 1

Ancient Times

• First “protocols” established in Mesopotamia– Evidence of medications, patient assessment

techniques, and bandages

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18th and 19th Centuries• Napoleonic Wars

– First efforts of field care developed by one of Napoleon’s surgeons. Triage, a method of sorting patients by severity, developed.

• U.S. Civil War– Triage and transport of wounded soldiers– Improvised hospitals in houses, barns, and churches

• First civilian ambulance service– Cincinnati, Ohio (1865)– New York City Health Department Ambulance

Service (1869)

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20th Century

• World War II– Transportation to appropriate facilities– Battlefield ambulances

• Vietnam and Korean conflicts– Soldiers treated in battlefield– Evacuation by helicopter

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Post-1960s Developments

• Mortician-operated ambulances withdrew due to costs and demand for additional services.

• Fire and police departments began providing EMS.• Growth of volunteer and independent local EMS

provider agencies.

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1966• The National Highway Safety Act established the

Department of Transportation, which provided grants for EMS.

• Publication of Accidental Death and Disability: The Neglected Disease of Modern Society – Highlighted deficiencies in prehospital

emergency care– Set guidelines for development of EMS

systems, training, ambulances, equipment

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1969

• The EMT-Ambulance program was made public. The first paramedic curriculum followed in 1977.

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1971

• White House issued $9 million in EMS grants for EMS demonstration projects.– Designed to be models for subsequent system development

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1972

• The Department of Health, Education, & Welfare funded initiatives to develop regional systems.

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EMS Systems Act of 1973

• Provided funding for a series of trauma projects• $300 million allocated to study EMS planning,

operations, expansion, and research• Continued funding for regional systems until 1981

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Manpower Training Communications

Transportation Emergency Facilities Critical Care Units

Public Safety Agencies

Consumer Participation Access to Care

Patient Transfer Standardized Recordkeeping

Public Information and Education

System Review and Evaluation

Disaster Management

PlansMutual Aid

To be eligible for funding a system must address:(The 15 components of EMS System )

Two Items the Legislation Omitted

• System finance• Medical direction

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1977

• First EMT-Paramedic curriculum was developed.

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1981

• The passage of the Consolidated Omnibus Budget Reconciliation Act (COBRA) wiped out federal EMS funding.

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1988

• Regulation and policy• Resources

management• Human

resources/training• Transportation• Facilities

• Communications• Trauma systems• Public information and

education• Medical direction• Evaluation

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EMS Agenda for the Future

• Published in 1996 as a comprehensive evaluation of the history of EMS

• Casts a vision for the future for EMS in the United States

Bledsoe et al., Essentials of Paramedic Care: Division 1

© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Continued Development of 14 EMS Attributes

• Integration of health services

• EMS research• Legislation and

regulation• System finance• Human resources• Medical direction• Education systems

• Public education• Prevention• Public access• Communication systems• Clinical care• Information systems• Evaluation

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Today’s EMS System

• Every EMS system must develop a system that best meets its needs.

• State- and regional-level EMS systems are often responsible for planning, developing protocols, and establishing standards.

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Medical Direction (1 of 2)

• A medical director is a physician who is legally responsible for all clinical aspects of the system.

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Medical Direction (2 of 2)

• The medical director’s role in a system is to:– Educate and train personnel– Participate in personnel and equipment selection– Develop clinical protocols– Participate in quality improvement and problem resolution– Provide direct input into patient care– Interface with the EMS system– Advocate within the medical community– Serve as the “medical conscience” of the EMS system

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The medical director can

provide on-line guidance to EMS personnel in the

field. This is known as

on-line medical direction.

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© Kenneth Kerr

Off-line medical direction refers to medical policies,

procedures, and practices that medical direction has

set up in advance of a call, such as standard protocols or standing

orders.

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Bledsoe et al., Essentials of Paramedic Care: Division 1

Protocols are the policies and procedures for all elements of an EMS system.