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Bledsoe v1 ch02_lecture

This document summarizes the history of emergency medical services (EMS) systems from ancient times to the present. It describes early developments in pre-hospital care and transport during wars and the 19th century. Major advances in the 20th century included the development of CPR, defibrillation, trauma systems, and the establishment of EMS education and training standards. The document also outlines federal legislation and reports that established EMS systems and outlined essential components, including the 15 components defined in the 1973 EMS Systems Act and 10 elements from NHTSA in 1988. It concludes with ongoing challenges and issues facing EMS in the 21st century.

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Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Paramedic Care: Principles & Practice Volume 1, 5e Chapter 2 EMS Systems
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Multimedia Directory Slide 73 Ambulance Service Video
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Standard • Preparatory (EMS Systems)
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Competency • Integrates comprehensive knowledge of EMS systems, the safety and well-being of the paramedic, and medical-legal and ethical issues, which is intended to improve the health of EMS personnel, patients, and the community.
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Introduction • Out-of-Hospital Components – Community members trained in first aid and CPR – Communications system – EMS providers, including paramedics – Fire/rescue; hazardous-materials services
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Introduction • Out-of-Hospital Components – Law enforcement officers – Public utilities – Resource centers
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Introduction • In-Hospital Components – Emergency nurses – Advanced-practice providers – Emergency and specialty physicians – Ancillary services – Social workers – Mental health providers – Rehabilitation services
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Introduction • EMS operation begins with citizen activation. • EMS dispatch responsible for: – Collecting information – Sending staffed and equipped unit – Providing prearrival instructions
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Introduction • First EMS provider to respond: – Police officer – Firefighter – Lifeguard – Teacher – EMR-trained community member
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Introduction • Dispatcher will send: – EMT-level or paramedic level ambulance – Tiered response: multiple levels of emergency care personnel to same incident – Paramedic personnel to every incident regardless of level of care needed
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Introduction • EMS providers decide on: – Medical facility – Type of care needed – Transport time – Local protocols
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter History of EMS • Most significant advances in EMS during last 50 years
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Table 2–1 An EMS Timeline (1 of 5) 1797 Napoleon’s chief physician implements a prehospital system designed to triage and transport the injured from the field to aid stations. 1860s Civilian ambulance services begin in Cincinnati and New York City. 1891 Dr. Friedrich Maass performs the first equivocally documented chest compression in humans. 1915 First-known air medical transport occurs during the retreat of the Serbian army from Albania. 1920 First volunteer rescue squads organize in Roanoke, Virginia, and along the New Jersey coast. 1947 Claude Beck develops first defibrillator and first human saved with defibrillation. 1958 Dr. Peter Safar demonstrates the efficacy of mouth-to-mouth ventilation. 1960 Cardiopulmonary resuscitation (CPR) is shown to be efficacious.
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Table 2–1 (continued) An EMS Timeline (2 of 5) 1965 J. Frank Pantridge converts an ambulance into a mobile coronary care unit with a portable defibrillator and recorded ten prehospital resuscitations with a 50 percent long-term survival rate. 1966 The National Academy of Sciences, National Research Council publishes Accidental Death and Disability: The Neglected Disease of Modern Society. 1966 Highway Safety Act of 1966 establishes the Emergency Medical Services Program in the Department of Transportation. 1967 Star of Life is patented by the American Medical Association. 1968 AT&T designates 911 as its new national emergency number. 1970 National Registry of EMTs is founded. 1970 Television show Emergency! debuts on NBC. 1972 Department of Health, Education, and Welfare allocates $16 million to EMS demonstration programs in five states.
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Table 2–1 (continued) An EMS Timeline (3 of 5) 1973 The Emergency Medical Services Systems (EMSS) Act provides additional federal guidelines and funding for the development of regional EMS systems; the law establishes 15 components of EMS systems. 1975 National Association of EMTs is organized. 1979 First automated external defibrillators (AEDs) become available. 1981 The Omnibus Budget Reconciliation Act consolidates EMS funding into state preventive health and health services block grants, and eliminates funding under the EMSS Act. 1981 Prehospital trauma life support (PHTLS) is developed. 1981 International trauma life support (ITLS), formerly basic trauma life support (BTLS), is developed. 1984 The EMS for Children program, under the Public Health Act, provides funds for enhancing the EMS system to better serve pediatric patients.
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Table 2–1 (continued) An EMS Timeline (4 of 5) 1985 National Research Council publishes Injury in America: A Continuing Public Health Problem, describing deficiencies in the progress of addressing the problem of accidental death and disability. 1988 The National Highway Traffic Safety Administration initiates the Statewide EMS Technical Assessment program based on ten key components of EMS systems. 1990 The Trauma Care Systems and Development Act encourages development of inclusive trauma systems and provides funding to states for trauma system planning, implementation, and evaluation. 1993 The Institute of Medicine publishes Emergency Medical Services for Children, which points out deficiencies in our health care system’s ability to address the emergency medical needs of pediatric patients. 1995 Congress does not reauthorize funding under the Trauma Care Systems and Development Act.
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Table 2–1 (continued) An EMS Timeline (5 of 5) 1999 President Clinton signs bill designating 911 as national emergency number. 2003 Health Insurance Portability and Accountability Act (HIPAA) becomes effective, strictly regulating the flow of confidential information. 2006 The National Highway Traffic Safety Administration publishes Emergency Medical Services: Agenda for the Future to guide the development of EMS in the United States in the twenty-first century.
