Chapter 1 - EMS Care Systems, Research, and Public Health

Phase 2 Enhanced 911

911 where the provider must provide lat and long of caller accurate within 50-300 meters.

Basic 911

911 where the wireless provider is required to transmit call to a PSAP regardless of whether the caller has the provider's service

Phase 1 Enhanced 911

911 where the wireless provider must provide PSAP with phone number and location of cell site or station transmitting the call

Highway Safety Act

Act that determined major causes of American death/injury in relation to transportation. Resulted in: -revamped highway design -roadway safety guidelines/program -emphasis on vehicular safety Created National Highway Transportation Safety Administration (NHTSA) which oversaw development of EMS and created curriculum. 1966

911 Challenges

Cell phones and Voice over Internet protocol services Cells are not identified with a fixed site, location is the closest cell tower

Automatic number and location identification

E911 provides two things

Types of EMS

EMS varieties: -Fire EMS: fire based EMS service -Municipal EMS: 3rd service after fire and police, works closely with other 2 departments -Private EMS: private companies -Hospital Based EMS: operate out of hospitals, provide inter-facility transfers -Law Enforcement EMS: rare, may be found in small communities -Public Safety Officer: personnel who respond to fire, police, and EMS calls

Civilian Ambulance

First known use of this in the 1860's Driven by horse and carriage.

Offline medical direction

Medical direction through guidelines and protocols or standing orders where EMTs use their own judgement in providing care

National EMS Scope of Practice Model

Model that defines the four levels of EMT licensure: -Emergency medical responder -Emergency medical technician -Advanced emergency medical technician -Paramedic

EMS White Paper

Paper that identified deficiencies and needs of an EMS system. Lack of training, and organized systems. Spearheaded development of EMS in America. Also known as Accidental Death and Disability paper 1966 - same year DOT was created (department of transportation)

Special Facilities

Patients may need transport to these facilities that aren't normally part of a hospital: -trauma center: rapid surgical intervention -burn center: serious burns -obstetrical center: childbirth -pediatric center: infants and children -stroke center: acute stroke patients -poison center: special treatment for poisonings -cardiac center: heart emergencies -hyperbaric center: victims of toxic exposures, diving emergencies -spine injury center: spine injury victims -psychiatric center: care for patients with behavioral issues

Cardiopulmonary Resuscitation

Procedures for this was developed in the 1960's and was starting to be taught to the general public in the 1970's by the American Heart Association

Online medical direction

Real time medical direction over the phone video radio

Technical Assistance Program Assessment Standards

These are recommended standards for EMS systems around the country: -regulation and policy: must have laws, regulations, policies -resource management: must have central control of EMS resources -HR and training: all personnel must be at least EMT level -Transportation: patients must have safe transport -Facilities: patients must be delivered to facility in timely manner -Communications: system for comms must be in place -Public info and education: systems should partake in programs to educate public in prevention -medical direction: must have a physician as a medical director to provide oversight -Trauma systems: have a system for care of trauma patients -Evaluation: must have a quality improvement system for continuous improvement

Other EMS Significant Developments

These led to the development of the modern EMS system: -EMS system act of 1973: access to money for funding for EMS -National EMS education practice blueprint 1993: guides EMS training development -EMS agenda for the future 1996: plans for EMS system -National EMS Core Content 2005: promotes universal skills/knowledge for EMS personnel -Future of EMS Care 2006: recommendation that all state governments adopt a common scope of practice

EMS Goals

These should be included in the system as things to strive for: -clinical quality: performance must be good quality -service quality: must meet patient/public needs -economic efficiency: high quality service with low cost -accountability: ensures system meets patient needs -improvement: continual striving to improve the system -resilience: system should adapt to changes that affect it

Mobile Integrated Healthcare and Community paramedicine

These two terms are the provision of patient-centered health care in the out of hospital environment using mobile technology and resources. MIH: services provided by a variety of health care entities and practitioners that are integrated with the EMS system. CP: deals with services provided by EMS and its personnel that are integrated with other entities Both may include services like: -increasing access to care in underserved areas -providing advice to 911 callers via telephone -using specially trained EMS personnel to manage patients who are high volume users Main purpose is to provide not only emergency response but patient education preventative care, chronic disease management, post-discharge follow up and alternative healthcare.

