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EMS Systems
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- 2. Preparatory Integrates comprehensive knowledgeof the EMS system, safety/well-being of the paramedic, and medical/legal and ethical issues, which are intended to improve the health of EMS personnel, patients, and the community. National EMS Education Standard Competencies
- 3. Emergency Medical Services(EMS) Systems • EMS systems • History of EMS • Roles/responsibilities/professionalism of EMS personnel • Quality improvement • Patient safety National EMS Education Standard Competencies
- 4. Research • Impact ofresearch on emergency medical responder (EMR) care • Data collection • Evidence-based decision making • Research principles to interpret literature and advocate evidence-based practice National EMS Education Standard Competencies
- 5. Introduction • The EMSsystem is constantly evolving. – Originally, primary role was transportation. • As a paramedic, you will encounter many different situations. © BSIP SA/Alamy.
- 6. Introduction • The public’sperception of you is based on: – TV and articles – Patient’s previous experiences – Your treatment of their loved ones • Continued education is a must. • Treat everyone with respect and dignity.
- 7. EMS System Development •Much of the prehospital emergency care paramedics deliver is attributed to visionary advances of pioneers such as: – Dr. Peter Safar – Dr. Nancy Caroline • You may be surprised how long organized systems have been in place.
- 8. The History ofEMS • 1487 – First use of an ambulance – Transport only • 1800s – First prehospital system for triaging and transporting patients • 1926 – Start of service similar to present day • 1940s – Fire and police department–based EMS – No standards set
- 9. The 20th Centuryand Modern Technology • EMS made major strides after WWII. – Bringing hospital to field gave patients a better chance for survival – Korean War • First use of a helicopter • MASH units © National Library of Medicine.
- 10. The 20th Centuryand Modern Technology • 1956 – Mouth-to-mouth resuscitation was developed. • Late 1950s/early 1960s – Focus shifted to bringing hospital to patients. – Mobile intensive care units (MICUs) developed.
- 11. The 20th Centuryand Modern Technology • 1965: “The White Paper” released – Findings included: • Lack of uniform laws and standards • Equipment of poor quality or nonexistent • Lack of communication • Lack of training • Only part-time staff
- 12. The 20th Centuryand Modern Technology • “The White Paper” outlined 10 critical points for EMS system. – Led to National Highway Safety Act – Created US Department of Transportation (US DOT) • 1968 – Training standards implemented – 9-1-1 system created
- 13. The 20th Centuryand Modern Technology • 1969 – First true paramedic program – Standards for ambulance design and equipment • 1970s – NREMT began Courtesy of Eugene L. Nagel and the Miami Fire Department.
- 14. The 20th Centuryand Modern Technology • 1970s (cont’d) – 1971: Emergency Care and Transportation of the Sick and Injured by the AAOS – 1973: Emergency Medical Services Systems Act – 1977: First National Standard Curriculum for paramedics by US DOT
- 15. The 20th Centuryand Modern Technology • 1980s/1990s – The number of trained personnel grew significantly. – NHTSA developed 10 system elements to help sustain EMS system. – Responsibility for EMS transferred to the states. – Major legislative initiatives came about.
- 16. The 21st CenturyProgress • Numerous initiatives are appearing: – EMS Compass – EMS training used in other areas of health care (as opposed to strictly in an ambulance) – Community paramedicine
- 17. Licensure, Certification, and Registration •Depending on your state, you may be registered or licensed. – Board of registration holds your: • Education records • State or local licensure • Recertification – Once you complete your initial paramedic education, depending on your state, you will be able to take your state’s certification examination.
- 18. Licensure, Certification, and Registration •Passing grade on certification examination: – Ensures all health care providers have the same basic level of knowledge and skill – Entitles you to a state- and/or NREMT-issued certificate or license
- 19. Licensure, Certification, and Registration •Licensure: – How states control who practices – Also known as certification or credentialing – Unlawful to practice without licensure • Holding a license shows that you: – Completed initial education – Met the requirements to achieve the license
- 20. Licensure, Certification, and Registration •CoAEMSP – The only accrediting body for paramedic programs to date – Mission to continuously improve the quality of EMS education through accreditation and recognition services
- 21. Licensure, Certification, and Registration •Reciprocity – Certification granted from another state/agency – Requirements: • Hold a current state licensure • Be in good standing • National Registry certification
- 22. Traditional EMS Employment •Once you become licensed, a variety of career options are available to you: – Fire-based EMS – Third-service EMS – Private EMS agency – Hospital-based EMS – Hybrid or other
- 23. The EMS System •A complex network of coordinated services that provides care to the community • The public needs to be taught how to: – Recognize emergencies – Activate the EMS system – Provide basic care
- 24. The EMS System –Bystander care – Dispatch – Response – Prehospital assessment and care – Transportation – Emergency department care – Definitive care – Rehabilitation • Patient outcomes determined by:
- 25. The EMS System •Dispatchers – Usually the public’s first contact – Training level varies by state • Scene not necessarily what dispatcher relays – Never under- or overestimate information
- 26. The EMS System •As a paramedic, you must: – Develop a care plan – Determine the most appropriate facility within a reasonable distance
- 27. Levels of Education •EMS system functions from a federal to local level. – Federal: National EMS Scope of Practice Model – State: Licensure, laws, and regulations – Local: Medical director decides day-to-day limits
- 28. Levels of Education •The national guidelines are designed to create more consistent delivery of EMS nationally. – Medical director can limit the scope of practice. • In 2009, the National EMS Education Standards were revised. – Federal administrative source
- 29. The Dispatcher • Playsa critical role – Receives and enters information – Interprets it – Relays it to appropriate service • May be trained to give prearrival instructions © Terry Moore/Stocktrek Images/Alamy.