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter History of EMS • Early Development – Ancient tablets – Step-by-step instructions for patient care – How to create medications
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter History of EMS • Early Development – Code of Hammurabi: governed criminal and civil matters; regulation of medical fees and penalties. – Out-of-hospital care: transport. – Dominique-Jean Larrey (Napoleon's chief surgeon): first prehospital system using triage and transport.
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter History of EMS • Early Development – Ambulances in U.S.: nineteenth century. – Nurse Clara Barton organized triage and transport during Civil War. – First civilian ambulance: 1860 in Cincinnati. – Bellevue Hospital in Manhattan (1869): began to operate ambulance service.
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter History of EMS • The Twentieth Century – WWI: high mortality rate of soldiers associated with evacuation time. – WWII: transport to echelons (levels) of care created. – Hospitals experimented with placing physician interns on ambulances.
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter History of EMS • The Twentieth Century – Korean War: helicopters moved injured to mobile army surgical hospitals (MASHs). – Set stage for trauma system in U.S. – 1956: mouth-to-mouth resuscitation – 1959: portable defibrillator – 1960: cardiopulmonary resuscitation (CPR)
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Figure 2-2 Medical evacuation helicopters, colloquially called “Dustoff,” saved many lives during the Vietnam War. (Dust off © Joe Kline Aviation Art)
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter History of EMS • The Twentieth Century – 1966: Accidental Death and Disability: The Neglected Disease of Modern Society (White Paper) – Guidelines for:  Development of EMS systems  Training of prehospital emergency medical providers  Upgrading of ambulances and equipment
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter History of EMS • The Twentieth Century – 1970: National Registry of Emergency Medical Technicians established – 1972: television show Emergency!; public attention to prehospital care – 1973: Emergency Medical Services Systems Act
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter History of EMS • 15 Components of EMS Systems – Manpower – Training – Communications – Transportation – Emergency facilities
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter History of EMS • 15 Components of EMS Systems – Critical care units – Public safety agencies – Consumer participation – Access to care – Patient transfer
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter History of EMS • 15 Components of EMS Systems – Standardized record keeping – Public information and education – System review and evaluation – Disaster management plans – Mutual aid
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter History of EMS • 1988 NHTSA: Ten System Elements – Regulation and policy – Resources management – Human resources and training – Transportation – Facilities
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter History of EMS • 1988 NHTSA: Ten System Elements – Communications – Trauma systems – Public information and education – Medical direction – Evaluation
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter History of EMS • The Twentieth Century – 1980s: Helicopter air ambulances (HAA) developed – 1996: National Highway Traffic Safety Administration (NHTSA) published EMS Agenda for the Future
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter History of EMS • 14 Core EMS Attributes – Integration of health services – EMS research – Legislation and regulation – System finance – Human resources – Medical direction – Education systems
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter History of EMS • 14 Core EMS Attributes – Public education – Prevention – Public access – Communication systems – Clinical care – Information systems – Evaluation
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter History of EMS • The Twenty-First Century – Result of September 11:  Department of Homeland Security: coordinates agencies responsible for protecting country.  National Incident Management System (NIMS): prepares country for terrorist attacks and other threats.
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Figure 2-4 The attacks on New York City and Washington on September 11, 2001, forever changed the face of EMS. (© Reuters)
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter History of EMS • The Twenty-First Century – 2006: Emergency Medical Services: At the Crossroads  Insufficient coordination  Coordination of transport within regions was limited  Disparities in response times
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter History of EMS • The Twenty-First Century – 2006: Emergency Medical Services: At the Crossroads  Uncertain quality of care  Lack of readiness for disasters  Divided professional identity  Limited evidence base
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter History of EMS • The Twenty-First Century – 2006: The National Report Card on the State of Emergency Medicine: Evaluating the Environment of Emergency Care Systems State by State
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter History of EMS • The Twenty-First Century – 2001: national medical helicopter fleet expanded from 300 to 900 – 2008: record number of helicopter air ambulance crashes with fatalities – 2009: NTSB hearings
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Today's EMS Systems • Fire-based systems • Third service • Private (profit or nonprofit) • Hospital-based systems • Volunteer • Hybrid (combination of any of these)
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Today's EMS Systems • Chain of Survival – Continuum of care that begins once emergency occurs – Ends when patient completes care and returns to normal activities of daily living
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Today's EMS Systems • American Heart Association Chain of Survival – Immediate recognition and activation of EMS – Early CPR – Rapid defibrillation – Effective advanced life support – Integrated post-cardiac arrest care
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Today's EMS Systems • Chain of Survival – Bystander care – Dispatch – Response – Prehospital care – Transportation – Emergency department care – Definitive care – Rehabilitation
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Health Care System Integration – Public service access points (PSAPs)  911 call centers; interface between EMS system and communities it serves  Identification of acute coronary syndrome and ST-segment elevation myocardial infarction (STEMI)  Primary percutaneous coronary intervention (PPCI)
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Levels of Licensure/Certification – Emergency Medical Responder (EMR) – Emergency Medical Technician (EMT) – Advanced EMT (AEMT) – Paramedic • Each level: unique role, set of skills, knowledge base.
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Education – 2009: National EMS Education Instructional Guidelines – National EMS Core Content – National EMS certification – National EMS Education program accreditation – National EMS Scope of Practice Model – National EMS Education Standards
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Local- and State-Level Agencies – Administrative oversight agency – Planning board – Define who may function within system – Policies consistent with state requirements – State EMS agencies: allocate funds; enact legislation.
