Chapter 1 - EMS Systems

Part One; You are a recently certified EMT. You and your partner, a paramedic, are dispatched to a possible heart attack at 200 South 12th Avenue. As you get into the ambulance, the dispatcher announces, "CPR in progress." You're excited at the thought of working your first cardiac arrest and possibly saving a patient's life. En route to the location, you and your partner discuss what roles you will play to assist each other in expediting defibrillation, airway management, intravenous access, and pharmacologic therapies. You feel ready to tackle all the tasks the paramedic has placed in your charge and feel confident as a member of the prehospital team. 1. What are the components of a people-centered EMS system? 2. In the overall scheme of prehospital medicine, what are the primary roles and responsibilities of an EMT?

1. The components outlined in the EMS Agenda 2050 include clinical care that is comprehensive, quality, convenient, evidence-based, efficient, and well-rounded, as well as promoting preventive care and comprehensive, easily accessible patient records. 2. The primary roles and responsibilities of an EMT relate to being prepared for a call, emergency vehicle operation, scene safety, patient access and assessment, emergency medical care, emotional support of patient/others, and maintaining continuity of care by working with other medical professionals. It also involves being an on-scene leader, obtaining additional resources as needed, resolving emergency incidents, maintaining privacy/confidentiality, and upholding medical/legal standards. Additional roles may involve performing administrative support duties, participating in community relations, maintaining professional development, and contributing to the EMT profession.

Part Two; As you arrive on the scene and pull into the driveway, you notice a law enforcement officer's vehicle and a pickup truck with a red rotating beacon on the roof, used by responders from the volunteer fire department. When you and your partner enter the house, you find a police officer and firefighter on either side of the patient. The police officer states he was first on the scene and immediately started CPR. After the firefighter arrived, he applied an AED to the patient and successfully administered a shock. The patient now has a carotid pulse. 3. What are your immediate concerns regarding patient care, and what are your overall responsibilities as an EMT?

3. You should assist the paramedic to assess the patient's current status: Has the patient regained consciousness? Does the patient need airway support, ventilation, oxygen, etc.? Vital sign monitoring will be very important and can be done while the paramedic performs other duties. You may also be able to assist the paramedic with other assessment or management and transport needs, and you should be prepared to resume CPR if the patient again goes into cardiac arrest. You may also be able to evaluate the scene for clues to the patient's medical history, medications the patient takes, or factors that may have caused the cardiac arrest.

Part Three; Because of the teamwork among you, the police officer, the firefighter, and the paramedic, a cardiac rhythm has been successfully established, the patient has been intubated, and an IV has been established to administer essential medications. As you are preparing the patient for transport, a family member arrives and appears to be confused and very upset by what she sees. She explains that her father called her complaining of chest pain, so she told him to rest while she called 9-1-1. 4. How can you help the patient's daughter, and what should you do or say?

4. It is important to be empathetic to the daughter, explaining what actions are being taken to help her father and reassuring her that you and your partner are doing your best to treat her father and promptly transport him to the hospital for additional care. You should be truthful and professional, while maintaining patient confidentiality as appropriate. Avoid using technical jargon or euphemisms, and also avoid any speculation on the patient's current and future status.

Part Four; Without delaying patient transport, you briefly explain to the family member that upon your arrival, her father was not awake, was not breathing, and did not have a pulse. You explain that you have helped his heart to start beating again and are breathing for him, but that he is still unconscious. You explain that everything is being done to help him until he arrives at the hospital and physicians take over his care. She seems comforted by your kind words and professional demeanor and asks to travel with you to the hospital. You assist her to the front of the ambulance and help her with her seat belt. The volunteer firefighter is trained to drive emergency vehicles and offers to drive you and your partner to the hospital. The paramedic requests your help in the patient compartment. 5. What are some considerations for successful patient management during transport? Minutes later, you arrive at the hospital. You and your partner have continued stabilizing the patient by reassessing the airway to confirm proper tube placement, providing additional medications as needed, and continuously monitoring the cardiac rhythm. One week later, you learn that the patient has made an impressive recovery and has been discharged from the hospital. He and his daughter later visit you and the other responders to express their thanks with homemade treats for everyone to enjoy.

5. Monitoring of vital signs and other patient assessments will need to be done frequently to watch for changes in patient status. Additional treatments may be needed, and ongoing treatments need to be monitored for effectiveness and correct administration. Patient and crew safety and good teamwork is also essential to a successful transport.

Public Safety Access Point

A call center, staffed by trained personnel who are responsible for managing requests for police, fire, and ambulance services.

Automated External Defibrillator (AED)

A device that detects treatable life-threatening cardiac dysrhythmias (ventricular fibrillation and ventricular tachycardia) and delivers the appropriate electrical shock to the patient.

National EMS Scope of Practice Model

A document created by the National Highway Traffic Safety Administration (NHTSA) that outlines the skills performed by various EMS providers.

Community Paramedicine (CP)

A health care model in which experienced paramedics receive advanced training to equip them to provide additional services in the prehospital environment, such as health evaluations, monitoring of chronic illnesses or conditions, and patient advocacy.

Mobile Integrated Healthcare (MIH)

A method of delivering health care that involves providing health care within the community rather than at a physician's office or hospital.

Emergency Medical Services

A multidisciplinary system that represents the combined efforts of several professionals and agencies to provide prehospital emergency care to the sick and injured.

Certification

A process in which a person, an institution, or a program is evaluated and recognized as meeting certain predetermined standards to provide safe and ethical care.