Medical Director Protocols and Standing Orders

These two things involved with the medical director include: -guidelines defining the scope of medical care, provided in both off and online medical direction, off line is often referred to as standing orders where EMTs perform tasks without direction, online involves contact medical direction for additional orders -subset of protocols that do not require real-time physician input to perform

Personal Traits

This EMT attribute involves being able to handle the stresses of the job: -calm reassuring personality: speaking to patients -leadership: act quickly and take control of situation -good judgement: make appropriate decisions -good moral character: make ethical decisions -stability and adaptability: able to adapt to changing situations -listening: careful listening allows proper info gathering -resourcefulness and ability to improvise: changing plans if one idea doesn't work -cooperativeness: being able to work with other emergency services

Physical Demands

This EMT attribute involves being in good physical health: -you must be able to carry 125 pounds -good eyesight -good color vision -good communication skills -good hearing

Maintenance of Certification and Licensure

This EMT attribute involves maintaining your EMT status to practice, avoiding any criminal behavior and paying any fees necessary.

Knowledge and Skills

This EMT attribute involves: -completing basic EMT training program Knowing: -how to use and maintain common emergency equipment: suction machines, oxygen delivery systems, airway adjuncts, AED's, spinal immobilization equipment, splints, obstetrical kits, patient moving devices -how to assist with administration of medications -how to clean, disinfect, and sterilize equipment that is not disposable -safety and security measures: for your, your partner, and other rescuers, for patient and bystanders -territory and terrain: know it to allow for quick response -state and local laws: know ones concerning transport of sick and injured

Appearance

This EMT attribute involves: -excellent personal grooming -responding in complete uniform This helps provide patient confidence

Evidence-based guidelines

This concept uses strong valid research studies to develop guidelines for medical practices. Used to develop guidelines to establish standards of care that impact delivery of EMS. Procedure: -system inputs -guideline initiation -establish priorities for guideline development -EMS protocol development -dissemination of guidelines/protocols -implementation -evaluation of effectiveness, outcomes, research The use of this contributes to better patient management in the prehospital setting.

Quality Improvement

This is a system of internal and external reviews and audits of all aspects of an EMS system to ensure that the public is receiving the highest quality prehospital care. EMT's roles in this are: -document carefully: each call, identify long response times, refresher skills -perform reviews and audits: on other EMTs and the scene of a call -obtain feedback: from patients, other EMS personnel, hospital staff about your performance after a call -maintain equipment: -participate in continuing education: refresher courses -maintain skills

State EMS Agency

This is an agency that leads the state. Its responsibilities include: -overall planning of the statewide EMS system -coordination of the statewide EMS system -regulation of the statewide EMS system -licensing local EMS agencies and personnel Involved in ensuring a high-quality EMS is provided to the public

EMS Research

This is done through concepts such as: Evidence-based medicine: focuses on research to provide clear evidence that certain procedures, medications, and equipment improve the patient's outcome. 1. formulate4 a question about emergency care that needs to be answered based on your clinical practice 2. search medical literature for research data related to the question 3. appraise the evidence for validity and reliability 4. if evidence supports a change in practice, implement the change Scientific Method; -ask question, conduct review of research already performed, develop hypothesis, conduct research, collect data, support or reject hypotheses, identify limitations of the study, report findings Also from agencies who help perform research. EMS uses research to: -ensure current care provides safest care and best outcomes for patient -demonstrate the value of EMS care -improve safety of EMS personnel -promote accurate documentation of patient encounters