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Medical Oversight – Medical director: physician legally responsible for all clinical and patient-care aspects of system. – Prehospital care providers are medical director's designated agents.
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Medical Director's Roles – Educate and train personnel – Participate in personnel and equipment selection – Develop clinical protocols in cooperation with expert EMS personnel – Participate in quality improvement and problem resolution
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Medical Director's Roles – Provide direct input into patient care – Interface between EMS system and other health care agencies – Advocate within medical community – Serve as "medical conscience" of EMS system
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • On-line medical direction: qualified physician gives direct orders to prehospital care provider by radio or telephone. • Intervener physician: on scene or on-line medical direction may not exist; paramedic relinquishes responsibility to physician.
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Off-line medical oversight: medical policies, procedures, practices that system medical director has established in advance of call. – Prospective medical oversight – Retrospective medical oversight
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Off-Line Medical Oversight – Clinical protocols  Policies and procedures of all medical components of EMS system  Responsibility of medical director
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Four "Ts" of Emergency Care – Triage – Treatment – Transport – Transfer
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Public Information and Education – Recognize emergency – Access system – Provide basic life support assistance – Relationship between rapid emergency care and mortality (death) rates of patients – Automated external defibrillators (AEDs)
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Figure 2-7 Providing disease and injury prevention education to the public has become an important role of EMS in the twenty-first century. (© Dr. Bryan E. Bledsoe)
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Effective Communications – Heart of regional EMS system – Coordinates components into organized response to urgent medical situations – Citizen access (911) – Single control center
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Effective Communications – Operational communications capabilities – Medical communications capabilities – Communications hardware – Communications software
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Figure 2-8 The EMS communications center is truly the heart of the modern EMS system.
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Effective Communications – Emergency Medical Dispatcher (EMD):  Sends ambulances to scene  Ensures system resources in constant readiness to respond  Both medically and technically trained
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Communications – EMS dispatch: assigns and directs appropriate medical care to patients.  Interrogation protocols  Response configurations  System status management  Prearrival caller instructions
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Education and Certification – Initial education: completing course following National EMS Education Instructional Guidelines published by U.S. DOT.  Cognitive  Affective  Psychomotor
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Education and Certification – Accreditation: all paramedic education programs meet guidelines for faculty, facilities, equipment, medical oversight, clinical affiliations, financial stability  Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions (CoAEMSP)
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Education and Certification – Continuing education: refresher courses for recertification and periodic in-service training sessions; mandatory.  Continuing Education Coordinating Board for Emergency Medical Services (CECBEMS)
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Licensure, Certification, Registration, and Reciprocity – Licensure: occupational regulation. – Certification: agency or association grants recognition to individual who has met its qualifications. – Registration: enter name and essential information within a particular record.
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Licensure, Certification, Registration, and Reciprocity – Reciprocity: agency grants automatic certification or licensure to individual who has comparable certification or licensure from another agency.
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • National Registry of EMTs (NREMT) – Nonprofit entity – Prepares and administers standardized tests for EMS provider levels – Establishes qualifications for registration and biennial reregistration – Establishes national minimum standard of competency
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Professional Organizations – National Association of Emergency Medical Technicians (NAEMT) – National Association of Search and Rescue (NASAR) – National Association of EMS Educators (NAEMSE) – National Association of EMS Physicians (NAEMSP)
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Professional Organizations – International Flight Paramedics Association (IFPA) – National EMS Management Association (NEMSMA) – National Council of State EMS Training Coordinators (NCSEMSTC)
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Professional Journals and Magazines – Academic Emergency Medicine – American Journal of Emergency Medicine – Annals of Emergency Medicine – Emergency Medical Services – Journal of Emergency Medical Services (JEMS)
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Professional Journals and Magazines – Journal of Pediatric Emergency Medicine – Journal of Trauma: Injury, Infection and Critical Care – Prehospital Emergency Care
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • The Internet – Websites designed for EMS providers – Updated content and news – Accredited continuing education programs – International EMS discussions; networking
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Ambulance Service Video Click here to view a video on the topic of ambulance service. Back to Directory
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Patient Transportation – Medical oversight designates facility based on needs of patient; availability of services. – Transported by ground or air – Fixed-wing aircraft when patients transported long distances – Vehicles licensed; meet local and state EMS requirements
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Figure 2-11 Patients may be transported by ground or air. Medical helicopter transport was introduced in the 1950s during the Korean War. (© Ed Effron)
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Figure 2-12 Fixed-wing aircraft, as well as helicopters, have become an important part of patient transport in the modern EMS system. (© REACH Air Medical Services)
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Patient Transportation—Ambulances – Type I: conventional cab and chassis; module ambulance body mounted; no passageway between driver and patient compartments. – Type II: standard van, body, and cab form integral unit; raised roof.
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Figure 2-13 Type I ambulance.
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Figure 2-14 Type II ambulance.
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Patient Transportation—Ambulances – Type III: specialty van with forward cab and integral body; passageway from driver compartment to patient compartment. – Medium-duty truck chassis: built for rugged durability and large storage and work areas. – Diesel: developed for fuel economy.
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Figure 2-15 Type III ambulance.
