EMS/EMT Course Chapter 1: Introduction/ Quality Control

Areas of the EMS system

1. Ambulence- used for tranport of patients 2. Specialty Centers- Burn Units Cardiac Centers, Pediactric, Geriatrics 3. Interfacility Transports- Transporting of patients from one hospital to another hospital.

EMS System Hospital Staff

1. Ems is apart of a whole continum of care. (Doctors, Nurses, Specialists) 2. Working with public safety( Law enforcment, firfighters, First responders) 3. Training continues from begining of accident until the patient is out of the hospital.

Continuing education of the EMT-B

1.Continuing education required to renew certification 2. Every three years by state regulation 40 hours - yearly AED training, Intubation check off 3. Every three months for national 4. yearly protocol

Professional and personal attributes of the EMT-Basic

1.Puting Patient needs as a priority without endangering self 2. Maintains Professional apperaence and manner 3. Performs under pressure. 4. Treats Patient and families with Understanding, Respect, and Compassion 5. Priority of respecting Patients confidentiality

Providing a Coordinated Continuum of Care

1st Phase- Access to EMS System 2nd Phase- Pre-Hospital Care 3rd Phase- Emergency Department Care(Ambulence) 4th Phase- Definitive Care(Hospital)

In 1960' what "white paper" was created by the DOT/NHTSA?

Accidental Death and Disability: The Neglected Disease of Modern Society

Facilities:

Acutely ill or injured patients should be transported in a timely manner to the nearest appropriate facility.

Human Resources and Training:

All personnel providing patient care on an ambulance should be trained to the EMT-Basic level or above using a standardized curriculum.

First Responder:

Also known as a Certified First Responder (CFR) or Emergency Medical Responder (EMR), these providers are often found in police and fire departments or in industrial facilities. These are individuals whose jobs often place them as the first responder on the scene of a medical emergency, so their EMS training focuses on activating the EMS system if it has not already been activated, and providing care for immediate life threats while preparing for the arrival of an ambulance. Training: 40 hours of experience in a condensed course.

Emergency Medical Technician - Basic:

An EMT-Basic is the technical minimum level of certification for personnel providing patient care in an ambulance during transport. EMT-Basics are trained in non-invasive techniques of assessment and management of the ill or injured patient, and have completed a course compliant with the US DOT's EMT-Basic National Standard Curriculum or its equivalent, as approved by the state emergency medical services authority. Training: drive ambulance, initial care, airway maintenance, 130 hours of training

Communications:

An effective communications system should begin with a universal access number (9-1-1), and includes appropriate and efficient mechanisms for dispatch-to-ambulance, ambulance-to-ambulance, ambulance-to-facility, and facility-to-facility communications.

Lay rescuer:

Anyone with first aid, cpr, - very little experience.

Patient Assessment:

As an EMT-Basic, one of your primary responsibilities is the assessment of your patient in order to gain enough information about your patient's medical condition to provide the appropriate emergency medical care.

Which three (3) cities were among the first cities in America to have formal municipal services?

Cincinnati, New York City, and Boston

Public Information and Education:

EMS personnel can and should continuously work to educate the public about their role in the EMS system, how the public should access the EMS system, and ways to prevent injury and illness before it requires the use of the EMS system.

Roles and responsibilities of the EMT-Basic

EMT-Basics perform a wide range of tasks. When dispatched to an emergency, EMT-Basics role will depend on the crew with which you respond, but in general they will have several basic roles and responsibilities, as outlined below. Personal Safety: Safety of crew, patient, and bystanders: Patient Assessment: Patient Care: Lifting and moving patients: Transport/Transfer of Care: Record keeping/Data Collection: Patient Advocacy:

Patient Advocacy:

EMTs are expected to advocate for their patients, both in terms of presenting patients to the receiving department and in terms of ensuring that your patient's rights are protected at all times. As a medical provider, you are expected to treat more than just the symptoms - you are expected to treat the patient as a whole. It is a very important responsibility, and one that may very well determine how you and your agency are viewed by the community you serve.

Record keeping/Data Collection:

EMTs are responsible for accurate record keeping as their written reports serve as a permanent part of the patient's medical record and document the care which was provided by the EMT as both a medical and legal record. The data obtained by EMTs is also used for billing purposes, and to review and improve the quality of care through the Quality Improvement process.

Trauma Systems:

Each state must establish, through legislation, a trauma system consisting of one or more hospitals designated as trauma centers, and creating triage and transfer guidelines for trauma patients, rehabilitation programs, data collection programs, mandatory autopsies, and a means for maintaining the system and assuring its continued efficient operation. Massachusetts has six (6) Level 1 Trauma Centers: BMC, B&W, TUFTS, BI, MGH, UMASS MEM.

Evaluation:

Each state should establish a program for Quality Improvement (QI) which evaluates and improves the effectiveness and efficiency of the provision of emergency medical care in the state.

What does (EMS) stand for?

Emergency Medical Services

What does (EMT) stand for?

Emergency Medical Technician

Medical Direction:

Every EMS provider must work under the authority of a medical director, and every EMS agency should have a designated medical director who delegates the necessary authority to practice medicine to providers in that agency.

Trauma Centers:

Facilities which are equipped to provide comprehensive Emergency Medical services to patients who have suffered from a major trauma. These facilities are required to have certain specialized physicians on staff and certain specialized equipment available at all times in order to maintain their designation as a trauma center. Lower levels of trauma centers may also be established by agreements with major trauma centers, so that remote regions can have faster access to hospitals equipped to stabilize critical trauma patients before transferring them to a fully equipped trauma center.

