2. Preparatory
Integrates comprehensive knowledge of the
EMS system, safety/well-being of the
paramedic, and medical/legal and ethical
issues, which are intended to improve the
health of EMS personnel, patients, and the
community.
National EMS Education
Standard Competencies
3. Emergency Medical Services (EMS)
Systems
• EMS systems
• History of EMS
• Roles/responsibilities/professionalism of EMS
personnel
• Quality improvement
• Patient safety
National EMS Education
Standard Competencies
4. Research
• Impact of research on emergency medical
responder (EMR) care
• Data collection
• Evidence-based decision making
• Research principles to interpret literature and
advocate evidence-based practice
National EMS Education
Standard Competencies
6. Introduction
• The public’s perception of you is based on:
– TV and articles
– Patient’s previous experiences
– Your treatment of their loved ones
• Continued education is a must.
• Treat everyone with respect and dignity.
7. EMS System Development
• Much of the prehospital emergency care
paramedics deliver is attributed to visionary
advances of pioneers such as:
– Dr. Peter Safar
– Dr. Nancy Caroline
• You may be surprised how long organized
systems have been in place.
8. The History of EMS
• 1487
– First use of an
ambulance
– Transport only
• 1800s
– First prehospital
system for triaging
and transporting
patients
• 1926
– Start of service
similar to present
day
• 1940s
– Fire and police
department–based
EMS
– No standards set
10. The 20th Century and Modern
Technology
• 1956
– Mouth-to-mouth resuscitation was developed.
• Late 1950s/early 1960s
– Focus shifted to bringing hospital to patients.
– Mobile intensive care units (MICUs) developed.
11. The 20th Century and Modern
Technology
• 1965: “The White Paper” released
– Findings included:
• Lack of uniform laws and standards
• Equipment of poor quality or nonexistent
• Lack of communication
• Lack of training
• Only part-time staff
12. The 20th Century and Modern
Technology
• “The White Paper” outlined 10 critical points
for EMS system.
– Led to National Highway Safety Act
– Created US Department of Transportation (US
DOT)
• 1968
– Training standards implemented
– 9-1-1 system created
13. The 20th Century and Modern
Technology
• 1969
– First true paramedic
program
– Standards for
ambulance design
and equipment
• 1970s
– NREMT began Courtesy of Eugene L. Nagel and the Miami Fire Department.
14. The 20th Century and Modern
Technology
• 1970s (cont’d)
– 1971: Emergency Care and Transportation of the
Sick and Injured by the AAOS
– 1973: Emergency Medical Services Systems Act
– 1977: First National Standard Curriculum for
paramedics by US DOT
15. The 20th Century and Modern
Technology
• 1980s/1990s
– The number of trained personnel grew
significantly.
– NHTSA developed 10 system elements to help
sustain EMS system.
– Responsibility for EMS transferred to the states.
– Major legislative initiatives came about.
16. The 21st Century Progress
• Numerous initiatives are appearing:
– EMS Compass
– EMS training used in other areas of health care
(as opposed to strictly in an ambulance)
– Community paramedicine
17. Licensure, Certification, and
Registration
• Depending on your state, you may be
registered or licensed.
– Board of registration holds your:
• Education records
• State or local licensure
• Recertification
– Once you complete your initial paramedic
education, depending on your state, you will be
able to take your state’s certification
examination.
18. Licensure, Certification, and
Registration
• Passing grade on certification examination:
– Ensures all health care providers have the
same basic level of knowledge and skill
– Entitles you to a state- and/or NREMT-issued
certificate or license
19. Licensure, Certification, and
Registration
• Licensure:
– How states control
who practices
– Also known as
certification or
credentialing
– Unlawful to
practice without
licensure
• Holding a license
shows that you:
– Completed initial
education
– Met the
requirements to
achieve the license
20. Licensure, Certification, and
Registration
• CoAEMSP
– The only accrediting body for paramedic
programs to date
– Mission to continuously improve the quality of
EMS education through accreditation and
recognition services
21. Licensure, Certification, and
Registration
• Reciprocity
– Certification granted from another state/agency
– Requirements:
• Hold a current state licensure
• Be in good standing
• National Registry certification
22. Traditional EMS Employment
• Once you become licensed, a variety of
career options are available to you:
– Fire-based EMS
– Third-service EMS
– Private EMS agency
– Hospital-based EMS
– Hybrid or other
23. The EMS System
• A complex network of coordinated services
that provides care to the community
• The public needs to be taught how to:
– Recognize emergencies
– Activate the EMS system
– Provide basic care
24. The EMS System
– Bystander care
– Dispatch
– Response
– Prehospital
assessment and
care
– Transportation
– Emergency
department care
– Definitive care
– Rehabilitation
• Patient outcomes determined by:
25. The EMS System
• Dispatchers
– Usually the public’s first contact
– Training level varies by state
• Scene not necessarily what dispatcher
relays
– Never under- or overestimate information
26. The EMS System
• As a paramedic, you must:
– Develop a care plan
– Determine the most appropriate facility within a
reasonable distance
27. Levels of Education
• EMS system functions from a federal to
local level.
