EMT 128 Ch. 1
Describe the EMS attribute: Clinical care
The care the EMS professionals provide must continue to be driven by evidence and maximize the use of technology and advances in science.
Describe the EMS attribute: Information systems
The federal government has mandated that EMS systems collect data on many aspects of their performance within the communities they serve. The ability to collect, link, and analyze this data will allow EMS systems to respond more appropriately to the needs of the community.
Explain the various types of medical direction and how the Emergency Medical Responder might interact with each.
There are two broad types of medical direction. The first type is off-line medical direction. It consists of protocols - clearly defined, written guidance that describe how to manage the most common conditions - and standing orders, which give the EMS provider permission to administer specific interventions. The second type of medical direction, called on-line medical direction, is quite rare but consists of medical orders given directly by radio or phone. These are procedures that aren't covered by protocols or standing orders, which require an on-duty physician to administer.
Describe the EMS attribute: Legislation and regulation
To provide a quality, effective system of emergency medical care, each state must have legislation and regulations that identify and support a lead EMS agency. This agency has the authority to plan and implement an effective EMS system. It can also create appropriate rules and regulations for each recognized component of the EMS system.
Describe the EMS attribute: EMS research
Updating EMS research leads to better care and patient health outcomes. The NIH (National Institute of Health) are committed to funding EMS research. EMS systems are placing greater emphasis on evidence-based practice when developing policies and protocols.
Explain how state and local statutes and regulations affect how an Emergency Medical Responder might function.
While a scope of practice typically is defined at the state level, local counties and/or EMS agencies may further define the scope of practice based on local needs. Most EMS providers are licensed or certified by a state or local EMS agency to practice in the EMS system.
evidence-based practice
integrating clinical expertise with the best available clinical evidence from systematic research.
on-line medical direction
orders to perform a skill or administer care from the on-duty physician given to the rescuer in person by radio or by phone. Also called direct medical direction.
Disaster Medical Assistance Team (DMAT)
specialized teams designed to provide medical care following a disaster.
scope of practice
the care that an Emergency Medical Responder, an Emergency Medical Technician, or Paramedic is allowed and supposed to provide according to local, state, or regional regulations or statutes. Also called scope of care.
emergency medical services (EMS) system
the chain of human resources and services linked together to provide continuous emergency care at the scene and during transport to a medical facility.
National EMS Education Standards
the education and training standards developed by the National Highway Traffic Safety Administration (NHTSA) for the four nationally recognized levels of EMS training
emergency care
the prehospital assessment and basic care for the ill or injured patient.
medical oversight
the supervision related to patient care provided for an EMS system or one of its components by a licensed physician.
research
the systematic investigation to establish facts.
protocols
written guidelines that direct the care EMS personnel provide for patients.
Differentiate the various EMS models in practice around the United States.
1. Fire-based EMS Model: In this system, much of the EMS service and infrastructure is operated by a local fire department or group of organized fire departments within a city or region. 2. "Third-service" or "public utility" Model: Typically operated by non-fire-based government entities within cities or counties. EMS agencies in this model report directly to governmental authorities. 3. Hospital-based EMS Model: Typically operated by a large hospital or group of hospitals serving a particular region. 4. Private EMS Model: Consists of the delivery of EMS services by a privately owned company. The company often contracts with a municipality (a city or town that has corporate status and local government) to provide services for a specific area.
What are the 14 key attributes of an integrated EMS system, as identified by the NHTSA?
1. Integration of health services 2. EMS research 3. Legislation and regulation 4. System finance 5. Human resources 6. Medical direction 7. Education systems 8. Public education 9. Prevention 10. Public access 11. Communication systems 12. Clinical care 13. Information systems 14. Evaluation
Differentiate the four nationally recognized levels of EMS provider.
EMRs are often first to respond to a scene and provide basic emergency care, and to assist the ambulance personnel when they arrive. However, their scope of practice is more limited than an EMT's scope of practice. EMTs can transport patients via ambulance and can help administer some medications. An AEMT has received more advanced training than an EMT, and can start IV lines, insert certain advanced airways, and administer certain medications. Paramedics perform advanced life support care and have more responsibility than AEMTs. In addition to the duties of an AEMT, they can also administer a large list of medications, interpret electrocardiograms, monitor cardiac rhythms, and perform cardiac defibrillation.
Explain the role of the Emergency Medical Responder with regard to continuous quality improvement (CQI).
EMRs contribute to continuous quality improvement (CQI) by submitting accurate and complete patient care reports, which will be audited to provide data that is used to improve future care. EMRs also may be asked to participate in training or serve on a quality committee as part of the CQI process.
Describe the characteristics of professionalism as they relate to the Emergency Medical Responder.
