DMACC EMT Chapter 1

1. PREHOSPITALPREHOSPITAL
EMERGENCY CAREEMERGENCY CARE
CHAPTER
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Prehospital Emergency Care, 10th
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TENTH EDITION
Emergency Care
Medical Systems,
Research, and Public
Health
1

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Learning ReadinessLearning Readiness
• EMS Education Standards
 Preparatory
 Public Health

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Learning ReadinessLearning Readiness
ObjectivesObjectives
• Please refer to pages 1 and 2 of your
text to view the objectives for this
chapter.

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Learning ReadinessLearning Readiness
Key TermsKey Terms
• Please refer to page 2 of your text to
view the key terms for this chapter.

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Setting the StageSetting the Stage
• Overview of Lesson Topics
 The emergency medical services (EMS)
system
 Roles, responsibilities, and attributes of
EMTs
 State EMS agencies, medical direction,
and quality improvement (QI)
continued on next slide

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Setting the StageSetting the Stage
• Overview of Lesson Topics
 Patient safety
 Research in EMS
 Public health and EMS

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Case Study IntroductionCase Study Introduction
Every Saturday Ben Melton has breakfast
at Dave’s Diner, a favorite with locals in
the small tourist town. Despite having
diabetes and carrying an extra 40 pounds
around his waist, 51-year-old Ben finds it
hard to pass on Dave’s breakfast platter
of eggs, steak, and fried potatoes.
continued on next slide

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Case Study IntroductionCase Study Introduction
This morning, by the time his coffee
arrives, Ben isn’t feeling so well. Just as
his friend, Arnie, notices that Ben has
turned pale and broken into a sweat, Ben
collapses, pulling the tablecloth with him
to the floor.

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Case StudyCase Study
• What components of a health care
system must be in place for Ben to
receive immediate help?
• What weaknesses in a system could
decrease Ben’s chances of getting help?

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IntroductionIntroduction
• Sudden loss of life and disability from
catastrophic accidents and illnesses is a
major public health problem.
• Every year thousands of people die or
suffer permanent harm because of lack
of access to adequate to emergency
medical services.
• EMTs can make a positive difference.

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The EMS System: HistoryThe EMS System: History
• What happens to an injured or ill
patient before he reaches the hospital
can make a critical difference.
• Lessons learned from observations in
the Korean and Vietnam wars have
impacted the development of modern
EMS systems.
continued on next slide

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The EMS System: HistoryThe EMS System: History
• In the past, care did not begin until the
patient reached the hospital.
• In 1966, the EMS “white paper”
identified deficiencies in prehospital
medical care, including lack of EMT
training and lack of organized systems.
continued on next slide

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The EMS System: HistoryThe EMS System: History
• Modern EMS is part of a continuum of
care that begins at the scene of the
emergency and continues through
hospital discharge and rehabilitation.
• Several significant developments
helped lead to this EMS system.
continued on next slide

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The EMS System: HistoryThe EMS System: History
• The Highway Safety Act of 1966
 Required each state to establish a
highway safety program that included
emergency services
 The National Highway Transportation
Safety Administration (NHTSA), part of
the Department of Transportation
(DOT), led the development of EMS.
 An early initiative was the development
of national standard curricula for EMS.
continued on next slide

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The EMS System: HistoryThe EMS System: History
• The Emergency Medical Services
System Act of 1973 provided access to
millions of dollars of funding for EMS.
• The American Heart Association (AHA)
began to teach CPR to the public.
continued on next slide

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The EMS System: HistoryThe EMS System: History
• In 1993 the National Registry of EMTs
(NREMT) released the National
Emergency Medical Services Education
and Practice Blueprint, which:
 Defined issues related to EMS training
and education
 Served as a guide to the development of
national training curricula
continued on next slide

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The EMS System: HistoryThe EMS System: History
• NHTSA documents
 1996 EMS Agenda for the Future
• Focused on making EMS a greater
component in the health care system
 2000 EMS Education Agenda for the
Future: A Systems Approach
• Focused on the need for nationwide
consistency in the education, training,
certification, and licensure of entry-level
EMS personnel
continued on next slide

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The EMS System: HistoryThe EMS System: History
• NHTSA documents
 2005 National EMS Core Content
• Defined the domain of knowledge of the
National EMS Scope of Practice Model
 2006 National EMS Scope of Practice
Model
• Defines four levels of EMS licensure
 National EMS Education Standards
• Outline minimum terminal objectives for
EMS education programs continued on next slide

