EMS System

Who are the two people you talk to when you call 911, and what are their roles?

1. *Call taker*. -ask questions to filter calls of varying levels of emergency. 2. *Dispatcher*. -sends resources.

3 Types of Patient Consent

1. *Expressed Consent*. -used in healthcare. 2. *Implied Consent*. -used in healthcare. 3. *Exception to Consent*. -used in research.

To truly convict an EMT of negligence, what 3 major factors must be present?

1. *there was a duty to act*. -if EMT did not act, there would have to be a damn good reason. 2. *there was a breach of duty*. -EMT failed to provide standard of care, or failed to act. 3. *a proximate causation*. -that the patient even suffered any harm, either by EMT action or inaction.

6 Types of EMS Agencies

1. Ambulance services. 2. Fire Departments. 3. Medical facilities. 4. Rural/wilderness teams. 5. Industrial settings. 6. Career and volunteer.

What are the 10 NHTSA Standards for EMS Systems? (see notes for further details)

1. Regulation and Policy. 2. Resource Management. 3. Human Resources and Training. 4. Transportation. 5. Facilities. 6.Communications. 7. Trauma Systems. 8. Evaluation. 9. Public Information and Education. 10. Medical Direction.

What 4 conditions are under the Mandatory Reporting Guidelines?

1. child/elderly/domestic abuse. 2. sexual assault. 3. stab/gunshot wounds. 4. animal attacks. etc....

Under what two conditions is involuntary transportation allowed?

1. patient is considered a threat to self or others. 2. court order. -both require decision by mental health professional, police officer, etc.

A patient may refuse care under what four conditions to reduce liability to EMT?

1. patient is legally able to consent. 2. patient is mentally competent and oriented. 3. patient is fully informed of risks. 4. patient signs a release form.

Components of the EMS System

1. public safety. 2. emergency department. 3. public health. 4. specialized care facilities.

When was the NEMSSA enacted? What was its significance?

1972. Required federal funding for national emergency medical systems.

What does each level of EMS training qualify a person to perform?

EMR: just stabilize patient. EMT: can perform CPR. Advanced EMT and Paramedics: can start IVs and give medications.

When did non-military ambulance services begin operating in the US?

Early 1900s.

Exceptions to parents providing consent for children.

In loco parentis (schools). emancipated minors. Life-threatenting illness/injury. Minors who have children. Minors in armed forces.

What does NEMSSA stand for?

National Emergency Medical Service Systems Act

What do these methods of accessing the EMS system have in common: calling enhanced 911, calling with cell phone?

both of these methods allow dispatchers to know your exact location upon calling for help.

Abandonment of Care

care, after initiated, was discontinued before it could be transferred to medical personnel of equal or great training.

Chain of 7 human resources in an EMS system.

patient; a caller of 911; the dispatcher; the first responder; EMTs; ER staff; allied health staff.

Standard of Care

the care expected from an EMT with similar training for a patient in a similar situation. -reduces risk of legal action.

Ethics

the morals or standards governing EMS behavior.

Duty to Act

the obligation of an EMT to provide care while on duty, if no threat to their safety. -follow local laws and conscience.

How is consent obtained for mentally incompetent adults?

these individuals are treated under implied consent. -Hostler's method: if they can live independently, the person probably has the mental capacity to give consent.

What do all levels of EMS Training have in common?

they are all certifications, (not licensed).

Examples of specialized care facilities.

trauma centers, burn centers, stroke centers, poison control, etc.

Who has the ultimate responsibility for patient care in an EMS system?

*the medical director*. -all patient care is performed under direction of a medical director. -oversees training and develops treatment protocols.

Examples of EMS role in public health

-injury prevention in community. -blood pressure clinics. -public vaccination programs. -disease surveillance.

How are liability damages and punitive damages different?

-liability damages are precise amounts calculated with a calculator. -punitive damages are additional damages meant to hurt the person who did something wrong, (especially occurs when something intentionally bad was done).

4 levels of EMS Training

1. Emergency Medical Responder (formerly first responder). 2. Emergency Medical Technician (formerly EMT Basic). 3. Advanced EMT. 4. Paramedic.

Of the following, which do or do not have a NYS scope of practice: personal trainers, strength coaches, dieticians, PTs, ATs?

Personal Trainers: no. Strength coaches: no. Dieticians: Yes. PTs: hell yeah. ATs: yes.

Standard of care *vs* Scope of practice

Scope of practice: *what* you can do. Standard of practice: *how* you should do it.

What is Scope of Practice?

a set of regulations and ethical considerations determined by national/state/local law that define the extent or limits of job duties. -may include skills and procedures.

Negligence

a situation in which a patient was harmed, because something was not done for them or was done incorrectly.