- 30. Emergency Medical Responder (EMR) •The EMR was formerly called “first responder.” • Requirements vary by state. • EMRs should be able to: – Recognize seriousness of condition – Provide basic care – Relay information © Glen E. Ellman.
- 31. Emergency Medical Technician (EMT) •This is the primary provider level in many EMS systems. • EMT certification precedes paramedic education. • This is the most common level in the system. © Carlos Chavez/Los Angeles Times/Getty.
- 32. Advanced EMT (AEMT) •Formerly EMT-I • Initially developed in 1985 – Major revision in 1999 • Trained in: – More advanced pathophysiology – Some advanced procedures
- 33. Paramedic • Highest skilllevel to be nationally certified – 1998: Major revisions to curriculum greatly increased level of training and skills. • Even if independently licensed, you must: – Function under guidance of physicians – Be affiliated with a paramedic-level service
- 34. Paramedic Education • Initialeducation – Most states base education programs on the National EMS Education Standards. • Outline minimum knowledge needed for practice – States require varying hours of education. • National average: 1,000-1,500 hours
- 35. Paramedic Education • Continuingeducation – Most states require a certain number of hours/refresher programs. – Attend conferences and seminars. – Read EMS journals. – Consider CAPCE-accredited programs. – Get everyone involved in postrun critiques. • The responsibility for continuing education rests with you.
- 36. Additional Types ofTransports • Specialty center – Require in-house staffs of specialists – Possibility of slightly longer transport time – Know: • Location of centers • Protocol for direct transport • Interfacility – Use for: • Nonambulatory patients • Patients who require medical monitoring – Other medical professionals may accompany patient.
- 37. Working With Other Professionals •Hospital staff – Become familiar with the hospital. – You may consult with staff by using the radio through established (online) procedures. – The best patient care occurs when emergency care providers have close rapport.
- 38. Working With Other Professionals •Public safety agents – Some have EMS training. • Can better perform certain functions than you – Interagency cooperation benefits the patient.© Mark C. Ide.
- 39. Working With Other Professionals •Continuity of care – The community has expectations of EMS. – Focus on prevention. – You will interact with many professionals and groups. – Understand your role, as well as theirs.
- 40. National EMS Group Involvement •Many national and state organizations exist and invite paramedic membership. – Impact EMS future – Provide access to resources – Promote uniformity © Jones & Bartlett Learning.
- 41. Professionalism • You haveresponsibilities as a health care professional. • You will be measured by: – Standards, competencies, and education requirements – Performance parameters – Code of ethics
- 42. Professionalism • You arein a highly visible role in your community. • You must: – Instill confidence. – Establish and maintain credibility. – Show concern for your patients.
- 43. Professionalism • Your appearanceis of utmost importance. – Has more impact than you may think • Present a professional image and treat colleagues with respect. – Arguing with colleagues is inappropriate. – Raise issues at the appropriate time and place.
- 44. Professionalism – Integrity – Empathy –Self-motivation • Have an internal drive for excellence. – Confidence • Strive to be the best paramedic you can. – Communications • Express and exchange ideas, thoughts, and findings. • Listen well. • Documentation is important. • Attributes of professionalism:
- 45. Professionalism – Teamwork and respect •Work together. – Patient advocacy • Act in the patient’s best interest. – Injury prevention – Careful delivery of service – Time management • Prioritize your patient’s needs. – Administration • Attributes of professionalism (cont’d):
- 46. Professionalism • More healthcare locations are using paramedic services, including: – Administering vaccinations – Performing special transports
- 47. Roles and Responsibilities ©Jones & Bartlett Learning; Photo: © Glen E. Ellman.