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Figure 2-16 Some EMS systems have elected to use medium-duty ambulances that are built on a commercial truck chassis. (© Pat Songer)
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Figure 2-17 The diesel, unibody ambulance is becoming increasingly popular because of cost, fuel economy, and safety. (© Acadian Ambulance Services)
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Appropriate Receiving Facilities – EMS systems organize hospitals into categories – Identify readiness and capability – Staff to receive and treat emergency patients – Trauma centers; chest pain centers; stroke centers; specialized care capabilities
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Appropriate Receiving Facilities – Specialty facilities:  Burn, trauma, pediatric, psychiatric, perinatal, cardiac, spinal, poison – All receiving facilities:  Emergency department; surgical facilities; lab and blood bank; medical imaging capabilities; critical and intensive care units
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Mutual Aid and Mass-Casualty Preparation – Ensures help available when needed – Transcends geographical, political, historical boundaries – Disaster plan for catastrophes – Incident command system – Mutual-aid agreement
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Quality Assurance and Improvement – Guidelines for Quality Improvement  Leadership  Information and analysis  Strategic quality planning  Human resources development and management
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Quality Assurance and Improvement – Guidelines for Quality Improvement  EMS process management  EMS system results  Satisfaction of patients and other stakeholders
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Quality Assurance and Improvement – Quality assurance (QA) program: maintains continuous monitoring and measurement of clinical care delivered to patients. – Problem-identifying mechanism
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Quality Assurance and Improvement – Continuous quality improvement (CQI): ongoing effort to refine and improve system in order to provide highest level of service possible. – Problem-solving methodology – Plan, do, check, act
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Quality Assurance and Improvement – Rules of Evidence  Must be a theoretical basis for change  Must be ample scientific human research to support the idea  Must be clinically important  Must be practical, affordable, teachable
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Quality Assurance and Improvement – Ethics: rules or standards that govern conduct of members of a particular group or profession. – Prehospital providers have ethical responsibility to patients and public.
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Quality Assurance and Improvement – Customer satisfaction: service quality. – Medical errors:  Skills-based failures  Rules-based failures  Knowledge-based failures
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Quality Assurance and Improvement – High-risk areas of EMS practice:  Hand-off  Communications issues  Medication issues  Airway issues  Dropping patients  Ambulance crashes  Death pronouncements
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Quality Assurance and Improvement – EMS system must have clear protocols – Must be understood by all providers – Standardization and organization of drugs and their packaging helps to minimize medication errors. – Medical error prevention – When in doubt, ask for help.
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Research – Component of EMS system for moral, educational, medical, financial, practical reasons. – Outcome studies required to justify funding and ensure future of EMS. – Paramedics play valuable role in data collection, evaluation, interpretation of research.
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Evidence-Based Medicine (EBM) – Conscientious, explicit, judicious use of current best scientific evidence in making decisions about care of individual patients – EMS personnel proficient in prehospital care; exercise sound clinical judgment
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Evidence-Based Medicine (EBM) – Be familiar with current and past research pertinent to prehospital care. – Be able to integrate that knowledge into care of patients. – Neither clinical experience nor external evidence alone is enough. – Ensures providing patients best care at lowest price
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • System Financing – EMS can be:  Hospital-based  Fire or police department-based  Municipal service  Private commercial business  Volunteer service  Some combination
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • System Financing – Fully tax-subsidized municipal systems – All-volunteer squads supported solely by contributions – Fee-for-service revenue (third-party payers) – Subsidized by local taxing entities
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Summary • Evolution of EMS over thousands of years. • Many innovations result of lessons learned from military conflicts. • EMS today result of federal legislation; investment from private foundations.
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Summary • EMS provides continuum of care. • EMS is total team effort. • EMS systems designed with patient as highest priority. • Each system has administrative agency. • EMS systems activated by single, universal number (911).
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Summary • Centralized communications center • Emergency response: BLS care less than 4 minutes; ALS care less than 8 minutes. • Ground and air transport follows established protocols. • Mutual-aid agreements ensure continuum of care during multiple-casualty incidents.
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Summary • Hospitals categorized according to readiness to provide essential or specialty services within region. • EMS providers trained according to U.S. DOT Instructional Guidelines. • Continuous quality improvement program documents EMS system's performance.
Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Summary • Ongoing research validates actions of prehospital providers through scientific evaluation. • EMS systems need strong, stable financial plans.

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Bledsoe v1 ch02_lecture

  • 1.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Paramedic Care: Principles & Practice Volume 1, 5e Chapter 2 EMS Systems
  • 2.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Multimedia Directory Slide 73 Ambulance Service Video
  • 3.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Standard • Preparatory (EMS Systems)
  • 4.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Competency • Integrates comprehensive knowledge of EMS systems, the safety and well-being of the paramedic, and medical-legal and ethical issues, which is intended to improve the health of EMS personnel, patients, and the community.
  • 5.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Introduction • Out-of-Hospital Components – Community members trained in first aid and CPR – Communications system – EMS providers, including paramedics – Fire/rescue; hazardous-materials services
  • 6.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Introduction • Out-of-Hospital Components – Law enforcement officers – Public utilities – Resource centers
  • 7.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Introduction • In-Hospital Components – Emergency nurses – Advanced-practice providers – Emergency and specialty physicians – Ancillary services – Social workers – Mental health providers – Rehabilitation services
  • 8.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Introduction • EMS operation begins with citizen activation. • EMS dispatch responsible for: – Collecting information – Sending staffed and equipped unit – Providing prearrival instructions
  • 9.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Introduction • First EMS provider to respond: – Police officer – Firefighter – Lifeguard – Teacher – EMR-trained community member
  • 10.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Introduction • Dispatcher will send: – EMT-level or paramedic level ambulance – Tiered response: multiple levels of emergency care personnel to same incident – Paramedic personnel to every incident regardless of level of care needed
  • 11.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Introduction • EMS providers decide on: – Medical facility – Type of care needed – Transport time – Local protocols
  • 12.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter History of EMS • Most significant advances in EMS during last 50 years
  • 13.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Table 2–1 An EMS Timeline (1 of 5) 1797 Napoleon’s chief physician implements a prehospital system designed to triage and transport the injured from the field to aid stations. 1860s Civilian ambulance services begin in Cincinnati and New York City. 1891 Dr. Friedrich Maass performs the first equivocally documented chest compression in humans. 1915 First-known air medical transport occurs during the retreat of the Serbian army from Albania. 1920 First volunteer rescue squads organize in Roanoke, Virginia, and along the New Jersey coast. 1947 Claude Beck develops first defibrillator and first human saved with defibrillation. 1958 Dr. Peter Safar demonstrates the efficacy of mouth-to-mouth ventilation. 1960 Cardiopulmonary resuscitation (CPR) is shown to be efficacious.
