Alexander ch02 lecture

Copyright © 2017, 2012 Pearson Education, Inc. All Rights Reserved.
Advanced EMT
A Clinical-Reasoning Approach, 2nd Edition
Chapter 2
Emergency Medical
Services, Health Care,
and Public Health
Systems

• Applies fundamental knowledge of the EMS
system, safety/well-being of the Advanced EMT,
and medical/legal and ethical issues to the
provision of emergency care.
• Uses simple knowledge of the principles of the
role of EMS during public health emergencies.
Advanced EMT
Education Standards

1. Define key terms introduced in this chapter.
2. Describe key historical events that have shaped the
development of EMS systems.
3. Briefly explain each of the components of the Technical
Assistance Program Assessment Standards.
4. Describe the components of an EMS system that must
be in place for a patient to receive emergency medical
care.
5. Discuss the features and benefits of 911 and enhanced
911 emergency access systems.
Objectives (1 of 4)

6. Explain the importance of Advanced EMTs understanding
the health care and public health resources available in
the community.
7. Discuss the role of EMS as part of the health care
system.
8. Describe the scope of concerns of a public health
system.
9. Describe the relationship between EMS and public
health.
Objectives (2 of 4)

10.Discuss the purposes of medical direction and medical
oversight in the EMS system.
11.Give examples of offline, online, prospective, concurrent,
and retrospective medical direction.
12.Describe the purpose of continuous quality
improvement (CQI) programs in EMS, and the
Advanced EMT’s role in CQI.
Objectives (3 of 4)

13.Identify current issues and trends in EMS.
14.Identify credible resources for learning about issues and
trends in EMS.
15.Given an issue or problem in EMS, suggest changes
that could be implemented.
Objectives (4 of 4)

Figure 2-1
EMS is at the intersection of health care, public health, and public safety.

• White paper, Accidental Death and Disability: The
Neglected Disease of Modern Society
• Lessons from military history
• Research and advocacy
Evolution of the EMS System (1 of 12)

Figure 2-2
An ambulance parked at the entrance of City Hospital, which would later become Wishard
Memorial Hospital and even later, Eskenazi Health, circa 1901–1903. The first City Hospital
ambulance began carrying sick and injured Indianapolis-area patients in 1887.
(Photo used with permission of Eskenazi Health)

• Transportation of the Sick and Injured
– Horse-drawn ambulances in use in 1869.
– Hearses used as ambulances.
• Emergency Prehospital Care
– First volunteer rescue squads began on East Coast in
1920s.
– Rapid development of EMS after publication of the
white papers.

Figure 2-3
Modern ambulances allow EMS providers to carry emergency equipment and provide
patient care en route to the hospital.

• First National Standard Curriculum (NSC) for
training EMTs published in 1971.
• Modern ambulances developed to carry
equipment and allow space for patient care.

Figure 2-4
Civilian air medical transport systems developed after the military used helicopters to
transport injured soldiers in the Korean and Vietnam wars.

Figure 2-5
Lessons learned from military experience include renewed recognition of the role of
tourniquets in life-threatening hemorrhage.

• Military Influence
– Prehospital care, especially trauma, comes from
military experiences.
– Helicopter transport began in Korean War (1950s) and
Vietnam War in the 1960s and 1970s.
– Military experience increased use of tourniquets to
control hemorrhage.

• Key events in EMS:1960s and 1970s
– 1960s: American Heart Association (AHA) begins
teaching public CPR classes.
– Highway Safety Act of 1970: EMS systems from federal
level. National Registry of EMTs (NREMT) formed.
– 1970: First national standard curricula for EMS training
formed
– Emergency Medical Services Act of 1973: Federal
funding for EMS systems and establishes components
of EMS system

• Key events in EMS: 19801989
– 1981: OBRA eliminates specific funding for EMS.
– 1984: EMS for Children (EMSC) Act focuses on
prehospital care of pediatric patients.
– 1988: NHTSA publishes EMS Technical Assessment
program.

– 1990: Trauma Care Systems and Development Act
focuses on trauma systems.
– 1993: National EMS Practice and Education Blueprint
developed.
– 1996: NHTSA EMS Agenda for the Future.