– Federal: National EMS Scope of Practice Model
– State: Licensure, laws, and regulations
– Local: Medical director decides day-to-day limits
28. Levels of Education
• The national guidelines are designed to
create more consistent delivery of EMS
nationally.
– Medical director can limit the scope of practice.
• In 2009, the National EMS Education
Standards were revised.
– Federal administrative source
32. Advanced EMT (AEMT)
• Formerly EMT-I
• Initially developed in 1985
– Major revision in 1999
• Trained in:
– More advanced pathophysiology
– Some advanced procedures
33. Paramedic
• Highest skill level to be nationally certified
– 1998: Major revisions to curriculum greatly
increased level of training and skills.
• Even if independently licensed, you must:
– Function under guidance of physicians
– Be affiliated with a paramedic-level service
34. Paramedic Education
• Initial education
– Most states base education programs on the
National EMS Education Standards.
• Outline minimum knowledge needed for
practice
– States require varying hours of education.
• National average: 1,000-1,500 hours
35. Paramedic Education
• Continuing education
– Most states require a certain number of
hours/refresher programs.
– Attend conferences and seminars.
– Read EMS journals.
– Consider CAPCE-accredited programs.
– Get everyone involved in postrun critiques.
• The responsibility for continuing education
rests with you.
36. Additional Types of Transports
• Specialty center
– Require in-house
staffs of specialists
– Possibility of slightly
longer transport
time
– Know:
• Location of centers
• Protocol for direct
transport
• Interfacility
– Use for:
• Nonambulatory
patients
• Patients who require
medical monitoring
– Other medical
professionals may
accompany patient.
37. Working With Other
Professionals
• Hospital staff
– Become familiar with the hospital.
– You may consult with staff by using the radio
through established (online) procedures.
– The best patient care occurs when emergency
care providers have close rapport.
39. Working With Other
Professionals
• Continuity of care
– The community has expectations of EMS.
– Focus on prevention.
– You will interact with many professionals and
groups.
– Understand your role, as well as theirs.
41. Professionalism
• You have responsibilities as a health care
professional.
• You will be measured by:
– Standards, competencies, and education
requirements
– Performance parameters
– Code of ethics
42. Professionalism
• You are in a highly visible role in your
community.
• You must:
– Instill confidence.
– Establish and maintain credibility.
– Show concern for your patients.
43. Professionalism
• Your appearance is of utmost importance.
– Has more impact than you may think
• Present a professional image and treat
colleagues with respect.
– Arguing with colleagues is inappropriate.
– Raise issues at the appropriate time and place.
44. Professionalism
– Integrity
– Empathy
– Self-motivation
• Have an internal
drive for excellence.
– Confidence
• Strive to be the best
paramedic you can.
– Communications
• Express and
exchange ideas,
thoughts, and
findings.
• Listen well.
• Documentation is
important.
• Attributes of professionalism:
45. Professionalism
– Teamwork and
respect
• Work together.
– Patient advocacy
• Act in the patient’s
best interest.
– Injury prevention
– Careful delivery of
service
– Time management
• Prioritize your
patient’s needs.
– Administration
• Attributes of professionalism (cont’d):
46. Professionalism
• More health care locations are using
paramedic services, including:
– Administering vaccinations
– Performing special transports
48. Roles and Responsibilities
• Teach the
community about
prevention of injury
and illness.
– Appropriate use of
EMS
– CPR and AED
training
– Influenza and
pandemic issues
Courtesy of Captain David Jackson, Saginaw Township Fire Department
49. Medical Direction
• Paramedics carry out advanced skills.
– Must take direction from medical directors
• Medical directors may perform many roles:
– Educate and train
– Recommend new personnel and equipment
– Develop protocols, guidelines, and quality
improvement programs
50. Medical Direction
• Roles of the medical director (cont’d):
– Provide input for patient care
– Interface between EMS and other agencies
– Advocate for EMS
– Serve as “medical conscience”
51. Medical Direction
• Medical directors provide online and off-line
medical control.