  • 14.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Table 2–1 (continued) An EMS Timeline (2 of 5) 1965 J. Frank Pantridge converts an ambulance into a mobile coronary care unit with a portable defibrillator and recorded ten prehospital resuscitations with a 50 percent long-term survival rate. 1966 The National Academy of Sciences, National Research Council publishes Accidental Death and Disability: The Neglected Disease of Modern Society. 1966 Highway Safety Act of 1966 establishes the Emergency Medical Services Program in the Department of Transportation. 1967 Star of Life is patented by the American Medical Association. 1968 AT&T designates 911 as its new national emergency number. 1970 National Registry of EMTs is founded. 1970 Television show Emergency! debuts on NBC. 1972 Department of Health, Education, and Welfare allocates $16 million to EMS demonstration programs in five states.
  • 15.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Table 2–1 (continued) An EMS Timeline (3 of 5) 1973 The Emergency Medical Services Systems (EMSS) Act provides additional federal guidelines and funding for the development of regional EMS systems; the law establishes 15 components of EMS systems. 1975 National Association of EMTs is organized. 1979 First automated external defibrillators (AEDs) become available. 1981 The Omnibus Budget Reconciliation Act consolidates EMS funding into state preventive health and health services block grants, and eliminates funding under the EMSS Act. 1981 Prehospital trauma life support (PHTLS) is developed. 1981 International trauma life support (ITLS), formerly basic trauma life support (BTLS), is developed. 1984 The EMS for Children program, under the Public Health Act, provides funds for enhancing the EMS system to better serve pediatric patients.
  • 16.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Table 2–1 (continued) An EMS Timeline (4 of 5) 1985 National Research Council publishes Injury in America: A Continuing Public Health Problem, describing deficiencies in the progress of addressing the problem of accidental death and disability. 1988 The National Highway Traffic Safety Administration initiates the Statewide EMS Technical Assessment program based on ten key components of EMS systems. 1990 The Trauma Care Systems and Development Act encourages development of inclusive trauma systems and provides funding to states for trauma system planning, implementation, and evaluation. 1993 The Institute of Medicine publishes Emergency Medical Services for Children, which points out deficiencies in our health care system’s ability to address the emergency medical needs of pediatric patients. 1995 Congress does not reauthorize funding under the Trauma Care Systems and Development Act.
  • 17.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Table 2–1 (continued) An EMS Timeline (5 of 5) 1999 President Clinton signs bill designating 911 as national emergency number. 2003 Health Insurance Portability and Accountability Act (HIPAA) becomes effective, strictly regulating the flow of confidential information. 2006 The National Highway Traffic Safety Administration publishes Emergency Medical Services: Agenda for the Future to guide the development of EMS in the United States in the twenty-first century.
  • 18.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter History of EMS • Early Development – Ancient tablets – Step-by-step instructions for patient care – How to create medications
  • 19.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter History of EMS • Early Development – Code of Hammurabi: governed criminal and civil matters; regulation of medical fees and penalties. – Out-of-hospital care: transport. – Dominique-Jean Larrey (Napoleon's chief surgeon): first prehospital system using triage and transport.
  • 20.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter History of EMS • Early Development – Ambulances in U.S.: nineteenth century. – Nurse Clara Barton organized triage and transport during Civil War. – First civilian ambulance: 1860 in Cincinnati. – Bellevue Hospital in Manhattan (1869): began to operate ambulance service.
  • 21.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter History of EMS • The Twentieth Century – WWI: high mortality rate of soldiers associated with evacuation time. – WWII: transport to echelons (levels) of care created. – Hospitals experimented with placing physician interns on ambulances.
