EMT CHAPTER 1

Personal Traits of an EMT

- A calm and reassuring personality - Leadership ability - Good Judgement - Good moral character - Stability and adaptability - Ability to listen - Resourcefulness and ability to improvise - Cooperativeness

What are the characteristics of Professional Behavior for EMT's?

- integrity - empathy - self motivation - professional appearance and hygiene - self confidence - effective time management - good verbal and written communication skills - teamwork and diplomacy - respect for patients, coworkers, and other health care professionals - patient advocate - careful delivery of service

What are the roles and responsibilities of an EMT?

- maintain vehicle and equipment readiness - ensure safety of the EMS crew, the patient, and bystanders at the scene -Operate the emergency vehicle - Assess the patient - Provide emergency care - Safely lift and move the patient - Prepare oral and written reports - Safely transport the patient - Perform record keeping and date collection - Serve as the patient's advocate - Provide emotional support to the patient, relatives, and others at the scene. - Integrate the EMS service with other emergency and nonemergency services. - Resolve the emergency incident - Maintain medical and legal standards - Provide administrative support - Enhance professional development - Develop and maintain community relations

What skills and knowledge do you need to know as an EMT?

-Use and maintenance of common emergency equipment - Assistance with the administration of medications - Cleaning, disinfection, and sterilization of nondisposable equipment - Know the territory - State and local traffic laws and ordinances

What steps can you take to prevent errors that may jeopardize the patient's safety?

1) Develop clear protocols 2) Light the scene effectively 3) Try to minimize interruptions during assessment and emergency care 4) Clearly mark all drugs and packages so each is very distinct 5) Reflect on all actions 6) Question all assumptions 7) Use decision aids if necessary 8) Ask for assistance if you need it

What are your roles as in EMT in quality improvement?

1) Document carefully 2) Perform reviews and audits 3) Obtain feedback 4) Maintain equipment 5) Participate in continuing education 6) Maintain skills

What are the roles of EMS in public health?

1) Health prevention and promotion through primary prevention (vaccinations. education), secondary prevention of complications of disease, and health screening 2) Disease surveillance through identifying and reporting certain diseases or conditions that are identified as public health issues 3) Injury prevention through education, promotion of the use of safety equipment (seat belt use, helmet use, falls prevention, fire prevention), and injury surveillance

What are the 10 greatest public health achievements in the United States in the 20th century?

1) Vaccinations 2) Motor-vehicle safety 3) Workplace safety 4) Control of infectious disease 5) Reduction in deaths from coronary heart disease and stroke 6) Safer and more healthful foods 7) Decline in maternal and infant mortality 8) Use of barrier devices during sexual contacts 9) Fluoridation of drinking water 10) Reduction in the use of tobacco products

What are the two main benefits to the 911 universal number?

1) the public service answering point (PSAP) is staffed by trained communications personnel. Many are EMDs, so they not only take the call and dispatch emergency services but they also provide instructions for lifesaving emergency care to the caller or whoever is available. 2) 911 reduces the time the caller takes to contact EMS (don't have to look up a long number). Also through 911, the fire, police, and emergency care department are connected so they all can be dispatched at the same time if needed.

What are the issues in patient safety?

1) transfer of care or "hand off" at the scene between emergency responders or at the medical facility 2) Poor communication skills that lead to misunderstanding and medical errors 3) Carrying and moving patients in a manner that puts them at risk for being dropped 4) Involvement in an ambulance crash while transporting the patient to a medical facility 5) Lack of spinal immobilization or improper spinal immobilization procedures that increase the risk of converting a stable spinal column injury into an unstable spinal column injury, or improper immobilization that exacerbates the existing injury

Medical director

A physician who is legally responsible for the clinical and patient care aspects of the EMS system

What was the white paper?

A report that detailed the number of deaths and injuries related to traffic crashes in the United States. It also identified what delivery of prehospital care in the U.S. was lacking and made recommendations intended to change ambulance systems, training requirements, and the provision of prehospital care.

Standing Orders

A subset of protocols that do not require real time physician input

What are communications?

A system of communications must be in place to provide public access to the system and communication among dispatcher, EMS personnel, and hospital

What is human resources and training?

All personnel who staff ambulances and transport patients must be trained to at least the EMT level

What was different about the early EMS system?

The patient did not receive care until they reached the hospital

Transport and Transfer of Care

Before leaving the scene, determine which facility (local emergency department, pediatric hospital, burn center or other) will be most appropriate. Use the communications equipment available to you to notify the receiving facility of the number of patients, the destination, and the nature and extent of injuries.

Protocols

Comprise a full set of guidelines that define the entire scope of medical care (triage, treatment, transport, destination) Often referred to as orders, protocols may consist of both off-line and on-line medical direction.

What is public information and education?

EMS personnel should participate in programs designed to educate the public in the prevention injuries and how to properly and appropriately access the EMS system

What is medical direction?

Each EMS system must have a physician as a medical director to provide the medical oversight that includes overseeing patient care and delegating appropriate medical practices to EMTs and other EMS personnel

What are facilities?