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The EMS System: HistoryThe EMS System: History
• The 2006 Institute of Medicine (IOM)
report The Future of EMS Care: EMS at
the Crossroads recommends:
 Common scopes of practice to allow
reciprocity between states
 National accreditation for all paramedic
programs
 National certification as a prerequisite
for state licensure and local
credentialing

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The EMS System: StandardsThe EMS System: Standards
• NHTSA provides a set of recommended
state standards, the Technical
Assistance Program Assessment
Standards.
• There are ten components.
continued on next slide

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The EMS System: StandardsThe EMS System: Standards
• Regulation and policy
 Laws, regulations, policies, and
procedures that govern the EMS system
 A state-level EMS agency to provide
leadership to local jurisdictions
• Resource management
 Central control of EMS resources so that
there is equal access to acceptable
emergency care
continued on next slide

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The EMS System: StandardsThe EMS System: Standards
• Human resources and training
 All personnel who staff ambulances and
transport patients must be trained to at
least the EMT level
• Transportation
 Safe, reliable transportation by ground
or air ambulance
continued on next slide

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The EMS System: StandardsThe EMS System: Standards
• Facilities
 Patients must be delivered to
appropriate medical facilities
• Communications
 Public access to the system
 Communication among dispatcher, EMS
personnel, and hospital
continued on next slide

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The EMS System: StandardsThe EMS System: Standards
• Public information and education
 EMS personnel should participate in
programs to educate the public in injury
prevention and how to access the EMS
system.
• Medical direction
 A physician medical director to provide
medical oversight
continued on next slide

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The EMS System: StandardsThe EMS System: Standards
• Trauma systems
 A system of specialized care for trauma
patients
• Evaluation
 A quality improvement system

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EMS System AccessEMS System Access
• The most common way of accessing
EMS is dialing 911.
• Enhanced 911 (E-911) allows:
 Automatic number identification
 Automatic location information
continued on next slide

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Communications play a vital role in the Emergency Medical Services (EMS) system.

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EMS System AccessEMS System Access
• Benefits of 911
 Public safety answering point (PSAP) is
staffed by specially trained dispatchers.
 The number is easy to remember and
use.
 All emergency services—police, fire, and
EMS—are accessible by dialing one
number.
continued on next slide

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EMS System AccessEMS System Access
• Cell phones pose some challenges to
911 systems.
 They are not identified with a fixed site,
so the location is identified as the
closest cell tower.
 Calls near geographic boundaries can go
to a different PSAP.
 FCC rules are being implemented to
improve cellular access to 911.
continued on next slide

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EMS System AccessEMS System Access
• Voice over Internet Protocol (VoIP) also
poses potential challenges that are
addressed by FCC rules.
 911 service must be a standard feature
to all customers.
 The subscriber must give the physical
location of where the service will be
used.
continued on next slide

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EMS System AccessEMS System Access
• Voice over Internet Protocol (VoIP) also
poses potential challenges that are
addressed by FCC rules.
 The provider must transmit all 911 calls
and associated information to the
appropriate PSAP.

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Case StudyCase Study
Charlene, one of the waitresses in the
restaurant, pulls a cell phone from her
pocket and dials 911. The dispatcher
immediately transfers the call to a
specially trained emergency medical
dispatcher. The EMD asks Charlene a
series of questions to get help on the
way, and gives her instructions for
checking and monitoring Ben’s condition
until help arrives. continued on next slide

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Case StudyCase Study
• What components of the EMS system
have been used in this case so far?
Click each item you select.
Regulations &
Policy
Regulations &
Policy
Resource
Management
Resource
Management
Human
Resources &
Training
Human
Resources &
Training
TransportationTransportation FacilitiesFacilities
CommunicationCommunication
Public
Information &
Education
Public
Information &
Education
Medical
Direction
Medical
Direction
Trauma
Systems
Trauma
Systems
EvaluationEvaluation

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Case StudyCase Study
EMTs Juliana Smock and Peter Saylor,
who had just finished their check of the
ambulance, respond to the dispatch,
heading down Highway 129 toward
Dave’s. An anxious customer holds open
the front door as Juliana and Peter pull to
a stop in front of the restaurant. Taking a
look around at the scene, the EMTs grab
their equipment and head for the door.
continued on next slide

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Case StudyCase Study
• What EMT responsibilities have Juliana
and Peter demonstrated so far?
• What EMT responsibilities do you
predict they will perform next?
• How will the EMTs’ appearance and
actions determine how they are
perceived by others?