  • 22.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter History of EMS • The Twentieth Century – Korean War: helicopters moved injured to mobile army surgical hospitals (MASHs). – Set stage for trauma system in U.S. – 1956: mouth-to-mouth resuscitation – 1959: portable defibrillator – 1960: cardiopulmonary resuscitation (CPR)
  • 23.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Figure 2-2 Medical evacuation helicopters, colloquially called “Dustoff,” saved many lives during the Vietnam War. (Dust off © Joe Kline Aviation Art)
  • 24.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter History of EMS • The Twentieth Century – 1966: Accidental Death and Disability: The Neglected Disease of Modern Society (White Paper) – Guidelines for:  Development of EMS systems  Training of prehospital emergency medical providers  Upgrading of ambulances and equipment
  • 25.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter History of EMS • The Twentieth Century – 1970: National Registry of Emergency Medical Technicians established – 1972: television show Emergency!; public attention to prehospital care – 1973: Emergency Medical Services Systems Act
  • 26.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter History of EMS • 15 Components of EMS Systems – Manpower – Training – Communications – Transportation – Emergency facilities
  • 27.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter History of EMS • 15 Components of EMS Systems – Critical care units – Public safety agencies – Consumer participation – Access to care – Patient transfer
  • 28.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter History of EMS • 15 Components of EMS Systems – Standardized record keeping – Public information and education – System review and evaluation – Disaster management plans – Mutual aid
  • 29.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter History of EMS • 1988 NHTSA: Ten System Elements – Regulation and policy – Resources management – Human resources and training – Transportation – Facilities
  • 30.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter History of EMS • 1988 NHTSA: Ten System Elements – Communications – Trauma systems – Public information and education – Medical direction – Evaluation
  • 31.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter History of EMS • The Twentieth Century – 1980s: Helicopter air ambulances (HAA) developed – 1996: National Highway Traffic Safety Administration (NHTSA) published EMS Agenda for the Future
  • 32.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter History of EMS • 14 Core EMS Attributes – Integration of health services – EMS research – Legislation and regulation – System finance – Human resources – Medical direction – Education systems
  • 33.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter History of EMS • 14 Core EMS Attributes – Public education – Prevention – Public access – Communication systems – Clinical care – Information systems – Evaluation
  • 34.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter History of EMS • The Twenty-First Century – Result of September 11:  Department of Homeland Security: coordinates agencies responsible for protecting country.  National Incident Management System (NIMS): prepares country for terrorist attacks and other threats.
  • 35.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Figure 2-4 The attacks on New York City and Washington on September 11, 2001, forever changed the face of EMS. (© Reuters)
  • 36.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter History of EMS • The Twenty-First Century – 2006: Emergency Medical Services: At the Crossroads  Insufficient coordination  Coordination of transport within regions was limited  Disparities in response times
  • 37.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter History of EMS • The Twenty-First Century – 2006: Emergency Medical Services: At the Crossroads  Uncertain quality of care  Lack of readiness for disasters  Divided professional identity  Limited evidence base
  • 38.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter History of EMS • The Twenty-First Century – 2006: The National Report Card on the State of Emergency Medicine: Evaluating the Environment of Emergency Care Systems State by State
  • 39.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter History of EMS • The Twenty-First Century – 2001: national medical helicopter fleet expanded from 300 to 900 – 2008: record number of helicopter air ambulance crashes with fatalities – 2009: NTSB hearings
  • 40.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Today's EMS Systems • Fire-based systems • Third service • Private (profit or nonprofit) • Hospital-based systems • Volunteer • Hybrid (combination of any of these)
  • 41.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Today's EMS Systems • Chain of Survival – Continuum of care that begins once emergency occurs – Ends when patient completes care and returns to normal activities of daily living
  • 42.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Today's EMS Systems • American Heart Association Chain of Survival – Immediate recognition and activation of EMS – Early CPR – Rapid defibrillation – Effective advanced life support – Integrated post-cardiac arrest care
  • 43.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Today's EMS Systems • Chain of Survival – Bystander care – Dispatch – Response – Prehospital care – Transportation – Emergency department care – Definitive care – Rehabilitation
  • 44.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Health Care System Integration – Public service access points (PSAPs)  911 call centers; interface between EMS system and communities it serves  Identification of acute coronary syndrome and ST-segment elevation myocardial infarction (STEMI)  Primary percutaneous coronary intervention (PPCI)
  • 45.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Levels of Licensure/Certification – Emergency Medical Responder (EMR) – Emergency Medical Technician (EMT) – Advanced EMT (AEMT) – Paramedic • Each level: unique role, set of skills, knowledge base.
  • 46.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Education – 2009: National EMS Education Instructional Guidelines – National EMS Core Content – National EMS certification – National EMS Education program accreditation – National EMS Scope of Practice Model – National EMS Education Standards
  • 47.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Local- and State-Level Agencies – Administrative oversight agency – Planning board – Define who may function within system – Policies consistent with state requirements – State EMS agencies: allocate funds; enact legislation.
  • 48.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Medical Oversight – Medical director: physician legally responsible for all clinical and patient-care aspects of system. – Prehospital care providers are medical director's designated agents.
  • 49.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Medical Director's Roles – Educate and train personnel – Participate in personnel and equipment selection – Develop clinical protocols in cooperation with expert EMS personnel – Participate in quality improvement and problem resolution
  • 50.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Medical Director's Roles – Provide direct input into patient care – Interface between EMS system and other health care agencies – Advocate within medical community – Serve as "medical conscience" of EMS system
  • 51.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • On-line medical direction: qualified physician gives direct orders to prehospital care provider by radio or telephone. • Intervener physician: on scene or on-line medical direction may not exist; paramedic relinquishes responsibility to physician.
  • 52.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Off-line medical oversight: medical policies, procedures, practices that system medical director has established in advance of call. – Prospective medical oversight – Retrospective medical oversight
  • 53.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Off-Line Medical Oversight – Clinical protocols  Policies and procedures of all medical components of EMS system  Responsibility of medical director
  • 54.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Four "Ts" of Emergency Care – Triage – Treatment – Transport – Transfer
  • 55.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Public Information and Education – Recognize emergency – Access system – Provide basic life support assistance – Relationship between rapid emergency care and mortality (death) rates of patients – Automated external defibrillators (AEDs)
  • 56.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Figure 2-7 Providing disease and injury prevention education to the public has become an important role of EMS in the twenty-first century. (© Dr. Bryan E. Bledsoe)
  • 57.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Effective Communications – Heart of regional EMS system – Coordinates components into organized response to urgent medical situations – Citizen access (911) – Single control center
  • 58.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Effective Communications – Operational communications capabilities – Medical communications capabilities – Communications hardware – Communications software
  • 59.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Figure 2-8 The EMS communications center is truly the heart of the modern EMS system.
