Discuss topics that will be covered in this chapter.
While numerous influences have contributed to the development of modern day EMS systems, the most basic of EMS system organization did not start to emerge until the 1940s and 1950s. Some of the problems with early EMS systems was that little or no treatment was received by the patient until they arrived at the hospital. Often times, it was the funeral home that provided emergency treatment since they had the only vehicle that could conveniently transport a person lying down. Over the years, however, due to the influence of military operations and various governmental regulations, EMS has grown to a much more sophisticated system. 1-1.1 Define Emergency Medical Services (EMS) systems.
The modern EMS system has evolved from its beginnings in the 1960s when the President ’s Committee for Traffic Safety identified a need to reduce the injuries and deaths related to highway crashes. In 1966, the National Academy of Sciences Research Council published a report entitled Accidental Death and Disability: The Neglected Disease of Modern Society that became known as the “white paper” detailing the number of deaths and injuries related to traffic crashes in the United States. The “white paper” also identified severe deficiencies in the delivery of prehospital care in the United States and made recommendations intended to change ambulance systems, training requirements, and the provision of prehospital care. The following bullets represent some of the significant developments that have had a profound effect on emergency medical services.
Each state has control of its own EMS system, independent of the federal government. However, the National Highway Traffic Safety Administration (NHTSA) provides a set of recommended standards called the “Technical Assistance Program Assessment Standards.” Provide for the student a brief description of each of the standards, and remind them that they will be discussed in much more detail throughout the text and in the EMT course.
Often referred to as the universal number, 9-1-1 is the phone number used nationwide to access emergency services, including police, fire, and EMS. The most common 9-1-1 system is enhanced. An enhanced 9-1-1 system, called E-9-1-1, provides automatic number identification (ANI) and automatic location identification (ALI), which indicate the exact address and phone number from which the call is being made. This information is automatically displayed on the computer screen of the call taker, even if the individual making the call hangs up. The main advantage of E-9-1-1 is that the address and phone number are automatically displayed, and an immediate response can be dispatched, even if the caller is unable to communicate. The public service answering point is generally staffed by trained communications personnel. Many are specially trained as Emergency Medical Dispatchers (EMDs), who not only take the call and facilitate the dispatch of emergency services but also provide instructions for lifesaving emergency care, such as bleeding control or CPR, that can be administered immediately by the caller or another person at the scene.
There are four nationally accepted levels of prehospital emergency medical training, although the titles may be changing within the next few years (see next slide): First Responder, EMT-Basic, EMT-Intermediate, and EMT-Paramedic. The First Responder is typically the first person on the scene with emergency medical care training. He may be a police officer, for example, or a firefighter, industrial health officer, truck driver, schoolteacher, or a volunteer associated with the community emergency care system. EMT-Basic (EMT-B) level of certification is held by those who successfully complete a course based on the U.S. Department of Transportation curriculum and who have been certified as EMT-Basics by the state emergency medical services division. They are responsible for managing both life threatening injuries as well as illnesses. EMT-Intermediate (EMT-I) is an EMT-Basic who completes additional training prescribed by the U.S. Department of Transportation EMT-Intermediate curriculum. The training includes human systems, emergency pharmacology, venous access and medication administration, patient assessment, medical conditions, traumatic injuries, obstetrics, neonatal resuscitation, pediatrics, and geriatrics. Additional skills include intravenous therapy, manual defibrillation, medication administration, endotracheal intubation and use of alternative advanced airway devices, and ECG interpretation. The title EMT-Paramedic (EMT-P) is assigned to those who are trained in all aspects of prehospital emergency care, including or equal to the U.S. Department of Transportation paramedic curriculum, and who have received the appropriate certification. Paramedics have a broad foundation of knowledge in emergency care. They also can perform advanced interventions including starting intravenous lines, administering a wide variety of medications, inserting endotracheal tubes and alternative advanced airway devices, decompressing the chest cavity, reading electrocardiograms, using manual defibrillators to restore heart rhythm, cardiac pacing, needle jet insufflation, and advanced cardiac life support.
The National EMS Scope of Practice Model released by the National Highway Traffic Safety Administration in 2005 was developed to bring a higher degree of consistency to EMS throughout the United States, improve patient care and safety, allow for easier reciprocity between states, and to decrease the confusion of the public by identifying specific national levels of EMS practitioners. The National Scope of Practice Model identifies the four levels of EMS practitioners. They roughly equate to the four levels previously mentioned, in the same order.
First Responders and EMTs are an integral part of a community ’s health care system—a network of medical care that begins in the field and extends to hospitals and other treatment centers. In essence, EMTs provide prehospital care —emergency medical treatment given to patients before they are transported to a hospital or other facility.
First Responders and EMTs are an integral part of a community ’s health care system—a network of medical care that begins in the field and extends to hospitals and other treatment centers. In essence, EMTs- provide prehospital care —emergency medical treatment given to patients before they are transported to a hospital or other facility.
