Advance Preparation Invite state/regional EMS official to class. Invite state/regional medical director to class. Prepare examples of EMS research.
Planning Your Time: Plan 40 minutes for this chapter. The Emergency Medical Services System (20 minutes) Components of the EMS System (20 minutes) Note: The total teaching time recommended is only a guideline.
Teaching Time: 20 minutes Teaching Tips: This is an important introductory lesson for a new EMT. It provides context for the EMT’s “place in the world” and lays the foundation for future growth within the system. As an instructor, it is your opportunity to lay a strong foundation and teach a positive future outlook. EMS is a relatively new profession. Many of those who built the system are still actively involved at the state level. Contact your local state office and invite such people to class.
Point to Emphasize: Modern emergency medical systems have their roots in battlefield casualty care. Talking Points: During the Napoleonic Wars, injured soldiers were transported from the battlefield to be cared for by physicians. The Civil War saw the beginning of organized medical care with people like Clara Barton, who went on to establish the American Red Cross. Immediate care in field hospitals with transport to hospitals behind the lines by train was also pioneered. In World War I, volunteer ambulance personnel assisted in the transport of the wounded to hospitals. In the Korean War, Mobile Army Surgical Hospital (MASH) units were used, and in both Korea and Vietnam, helicopter transport was used for the wounded. These wars also brought about the development of civilian hospitals specializing in the treatment of trauma. Discussion Topic: Discuss the history of EMS. Describe the roots of modern EMS systems.
Point to Emphasize: In 1966, the National Highway Safety Act developed EMS standards and assisted states in upgrading the quality of their prehospital emergency care. Talking Points: The establishment of EMS standards was spurred by the 1966 government white paper “Trauma: The Neglected Disease of Modern Society.” It dealt with the high number of deaths from traffic collisions due to inadequate emergency medical care. Since this was considered a highway safety issue at the time, EMS is regulated by the National Highway Traffic Safety Administration. The NREMT established national standards for testing and certifying EMS personnel. The NEMSSA made funds available to establish and upgrade EMS systems nationwide. Discussion Topic: Discuss the federal and local agencies involved in the oversight of EMS systems.
Point to Emphasize: The National Highway Traffic Safety Administration (NHTSA) Technical Assistance Program established an assessment standard that includes regulation, resource management, and trauma systems. Knowledge Application: Have students research specific examples of NHTSA standards for EMS systems as the standards apply to their local system. Ask students to present their examples to the class. Discussion Topic: List and describe the components of the NHTSA standards for EMS systems.
Talking Points: QI = Quality Improvement, QA = Quality Assurance, TQM = Total Quality Management. These are interchangeable terms used to assure that quality is incorporated into all phases of the operation.
Critical Thinking: Consider your own EMS system compared to the NHTSA standards. Are there areas in which your system might improve? In what areas is your system exceptional?
Video Clip The Long and Winding Road of Ambulance Service Discuss the progression of EMS throughout history. What is the purpose of the Emergency Medical Services system? What agency developed the standard for the assessment and care of prehospital patients? Discuss possible future advancements in EMS.
Teaching Time: 20 minutes Teaching Tips: Describe components of the EMS system in local terms. Use specific local examples to demonstrate larger concepts. Use actual EMS providers to discuss the various levels of training. Use a discussion format to review important traits of a good EMT. Allow students to formulate their own ideas of what the important elements are.
Point to Emphasize: It is important to consider the EMS system from the viewpoint of the patient. Class Activity: Visit a state or regional EMS office. Use this opportunity to discuss the organization of your local system.
Knowledge Application: Have groups of students build a mock EMS system. Discuss the key components and compare these components to existing systems. Discussion Topic: Describe the components of the EMS system from access to delivery at the hospital. Consider the viewpoint of the patient.
Talking Points: Have students list medical services available; add others that are not obvious. Discuss with students their responsibility to know this essential information.