  • 60.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Effective Communications – Emergency Medical Dispatcher (EMD):  Sends ambulances to scene  Ensures system resources in constant readiness to respond  Both medically and technically trained
  • 61.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Communications – EMS dispatch: assigns and directs appropriate medical care to patients.  Interrogation protocols  Response configurations  System status management  Prearrival caller instructions
  • 62.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Education and Certification – Initial education: completing course following National EMS Education Instructional Guidelines published by U.S. DOT.  Cognitive  Affective  Psychomotor
  • 63.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Education and Certification – Accreditation: all paramedic education programs meet guidelines for faculty, facilities, equipment, medical oversight, clinical affiliations, financial stability  Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions (CoAEMSP)
  • 64.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Education and Certification – Continuing education: refresher courses for recertification and periodic in-service training sessions; mandatory.  Continuing Education Coordinating Board for Emergency Medical Services (CECBEMS)
  • 65.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Licensure, Certification, Registration, and Reciprocity – Licensure: occupational regulation. – Certification: agency or association grants recognition to individual who has met its qualifications. – Registration: enter name and essential information within a particular record.
  • 66.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Licensure, Certification, Registration, and Reciprocity – Reciprocity: agency grants automatic certification or licensure to individual who has comparable certification or licensure from another agency.
  • 67.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • National Registry of EMTs (NREMT) – Nonprofit entity – Prepares and administers standardized tests for EMS provider levels – Establishes qualifications for registration and biennial reregistration – Establishes national minimum standard of competency
  • 68.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Professional Organizations – National Association of Emergency Medical Technicians (NAEMT) – National Association of Search and Rescue (NASAR) – National Association of EMS Educators (NAEMSE) – National Association of EMS Physicians (NAEMSP)
  • 69.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Professional Organizations – International Flight Paramedics Association (IFPA) – National EMS Management Association (NEMSMA) – National Council of State EMS Training Coordinators (NCSEMSTC)
  • 70.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Professional Journals and Magazines – Academic Emergency Medicine – American Journal of Emergency Medicine – Annals of Emergency Medicine – Emergency Medical Services – Journal of Emergency Medical Services (JEMS)
  • 71.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Professional Journals and Magazines – Journal of Pediatric Emergency Medicine – Journal of Trauma: Injury, Infection and Critical Care – Prehospital Emergency Care
  • 72.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • The Internet – Websites designed for EMS providers – Updated content and news – Accredited continuing education programs – International EMS discussions; networking
  • 73.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Ambulance Service Video Click here to view a video on the topic of ambulance service. Back to Directory
  • 74.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Patient Transportation – Medical oversight designates facility based on needs of patient; availability of services. – Transported by ground or air – Fixed-wing aircraft when patients transported long distances – Vehicles licensed; meet local and state EMS requirements
  • 75.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Figure 2-11 Patients may be transported by ground or air. Medical helicopter transport was introduced in the 1950s during the Korean War. (© Ed Effron)
  • 76.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Figure 2-12 Fixed-wing aircraft, as well as helicopters, have become an important part of patient transport in the modern EMS system. (© REACH Air Medical Services)
  • 77.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Patient Transportation—Ambulances – Type I: conventional cab and chassis; module ambulance body mounted; no passageway between driver and patient compartments. – Type II: standard van, body, and cab form integral unit; raised roof.
  • 78.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Figure 2-13 Type I ambulance.
  • 79.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Figure 2-14 Type II ambulance.
  • 80.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Patient Transportation—Ambulances – Type III: specialty van with forward cab and integral body; passageway from driver compartment to patient compartment. – Medium-duty truck chassis: built for rugged durability and large storage and work areas. – Diesel: developed for fuel economy.
  • 81.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Figure 2-15 Type III ambulance.
  • 82.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Figure 2-16 Some EMS systems have elected to use medium-duty ambulances that are built on a commercial truck chassis. (© Pat Songer)
  • 83.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Figure 2-17 The diesel, unibody ambulance is becoming increasingly popular because of cost, fuel economy, and safety. (© Acadian Ambulance Services)
  • 84.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Appropriate Receiving Facilities – EMS systems organize hospitals into categories – Identify readiness and capability – Staff to receive and treat emergency patients – Trauma centers; chest pain centers; stroke centers; specialized care capabilities
  • 85.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Appropriate Receiving Facilities – Specialty facilities:  Burn, trauma, pediatric, psychiatric, perinatal, cardiac, spinal, poison – All receiving facilities:  Emergency department; surgical facilities; lab and blood bank; medical imaging capabilities; critical and intensive care units
  • 86.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Mutual Aid and Mass-Casualty Preparation – Ensures help available when needed – Transcends geographical, political, historical boundaries – Disaster plan for catastrophes – Incident command system – Mutual-aid agreement
  • 87.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Quality Assurance and Improvement – Guidelines for Quality Improvement  Leadership  Information and analysis  Strategic quality planning  Human resources development and management
  • 88.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Quality Assurance and Improvement – Guidelines for Quality Improvement  EMS process management  EMS system results  Satisfaction of patients and other stakeholders
  • 89.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Quality Assurance and Improvement – Quality assurance (QA) program: maintains continuous monitoring and measurement of clinical care delivered to patients. – Problem-identifying mechanism
  • 90.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Quality Assurance and Improvement – Continuous quality improvement (CQI): ongoing effort to refine and improve system in order to provide highest level of service possible. – Problem-solving methodology – Plan, do, check, act
  • 91.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Quality Assurance and Improvement – Rules of Evidence  Must be a theoretical basis for change  Must be ample scientific human research to support the idea  Must be clinically important  Must be practical, affordable, teachable
  • 92.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Quality Assurance and Improvement – Ethics: rules or standards that govern conduct of members of a particular group or profession. – Prehospital providers have ethical responsibility to patients and public.