EMRs have a responsibility to remain professional and compassionate even when it is difficult to do so. This means overlooking rude behavior and unreasonable demands. realizing that patients may act this way because of fear, uncertainty, or pain. EMRs must also be honest, realistic, and uphold the best care possible, without being discriminatory of other races, genders, ages, etc.
Describe the EMS attribute: Public education
EMS can play an important role in the education of the community on topics, such as system function, access, bystander care, and prevention.
Describe the EMS attribute: Human resources
EMS quality care depends on the availability of qualified, competent, and compassionate personnel. The EMS must then create a strong career ladder, like other health care professions, to attract these personnel.
Describe the EMS attribute: System finance
EMS systems require financial stability to provide services and continue to improve those services. System finance involves EMS systems and their relationships with health insurance companies/ health care providers to become more financially efficient and sustainable.
Describe the EMS attribute: Evaluation
Each state EMS system is responsible for evaluating the effectiveness of its services. A uniform, statewide data-collection system must exist to capture the minimum data necessary to measure compliance with standards. It also must ensure that all EMS providers consistently and routinely provide data to the lead agency. The lead agency performs routine analysis of that data.
Explain the role that Disaster Medical Assistance Teams (DMAT) play and how they integrate with EMS systems.
Each state has identified specific individuals already working in its EMS systems to participate in specialized teams designed to provide medical care following a disaster. This type of team is called a Disaster Medical Assistance Team (DMAT). The individuals who make up DMATs are highly experienced, trained EMS personnel. They can be deployed on a moment's notice should a disaster strike anywhere in the United States.
Describe the EMS attribute: Communication systems
Effective communication is a vital component of EMS systems. As more agencies and institutions become integrated into an overall health care delivery model, the need for efficient communications becomes more important.
Describe the EMS attribute: Prevention
In addition to education about injury prevention, EMS systems can collect data to identify trends related to illness and injury rates in a community. Education programs and other systems can then be developed to target those prevention needs.
Explain the roles that state and local EMS offices, medical oversight, and local credentialing play in an EMS system.
In an EMS system, each EMS role has its own scope of practice. This scope of practice is defined by state and/or regional (local) statutes and regulations. Those statutes and regulations will also define any related licensing, credentialing, and certification that may be required. Most EMS providers are licensed or certified by a state or local EMS agency to practice in the EMS system. Medical oversight for all EMS providers must be used to evaluate medical care as it relates to patient outcomes, training programs, and medical direction.
Describe the EMS attribute: Education systems
Members of the EMS system must receive proper education and training to provide the best patient care. Technological advancements will be a cornerstone of future EMS systems.
Explain the various methods used to access the EMS system.
Most US citizens activate the EMS system by using a phone to call 911. Most 911 calls are directed to a PSAP (called an enhanced 911 system) which contact specially-trained dispatchers who send resources and responders (of each of the four EMS level providers) to the scene. Some areas, who don't have a 911 system, dial a seven-digit number for EMS.
Explain the role of public health systems and their relationship to EMS, disease surveillance, and injury prevention.
Public health systems help ensure the quality of life by monitoring the health of the population, providing health care, and educating the community about disease and injury prevention. They also serve to advance population-based health programs and policies. The EMS system (via the public education attribute) helps educate the community about public health.
Explain the role that research plays in EMS and the ways that an Emergency Medical Responder might seek out and support research.
Research is constantly being conducted to improve how EMS providers practice emergency care. About every 5 years, the AHA and International Liaison Committee on Resuscitation (ILCOR) release new guidelines for EMS providers. EMRs can seek out an support research by reading and evaluating research that affects their job.
Describe the EMS attribute: Public access
The 911 number has been in service since 1968 and today serves approximately 96 percent of the population of the United States.3 Barriers to access-ing prompt EMS care still exist in many areas in the United States. EMS systems must continue to expand the reach of the 911 system in the communities they serve.
Differentiate the roles and responsibilities of the Emergency Medical Responder from other EMS providers.
The EMR is most limited in his or her scope of practice, compared to the other three EMS responder types. They are usually the first to arrive to a scene and their training emphasizes scene safety and how to provide immediate care for life-threatening injuries/ illnesses. Transfer of care occurs when EMTs arrive and they may assist the ambulance personnel when they arrive.
Describe the EMS attribute: Medical direction
The EMS system needs direction and oversight from physicians. The medical director is a physician who has legislative authority over and responsibility for EMS standards, protocols, and evaluation of patient care. Also, oversight for all EMS providers must be used to evaluate medical care as it relates to patient outcomes, training programs, and medical direction. This is called "medical oversight."
Describe the EMS attribute: Integration of health services
The EMS, instead of solely focusing on prehospital care, aims to work with other health departments and health care networks to address non-emergent health needs in the community and also assist in providing for those needs.