Class Activity: Have students work in groups to research examples of EMS systems that pertain to services in their area. Assign various topics including local, regional, state, and federal systems. Have groups present their findings to the class.
Point to Emphasize: The 911 and enhanced 911 telephone systems are common methods of accessing the EMS system.
Talking Points: Every situation is different, and transport decisions are often based on local protocols. This list should initiate discussion.
Talking Points: There are four general levels of EMS training and certification. They vary from place to place. Emergency Medical Responder (EMR): This is designed for the person who is often first at the scene, such as police, firefighters, and industrial health personnel. The emphasis is on activating the EMS system and providing immediate care for life-threatening injuries, controlling the scene, and preparing for the arrival of the ambulance. Emergency Medical Technician (EMT): In most areas, this is considered the minimum level of certification for ambulance personnel. EMTs provide basic-level medical and trauma care and transportation to a medical facility. Advanced Emergency Medical Technician (AEMT): The AEMT provides basic-level care and transportation as well as some advanced-level care, including using advanced airway devices, monitoring blood glucose levels, and administering some medications, which may include intravenous and intraosseous administration. Paramedic: The paramedic performs all of the skills of the EMT and AEMT plus advanced-level skills. The paramedic provides the most advanced level of prehospital care, such as advanced assessment, drug therapy, EKG interpretation, and additional lifesaving skills .
Talking Points: It is not possible to help a patient if you are injured, so your first responsibility is to keep yourself safe. The same dangers you face will also be faced by others at the scene. You must be concerned with their safety as well as your own. One of the EMT’s most important functions is patient assessment, or finding out enough about the patient to provide appropriate emergency care. Based on your assessment findings, patient care is an action or series of actions that your training will prepare you to take in order to help the patient deal with and survive the illness or injury. Since EMTs are usually involved in transporting patients to the hospital, lifting and moving patients are important tasks. It is a serious responsibility to operate an ambulance at any time, but even more so when there is a patient on board. Upon arrival at the hospital, you will transfer care of the patient to hospital personnel. You must never abandon care of the patient until transfer has been properly completed. As an EMT, you are an advocate, the person who speaks up for your patient and pleads her cause. In your role as advocate you may perform a task as important as reporting information that will enable the hospital staff to save the patient’s life—or as simple as making sure a relative of the patient is notified. Discussion Topic: Discuss the roles and responsibilities of an EMT. What are the most important traits of a good EMT?
Talking Points: You should be fit to carry out your duties. If you are physically unable to provide needed care, then all your training may be worthless to the patient. Practice with other EMTs is essential so that you can carry your share of the combined weight of the patient and all equipment. Coordination and dexterity are needed, as well. You will have to perform basic rescue procedures, lower stretchers and patients from upper levels, and negotiate fire escapes and stairways. You must be able to see distant objects as well as those close at hand. Color vision is important to driving as well as patient assessment. Color of the skin, lips, and nail beds often provides valuable clues to the patient’s condition. You have to give and receive oral and written instructions and communicate with patients, bystanders, and other members of the EMS system. Eyesight, hearing, and speech are important; any problems must be corrected.
Talking Points: Pleasant to inspire confidence and help calm the sick and injured. Sincere to convey an understanding of the situation and the patient’s feelings. Cooperative to allow for faster and better care, establish better coordination with other members of the EMS system, and bolster the confidence of patients and bystanders. Resourceful to be able to adapt a tool or technique to fit an unusual situation.
Talking Points: Self starter to show initiative and accomplish what must be done without having to depend on someone else to start procedures. Emotionally stable to help overcome the unpleasant aspects of an emergency so that needed care may be rendered and any uneasy feelings that exist afterward may be resolved. Able to lead in order to take the steps necessary to control a scene, organize bystanders, deliver emergency care, and when necessary, to take charge. Neat and clean to promote confidence in both patients and bystanders and to reduce the possibility of contamination. Knowledge Application: Have students play the role of EMTs. Assign negative traits and have students demonstrate the serious impact of poor behavior. Discuss.
