Management of EMS.ppt

Management of EMS
Government Structure
and EMS

Bruce E. Evans • Jeff T. Dyar — Management of EMS
Copyright © 2010 by Pearson Education, Inc. Upper Saddle River, NJ 07458
The Beginning of EMS
• History of prehospital emergency
medicine
– Napoleonic Wars
– Union Army, 1862
– World War II
– Korean War
– Vietnam War

The White Paper
1966
• Accidental Death and Disability: The
Neglected Disease of Modern Society
– National Academy of Sciences (NAS)
 Long-range effects of quality emergency
medical care on mortality
 Concluded:
• Average response time exceeded 40 minutes
• Crews were inadequately equipped and trained
• Americans had a greater chance of surviving in the
combat zones of Korea or Vietnam than on the
nation’s highways

The White Paper
Summary of the Recommendations of the White Paper.

National Highway Traffic Safety
Administration
• Created in 1966 by Congress
• First federal standards in EMS
• Highway Safety Act of 1966
– Developed specifications for training,
equipment requirements, and design of the
emergency vehicle itself
– Funds communications and education for
EMS

Federal Initiatives
• Emergency Medical Services Systems
Act of 1973
– Designated federal funding
– Developed the first set of DOT national
curriculums for EMTs and paramedics
– Funded Department of Health, Education,
and Welfare
– Identified 15 components of an EMS
system

Components of an EMS System
Original Components of an EMS System
(1973).

The EMS Agenda for the Future
1996
• Department of Transportation and the
National Highway Traffic Safety
Administration
• More of a community-based approach to
EMS

• 14 attributes for EMS systems:
– Integration of health-care services
– EMS research
– Legislation and regulation
– System finance
– Human resources
– Medical direction
– Education systems

(Cont.)
• 14 attributes for EMS
systems (cont.)
– Public education
– Prevention
– Public access
– Communication
systems
– Clinical care
– Information systems
– Evaluation
− Public Education
− Prevention
− Public Access
− Communication Systems
− Clinical Care
− Information Systems
− Evaluation

(Cont.)
• The effectiveness of EMS will be
measured by the impact it has on the
movement of the patient through the
health-care system

Integration of EMS and the
Health-Care System
• Key partnerships with EMS
– Hospitals
 Receiving facilities, medical control,
education resource
– Fire departments, rescue squads, law
enforcement
 First responders, specialized resources

Integration of EMS and
Health-Care System (Cont.)
• Key partnerships with EMS
– Regional, state, and national EMS
organizations
 Funding, advocacy, education, lobbying
efforts
 ASTM, NFPA

Functions of an EMS System
• System organization and management
– Authority to direct, develop, and allocate
resources
• Medical direction
– Offline and online or direct
– Protocols
 Direct transport, treatment, and triage decisions

Functions of an EMS System
(Cont.)
• Communication systems
– Interagency, mutual aid, disaster
communication
• Public education
– Prevention, system access, system
education, citizen CPR and first aid
• Quality improvement
– Ongoing review of performance of all
systems

Star of Life
• National EMS
symbol
• Six-barreld cross
represents
– Six system functions:
 Detection
 Reporting
 Response
 On-scene care
 Care in transit
 Transfer to definitive
care

The End of Federal Funding
• Mid-1980s
• EMS programs slashed or eliminated
• Systems became dependent on state
and local funding
• Lack of comprehensive 911 coverage

The Impact of Television on
EMS
• Emergency, Rescue 911
– Raised awareness and expectations
– Public demand for high-quality EMS
• Integration of EMS services

Federal Government and EMS
• Department of Homeland Security
– Safe, Accountable, Flexible, Efficient
Transportation Equity Act
 Federal Interagency Committee on EMS
• Federal oversight committee for EMS
• Congressional mandate to report to congress
yearly
– National EMS credentialing system
– Federal Emergency Management
Agency (FEMA)
– National Fire Academy

National Fire Academy
• Located in Emmitsburg, Maryland
• Focuses on EMS management, EMS
special operations, EMS safety and
incident command