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Levels of ProvidersLevels of Providers
• The National EMS Scope of Practice
Model identifies four levels of EMS
practitioners.
continued on next slide

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The four levels of EMS practitioners.
continued on next slide

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Levels of ProvidersLevels of Providers
• Emergency Medical Responder
 Provides immediate lifesaving care to
patients while awaiting response from a
higher-level EMS practitioner
continued on next slide

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Levels of ProvidersLevels of Providers
• Emergency Medical Technician
 Provides basic emergency medical care
and transportation using the basic
equipment found on an ambulance
continued on next slide

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Levels of ProvidersLevels of Providers
• Advanced Emergency Medical
Technician
 Provides basic and limited advanced
emergency medical care and
transportation to patients in the
prehospital environment
continued on next slide

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Levels of ProvidersLevels of Providers
• Paramedic
 Performs advanced assessments, forms
field impressions, and provides invasive
and drug interventions as well as
transport

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The Health Care SystemThe Health Care System
• A health care system is a network of
medical care that begins in the field
and extends to hospitals and other
treatment centers.
• EMS providers are part of a
community’s health care system.
continued on next slide

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The Health Care SystemThe Health Care System
• The different health care facilities to
which EMTs may transport patients
have different capabilities.
continued on next slide

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The Health Care SystemThe Health Care System
• Trauma center
• Burn center
• Obstetrical center
• Pediatric center
• Poison center
• Stroke center
• Cardiac center
• Hyperbaric center
• Spine injury center
• Psychiatric center
continued on next slide

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The Health Care SystemThe Health Care System
• Trauma centers
continued on next slide

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A trauma center can provide rapid surgical intervention and treatment of injuries that generally exceeds hospital
emergency department capabilities. (© Edward T. Dickinson)

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The Health Care SystemThe Health Care System
• EMTs work as team members with
other public safety personnel.
continued on next slide

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The EMT works closely with other public safety personnel.

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You will often work as a team with paramedics and others.

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Case StudyCase Study
After quickly determining the nature of
Ben’s problem, the EMTs head toward the
closest hospital, a 35-minute trip, with
Juliana behind the wheel and Peter in the
back of the ambulance, caring for Ben.
Having arranged for a paramedic unit to
meet them en route, Peter gives the
paramedics a quick radio report.
continued on next slide

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Case StudyCase Study
Peter continues patient care, following
protocols until they meet with the
paramedic unit.
continued on next slide

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Case StudyCase Study
• How can requesting a paramedic
intercept benefit the patient?
• What are some of the potential pitfalls
in patient safety at this phase of the
call?

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EMT ResponsibilitiesEMT Responsibilities
• All EMTs share a common set of
responsibilities.
continued on next slide

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Table 1-1 Roles and Responsibilities of the
Emergency Medical Technician
continued on next slide

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EMT ResponsibilitiesEMT Responsibilities
• Personal safety and the safety of others
continued on next slide

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The EMT must ensure personal safety at all times. (© Pat Songer)
continued on next slide

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EMT ResponsibilitiesEMT Responsibilities
• You cannot help the patient, other
rescuers, or yourself if you are injured.
 Use safe driving habits.
 Do not enter or stay on an unsafe
scene.
 Be alert to situations with a risk for
violence.
 Wear reflective clothing and protective
clothing as indicated.
continued on next slide

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EMT ResponsibilitiesEMT Responsibilities
• Patient assessment and emergency
care
continued on next slide

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The EMT is responsible for providing competent patient care.
continued on next slide

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EMT ResponsibilitiesEMT Responsibilities
• Gain access to patients, recognize and
evaluate problems, and provide
emergency care.
 Primary assessment
• Identify and manage immediate threats
to life.
 Secondary assessment
• Identify other problems.
 Treat the conditions you find.
continued on next slide

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EMT ResponsibilitiesEMT Responsibilities
• Safe lifting and moving
 Prevent further harm to the patient.
 Prevent yourself from being injured
through good body mechanics and
having an adequate amount of help.
continued on next slide