Continuous Quality Improvement (CQI)

A system of internal and external reviews and audits of all aspects of an EMS system aimed at improving outcomes.

Emergency Medical Dispatch

A system that assists dispatchers in selecting appropriate units to respond to a particular call for assistance and provides callers with vital instructions until the arrival of EMS crews.

Emergency Medical Responder

A trained professional, such as police officer, firefighter, lifeguard, or other rescuer, who may arrive first at the scene of an emergency to provide initial medical assistance.

Advanced Life Support (ALS)

Advanced life-saving procedures, some of which are now being provided by the EMT.

Evidence-Based Medicine

An approach to medicine where decisions are based on well-conducted research, classifying recommendations based on the strength of the scientific evidence; also called science-based medicine.

Credentialing

An established process to determine the qualifications necessary to be allowed to practice a particular profession, or to function as an organization.

Paramedic (EMT-P)

An individual who has extensive training in advanced life support, including endotracheal intubation, emergency pharmacology, cardiac monitoring, and other advanced assessment and treatment skills.

Emergency Medical Technician (EMT)

An individual who has training in basic life support, including automated external defibrillation, use of a definitive airway adjunct, and assisting patients with certain medications.

Advanced EMT (AEMT)

An individual who has training in specific aspects of advanced life support, such as intravenous therapy, and the administration of certain emergency medications.

Medical Director (MD)

The physician who authorizes or delegates to the EMT the authority to provide medical care in the field.

Americans with Disabilities Act (ADA)

Comprehensive legislation that is designed to protect people with disabilities against discrimination.

What is continuous quality improvement (CQI) and how is it used to help ensure the safety of patients?

Continuous quality improvement is a circular system of continuous internal and external reviews and audits of all aspects of an EMS system. By looking at all the components of an EMS system, the CQI process seeks to identify areas that need improvement and enables the problems to be resolved through remediation and training rather than through punitive measures.

Secondary Prevention

Efforts to limit the effects of an injury or illness that you cannot completely prevent.

Primary Prevention

Efforts to prevent an injury or illness from ever occurring.

Health Insurance Portability and Accountability Act (HIPAA)

Federal legislation passed in 1996. Its main effect in EMS is in limiting availability of patients' health care information and penalizing violations of patient privacy.

Licensure

The process whereby a competent authority, usually the state, allows people to perform a regulated act.

Quality Control (QC)

Oversight by the medical director to ensure the appropriate medical care standards are met by EMTs on each call.

Medical Control

Physician instructions given directly by radio or cell phone (online/direct) or indirectly by protocol/guidelines (off-line/indirect), as authorized by the medical director of the service program.

Why is EMS research a vital part in the evolution of patient management?

Research provides data that identify treatments that are beneficial and/or lifesaving for trauma patients and those that are not. Participation in EMS research empowers the EMT to help shape the future of trauma care.

You are tasked with teaching a review course for the National Registry written exam. Several students are worried about passing the cardiology and trauma sections. You reassure them that while these are very important topics, the fundamentals form the building blocks for our profession and should not be forgotten. After sharing those words of wisdom, you begin class.

See all multiple choice questions to determine how to correctly proceed with treating the patient.

Public Health

The branch of medicine that is focused on examining the health needs of entire populations with the goal of preventing health problems.

Intravenous Therapy (IV)

The delivery of medication directly into a vein.

Primary Service Area (PSA)

The designated area in which the EMS agency is responsible for the provision of prehospital emergency care and transportation to the hospital.

Which of the phases of being an emergency health care provider is continuous? a. Continuing medical education b. Teaching EMS courses c. Pursuing an advanced degree d. Completing weekly drug screening

a. Continuing medical education

Which of the following agencies is the federal source for the model EMT scope of practice and education standards? a. Department of Health and Human Services b. National Highway Traffic Safety Administration c. Federal Emergency Management Agency d. Department of Transportation

b. National Highway Traffic Safety Administration

An example of teamwork and diplomacy is: a. using your persona to project a sense of personal superiority to patients. b. being able to communicate while giving respect to the listener. c. acknowledging that others are not in high regard or importance. d. delegating multiple tasks only occasionally to ensure efficiency and safety.

b. being able to communicate while giving respect to the listener.

What is the primary role of the EMT? a. Provide appropriate medical care b. Diagnose the patient's condition c. Ensure personal safety d. Provide transport to the closest hospital

c. Ensure personal safety

Professional attributes include which of the following? a. Integrity, relying only on one's self, taking charge b. Blaming others, ignoring team members, lying c. Honest behavior; a clean, well-groomed persona; respecting others d. Placing your needs above the patient's care, listening to your patient, performing multiple tasks safely

c. Honest behavior; a clean, well-groomed persona; respecting others

Which of the following is an example of secondary prevention? a. Cardiac arrest management b. Administering vaccines c. Teaching pool safety when finding someone who slipped and fell near a pool by running d. Teaching safety in schools

c. Teaching pool safety when finding someone who slipped and fell near a pool by running

The roles and responsibilities of an EMT include all of the following EXCEPT: a. performing a patient assessment. b. upholding medical and legal standards. c. providing legal advice to patients. d. ensuring and protecting patient privacy.

c. providing legal advice to patients.

This act of legislation protects people with disabilities from being denied access to programs and services that are provided by state or local governments. a. Ryan White Act b. Marchman Act c. Equal Rights Amendment d. Americans with Disabilities Act

d. Americans with Disabilities Act