Bledsoe v1 ch02_lecture

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

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Multimedia Directory
Slide 73 Ambulance Service Video

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Standard
• Preparatory (EMS Systems)

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.

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

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Introduction
• Out-of-Hospital Components
– Law enforcement officers
– Public utilities
– Resource centers

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

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

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Introduction
• First EMS provider to respond:
– Police officer
– Firefighter
– Lifeguard
– Teacher
– EMR-trained community member

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

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Introduction
• EMS providers decide on:
– Medical facility
– Type of care needed
– Transport time
– Local protocols

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
History of EMS
• Most significant advances in EMS during last 50
years

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.

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.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
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.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
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.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
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.

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

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
History of EMS
– 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.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
History of EMS
– 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.

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.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
History of EMS
– 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)

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)

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
History of EMS
– 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

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
History of EMS
– 1970: National Registry of Emergency Medical
Technicians established
– 1972: television show Emergency!; public attention to
prehospital care
– 1973: Emergency Medical Services Systems Act

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
History of EMS
• 15 Components of EMS Systems
– Manpower
– Training
– Communications
– Transportation
– Emergency facilities

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
History of EMS
– Critical care units
– Public safety agencies
– Consumer participation
– Access to care
– Patient transfer

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
History of EMS
– Standardized record keeping
– Public information and education
– System review and evaluation
– Disaster management plans
– Mutual aid

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

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

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
History of EMS
– 1980s: Helicopter air ambulances (HAA) developed
– 1996: National Highway Traffic Safety Administration
(NHTSA) published EMS Agenda for the Future

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

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

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.

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)

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
History of EMS
– 2006: Emergency Medical Services: At the Crossroads
 Insufficient coordination
 Coordination of transport within regions was limited
 Disparities in response times

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
History of EMS
– 2006: Emergency Medical Services: At the Crossroads
 Uncertain quality of care
 Lack of readiness for disasters
 Divided professional identity
 Limited evidence base

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
History of EMS
– 2006: The National Report Card on the State of
Emergency Medicine: Evaluating the Environment of
Emergency Care Systems State by State

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
History of EMS
– 2001: national medical helicopter fleet expanded from
300 to 900
– 2008: record number of helicopter air ambulance
crashes with fatalities
– 2009: NTSB hearings

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)

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

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

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

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)

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• 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.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• 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

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• 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.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• 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.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• 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

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• 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

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• 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.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Off-line medical oversight: medical policies,
procedures, practices that system medical director
has established in advance of call.
– Prospective medical oversight
– Retrospective medical oversight

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Off-Line Medical Oversight
– Clinical protocols
 Policies and procedures of all medical components of EMS
system
 Responsibility of medical director

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Four "Ts" of Emergency Care
– Triage
– Treatment
– Transport
– Transfer

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• 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)

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)

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Effective Communications
– Heart of regional EMS system
– Coordinates components into organized response to
urgent medical situations
– Citizen access (911)
– Single control center

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
– Operational communications capabilities
– Medical communications capabilities
– Communications hardware
– Communications software

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.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
– Emergency Medical Dispatcher (EMD):
 Sends ambulances to scene
 Ensures system resources in constant readiness to respond
 Both medically and technically trained

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Communications
– EMS dispatch: assigns and directs appropriate medical
care to patients.
 Interrogation protocols
 Response configurations
 System status management
 Prearrival caller instructions

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Education and Certification
– Initial education: completing course following National
EMS Education Instructional Guidelines published by
U.S. DOT.
 Cognitive
 Affective
 Psychomotor

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
– 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)

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
– Continuing education: refresher courses for
recertification and periodic in-service training sessions;
mandatory.
 Continuing Education Coordinating Board for Emergency
Medical Services (CECBEMS)

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• 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.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Licensure, Certification, Registration, and
Reciprocity
– Reciprocity: agency grants automatic certification or
licensure to individual who has comparable certification
or licensure from another agency.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• 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

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• 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)

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Professional Organizations
– International Flight Paramedics Association (IFPA)
– National EMS Management Association (NEMSMA)
– National Council of State EMS Training Coordinators
(NCSEMSTC)

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• 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)

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Professional Journals and Magazines
– Journal of Pediatric Emergency Medicine
– Journal of Trauma: Injury, Infection and Critical Care
– Prehospital Emergency Care

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• The Internet
– Websites designed for EMS providers
– Updated content and news
– Accredited continuing education programs
– International EMS discussions; networking

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

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• 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

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)

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)

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• 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.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Figure 2-13 Type I ambulance.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Figure 2-14 Type II ambulance.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• 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.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Figure 2-15 Type III ambulance.

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)

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)

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• 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

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• 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

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• 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

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Quality Assurance and Improvement
– Guidelines for Quality Improvement
 Leadership
 Information and analysis
 Strategic quality planning
 Human resources development and management

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
– Guidelines for Quality Improvement
 EMS process management
 EMS system results
 Satisfaction of patients and other stakeholders

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
– Quality assurance (QA) program: maintains continuous
monitoring and measurement of clinical care delivered
to patients.
– Problem-identifying mechanism

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
– 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

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
– 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

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
– Ethics: rules or standards that govern conduct of
members of a particular group or profession.
– Prehospital providers have ethical responsibility to
patients and public.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
– Customer satisfaction: service quality.
– Medical errors:
 Skills-based failures
 Rules-based failures
 Knowledge-based failures

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
– High-risk areas of EMS practice:
 Hand-off
 Communications issues
 Medication issues
 Airway issues
 Dropping patients
 Ambulance crashes
 Death pronouncements

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
– 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.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• 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.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• 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

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• 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

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• System Financing
– EMS can be:
 Hospital-based
 Fire or police department-based
 Municipal service
 Private commercial business
 Volunteer service
 Some combination

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• 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

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.

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).

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.

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.

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.

Bledsoe v1 ch02_lecture

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Bledsoe v1 ch02_lecture

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