Levels of EMS Training:

First Responder: Emergency Medical Technician - Basic: EMT-Intermediate: EMT-Paramedic:

Personal Safety:

First and foremost, you must work to ensure your own safety. As an EMT-Basic you are dispatched to the scene of emergencies to mitigate whatever situation caused the emergency, and you cannot perform your duties if you fail to ensure your own safety and thus become just another part of the problem.

Access to the EMS System:

Most communities have access to a centralized dispatch center which can be easily accessed with the national emergency number, 9-1-1 (appropriately spoken as nine-one-one). Under the 9-1-1 system, when a citizen calls 9-1-1, their call is automatically directed to the appropriate Public Safety Answering Point (PSAP), where a trained emergency dispatcher answers the call and obtains necessary information in order to provide emergency responders with enough information in order to respond to the emergency being reported.

Patient Care:

Only after properly assessing your patient can you begin your next responsibility of providing appropriate medical care based on your assessment findings. From simple emotional support to life-saving CPR and defibrillation with an AED, patient care consists of the actions that you perform to help the patient deal with their medical problems.

Regulation and policy:

Regulations must be in place in each state, in the form of legislation creating funding for EMS, a lead EMS agency, and regulations, policies, and procedures regarding the certification of EMS providers and agencies, and the provision of EMS in the state.

Transportation:

Safe and reliable means of transportation must be secured for all patients. This can be in the form of a ground ambulance, or in some situations, air ambulances including helicopters and fixed-wing aircraft.

E 9-1-1:

Some PSAPs feature equipment which enables dispatchers to automatically identify the caller's phone number and location. This is known as Enhanced 9-1-1. This allows for emergency responders to be dispatched to the incident even if the line is disconnected or the caller is unable to communicate effectively with the dispatcher.

How many levels of (EMT) are there?

THREE(3): EMT-B, EMT-A/I, EMT-P

EMT-Intermediate:

The next level of Emergency Medical Technician is the EMT-Intermediate. EMT-Is can provide some level of invasive care, including the initiation of intravenous (IV) lines, advanced airway techniques, and the administration of certain limited medications beyond those administered as an EMT-B. Some states further divide this category to include Shock-Trauma Technicians or Critical Care Technicians. Training: IV, caradiac drugs, manual defib, start of advanced life support.

Safety of crew, patient, and bystanders:

The same dangers which you protect yourself from can affect every person on the incident scene, so you should always take steps to ensure that other crew members and bystanders don't become additional patients, and that your patient does not suffer any further injury while under your care.

What was the "Accidental Death and Disability: The Neglected Disease of Modern Society" report?

Today referred to as the EMS White Paper, this document laid the foundation for the modern day EMS system and, along with the National Highway Traffic Safety Act, provided a federal standard by which local EMS systems could be built.

Lifting and moving patients:

Unfortunately, patients are sometimes found in the most inconvenient places. Often you will find patients who are unable to walk or otherwise move themselves to the ambulance. In any case, every patient will ultimately need to be safely transported from where they were found on the scene onto the ambulance before they can be taken to an appropriate facility. This will often involve lifting and carrying patients. When lifting and carrying patients, you should always take care to ensure that you are not going to injure yourself or further injure your patient.

Transport/Transfer of Care:

Virtually every patient you encounter will need to be transported to a hospital and turned over to medical providers at that facility. It is an important part of the job of an EMT-Basic to ensure that the ambulance is operated safely at all times, and that the patient is properly secured in the ambulance when they are on board. It is also an important responsibility of the EMT-Basic to ensure that the receiving hospital is provided with a full report of the condition of the patient and any interventions performed to ensure continuity of care after the patient transfer.

EMT-Paramedic:

While still technically considered an Emergency Medical Technician, EMT-Paramedics are often referred to only as (Paramedics). Their training meets or exceeds the US DOT National Standard Curriculum for Paramedics, and these providers represent the highest level of prehospital care. They can provide a wide assortment of medications to patients, and can perform a variety of invasive procedures including IV access and placement of Endotracheal (ET) tubes, as well as interpretation of Electrocardiograms (ECG or EKG) and manual cardiac defibrillation and pacing. Training: advanced life support, monitor ekg, highest level of EMT.

The Health Care System

While the primary image of the EMS system is the back of an ambulance, the health-care facilities which interface with Ambulance services are an important part of the backbone of the EMS System.Traditionally, most patients will be turned over to a hospital Emergency department, where physicians specialized in the treatment of acute injuries and illnesses provide definitive care to fully diagnose and treat the patient's medical problems. These departments, however, serve only as general treatment centers, and are not appropriate for all patients. Patients such as those who have experienced major trauma, burns, or poisoning, and certain pediatric patients, require specialized care which can only be provided in specialty facilities. Trauma Centers: Burn Centers: Poison:

In the early 1900's who typically provided strictly patient transportation in smaller communities?

funeral homes / undertakers

Resource Management:

resources must be centrally managed so that everyone needing access to Emergency medical services can receive care from appropriately trained and equipped providers and transport to an appropriate facility in a timely manner.

Burn Centers:

specialized equipment and facilities for the management of patients with critical burns. The unique treatment implications and possible complications of critical burns mandate treatment at one of these highly specialized facilities.

Poison Centers:

specialized facilities for the treatment of poisoning. Typically reached by phone, they can provide assistance and medical direction to various levels of emergency medical providers, from citizen family members and bystanders, to EMTs and even physicians at other facilities.

Who currently publishes the National EMS Standards?

the National Highway Traffic Safety Administration (NHTSA), an agency of the United States Department of Transportation (DOT). Specifically, the Technical Assistance Program of the NHTSA has developed a set of Assessment Standards which set standards in certain categories, as outlined below, for EMS agencies nationwide.