Talking Points: Of good moral character and respectful of others to allow for trust in situations when the patient cannot protect his own body or valuables and so that all information relayed is truthful and reliable. In control of personal habits to reduce the possibility of rendering improper care and to prevent patient discomfort. This includes never consuming alcohol within eight hours of duty and not smoking when providing care. (Smoking can contaminate wounds and is dangerous around oxygen delivery systems.) Controlled in conversation and able to communicate properly in order to inspire confidence and avoid inappropriate conversation that may upset or anger the patient or bystanders or violate patient confidentiality. Able to listen to others to be compassionate and empathetic, to be accurate with interviews, and to inspire confidence. Nonjudgmental and fair treating all patients equally regardless of race, religion, or culture. There are many cultural differences you will encounter among patients.
Talking Points: An EMT must maintain up-to-date knowledge and skills. Education is a constant process that extends long past the original EMT course. Reading professional journals and joining EMS organizations will help you keep abreast of changes in the field. Ongoing research in emergency care causes occasional changes in procedure, so some of the information you are studying to become an EMT will become outdated. Most areas require regular recertification. Refresher courses present material to the EMT who has already been through a full course but needs to receive updated information. Refresher courses are required at two- to four-year intervals. Continuing education supplements the original course. For example, you may wish to learn more about pediatric or trauma skills or driving techniques. You can obtain this education in conferences and seminars and through lectures, classes, videos, or demonstrations.
Talking Points: Many fire and EMS agencies are volunteers, especially in rural communities. In addition, many fire department personnel are cross-trained as firefighters and EMTs.
Talking Points: NREMT exams are often used as state certification exams. If your state or region does not use the registry exam, ask your instructor how you can sit for the examination. Upon passing the exam and obtaining registry, you will be entitled to wear the NREMT patch.
Point to Emphasize: Quality assurance, research, and education ensure constant improvement for both individual providers and the EMS system in general.
Talking Points: Off-line medical control involves p olicies or protocols that authorize an EMT to perform particular skills in certain situations. On-line medical control involves requesting orders from medical control (usually by radio or phone) or getting approval by medical control before performing certain procedures. Discussion Topic: Explain how medical directors, medical research, and quality improvement impact the EMS system.
Talking Points: EMTs should stay abreast of ongoing EMS-related research, and should participate in the research process when possible to assure the quality of care for the patient. Critical Thinking: Once you have completed class, how will you continue to improve as an EMT? Use specific examples. Knowledge Application: Have students work in groups. Assign meaningful EMS research articles. Have the groups discuss how these articles impacted national and local EMS systems.
Talking Points: When on call to a geriatric patient’s home the EMT can identify things that may cause falls, such as footwear or rugs. EMS may also offer methods for the elderly to present medications and medical history to EMTs in the event of emergency (e.g., file of life). EMS is frequently involved in child safety seat clinics, distribution of bicycle helmets, and other programs. More EMS providers are being trained and allowed to provide vaccination clinics for the public. Seasonal flu and variations such as H1N1 are examples of vaccinations that are frequently offered by EMS providers. Some regions are beginning to allow specially trained EMS providers to take routine vaccinations (e.g., childhood vaccinations) out to the public—especially in areas where many children do not have routine well care and are at risk. At the front lines EMS reports may serve as an indication that a trend in injury or disease is beginning. This may range from flu to violence to terrorist attacks.
Video Clip Emergency Medical Services for Children Discuss the main purposes of EMS. Describe how most communities access EMS services. What is the role of the medical director? Describe some of the specific needs of children during an emergency.
Talking Points: Helicopter transport EMR, EMT, AEMT, paramedic On-line medical control
Talking Points: Help to contact a neighbor or relative that can come by and check on the dog; Patient advocate.
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