Bledsoe v1 ch03_lecture

Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Paramedic Care: Principles & Practice
Volume 1, 5e
Chapter 3
Roles and
Responsibilities of the
Paramedic

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Standard
• Preparatory (EMS Systems)

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Competency
• Integrates comprehensive knowledge of EMS
systems, the safety and well-being of the
paramedic, and medical–legal and ethical issues,
which is intended to improve the health of EMS
personnel, patients, and the community.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Introduction
• Strong knowledge of pathophysiology and current
medical technology
• Maintain professional attitude while making
medical and ethical decisions.
• Provide emotional support to patients and their
families.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Primary Responsibilities
• Preparation
– Ongoing Training
 Aerobics
 Exercises
 Stretching
 Understand biomechanics of lifting
 Effects of stress; ways to alleviate it

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Preparation
– Inspection and maintenance of emergency vehicle and
equipment
– Restocking medications; checking expiration dates
– Local EMS protocols, policies, procedures

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Preparation
– Communications system hardware and software
– Local geography
– Support agencies

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Figure 3-1 A paramedic provides emergency care to ill and injured patients—at the scene and in
the ambulance.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Response
– Personal safety number one priority
– Always follow basic safety precautions en route to
incident.
 Wear seat belt.
 Obey posted speed limits.
 Monitor road for potential hazards.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Response
– Correct location of incident
– Appropriate equipment en route
– Request additional personnel or services.
– Anticipate high-risk situations based on dispatch
information and experience.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Response
– Multiple patients
– Motor vehicle collisions
– Hazardous materials
– Rescue situations
– Violent individuals
– Use of weapon
– Knowledge of previous violence

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Scene Size-Up
– Primary concern safety of crew, patient, and
bystanders
– Identify all potential hazards.
– Never enter unsafe scene until hazards have been
dealt with.
– Any scene has potential to deteriorate.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Figure 3-2 Always assess the scene for potential hazards as you approach.
(© Ed Effron)

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Scene Size-Up
– Determine number of patients.
– Determine mechanism of injury (MOI) or nature of the
illness (NOI).

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Patient Assessment—Primary
– General impression of appearance
– Assess responsiveness.
– Assess airway, breathing, circulation.
– Treat life threats immediately.
– Decide whether to continue assessment on scene or
transport.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Patient Assessment—Primary
– Take patient's medical history.
– Continuously monitor patient.
– Provide additional emergency care needed.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Figure 3-3 During the primary assessment of your patient, you will look for and immediately
treat any life-threatening conditions.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Recognition of Illness or Injury
– First aspect of patient prioritization
– Patient priority based on urgency for transport.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Patient Management
– Follow protocols or treatment guidelines.
– Ensure use of proper equipment and availability of
adequate personnel.
– Medical direction:
 Instructions on how to proceed with emergency care
 Permission to perform certain procedures
 Alternatives to standard care