– 2000: NHTSA EMS Education Agenda for Future.
– 2006: Institute of Medicine (IOM) EMS at the
Crossroads.
– 2007: NHTSA National Scope of Practice Model.
– 2009: NHTSA EMS Education Standards.

• Key documents in EMS
– National Standard Curricula (NSC)
– Emergency Medical Services at the Crossroads
– EMS Agenda for the Future
– EMS Education Agenda for the Future: A Systems
Approach
– National EMS Core Content
– National EMS Scope of Practice Model
– National EMS Education Standards

• Key people in EMS
– Nancy Caroline, MD.
 lifesaving emergency care outside hospital
– Jeff Clawson, MD.
 first standardized dispatch protocols in 1978
– R. Adams Cowley, MD.
 rapid treatment of patients in shock; concept of the
“Golden Hour”

• Key people in EMS (continued)
– Joseph D. “Deke” Farrington
 Vehicle extrication; first aid training curriculum
– Norman McSwain, MD.
 Prehospital Trauma Life Support (PHTLS) course

• Key people in EMS (continued)
– Rocco Morando
 NAEMT
– James O. Page, JD.
 Journal of Emergency Medical Services (JEMS); technical
consultant Emergency!
– Peter Safar, MD.
 airway, breathing, and circulation (ABCs) in CPR, 1950s

Figure 2-6
Components of an EMS system.
(From the National Highway Traffic Safety Administration at
http://www.ems.gov/pdf/811077c.pdf)

Components of an EMS System (1 of 9)
• NHTSA Statewide Technical Assistance Program
Assessment Standards
– Regulation and policy
– Resource management
– Human resources and training
– Transportation
– Facilities

• NHTSA Statewide Technical Assistance Program
Assessment Standards (continued)
– Communications
– Public information and education
– Medical direction
– Trauma systems
– Evaluation

• State legislation and regulations address
standards in
– EMS education
– Licensure
– Communication
– Medical direction
– Provision of services
– Other aspects of EMS

• EMS Education Agenda for the Future goals for
EMS education
– National EMS Core Content
– National EMS Scope of Practice Model
– National EMS Education Standards
– National EMS Program Accreditation
– National EMS Certification

• Components of EMS system can exist in a
– Fire-based system
– Hospital-based system
– Private services contracted by local governments
– Municipal third services
– Some combination of these

• EMS system staffing configurations vary.
• EMS work requires
– Excellent clinical knowledge and skills
– Interpersonal skills
– Physical health
– Specific intrapersonal characteristics

• What is the number 911 widely used for?
• What is Enhanced 911 (E-911)?
• How are EMS vehicles selected?

• Physician Medical Director
– Prospective medical direction
– Concurrent medical direction
– Retrospective medical direction

• Continuous quality improvement (CQI) plan
– What benchmarks to measure
– How to measure them
– What the acceptable levels of performance are
– How to address deficiencies
– When to reassess interventions to improve deficiencies

Health Care and Public Health
• Why do EMS, health care systems, and systems
of public health exist?
• Who do EMS providers interact with?
• Why do public health systems exist?

Getting to the Future
• One of EMS’s greatest challenges in the future will
be the development of new leaders who can
continue to move the profession forward.
• Anyone who is passionate and knowledgeable
about a cause can make a difference.

Chapter Summary (1 of 4)
• EMS evolved from the need to reduce preventable
highway traffic deaths and manage out-of-hospital
cardiac arrest.
• Today, EMS is a complex system of private and
public agencies that provide coordinated delivery
of emergency medical care.

• The system is integrated with public safety, health
care, and public health.
• EMS is guided nationally by NHTSA, but each
state has laws and regulations that structure its
EMS system.

• EMS professionals work under the guidance of a
physician medical director.
• EMS providers transport patients to health care
facilities for emergency and ongoing specialty
care.

• Evaluation programs are used to continuously
improve the quality of EMS.
• Contributions of many individuals have allowed
EMS to make great strides since 1966.
• EMS Agenda for the Future has set the current
direction of the profession.

Alexander ch02 lecture

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Alexander ch02 lecture