In some areas the term out-of-hospital care is preferred over prehospital, reflecting a trend toward providing care on the scene with or without subsequent transport to a hospital. This also includes care provided during inter-facility transport.
Your first and most important priority is to protect your own safety. Remember this rule: You cannot help the patient, other rescuers, or yourself if you are injured. You also do not want to endanger other rescuers by forcing them to rescue you—instead of the patient. Once scene safety is assured, the patient ’s needs become your priority. Once you have ensured scene safety, you must gain access to patients, recognize and evaluate problems, and provide emergency care. 1-1.2 Differentiate the roles and responsibilities of the EMT-Basic from other prehospital care providers. 1-1.3 Describe the roles and responsibilities related to personal safety. 1-1.4 Discuss the roles and responsibilities of the EMT-Basic toward the safety of the crew, the patient, and bystanders.
Always perform an initial assessment to help you identify and care for immediately life-threatening problems, such as airway compromise, respiratory insufficiency, cardiac arrest, or severe bleeding. Then complete a rapid assessment or focused physical exam, depending on the patient ’s condition, after which you can stabilize and treat other emergency injuries or conditions you discover or suspect. Prevent further injury of patients by always using the easiest and safest recommended emergency urgent or non-urgent moves and equipment. Prevent injuring yourself by always using proper body mechanics and by making sure you have sufficient help to lift and move patients and equipment. 1-1.2 Differentiate the roles and responsibilities of the EMT-Basic from other prehospital care providers.
Before leaving the scene, determine which facility (local emergency department, pediatric hospital, burn center, or other) will be most appropriate. Consider the patient ’s condition, the extent of injuries, prior health care contact, the relative locations, and hospital staffing when making transport decisions. Consult medical direction if necessary, and follow your local transport protocols. 1-1.2 Differentiate the roles and responsibilities of the EMT-Basic from other prehospital care providers.
Throughout your shift, maintain an up-to-date log of calls if required. Before leaving the hospital, complete the written or electronic prehospital care report. A copy of this report will become part of the hospital ’s record on the patient and part of your EMS system’s permanent records. Patient advocacy deals with understanding and protecting the rights of the patient, as well as maintaining their privacy and being attentive to the needs of the family that may be on scene. 1-1.2 Differentiate the roles and responsibilities of the EMT-Basic from other prehospital care providers. 1-1.7 State the specific statutes and regulations in your state regarding the EMS system.
A number of professional attributes are important to maximize your effectiveness as an EMT. They include appearance, knowledge, skills, and the ability to meet physical demands, as well as your general interests and temperament. 1-1.2 Differentiate the roles and responsibilities of the EMT-Basic from other prehospital care providers.
As an EMT-Basic, you are the designated agent of the physician medical director of your EMS system. The care you render to patients is considered an extension of the medical director ’s authority. Remind the student to remain alert to state laws, statutes, and regulations in regard to medical direction in the state they work in. The medical director is responsible for providing medical direction. A primary charge of medical direction is developing and establishing the guidelines under which the emergency medical service personnel function. 1-1.2 Differentiate the roles and responsibilities of the EMT-Basic from other prehospital care providers.
Medical oversight encompasses the varied tasks which must be undertaken by the physician medical director. This could include developing medical protocols, ensuring quality assurance programs are being followed, and interfacing with various individuals in the hospital or in the political venues regarding EM-related issues. 1-1.2 Differentiate the roles and responsibilities of the EMT-Basic from other prehospital care providers.
Off-line medical direction is provided through a set of predetermined, written guidelines that allow the EMT to use his or her judgment to administer emergency medical care according to the written guidelines without having to contact a physician. On-line medical direction requires that the EMT acquire permission from a physician via cellular phone, telephone, or radio communication prior to administering specific emergency care. 1-1.2 Differentiate the roles and responsibilities of the EMT-Basic from other prehospital care providers.
Quality improvement (QI), also known as continuous quality improvement (CQI), is a system of internal and external reviews and audits of all aspects of an emergency medical system. To ensure that the public receives the highest quality of prehospital care, the goals of quality improvement are to identify those aspects of the system that can be improved and to implement plans and programs that will remedy any shortcomings. It is important to recognize that quality improvement is not truly designed to evaluate individual performance, but instead is used to determine how effective the “system” is and to identify what improvements can be made to deliver a better service. 1-1.5 Define quality improvement and discuss the EMT-Basic ’s role in the process. (pp. 10–11)
As an EMT-Basic, you have many roles in quality improvement. These include documentation: (carefully and thoroughly document each call), performing reviews and audits (being involved in the quality improvement process by volunteering for QI committee work or by critiquing the performance of other EMT-Basics at the scene of a call), obtaining feedback (gathering feedback from patients, other EMS personnel, and hospital staff), maintaining equipment, and participating in continuing education (to reinforce, update, and expand your knowledge and skills), and finally skill maintenance. 1-1.5 Define quality improvement and discuss the EMT-Basic ’s role in the process. (pp. 10–11)