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Appropriate Disposition
– Patient taken to appropriate facility by appropriate
mechanism of transport
– Mode of transportation; time and distance key factors
– Know resources available.
– Follow all local protocols.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
– Selecting appropriate receiving facility for patient is
your responsibility.
– Know which medical facilities in your area offer
appropriate services.
– Receiving facilities categorized based on level of care
they can provide.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
– Level I facility: regional resource trauma center; tertiary
care facility for trauma care system; university-based
teaching hospitals.
– Level II trauma center: hospital expected to provide
initial definitive trauma care, regardless of severity of
injury.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
– Level III trauma center: serves communities that do not
have immediate access to Level I or II institution.
– Level IV trauma facilities: provide advanced trauma life
support before patient transfer in remote areas where
no higher level of care is available.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
– Designated trauma centers offer unique services: burn,
pediatric, psychiatric, perinatal, cardiac, spinal, poison
centers.
– When in doubt, contact on-line medical direction for
advice and support.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
– In some areas, paramedics provide primary care and
then transport.
– Treat and release: paramedics on scene, assess
patient, provide emergency care, do not transport.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Patient Transfer
– When in doubt about patient's stability for duration of
transport, or capabilities of receiving facility, contact
medical direction.
– Hand-off: before removing patient from hospital,
request verbal report from primary care provider.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Patient Transfer
– First priority during transport is patient.
– All documents provided by sending facility turned over
to receiving care provider along with copy of run report.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Documentation
– Patient care report completed in entirety as soon as
emergency care completed.
– Notes taken copied into report
– Importance of accurate and complete documentation
cannot be overemphasized.
– Record only observations, not opinions.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Returning to Service
– Clean and decontaminate unit.
– Properly discard disposable materials.
– Restock supplies; replace and stow away equipment.
– Refuel unit.
– Review call with crew members.
– Check for signs of critical incident stress; assist anyone
who needs help.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Figure 3-4 A paramedic’s responsibility does not end with providing patient care.
Documentation, restocking, and cleaning of the ambulance and emergency equipment are
equally important.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Additional Responsibilities
• Training civilians in CPR
• EMS demonstrations and seminars
• Teaching first aid classes
• Organizing prevention programs
• Professional development activities

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Administration
– Station duties
– Record keeping and reporting
– Special projects
– Developing interagency relationships

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Community Involvement
– Help public learn how to:
 Recognize emergency
 Provide basic first aid measures
 Properly access EMS system
– Successful effort can save lives.
– Illness and injury risk surveys

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Support for Primary Care
– Promote wellness and prevent illness and injury.
– Reduce cost of services by decreasing burden on
system.
– Patient always receives appropriate emergency care
based on need, not cost.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Citizen Involvement in EMS
– Helps give insiders an outside, objective view of quality
improvement; problem resolution.
– Members of community used in development,
evaluation, regulation of EMS system.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Personal and Professional Development
– Responsibility to continue personal and professional
development
– As volume of calls decreases, training correspondingly
increases.
– Review previously learned materials; receive new
information.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Professionalism
• Paramedic member of health care professions
• Periodic recertification with specified amount of
continuing education time
• Promote quality patient care.
• Set and strive for highest standards.
• Earn respect and confidence of team members
and public.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Professionalism
• Professional Ethics
– Ethics: rules or standards that govern conduct of
members of a particular group or profession.
– Ethics are not laws; they are standards for honorable
behavior.
– Conformity to ethical standards expected.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Professionalism
• Professional Ethics
– Guiding principles for professional EMT service:
 1948: World Medical Association adopted "Oath of Geneva."
 1978: National Association of Emergency Medical Technicians
adopted "EMT Code of Ethics."

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Professionalism
• Professional Attitudes
– Establish excellence as goal
– Never be complacent about performance
– Practice skills
– Take refresher courses
– Set high standards

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Professionalism
• Professional Attitudes
– Critically review performance; seek ways to improve.
– Check all equipment prior to emergency response.
– Act in professional manner both on and off duty.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Professionalism
• Professional Attributes
– Leadership
– Integrity
– Empathy
– Self-motivation
– Professional appearance and hygiene
– Self-confidence

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Figure 3-7 As leader of the EMS team, the paramedic must interact with patients, bystanders,
and other rescue personnel in a professional and efficient manner.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Professionalism
• Professional Attributes
– Communication skills
– Time-management skills
– Diplomacy and teamwork
– Respect
– Patient advocacy
– Careful delivery of service

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Professionalism
• Continuing Education
– Maintaining certification responsibility of paramedic
– Develop further knowledge and skills
– Keep up with emergency health care delivery system.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Summary
• To become a paramedic, you must be willing to be
a leader in prehospital emergency medical care.
• Responsibilities: on-call emergency duties; off-
duty preparation.
• Be prepared to respond.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Summary
• Most time as paramedic will be spent preparing
yourself to do job properly—not providing
emergency care.
• The best paramedics are those who make a
commitment to excellence.

Bledsoe v1 ch03_lecture

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