Patient Safety

This is one of the most important issues when dealing with patients in the prehospital environment. High risk activities include: -transfer of care at the scene between emergency responders -poor communication -carrying patients in a manner that puts them at risk for dropping -involvement in an ambulance crash -lack of spinal stabilization Prevent errors by: -developing clear protocols -have proper scene lighting -minimize interruptions during assessment/care -clearly mark all drugs and packages -reflect on actions -question all assumptions -use decision aids if necessary -ask for assistance if needed

Transport and Transfer of Care

This role and responsibility of the EMT involves finding the closest facility for transport. Consider patient condition when doing so. Use communication equipment to notify receiving facility about patient, condition, and what will be needed at arrival. Safe driving is crucial to minimize further injury to patients. Report to receiving facility what care has been giving and the patient's response to the care. Do not leave before patient has been properly transferred.

Patient Assessment and Emergency Care

This role and responsibility of the EMT involves gaining access to patients, evaluating problems, and providing emergency care. Always perform a primary assessment to help identify immediate life-threatening problems like airway compromise, respiratory insufficiency, cardiac arrest, severe bleeding. Secondary assessment is next so you can stabilize and treat other emergency injuries or conditions.

Safe lifting and moving

This role and responsibility of the EMT involves preventing injury of patients by using safest emergency urgent and non urgent moves and equipment. Use proper body mechanics to help prevent injury to yourself

Record Keeping and Data Collection

This role and responsibility of the EMT involves: -keeping up to date logs of calls -completing prehospital care report

Patient Advocacy

This role and responsibility of the EMT involves: -protecting patient rights -collecting patient valuables at scene -protecting patient privacy -make sure patient's friends/family know where they are going -honor patient requests if you can

Personal Safety and Safety of Others

This role and responsibility of the EMT is first and most important. You cannot help the patient if you or your partner are a victim. Drive safely, use your seat belt, avoid hazardous areas, never enter volatile crowd situations, be careful of patients on drugs, wear proper PPE, reflective clothing at night, etc.

Public Health

This term deals with protecting the health of an entire population. 1st responsible for identifying problems that affect the health of a population under study. As EMTs you may be at the frontlines of identifying any problems for the population. You may have to report on the issue and provide education to those involved with the problem. This attempts to reduce the incidence of injuries and illness through preventative strategies geared at protecting, promoting, and improving the health of a population. Achieved through research, education and health promotion. 10 greatest achievements for this in the 20th century: -vaccinations -motor-vehicle safety -workplace safety -control of infectious diseases -reduction in deaths from coronary heart disease and stroke -safer and more healthy foods -decline jin maternal and infant mortality -use oil barrier devices during sexual contacts -fluoridation of drinking water -reduction in tobacco use EMS Roles in this: -health prevention and promotion -disease surveillance -injury prevention

Medical Oversight

This term refers to the responsibilities of the EMS system's medical director. Responsibilities include: -clinical and admin activities that exercise care provided for personnel and the entire EMS system Two types: -indirect: majority of the medical directors responsibilities, activities that control the practice of prehospital care, daily operations -direct: real-time oversight provided by a physician to an EMS provider who is seeking feedback or direction that impacts patient care, either on-line or on-scene.

Korean and Vietnam Wars

Two wars in 1950's/60's that impacted the development of modern EMS Used mobile hospitals and helicopters.

Trauma burn obstetrical pediatric poison stroke cardiac hyperbaric spine injury psychiatric

Types of hospital centers

advanced emergency medical technician

advanced airway devices, blood glucose monitoring, intravenous/intraosseous infusions, medicine administration

emergency medical technician

basic emergency care, advanced oxygen therapy, pulse oximetry, automatic blood pressure equipment

paramedic

more advanced assessment and patient management skills, invasive drug interventions and transport

emergency medical responder

use basic airway, ventilation, and oxygen therapy, takes vitals, spinal stabilization, eye irrigation, bleeding, CPR, AED, childbirth