Paramedic

1. Copyright © 2023 by Jones & Bartlett Learning, LLC, an Ascend Learning Company and the American Academy of Orthopaedic Surgeons.
EMS Systems
CHAPTER 1

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Introduction (1 of 2)
 The EMS system is constantly
evolving.
 As a paramedic, you will encounter
many different situations.
© Jones & Bartlett Learning. Courtesy of MIEMSS

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Introduction (2 of 2)
 The public’s perception of EMS
 Treat everyone with respect and dignity.
 Continued education is a must.

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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
Photo of Nancy L. Caroline provided in loving memory by her
mother, Zelda Caroline.

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The History of EMS
 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

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The 20th Century and Modern Technology (1 of 7)
 EMS made major strides in the
1950s and 1960s.
 Bringing hospital to field gave
patients a better chance for
survival.
 Korean War
 First use of a helicopter
 MASH units
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The 20th Century and Modern Technology (2 of 7)
 1956
 Mouth-to-mouth resuscitation was developed.
 Late 1950s/early 1960s
 Focus shifted to bringing hospital to patients.
 Mobile intensive care units (MICUs) were developed.

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The 20th Century and Modern Technology (3 of 7)
 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

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The 20th Century and Modern Technology (4 of 7)
 “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

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The 20th Century and Modern Technology (5 of 7)
 1969
 First true paramedic program
 Standards for ambulance design
and equipment
 1970s
 NREMT was established.
Courtesy of Eugene L. Nagel and the Miami Fire Department.

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The 20th Century and Modern Technology (6 of 7)
 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

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The 20th Century and Modern Technology (7 of 7)
 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.

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The 21st Century Progress
 Numerous initiatives are appearing:
 National EMS Quality Alliance (NEMSQA; formerly called EMS Compass)
 EMS training used in other areas of health care
 Community paramedicine

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Licensure, Certification, Registration, and Credentialing (1 of 3)
 Depending on your state, you may be registered or licensed.
 Registration
 Certification
 Licensure
 Holding a license shows that you:
 Completed initial education
 Met the requirements to achieve the license

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Licensure, Certification, Registration, and Credentialing (2 of 3)
 CoAEMSP
 Currently the only accrediting body for paramedic programs
 Mission to continuously improve EMS education quality through accreditation and
recognition services

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Licensure, Certification, Registration, and Credentialing (3 of 3)
 Reciprocity
 Certification granted from another state/agency
 Requirements:
 Hold a current state licensure
 Be in good standing
 National Registry certification

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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

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The EMS System (1 of 3)
 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

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The EMS System (2 of 3)
 Patient outcomes determined by:
 Bystander care
 Dispatch
 Response
 Prehospital assessment and care
 Transportation
 Emergency department care
 Definitive care
 Rehabilitation

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The EMS System (3 of 3)
 Dispatchers
 The public’s first contact
 Scene not necessarily what dispatcher relays
 As a paramedic, you must:
 Develop a care plan
 Determine the most appropriate facility within a reasonable distance

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Levels of Education (1 of 2)
 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

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Levels of Education (2 of 2)
 The national guidelines are designed to create more consistent delivery of EMS
nationally.
 In 2009, the National EMS Education Standards were revised.

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The Dispatcher
 Plays a critical role
 May be trained to give prearrival
instructions
© Terry Moore/Stocktrek Images/Alamy Stock Photo.

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Emergency Medical Responder (EMR)
 The EMR was formerly called “first
responder.”
 Requirements vary by state.
 Functions of an EMR
© Corbis/Getty Images.

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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.
© John Moore/Staff/Getty Images News/Getty Images.

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Advanced EMT (AEMT)
 Replaces intermediate EMT level
 Initially developed in 1985
 Trained in:
 More advanced pathophysiology
 Some advanced procedures

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Paramedic
 Highest skill level to be nationally certified
 Even if independently licensed, you must:
 Function under guidance of physicians
 Be affiliated with a paramedic-level service

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Paramedic Education (1 of 2)
 Initial education
 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

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Paramedic Education (2 of 2)
 Continuing education
 Most states require a certain number of hours and/or refresher programs.
 The responsibility for continuing education rests with you.
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Additional Types of Transports
 Specialty center
 Require in-house specialists
 Possibility of slightly longer
transport time
 Interfacility
 Transfer to and from:
 Clinics
 Rehabilitation centers
 Long-term facilities
 Hospitals
 Other medical professionals may
accompany patient.

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Working With Other Professionals (1 of 3)
 Hospital staff
 Become familiar with the hospital.
 Interact professionally with hospital personnel.
 You may consult with staff by using the radio through established (online)
procedures.

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Working With Other Professionals (2 of 3)
 Public safety agents
 Some have EMS training.
 Interagency cooperation benefits
the patient.
© John Moore/Staff/Getty Images News/Getty Images.

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Working With Other Professionals (3 of 3)
 Community expectations
 The community has expectations of EMS.
 Focus on prevention.
 You will interact with many professionals and groups.
 Understand your role, as well as theirs.

