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Pec11 chap 01 ems systems
1.
Prehospital: Emergency Care Eleventh
Edition Chapter 1 Emergency Medical Care Systems, Research, and Public Health Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved
2.
Learning Readiness Copyright ©
2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • EMS Education Standards, text p. 1. • Chapter Objectives, text p. 1. • Key Terms, text p. 1. • Purpose of lecture presentation versus textbook reading assignments.
3.
Setting the Stage
(1 of 2) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • Overview of Lesson Topics – The emergency medical services (EMS) system – The Emergency Medical Technician – EMS system organization and standards – EMS research
4.
Setting the Stage
(2 of 2) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • Overview of Lesson Topics – Evidenced-based guidelines – Public Health – Mobile integrated healthcare and community paramedicine
5.
Case Study Introduction
(1 of 2) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved 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.
6.
Case Study Introduction
(2 of 2) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved 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.
7.
Case Study (1
of 15) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • 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?
8.
Introduction Copyright © 2018,
2014, 2010 Pearson Education, Inc. All Rights Reserved • Sudden loss of life and disability from catastrophic accidents and illnesses is a major public health problem. • Thousands of people die or suffer permanent harm yearly because of a lack in access to adequate to EMS. • EMTs can make a positive difference.
9.
The EMS System:
History (1 of 6) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • 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.
10.
The EMS System:
History (2 of 6) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • 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.
11.
The EMS System:
History (3 of 6) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • 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.
12.
The EMS System:
History (4 of 6) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • Introduction of cardiopulmonary resuscitation (CPR) in the 1960s • The Highway Safety Act of 1966 • The EMS System Act of 1973 • National Emergency Medical Services Education and Practice Blueprint in 1993 by the National Registry of EMTs
13.
The EMS System:
History (5 of 6) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • NHTSA documents – 1996 EMS Agenda for the Future – 2000 EMS Education Agenda for the Future: A Systems Approach – 2005 National EMS Core Content – 2006 National EMS Scope of Practice Model ▪ National EMS Education Standards
14.
The EMS System:
History (6 of 6) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • 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 educational programs – National certification as a prerequisite for state licensure and local credentialing
15.
The EMS System:
Standards (1 of 3) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • NHTSA provides a set of recommended state standards, the Technical Assistance Program Assessment Standards. • There are ten components:
16.
The EMS System:
Standards (2 of 3) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved 1. Regulation and policy 2. Resource management 3. Human resources and training 4. Transportation 5. Facilities
17.
The EMS System:
Standards (3 of 3) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved 6. Communications 7. Public information and education 8. Medical direction 9. Trauma systems 10.Evaluation
18.
The EMS System:
System Goals Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • Emergency Medical Services: Clinical Practice and Systems Oversight, 2015 1. Clinical quality 2. Service quality 3. Economic efficiency 4. Accountability 5. Improvement 6. Resilience
19.
EMS System Access
(1 of 4) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • The most common way for the public to access EMS is by dialing 911. • Enhanced 911 (E-911) allows: – Automatic number identification – Automatic location information
20.
Communications Play a
Vital Role in the Emergency Medical Services (EMS) System Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved
21.
EMS System Access
(2 of 4) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • Benefits of 911 – The number is easy to remember and use. – Public safety answering point (PSAP) is staffed by specially trained dispatchers. – All emergency services—police, fire, and EMS—are accessible by dialing one number.
22.
EMS System Access
(3 of 4) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • 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.
23.
EMS System Access
(4 of 4) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • Voice over Internet Protocol (VoIP) also poses challenges addressed by FCC rules. – 911 service must be a standard feature. – Must give the physical location of where the service will be used. – The provider must transmit all 911 calls to the appropriate PSAP.
24.
Case Study (2
of 15) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved 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.
25.
Case Study (3
of 15) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved What components of the EMS system have been used in this case so far? • Regulations & Policy • Resource Management • Human Resources & Training • Transportation • Facilities • Communication • Public Information & Education • Medical Direction • Trauma Systems • Evaluation
26.