• Online
– Provides immediate
and specific patient
care resources
– Allows for continuous
quality improvement
– Can offer on-scene
assistance
• Off-line
– Allows for the
development of:
• Protocols or
guidelines
• Standing orders
• Procedures
• Training
52. Improving System Quality
• Continuous quality improvement (CQI)
– Tool to continually evaluate care
– Quality control: Process of assessing current
practices, looking for ways to improve
– Dynamic process
54. Improving System Quality
• CQI programs help
prevent problems
by:
– Evaluating day-to-
day operations
– Identifying
possible stress
points
• Look for ways to
eliminate human
error.
– Ensure adequate
lighting
– Limit interruptions
– Store medications
properly
55. Improving System Quality
• Ways to eliminate human error (cont’d)
– Be careful when handing patients off.
– Three main sources of errors:
• Rules-based failure
• Knowledge-based failure
• Skills-based failure
56. Improving System Quality
• Ways to eliminate human error (cont’d)
– Agencies need clear protocols.
– Be aware of your environment.
– Ask yourself, “Why am I doing this?”
– Use cheat sheets.
– Be conscientious of protocols.
57. EMS Research
• EMS has been drawn toward evidence-
based practice.
– Protocols should be based on scientific findings.
• Research typically performed by educated
researchers with a PhD or MD degree.
– Some colleges and universities offer an EMS
track for paramedics.
58. The Research Process
• Identify the problem, procedure, or
question.
• Develop research agenda by specifying:
– Questions to be answered
– Specific aims to be addressed
– Methods by which the study will be carried out
– Methods to gather data
• Stick to the research agenda.
59. The Research Process
• Determine the research domain.
– Area of research
– Domains: clinical, systems, or education
• Research may be performed within a
research consortium.
– Paramedics may be involved by gathering data.
60. Funding
• Researchers should use an institutional
review board (IRB) when a project begins.
• Major research requires specific funding.
– Any type of support is considered funding.
• Researchers should:
– Disclose sources of funding.
– Maintain transparency of research methods.
61. Types of Research
• Qualitative
– Focuses on
questions within
surrounding events
and concurrent
processes
– Often used when
quantitative
research does not
provide answers
• Quantitative
– Based on numeric
data
– Three types:
• Experimental
(scientific
approach)
• Nonexperimental
(descriptive)
• Survey
62. Types of Research
• Retrospective
– Examines available data
– May be used to:
• Develop educational sessions for EMS personnel
• Plan public education and prevention strategies
– In large studies, data often collected from
widespread databases
• Techniques can be used at the local level
63. Types of Research
• Other types of research:
– Prospective
– Cohort
– Case study
– Cross-sectional design
– Longitudinal design
– Literature review
64. Research Methods
• Identify the group(s) necessary for research.
• Ways to select subjects for research:
– Systematic sampling
– Alternative time sampling
– Convenience sampling
• Even in the best cases, sampling errors
occur.
65. Research Methods
• Studies can be:
– Blinded
• Investigators not
told project
specifics
• Single-, double-,
or triple-blinded
– Unblinded
• Participants
advised of all
aspects
• Research statistics
can be:
– Descriptive
• Observations
made
• No attempts made
to alter event
– Inferential
• Hypothesis used
to prove a finding
66. Ethical Considerations
• The organization’s IRB monitors whether a
study is conducted ethically and ensures:
– Protection of participants
– Appropriate conduct
• Risks must not outweigh potential benefits.
• Conflicts of interest must be identified.
68. Evaluating Medical Research
• When evaluating research, look for certain
criteria to determine the research quality.
– Know what questions to answer.
• Read every part of the research paper and
review:
– The hypothesis and population
– The patient and selection criteria
– The analysis of the data
– The authors and their conclusions
69. Evaluating Medical Research
• Peer review helps ensure quality.
– Subject matter experts review material prior to
publication.
• Internet sites can be valid tools.
• Studies must follow a structured process.
• There will always be limitations.
• Review research carefully.
70. Evidence-Based Practice
• Care should focus on procedures that have
proven useful in improving patient
outcomes.
– Evidence-based practice will have a growing
role in EMS.
• Stay up to date on health care advances.
– Make sure you understand new research
results.
71. Evidence-Based Practice
• Researchers often rate the quality of a study
to ensure quality evidence.
– There are many different rating systems.
– The American Heart Association assigns class
(strength) of recommendation and levels (quality)
of evidence.
72. Evidence-Based Practice
• Research determines the effectiveness of
treatment.
– Can help identify which procedures,
medications, and treatments do and do not work
• When following a new study, measure the
results with your CQI program.