  • 93.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Quality Assurance and Improvement – Customer satisfaction: service quality. – Medical errors:  Skills-based failures  Rules-based failures  Knowledge-based failures
  • 94.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Quality Assurance and Improvement – High-risk areas of EMS practice:  Hand-off  Communications issues  Medication issues  Airway issues  Dropping patients  Ambulance crashes  Death pronouncements
  • 95.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Quality Assurance and Improvement – EMS system must have clear protocols – Must be understood by all providers – Standardization and organization of drugs and their packaging helps to minimize medication errors. – Medical error prevention – When in doubt, ask for help.
  • 96.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Research – Component of EMS system for moral, educational, medical, financial, practical reasons. – Outcome studies required to justify funding and ensure future of EMS. – Paramedics play valuable role in data collection, evaluation, interpretation of research.
  • 97.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Evidence-Based Medicine (EBM) – Conscientious, explicit, judicious use of current best scientific evidence in making decisions about care of individual patients – EMS personnel proficient in prehospital care; exercise sound clinical judgment
  • 98.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • Evidence-Based Medicine (EBM) – Be familiar with current and past research pertinent to prehospital care. – Be able to integrate that knowledge into care of patients. – Neither clinical experience nor external evidence alone is enough. – Ensures providing patients best care at lowest price
  • 99.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • System Financing – EMS can be:  Hospital-based  Fire or police department-based  Municipal service  Private commercial business  Volunteer service  Some combination
  • 100.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Essential Components for Continuum of Care • System Financing – Fully tax-subsidized municipal systems – All-volunteer squads supported solely by contributions – Fee-for-service revenue (third-party payers) – Subsidized by local taxing entities
  • 101.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Summary • Evolution of EMS over thousands of years. • Many innovations result of lessons learned from military conflicts. • EMS today result of federal legislation; investment from private foundations.
  • 102.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Summary • EMS provides continuum of care. • EMS is total team effort. • EMS systems designed with patient as highest priority. • Each system has administrative agency. • EMS systems activated by single, universal number (911).
  • 103.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Summary • Centralized communications center • Emergency response: BLS care less than 4 minutes; ALS care less than 8 minutes. • Ground and air transport follows established protocols. • Mutual-aid agreements ensure continuum of care during multiple-casualty incidents.
  • 104.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Summary • Hospitals categorized according to readiness to provide essential or specialty services within region. • EMS providers trained according to U.S. DOT Instructional Guidelines. • Continuous quality improvement program documents EMS system's performance.
  • 105.
    Copyright © 2017,2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Summary • Ongoing research validates actions of prehospital providers through scientific evaluation. • EMS systems need strong, stable financial plans.

Editor's Notes

  • #6 Teaching Tip Discuss with students the different out-of-hospital and in-hospital components.
  • #8 Class Activities Assign members of the class a particular role as an out-of-hospital and in-hospital component. Give students a scenario and have them stand in a line as their part in the EMS call arrives. Once you have gone through the call, repeat with removal of one or two student roles, which allows students to visualize where the care is jeopardized when there is a break in the EMS and hospital components.
  • #19 Class Activities Create a timeline of dates and important EMS history. Have students match them together. (You may want to do this ahead of time. It works well if cards are laminated, which allows taping to the board.)
  • #22 Teaching Tips Explore the history of EMS with students, expanding on the role the military has played, as well as the most recent developments with curriculum changes.
  • #30 Discussion Topics Discuss with students why EMS struggles with funding, from the city and state level, through insurance and changes that have occurred in the standard of care for the paramedic.
  • #41 Teaching Tips Review all of the components with the student. Most information should be familiar.
  • #49 Points to Emphasize Focus on medical direction and off-line, on-line, prospective, and retrospective. Explain to students what to do if they have a physician arrive on their scene. Discuss with students the importance of safety. Have them list examples of unsafe practices in EMS and how those practices can be improved.
  • #52 Class Activities If not already done, take students through a mock peer review, first using a positive approach, then a negative approach. Discuss with students how a negative approach affects the review.
  • #56 Knowledge Application Assign the students a 5-minute homework project that includes presenting a safety program to family/friends in an informal setting, and have the participants write an evaluation on how the information given will aid them in staying safe and healthy (e.g., texting and driving, use of seat belts, rugs in the kitchen, etc.)
  • #63 Discussion Topics Discuss different education programs paramedics might be called on to present. Discuss with students why they feel it is important for the initial training program to follow a standard teaching curriculum. Discuss what could happen if there were no standard rules for education in EMS.
  • #74 Questions:  When and where was the first ambulance service introduced? Who acted as the first "paramedics"? What legislation standardized training, assessment, and care for the EMT? When was this legislation passed?
  • #97 Knowledge Application Assign students an assignment of finding two to four research articles from professional magazines, journals, Internet, etc. Have them write a few paragraphs on whether they agree or disagree with the information, and why.