Each seriously ill or injured patient must be delivered in a timely manner to an appropriate medical facility.

What are trauma systems?

Each state must develop a system or specialized care for trauma patients, including one or more trauma centers and rehabilitation programs, plus systems for assigning and transporting patients to those facilities.

What is evaluation?

Each state must have a quality improvement system for the continuing evaluation and upgrading of the system

What is resource management?

Each state must have central control of EMS resources so that each locality and all patients have equal access to acceptable emergency care.

What are the 4 levels of EMS practitioners?

Emergency Medical Responder (EMR), Emergency Medical Technicians (EMT), Advanced Emergency Medical Technician (AEMT), Paramedic

What caused the modern EMS system to evolve?

In the 1960's, the Presidents Committee for Traffic Safety identified a need to reduce the injuries and deaths related to highway crashes

Maintenance of Certification and Licensure

It is the personal responsibility of each EMT to maintain certification and licensure to practice

Physical Demands

Must be able to carry up to 125 pounds, good eyesight, good hearing, and good communication skills

Patient Assessment and Emergency Care

Once you have ensured scene safety, you must gain access to patients, recognize and evaluate problems, and provide emergency care

What is transportation?

Patients must be provided with safe, reliable transportation by ground or air ambulance

Safe Lifting and Moving

Prevent further injury of patients by always using the easiest and safest recommended emergency urgent or non urgent moves and equipment

Patient Advocacy

Protect the patients rights. At the scene, collect and safeguard a patients valuables on his person, transport them with the patient, and document what was given to emergency department personnel. Shield the patient as much as you can from curious bystanders and conceal the body of a patient who has died.

What is the Americans with Disabilities Act (ADA)?

Protects Americans with disabilities and allows them an equal opportunity to be hired

What are an EMT's duties?

Provide basic emergency medical care and transportation to patients who access the EMS system. Duties include all the duties performed by the EMR but with basic equipment found on an ambulance.The EMT level is similar in scope tot he EMT basic level with the addition of advanced oxygen therapy and ventilation equipment, pulse oximetry, use of automatic blood pressure monitoring equipment, and limited medication administration.

What are an AEMT's duties?

Provide both basic and limited advanced emergency medical care and transportation to patients in the pre hospital environment. The AEMT provides all of the skills of the EMT with the addition of the use of advanced airway devices, monitoring of blood glucose levels, initiation of intravenous and intraosseous (in the bone) infusions, and administration of a select number of medications.

What is an EMR's duties?

Provide immediate lifesaving care to patients who have accessed the EMS system and are awaiting response from a higher level EMS practitioner. They use basic airway, ventilation, and oxygen therapy devices; take patient vital signs, and provide stabilization of the spine and suspected extremity injuries, eye irrigation, bleeding control, emergency moves, CPR, automated external defibrillation, and emergency child birth care.

Off-line medical direction

Provided through a set of predetermined, written guidelines that allow EMTs to use their judgement to administer emergency medical care according to the written guidelines without having to contact a physician

What are the Technical Assistance Program Assessment Standards?

Regulation and policy, resource management, human resources and training, transportation, facilities, communications, public information and education, medical directions, trauma systems, evaluation (things each state must have)

On-line medical direction

Requires that the EMT acquire permission from a physician via cell phone, telephone, or radio communication prior to administering specific emergency care

What are a Paramedics duties?

Scope of practice includes the skills performed by the EMT and AEMT with the addition of more advanced assessment and patient management skills and provision of the highest level of prehospital care. Paramedics perform advanced assessments, form a field impression, and provide invasive and drug interventions as well as transport. Their care is designed to reduce disability and death of patients who access the EMS system.

Record Keeping and Data Collection

Throughout your shift, maintain an up-to-date log of calls, if required. Before leaving the hospital, or as soon as possible, complete the written or electronic prehospital care report

What are the 10 special facilities?

Trauma center, burn center, obstetrical center, pediatric center, poison center, stroke center, cardiac center, hyperbaric center, spine injury center, psychiatric center

What helped teach EMS the importance of prehospital emergency care?

Wars (Korean and Vietnam war initially, still learn about trauma care from Iraq and Afghanistan)

What is the rule with Personal Safety and the Safety of others?

You can not help the patient or yourself if you are injured

Quality Improvement

a system of internal and external reviews and audits of all aspects of an emergency medical system. The goals of quality improvement are to target the aspects of the system that can be improved and to make plans to fix them

Medical Oversight

describes the EMS system medical directors responsibilities. these include all of the clinical and administrative functions and activities performed by the medical director as necessary to exercise ultimate responsibility for the emergency care provided by individual personnel and the entire EMS system

Medical direction

developing and establishing the guidelines under which the emergency medical service personnel function

What is the regulation and policy?

each state has to have laws, regulations, policies, and procedures that govern its EMS system. A state-level EMS agency is also required to provide leadership to local jurisdictions.

Evidence Based Medicine

focuses on research to provide clear evidence that certain procedures, medications, and equipment improve the patient's outcome