Explain the role that the National EMS Education Standards and the National Scope of Practice Model play in shaping EMS around the country.
The National EMS Education Standards are responsible for setting the education and training standards for the four, nationally recognized, levels of EMS provider. These standards are developed by the NHTSA. The Scope of Practice Model is also developed by the NHTSA and describes the scope and limitations of care that each nationally recognized EMS provider levels can provide.
Explain the role of the National Highway Traffic Safety Administration (NHTSA) and its relationship to EMS.
The National Highway Traffic Safety Administration is responsible for keeping people safe on America's roadways. Through enforcing vehicle performance standards and partnerships with state and local governments, NHTSA reduces deaths, injuries and economic losses from motor vehicle crashes. The NHTSA has identified 14 key attributes of an integrated EMS system, and assists states in developing and assessing those components.
standing orders
a component of a protocol that allows the EMS personnel to provide specific interventions to a patient.
continuous quality improvement (CQI)
a continuous improvement in the quality of the product or service being delivered.
public safety answering point (PSAP)
a designated 911 emergency dispatch center.
specialty hospital
a hospital that is capable of providing specialized services, such as trauma care, pediatric care, cardiac care, stroke care, or burn care.
Emergency Medical Responder (EMR)
a member of the EMS system who has been trained to render first-aid care for a patient and to assist higher-level providers at the emergency scene
Emergency Medical Dispatcher (EMD)
a member of the EMS system who provides prearrival instructions to callers, thereby helping to initiate lifesaving care before EMS personnel arrive.
Emergency Medical Technician (EMT)
a member of the EMS system whose training emphasizes assessment, care, and transportation of the ill or injured patient. Depending on the level of training, emergency care may include starting IV (intravenous) lines, inserting certain advanced airways, and administering some medications.
Paramedic
a member of the EMS system whose training includes advanced life support care, such as inserting advanced airways and starting IV lines. Paramedics also administer medications, interpret electrocardiograms, monitor cardiac rhythms, and perform cardiac defibrillation.
Advanced Emergency Medical Technician (AEMT)
a member of the EMS system whose training includes basic-level EMT training plus responsibility for a minimal level of advanced life support. Additional skills include starting IV (intravenous) lines, inserting certain advanced airways, and administering certain medications.
Scope of Practice Model
a national model that defines the scope of care for the four nationally recognized levels of EMS provider.
medical director
a physician who assumes the ultimate responsibility for medical oversight of the patient care aspects of the EMS system.
Protocols and patient care decisions should be based on: a. current EMS research b. which options are cheapest c. the opinion of EMRs d. traditions and historical practice
a. current EMS research
The licensed physician who assumes the ultimate responsibility for the oversight of all patient care is called the: a. medical director b. fire chief c. ambulance supervisor d. nursing supervisor.
a. medical director
Protocols and standing orders are forms of: a. off-line medical direction. b. on-line medical direction. c. pre-arrival instructions. d. stand-by guidelines.
a. off-line medical direction.
The care that an Emergency Medical Responder is allowed and supposed to provide according to local, state, or regional regulations or statutes is known as: a. scope of practice b. standard of care c. national standard curricula d. Emergency Medical Responder care
a. scope of practice
off-line medical direction
an EMS system's written standing orders and protocols, which authorize personnel to perform particular skills in certain situations without actually speaking to the medical director or their designated agent. Also called indirect medical direction
Which one of the following BEST describes the role of the Emergency Medical Responder in an EMS system?: a. Decontaminates hazardous materials b. Cares for immediate life threats and assists EMTs c. Serves as an Incident Commander and directs other personnel d. Assists Paramedics with advanced skills
b. Cares for immediate life threats and assists EMTs
Specialized teams of experienced EMS personnel who respond on short notice during disasters are called: a. Rapid Response Work Groups b. Disaster Medical Assistance Teams c. Disaster Care Response Teams d. Rapid Response Task Force
b. Disaster Medical Assistance Teams
Clearly defined, written guidance that describe how to manage the most common types of conditions are called: a. dispatches b. protocols c. on-line direction d. prescriptions
b. Protocols
Which one of the following is NOT an attribute of an integrated EMS system?: a. EMS Research b. Medical Direction c. Health insurance companies d. Education systems
c. Health insurance companies
Which one of the following receives the highest level of training in an EMS system?: a. Emergency Medical Responder b. Emergency Medical Technician c. Advanced Emergency Medical Technician d. Paramedic
d. Paramedic
Emergency Medical Dispatchers receive training that allows them to: a. control the scene via the radio. b. triage patients via the radio. c. declare a mass-casualty incident. d. provide pre-arrival care instructions.
d. provide pre-arrival care instructions.