Case Study (4
of 15) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved EMTs Juliana Smock and Peter Saylor respond to the dispatch, heading down Highway 129 toward Dave’s restaurant. 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.
27.
Case Study (5
of 15) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • 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?
28.
Types of EMS
Systems Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • A variety of EMS system types exist in the Philippines: – Fire Department EMS – Municipal EMS – Private EMS – Hospital based EMS
29.
Levels of Providers Copyright
© 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • The National EMS Scope of Practice Model identifies four levels of EMS practitioners: – Emergency Medical Responder (EMR) – Emergency Medical Technician (EMT) – Advanced Emergency Medical Technician (AEMT) – Paramedic
30.
The Four Levels
of EMS Practitioners Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved
31.
The Health Care
System (1 of 5) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • A health care system is a network of medical care that begins in the field and extends to hospitals and other treatment centers, including: – “Prehospital” care – “Out-of-hospital” care
32.
The Health Care
System (2 of 5) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • The different health care facilities to which EMT s may transport patients have different capabilities. – Trauma center – Burn center – Obstetrical center – Pediatric center – Poison center – Stroke center – Cardiac center – Hyperbaric center – Spine injury center – Psychiatric center
33.
The Health Care
System (3 of 5) • Inside the “trauma bay” of a designated trauma center Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved
34.
The Health Care
System (4 of 5) • EMTs often work along side of paramedics and others. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved
35.
The Health Care
System (5 of 5) • EMTs interface with team members from other public safety organizations. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved
36.
Case Study (6
of 15) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved 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.
37.
Case Study (7
of 15) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • 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?
38.
EMT Responsibilities (1
of 10) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • All EMTs share a common set of roles and responsibilities. Table 1-1 Roles and Responsibilities of the Emergency Medical Technician • Maintain vehicle and equipment readiness. • Ensure safety of the EMS crew, the patient, and bystanders at the scene. • Operate the emergency vehicle. • Assess the patient.
39.
EMT Responsibilities (2
of 10) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • Provide emergency care. • Safely lift and move the patient. • Prepare oral and written reports. • Safely transport the patient. • Transfer patient care. • Perform record keeping and data collection. • Serve as the patient’s advocate.
40.
EMT Responsibilities (3
of 10) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • Provide emotional support to the patient, relatives, and others at the scene. • Integrate the EMS service with other emergency and nonemergency services. • Resolve the emergency incident. • Maintain medical and legal standards. • Provide administrative support. • Enhance professional development. • Develop and maintain community relations.
41.
EMT Responsibilities (4
of 10) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • 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.
42.
EMT Responsibilities (5
of 10) • Personal safety and the safety of others Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved
43.
EMT Responsibilities (6
of 10) • Patient assessment and emergency care Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved
44.
EMT Responsibilities (7
of 10) • Patient transport and care en route Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved
45.
EMT Responsibilities (8
of 10) • Contacting medical direction Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved
46.
EMT Responsibilities (9
of 10) • Transferring care at receiving facility Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved
47.
EMT Responsibilities (10
of 10) • Record-keeping, data collection and patient advocacy Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved
48.
Case Study (8
of 15) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved 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.
49.
Case Study (9
of 15) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • 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?
50.
EMT Professional Attributes
(1 of 4) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • EMS has professional attributes that are important to maximize effectiveness of the EMT. Table 1-2 Characteristics of Professional Behavior for EMTs • Integrity • Empathy • Self-motivation • Professional appearance and hygiene • Self-confidence
51.
EMT Professional Attributes
(2 of 4) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • Effective time management • Good verbal and written communication skills • Teamwork and diplomacy • Respect for patients, coworkers, and other health care professionals • Patient advocate • Careful delivery of service
52.
EMT Professional Attributes
(3 of 4) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved 1. Appearance 2. Knowledge and skills 3. Physical demands 4. Personal traits 5. Leadership ability 6. Good judgement
53.
EMT Professional Attributes
(4 of 4) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved 7. Good moral character 8. Stability and adaptability 9. Ability to listen 10.Resourcefulness 11.Cooperative 12.Maintenance of certification/licensure
54.