- 48. Roles and Responsibilities •Teach the community about prevention of injury and illness. – Appropriate use of EMS – CPR and AED training – Influenza and pandemic issues Courtesy of Captain David Jackson, Saginaw Township Fire Department
- 49. Medical Direction • Paramedicscarry out advanced skills. – Must take direction from medical directors • Medical directors may perform many roles: – Educate and train – Recommend new personnel and equipment – Develop protocols, guidelines, and quality improvement programs
- 50. Medical Direction • Rolesof the medical director (cont’d): – Provide input for patient care – Interface between EMS and other agencies – Advocate for EMS – Serve as “medical conscience”
- 51. Medical Direction • Medicaldirectors provide online and off-line medical control. • Online – Provides immediate and specific patient care resources – Allows for continuous quality improvement – Can offer on-scene assistance • Off-line – Allows for the development of: • Protocols or guidelines • Standing orders • Procedures • Training
- 52. Improving System Quality •Continuous quality improvement (CQI) – Tool to continually evaluate care – Quality control: Process of assessing current practices, looking for ways to improve – Dynamic process
- 53. Improving System Quality •Review ambulance runs when possible. • Focus of CQI is improving care. • CQI can be a peer review. – Try to rotate peer review team – Be professional © Jones & Bartlett Learning. Courtesy of MIEMSS.
- 54. Improving System Quality •CQI programs help prevent problems by: – Evaluating day-to- day operations – Identifying possible stress points • Look for ways to eliminate human error. – Ensure adequate lighting – Limit interruptions – Store medications properly
- 55. Improving System Quality •Ways to eliminate human error (cont’d) – Be careful when handing patients off. – Three main sources of errors: • Rules-based failure • Knowledge-based failure • Skills-based failure
- 56. Improving System Quality •Ways to eliminate human error (cont’d) – Agencies need clear protocols. – Be aware of your environment. – Ask yourself, “Why am I doing this?” – Use cheat sheets. – Be conscientious of protocols.
- 57. EMS Research • EMShas been drawn toward evidence- based practice. – Protocols should be based on scientific findings. • Research typically performed by educated researchers with a PhD or MD degree. – Some colleges and universities offer an EMS track for paramedics.
- 58. The Research Process •Identify the problem, procedure, or question. • Develop research agenda by specifying: – Questions to be answered – Specific aims to be addressed – Methods by which the study will be carried out – Methods to gather data • Stick to the research agenda.
- 59. The Research Process •Determine the research domain. – Area of research – Domains: clinical, systems, or education • Research may be performed within a research consortium. – Paramedics may be involved by gathering data.
- 60. Funding • Researchers shoulduse an institutional review board (IRB) when a project begins. • Major research requires specific funding. – Any type of support is considered funding. • Researchers should: – Disclose sources of funding. – Maintain transparency of research methods.
- 61. Types of Research •Qualitative – Focuses on questions within surrounding events and concurrent processes – Often used when quantitative research does not provide answers • Quantitative – Based on numeric data – Three types: • Experimental (scientific approach) • Nonexperimental (descriptive) • Survey
- 62. Types of Research •Retrospective – Examines available data – May be used to: • Develop educational sessions for EMS personnel • Plan public education and prevention strategies – In large studies, data often collected from widespread databases • Techniques can be used at the local level
- 63. Types of Research •Other types of research: – Prospective – Cohort – Case study – Cross-sectional design – Longitudinal design – Literature review
- 64. Research Methods • Identifythe group(s) necessary for research. • Ways to select subjects for research: – Systematic sampling – Alternative time sampling – Convenience sampling • Even in the best cases, sampling errors occur.
- 65. Research Methods • Studiescan be: – Blinded • Investigators not told project specifics • Single-, double-, or triple-blinded – Unblinded • Participants advised of all aspects • Research statistics can be: – Descriptive • Observations made • No attempts made to alter event – Inferential • Hypothesis used to prove a finding
- 66. Ethical Considerations • Theorganization’s IRB monitors whether a study is conducted ethically and ensures: – Protection of participants – Appropriate conduct • Risks must not outweigh potential benefits. • Conflicts of interest must be identified.
- 67. Ethical Considerations • Allsubjects must: – Give consent. – Know their rights will be protected. – Participate voluntarily. – Be informed of all potential risks. – Be free to withdraw at any time. © Jones & Bartlett Learning. Courtesy of MIEMSS.
- 68. Evaluating Medical Research •When evaluating research, look for certain criteria to determine the research quality. – Know what questions to answer. • Read every part of the research paper and review: – The hypothesis and population – The patient and selection criteria – The analysis of the data – The authors and their conclusions
- 69. Evaluating Medical Research •Peer review helps ensure quality. – Subject matter experts review material prior to publication. • Internet sites can be valid tools. • Studies must follow a structured process. • There will always be limitations. • Review research carefully.
- 70. Evidence-Based Practice • Careshould focus on procedures that have proven useful in improving patient outcomes. – Evidence-based practice will have a growing role in EMS. • Stay up to date on health care advances. – Make sure you understand new research results.
- 71. Evidence-Based Practice • Researchersoften rate the quality of a study to ensure quality evidence. – There are many different rating systems. – The American Heart Association assigns class (strength) of recommendation and levels (quality) of evidence.
- 72. Evidence-Based Practice • Researchdetermines the effectiveness of treatment. – Can help identify which procedures, medications, and treatments do and do not work • When following a new study, measure the results with your CQI program.