National EMS Credentialing
System
• Credentials EMS workers from across
state lines
• Documents minimum qualifications,
certifications, training, and education
• Designed to allow EMS providers to be
plugged into the national incident
management system

Health and Human Services
• Department of Health and Human
Services
– Contributes to national EMS activities

(Cont.)
• Centers for Disease Control (CDC)
– Injury prevention programs, surveillance,
maintains WISQAR, database
– Education on infectious disease,
promotes standards for bloodborne
pathogens
– Maintains Strategic National Stockpile

(Cont.)
• Center for Medicare/Medicaid
Services
– Sets reimbursement schedules,
standards for billing, privacy regulations,
works with Joint Commission on the
Accreditation of Healthcare
Organizations (JCAHO)

• Federal Office of Rural Health Care
Policy
– Rural EMS Agenda for the Future
– Provides funding for rural EMS
associations
– Rural EMS and Trauma Technical
Assistance Center
 Radio equipment, support facilities,
information technology
(Cont.)

Federal Communications
Commission
• FCC has long history of helping EMS
– Telemetry units, field radios, base-station
frequencies, 911
– Creating cell phone technologies
– Wireless Telecommunications Bureau
 Oversees the development of public safety
radio systems
 Wireless frequencies for paperless systems

Department of Commerce
• Manages national quality award
– Malcolm Baldrige Award
• The Baldrige national quality program
– Public-private partnership to improve the
performance of national organizations
– Award presented by the president of the
United States
– Categories of health care, small business,
manufacturing, and education

State Organizations
Activities
• U.S. Department of Health and Human
Services
– Robert Wood Johnson Foundation
 Provided $15 million dollars for 44 EMS projects
in 32 states
– Wedworth-Townsend Act
 Governor Ronald Reagan 1970
 “Mobile intensive care paramedics”

State EMS Offices
• Funnel federal funds to EMS agencies
• Located within the state department of
health, or department of public safety

State EMS Offices (Cont.)
• State directors advise state legislatures
on:
– Medical practice
– Certification requirements
– Educational standards
– Funding appropriations

State EMS Offices
• State fire marshall office
– Provides equipment, training on ICS, and
other training

County and Local
Governments
• Provide oversight and accountability to the
public
• Oversee health-related activities
• Local health departments
– Oversee many large metropolitan EMS
services

Medical Authority
• Grants certification, recertification, and
decertifies prehospital personnel
• Grants privileges
• Establishes, implements, revises, and
authorizes medical protocols, policies, and
procedures
• Establishes destination criteria
• Ensures competency of personnel
• Establishes training levels

Structure of Local EMS
Providers
• Single-role organization
• Multiple-role organization
• Fire-based
– Cross-trained/dual role
• Third service
– Private enterprise, corporate
– Has public oversight

Professional Organizations
• International Association of Fire Chiefs
(IAFC)
• International Association of Fire Fighters
(IAFF)
• International City/County Management
Association (ICMA)
• American Federation of State, County,
and Municipal Employees (AFSCME)

Other Groups
• American Red Cross
• American Heart Association
• American Stroke Association
• American Ambulance Association
• American College of Emergency
Physicians
• National Association of EMS Physicians
• American College of Surgeons

Other Groups (Cont.)
• Association of Air Medical Services
• Air Medical Physician Association
• American Society for Testing and
Materials
• National Fire Protection Association

Accreditation Agencies
• Commission on Accreditation of Allied
Health Education Programs
– Committee on Accreditation of Educational
Programs for the Emergency Medical
Services Professions
• Commission on Accreditation of
Ambulance Services

Provider Associations
• National Association of EMS Educators
• Emergency Nurses Association
• International Tactical EMS Association
• National Association of Emergency
Medical Technicians
• National Registry of EMT’s

Volunteers
• National Volunteer Fire Council
– 49 state firefighter organizations

Summary
• Responsibility to manage an EMS
system requires an understanding of a
larger picture involving outside agencies
and government sources
• Research, standards, regulation, and
education emanate from many outside
sources; EMS personnel should utilize
these resources to ensure life long
learning

THANK YOU

Management of EMS.ppt

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Management of EMS.ppt