EMS System Organization
and Standards (1 of 4) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • State EMS agency role: – State EMS agencies are responsible for planning and coordinating EMS. – Every state and territory in the US has a lead EMS agency.
55.
Case Study (10
of 15) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved 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.
56.
Case Study (11
of 15) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • 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?
57.
EMS System Organization
and Standards (2 of 4) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • Medical Oversight of EMS – Every EMS system must have a physician medical director. ▪ Direct medical oversight ▪ Indirect medical oversight ▪ On and off-line medical direction ▪ Standing orders
58.
Medical Direction Copyright ©
2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • 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.
59.
EMS System Organization
and Standards (3 of 4) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • Quality improvement (QI) – Is a system of internal and external reviews and audits of all aspects of an emergency medical system. – May also be known as continuous quality improvement (CQI).
60.
Quality Improvement • The
EMT also has roles in QI Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved
61.
EMS System Organization
and Standards (4 of 4) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • Issues in Patient Safety – Certain aspects of prehospital care are high-risk in terms of patient safety. ▪ Transfer of care from one provider to another ▪ Communications with other providers ▪ Carrying and moving patients ▪ Ambulance transport destinations ▪ Spine motion restriction decisions
62.
Issues in Patient
Safety Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • Errors during patient care can cause harm, and usually result from: – Improper skill performance – Not following the rules – Lack of knowledge
63.
EMS Research Copyright ©
2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • Research in EMS – Evidence-based medicine (EBM) uses research to provide evidence that certain procedures, medications, and equipment improve the patient’s outcome.
64.
Research in EMS
(1 of 3) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • 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.
65.
Research in EMS
(2 of 3) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • 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.
66.
Research in EMS
(3 of 3) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • 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.
67.
Evidence-Based Guidelines (1
of 2) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • Evidence Based Guidelines: – Uses the same approach as evidence based medicine to develop guidelines for medical practice. – FICEMS and NEMSAC facilitated the development of the “National Prehospital Evidence-Based Guideline Model Process.”
68.
Evidence-Based Guidelines (2
of 2) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • National Prehospital Evidence-Based Guideline Model Process – Process starts with input from national guidelines – Evidence is collected and evaluated – Protocols are developed and disseminated – Following implementation, the process is reviewed for effectiveness
69.
Case Study (12
of 15) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved 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.
70.
Case Study (13
of 15) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • 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?
71.
Public Health (1
of 6) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • 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.
72.
Public Health (2
of 6) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • The 10 greatest public health achievements in the United States in the 20th century were: 1. Vaccinations 2. Motor vehicle safety 3. Workplace safety 4. Control of infectious diseases 5. Reduction in deaths from coronary heart disease and stroke
73.
Public Health (3
of 6) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • The 10 greatest public health achievements in the United States in the 20th century were: 6.Safer and more healthful foods 7. Decline in maternal and infant mortality 8. Use of barrier devices during sex 9.Fluoridation of drinking water 10.Reduction in the use of tobacco products
74.
Public Health (4
of 6) • Roles of EMS in public health include health prevention and promotion Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved
75.
Public Health (5
of 6) • Roles of EMS in public health include disease surveillance Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved
76.
Public Health (6
of 6) • Roles of EMS in public health include education and injury prevention Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved
77.
Mobile Integrated Healthcare
and Community Paramedicine (1 of 2) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • Mobile Integrated Healthcare – Integrates services provided by a variety of health care entities and practitioners into EMS • Community Paramedicine – Services provided by the EMS agency and its EMS personnel
78.
Mobile Integrated Healthcare
and Community Paramedicine (2 of 2) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • MIH-CP may include services such as: – Increasing access to underserved areas – Providing advice to 911 callers via phone rather than dispatching resources – Use of specially trained EMS providers to help individuals manage chronic diseases and follow up care
79.
Case Study (14
of 15) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved 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.
80.
Case Study (15
of 15) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved 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.
81.
Lesson Summary (1
of 3) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • 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.
82.
Lesson Summary (2
of 3) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • 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.
83.
Lesson Summary (3
of 3) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • 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. • Mobile Integrated Healthcare and Community Paramedicine will continue to evolve and shape EMS.
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