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National EMS Group Involvement
 Many national and state organizations exist and invite paramedic membership.
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Professionalism (1 of 4)
 You have responsibilities as a health care professional.
 You will be measured by:
 Standards, competencies, and education requirements
 Performance parameters
 Code of ethics

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Professionalism (2 of 4)
 You are in a highly visible role in
your community.
 You must:
 Instill confidence
 Establish and maintain credibility
 Show concern for your patients
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Professionalism (3 of 4)
 Your appearance is of utmost importance.
 Present a professional image and treat colleagues with respect.

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Professionalism (4 of 4)
 Attributes of professionalism:
 Integrity
 Empathy
 Self-motivation
 Confidence
 Communications
 Teamwork and respect
 Patient advocacy
 Injury prevention
 Careful delivery of service
 Time management
 Administration

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Roles and Responsibilities (1 of 2)
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Roles and Responsibilities (2 of 2)
 Teach the community about injury
and illness prevention.
 Appropriate use of EMS
 CPR and AED training
 Influenza and pandemic issues
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Medical Direction (1 of 3)
 Paramedics carry out advanced skills.
 Medical directors may perform many roles:
 Educate and train
 Recommend new personnel and equipment
 Develop protocols, guidelines, and quality improvement programs

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Medical Direction (2 of 3)
 Roles of the medical director (cont’d):
 Provide input for patient care
 Interface between EMS and other agencies
 Advocate for EMS
 Serve as “medical conscience”

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Medical Direction (3 of 3)
 Medical directors 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

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Improving System Quality (1 of 5)
 Continuous quality improvement (CQI)
 Tool to continually evaluate care
 Quality control: Process of assessing current practices, looking for ways to improve
 Dynamic process

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Improving System Quality (2 of 5)
 CQI programs help prevent problems by:
 Evaluating day-to-day operations
 Identifying stress points, such as:
 Medical direction issues
 Education
 Communications
 Prehospital treatment
 Transportation issues
 Financial issues
 Receiving facility review

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Improving System Quality (3 of 5)
 Review emergency calls when
possible.
 Focus of CQI is improving care.
 CQI can be a peer review.
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Improving System Quality (4 of 5)
 Look for ways to eliminate human error.
 Three primary sources of errors:
 Rules-based failure
 Knowledge-based failure
 Skills-based failure

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Improving System Quality (5 of 5)
 Look for 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.

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EMS Research
 EMS has been drawn toward evidence-based practice.
 Protocols should be based on scientific findings.
 Research is typically performed by educated researchers with a PhD or MD
degree.

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The Research Process (1 of 2)
 Identify the problem, procedure, or question.
 Develop research agenda.
 Stick to the research agenda.

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The Research Process (2 of 2)
 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.

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Funding
 Researchers should use an institutional review board (IRB) before a project
begins.
 Major research requires specific funding.
 Researchers should:
 Disclose sources of funding
 Maintain transparency of research methods

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Types of Research (1 of 3)
 Qualitative
 Questions within surrounding
events and concurrent processes
 Often used when quantitative
research does not provide answers
 Quantitative
 Numeric data
 Three types:
 Experimental (scientific)
 Nonexperimental (descriptive)
 Survey

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Types of Research (2 of 3)
 Retrospective
 Examines available data
 Applications for EMS
 In large studies, data often collected from widespread databases

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Types of Research (3 of 3)
 Other types of research:
 Prospective
 Cohort
 Case study
 Cross-sectional design
 Longitudinal design
 Literature review

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Research Methods (1 of 2)
 Identify the group(s) necessary for research.
 Ways to select subjects for research
 Even in the best cases, sampling errors occur.

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Research Methods (2 of 2)
 Studies can be:
 Blinded
 Unblinded
 Research statistics can be:
 Descriptive
 Inferential

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Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Ethical Considerations (1 of 2)
 The organization’s IRB monitors whether a study is conducted ethically.
 Risks must not outweigh potential benefits.
 Conflicts of interest must be identified.

59. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Ethical Considerations (2 of 2)
 All subjects must:
 Give consent
 Know their rights will be protected
 Participate voluntarily
 Be informed of all potential risks
 Be free to withdraw at any time
© Al Seib/Los Angeles Times/Getty Images.

60. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Evaluating Medical Research (1 of 2)
 When evaluating research, look for certain criteria to determine the research
quality.
 Read every part of the research paper.

61. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Evaluating Medical Research (2 of 2)
 Peer review helps ensure quality.
 Internet sites can be useful tools.
 Studies must follow a structured process.
 There will always be limitations.
 Review research carefully.

62. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Evidence-Based Practice (1 of 2)
 Care should focus on procedures that have proven useful in improving patient
outcomes.
 Stay up-to-date on health care advances.
 Researchers often rate the quality of a study to ensure quality evidence.

63. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Evidence-Based Practice (2 of 2)
 Research determines the effectiveness of treatment.
 When following a new study, measure the results with your CQI program.