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EMT ResponsibilitiesEMT Responsibilities
• Transport and transfer of care
 Make a destination decision according to
protocols.
 Notify the receiving facility of the
patient’s condition.
continued on next slide

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The EMT can get on-line medical direction by telephone, cell phone, or radio.
continued on next slide

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EMT ResponsibilitiesEMT Responsibilities
• Transport and transfer of care
 Continue care en route.
 Drive safely.
continued on next slide

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Assessment and emergency care are continued en route to the medical facility.
continued on next slide

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EMT ResponsibilitiesEMT Responsibilities
• Transport and transfer of care
 Give verbal and written reports.
 Provide additional assistance as needed.
continued on next slide

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The EMT is responsible for properly transferring the care of the patient to the appropriate medical personnel.
continued on next slide

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EMT ResponsibilitiesEMT Responsibilities
• Record-keeping and data collection
 Log the call.
 Complete patient care reports.
continued on next slide

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As soon as possible, complete the written or electronic prehospital care report.
continued on next slide

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EMT ResponsibilitiesEMT Responsibilities
• Patient advocacy
 EMTs are responsible for protecting the
patient’s rights.
• Secure and transport personal belongings
if needed.
• Protect the patient’s privacy.
• Make sure that the patient’s family
knows how to get to the hospital.
continued on next slide

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EMT ResponsibilitiesEMT Responsibilities
• Patient advocacy
 EMTs are responsible for protecting the
patient’s rights
• Provide necessary information to hospital
personnel.
• Honor any patient requests you
reasonably can.
• Maintain patient confidentiality.

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Case StudyCase Study
At the designated point, the EMTs meet
the paramedic unit and give an update
on Ben’s status. The paramedic, Alexis
Brady, further assesses Ben and
implements advanced life support (ALS)
treatment. Following the treatment,
which was administered to increase Ben’s
abnormally slow heart rate, Ben regains
consciousness and is confused about
what is happening. continued on next slide

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Case StudyCase Study
• Now that Ben is conscious, what do you
think are his expectations for how Peter
and Alexis interact with him?
• How could the nature of those
interactions affect the quality of patient
care?

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EMT Professional AttributesEMT Professional Attributes
• Certain professional attributes are
important to maximize effectiveness as
an EMT.
continued on next slide

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Table 1-2 Characteristics of Professional Behavior
for EMTs

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EMT Professional AttributesEMT Professional Attributes
• Appearance
 Excellent personal grooming and a neat,
clean appearance help instill confidence
in patients and help protect them from
contamination that caused by dirty
hands, fingernails, or clothing.
 Proper appearance can send the
message that you are competent and
can be trusted to make the right
decisions.
continued on next slide

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EMT Professional AttributesEMT Professional Attributes
• Knowledge and skills
 Required coursework
 Use and maintenance of equipment
 Safety and security procedures
 Geography and travel routes
 Traffic laws
 Continuing education
continued on next slide

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EMT Professional AttributesEMT Professional Attributes
• Physical demands
 Ability to lift and carry up to 125 pounds
 Good (or correctable) eyesight and color
vision
 Ability to communicate effectively orally
and in writing
 Good hearing
continued on next slide

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EMT Professional AttributesEMT Professional Attributes
• Personal traits
 Patients look toward someone to re-
establish order in a suddenly chaotic
world.
 That requires the characteristics listed
on the following slides.
continued on next slide

80. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
EMT Professional AttributesEMT Professional Attributes
• Leadership ability
 Assess a situation quickly.
 Step forward to take control when
appropriate.
 Set action priorities.
continued on next slide

81. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
EMT Professional AttributesEMT Professional Attributes
• Leadership ability
 Give clear and concise directions.
 Be confident and persuasive enough to
be obeyed.
 Carry through with what needs to be
done.
continued on next slide

82. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
EMT Professional AttributesEMT Professional Attributes
• Calm, reassuring personality
 Be able to calm anxious and agitated
patients.
• Good judgment
 EMTs must make decisions in stressful
situations.
continued on next slide

83. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
EMT Professional AttributesEMT Professional Attributes
• Good moral character
 EMTs are in a position of public trust
that cannot be defined by laws alone.
• Stability and adaptability
 EMTs are exposed to stressful situations
and must delay expression of emotions
until an appropriate time.
continued on next slide

84. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
EMT Professional AttributesEMT Professional Attributes
• Ability to listen
 EMTs must accurately gather
information from patients and
bystanders.
 EMTs must be accurate when receiving
orders from medical direction.
continued on next slide

85. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
EMT Professional AttributesEMT Professional Attributes
• Resourcefulness and ability to
improvise
 Each call, situation, and patient is
different, requiring that EMTs be
resourceful to provide efficient, effective
care.
continued on next slide

86. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
EMT Professional AttributesEMT Professional Attributes
• Cooperativeness
 The care of a patient requires the
cooperative interactions of many
personnel.
• Maintenance of certification and
licensure
 This is a personal responsibility that
involves obtaining continuing education
and submitting required forms and fees.

87. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
State EMS Agency RoleState EMS Agency Role
• There is overlap between the EMS,
public safety, and public health.
• State EMS agencies act in ensuring that
high-quality EMS is provided in order to
protect the health and safety of the
public.
continued on next slide

88. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
State EMS Agency RoleState EMS Agency Role
• Primary responsibilities include:
 Overall planning, coordination, and
regulation of the statewide EMS system
 Licensing EMS agencies and personnel

89. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Case StudyCase Study
En route to the hospital, Alexis and Peter
continue their treatment and Alexis calls
in a report to the receiving hospital. As
Peter continues to reassure Ben and
monitor his condition, Alexis begins some
preliminary paperwork.
continued on next slide

90. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Case StudyCase Study
• What is the legal basis for EMTs
providing medical treatment to
patients?
• What mechanisms must be in place to
ensure that the care provided is of the
highest quality and conforms to the
standards of the medical community?

91. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Medical DirectionMedical Direction
• Every EMS system must have a
physician medical director.
• EMTs are designated agents of the
medical director.
• The medical director is legally
responsible for the patient care aspects
of the EMS system.
continued on next slide

92. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Medical DirectionMedical Direction
• Medical directors participate in EMS
provider education and EMS system
quality assurance.
• A primary charge of medical direction is
developing and establishing the
guidelines under which the emergency
medical service personnel function.
continued on next slide

93. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Medical DirectionMedical Direction
• Protocols are a complete set of
guidelines that define the scope of
medical care provided by EMS
personnel.
• Protocols may be used off-line or may
require on-line medical direction.
continued on next slide

94. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Medical DirectionMedical Direction
• Off-line medical direction consists of a
set of written guidelines that allow
EMTs to use their judgment to provide
care without having to contact a
physician.
• Sometimes called standing orders
continued on next slide

95. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Medical DirectionMedical Direction
• On-line medical direction requires that
the EMT contact a physician for
consultation and authorization prior to
administering specific emergency care.

96. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Quality ImprovementQuality Improvement
• Quality improvement (QI), or
continuous quality improvement (CQI),
is a system of internal and external
reviews and audits of all aspects of an
emergency medical system.
continued on next slide

97. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Quality ImprovementQuality Improvement
• The purpose of QI is to ensure that the
public receives the highest quality of
prehospital care.
• The goals of quality improvement are
to:
 Identify aspects of the system that can
be improved.
 Implement plans and programs to
remedy shortcomings.
continued on next slide

98. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Quality ImprovementQuality Improvement
• QI is focused on how effective the
system is and to identify what
improvements can be made to deliver a
better service.
• QI can assist individuals with poor
performance, but is should be used an
evaluation of system effectiveness, not
as a punitive mechanism.
continued on next slide

99. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
The EMT takes an active role in quality improvement.

100. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Issues in Patient SafetyIssues in Patient Safety
• Certain aspects of prehospital care are
high-risk in terms of patient safety.
• High-risk activities include:
 Transfer of care from one provider to
another
 Communications with other providers
 Carrying and moving patients
 Ambulance transportation
 Spinal immobilization decisions
continued on next slide

101. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Issues in Patient SafetyIssues in Patient Safety
• Errors during patient care can cause
harm, and usually result from:
 Improper skill performance
 Not following the rules
 Lack of knowledge
continued on next slide

102. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Issues in Patient SafetyIssues in Patient Safety
• Steps to reduce errors include:
 Clear protocols
 Providing enough light to work
effectively
 Minimizing interruptions during
assessment and care
 Clearly marking drugs and packaging
continued on next slide

103. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Issues in Patient SafetyIssues in Patient Safety
• Steps to reduce errors include:
 Reflecting on all actions
 Questioning assumptions
 Using decision aids
 Asking for assistance when needed

104. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Research in EMSResearch in EMS
• Evidence-based medicine (EBM) uses
research to provide evidence that
certain procedures, medications, and
equipment improve the patient’s
outcome.
continued on next slide

105. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Research in EMSResearch in EMS
• There are four steps in evidence-based
decision-making:
1. Formulate a question that needs to be
answered.
2. Search medical literature for applicable
data.
continued on next slide

106. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Research in EMSResearch in EMS
• There are four steps in evidence-based
decision-making:
3. Appraise the data for validity and
reliability.
4. If the evidence supports a change in
practice, change protocols and
implement the change in prehospital
emergency care.
continued on next slide

107. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Research in EMSResearch in EMS
• Research does not exist to support
many practices in EMS.
• Research in hospital settings does not
always transfer well to EMS settings.
• If the opportunity arises, every EMT
has an obligation to participate in
research that contributes to the
profession.

108. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Case StudyCase Study
Ben was seen in the emergency
department, and then admitted to the
cardiac care unit of the hospital. Ben’s
cardiologist told Ben that he has several
risk factors for heart problems, but that
some of the risk factors can be changed.
continued on next slide

109. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Case StudyCase Study
• What are some public health efforts
that can help decrease the rate of
illnesses like Ben’s?
• What role could EMS providers take in
such public health efforts?

110. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Public HealthPublic Health
• EMTs are part of the public health
team.
• Public health deals with protecting the
health of an entire population.
• EMTs can play a role in identifying
public health problems and in attempts
to reduce injury and illness and
promote health.
continued on next slide

111. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Public HealthPublic Health
• The ten greatest public health
achievements in the United States in
the 20th century were:
 Vaccinations
 Motor vehicle safety
 Workplace safety
continued on next slide

112. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Public HealthPublic Health
• The ten greatest public health
achievements in the United States in
the 20th century were:
 Control of infectious disease through
clean water and sanitation
 Reduction in death from coronary heart
disease and stroke
continued on next slide

113. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Public HealthPublic Health
• The ten greatest public health
achievements in the United States in
the 20th century were:
 Safer, healthier foods
 Decreased maternal and infant mortality
 Use of barrier devices during sexual
contact
 Fluoridation of drinking water
 Reduction of tobacco use
continued on next slide

114. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Public HealthPublic Health
• Roles of EMS in public health include:
 Health prevention and promotion
through primary prevention
(vaccinations, education), secondary
prevention of complications of disease,
and health screening
 Disease surveillance through identifying
and reporting certain diseases or
conditions that are identified as public
health issues
continued on next slide

115. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
The roles of the EMS in public health include participation in public education programs (CPR).
continued on next slide

116. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Public HealthPublic Health
• Roles of EMS in public health include:
 Injury prevention through education,
promotion of the use of safety
equipment (seat belt use, helmet use,
falls prevention, fire prevention), and
injury surveillance
continued on next slide

117. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
The roles of the EMS in public health include participation in health screenings.

118. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Case StudyCase Study
After giving a report to the emergency
department (ED) about Ben’s condition
and prehospital treatment, Alexis
compliments Peter and Juliana on their
assessment and care. Peter takes the
opportunity to ask Alexis a few questions
about patients who present as Ben did.
continued on next slide

119. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Case StudyCase Study
Ben was discharged from the hospital
with a cardiac pacemaker to keep his
heart beating at the right rate. He
participates in a cardiac rehabilitation
program and is working with a
nutritionist on his diet. He still frequents
Dave’s, but more often than not, opts for
a bowl of oatmeal with fruit.

120. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Lesson SummaryLesson Summary
• The shape of the modern EMS system
has been influenced by many events
throughout history.
• EMS systems must address 10 specific
areas as defined by NHTSA.
• 911 is the access number for EMS in
the United States.
continued on next slide

121. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Lesson SummaryLesson Summary
• There are four nationally recognized
levels of EMS providers in the United
States.
• EMTs have several specific
responsibilities.
• Medical direction and QI are essential
components of all EMS systems.
continued on next slide

122. Prehospital Emergency Care, 10th
edition
Mistovich | Karren
Copyright © 2014, 2010, 2008 by Pearson Education, Inc.
All Rights Reserved
Lesson SummaryLesson Summary
• EMS practices change over time, based
on research findings.
• EMS is part of the public health system
and can make an impact on the health
of the community.