Chapter 2: Emergency Medical Services, Health Care, and Public Health Systems

vaccination, motor vehicle safety, safe for workplaces, control of infectious disease, decline in deaths from coronary heart disease and stroke, safer and healthier foods, healthier mothers and babies, family planning, fluoridation of drinking water, recognition of tobacco use as a health hazard

10 great Public Health achievements from 1900 to 1999

communications

A ______ system must be in place to allow public access to EMS and to allow _______ among dispatchers, EMS providers, and hospital personnel

EMS dispatch standards

Dr Jeff clawson is recognized for his contribution to the development of:

hospitals, clinics, treatment and diagnostic centers, physicians offices, rehabilitation centers, and extended-care facilities

EMS providers interact with many of these facilities in the course of both emergency calls and interfacility transfers

public information and education

EMS should participate in activities to educate the public and prevent injuries in their communities

The American Heart Association (AHA)begins teaching public CPR classes

Key events in EMS 1960s

first national standard curricula for EMS training are published by NHTSA: EMT - ambulance in 1971 EMT - paramedic in 1977; and first responder in 1979

Key events in EMS 1970s (A)

National Registry of Emergency Medical Technicians (NREMT) is formed to develop uniform standards for credentialing ambulance attendance.

Key events in EMS 1970s (B)

AMA establishes essentials for the accreditation of EMT - paramedic programs: adopted by The joint review committee on education for the emt- paramedic (now called the Committee on Accreditation of EMS programs[CoAEMSP])

Key events in EMS 1978

True

True or False: as an EMT you may be able to participate in vaccination and health screening programs in your community.

Publication of accidental death and disability: the neglected disease of modern society.

What events marks the history of present-day EMS system development?

critical access

a small rural hospital that meets certain criteria and can stabilize critical patients for transfer to a facility with a higher level of care is a ____________ hospital.

R. Adams Cowley, MD

after whom the renowned shock trauma center in Baltimore is named, recognize the need for rapid treatment of patients in shock. He developed the concept of the Golden Hour and was instrumental in the development of one of the first air EMS Services any country through the Maryland state police.

examples of Public Health functions and programs

agricultural and environmental health, behavioral health programs, disease prevention and immunization ,Emergency Management / emergency response, emergency medical services, epidemiology/disease surveillance, food and water safety monitoring, health facility licensure, health promotion and injury prevention, issuing birth and death certificates, LED and radon detection programs, medical error reporting program, oral health programs, professional licensure, radiologic safety, trauma programs, women, children, and minority health programs

human resources and training

all personnel whose staff ambulances must be trained to at least the EMT level

accredited

an EMS education program that has been evaluated by an official third party organization and meets certain standards is:

Tiered Response

an EMS system in which a greater number of BLS units distributed throughout the area can respond to emergencies quickly to provide initial care while awaiting response from a few strategically dispatched ALS units

transportation

an EMS system must provide safe and reliable _______. Depending on population density and geographical location, this may include ground ambulance, air medical helicopters, and fixed-wing air ambulance.

Reciprocity

an agreement through which one state accepts the license shore of professionals from another state as evidence of competency for licensure.

White Paper

an authoritative government report that describes specific issues and makes recommendations for solving them.

NEMSIS (National EMS Information System)

beyond the improvement of a single EMS system, data reported to the ______can be used for research to improve EMS practices Nationwide

Jeff Clawson, MD

developed the first set of standardized dispatch protocols in 1978, which have evolved into the widely used medical priority dispatch system.

enhanced 911

displays the callers location on the emergency operator or dispatcher's computer terminal. Also called E-911.

resource management

each state must ensure that every locality within the state has access to an acceptable level of emergency care. this requires coordination among different hospitals in the state.

regulation and policy

each state must have a lead EMS agency. each state must also have legislation, regulations, policies, and procedures to govern the operation of EMS. Cities and counties also have policies governing EMS.

EMS agenda for the future

goals for the development of the EMS system were published in 1996 in the:

trauma systems

must exist in each state to provide care to _______ patients

smaller cities and rural areas

offer limited range of health services

facilities

patients must be transported to an appropriate _________ in a timely manner. rural areas may have critical access hospitals that can stabilize critical patients for later transportation to a hospital with greater capabilities.

indirect medical direction/offline medical direction/prospective Medical direction

physician guidance of Emergency Medical Care through protocols or standing orders rather than through direct, real,-time contact with EMS providers. also called offline medical direction.

retrospective medical direction

physician review of the EMS care provided to a patient.

larger cities

provide full service hospitals that offer a range of specialty services such as intensive and critical care units, trauma centers, burn centers, cancer centers, cardiac Care centers, centers for high risk obstetric and neonatal patients, emergency mental health services, pediatric hospitals, poison centers, and stroke centers

concurrent medical direction/direct medical direction / online medical direction

real-time position supervision of Emergency Medical Care.

Certification

recognition of achievements of requirements, which can be granted by any agency.

critical access hospitals

small rural hospitals that provide 24-hour emergency care to stabilize critical patients for transfer to a facility that provides a higher level of care.

National EMS core content, National EMS scope of practice model, National EMS education standards, National EMS program accreditation

the EMS education agenda for the future (NHTSA, 1998) spelled out many goals for EMS education to be accomplished by 2010. those goals are:

Norman McSwain, MD

the director of trauma surgery at Charity hospital in New orleans, was instrumental in the development of the Pre-Hospital Trauma Life Support (PHTLS) course through the National Association of EMTs (NAEMT). He made tremendous contributions to the United States and worldwide to the education of EMS personnel.

Highway traffic deaths

the origins of the modern EMS systems arose from public concern over

licensure

the process through which a government agency grants permission for qualified individuals to engage in an occupation.

Evaluation

there must be an EMS quality improvement system in each state to assess and improve pre-hospital care.

peak load

time at which the volume of EMS calls is the highest period

James O. Page, JD

was an EMS pioneer in the Los Angeles county fire department, founder of the journal of Emergency Medical Services (JEMS), and technical consultant to the television show Emergency!.

Nancy Caroline, MD

was committed to the idea that people who are not physicians could be taught to deliver lifesaving Emergency Care outside the hospital. she was involved with one of the first paramedic programs in the country, and authorized the first paramedic textbook in the 1970s.

Rocco Morando

was the founding executive director of the NREMT and was instrumental in developing the NAEMT.

You can subscribe to professional publications and journals, and you can join local, state, and national EMS organizations and visit their websites.

what are some ways you can find out about issues in EMS and make a difference in its future?

medical treatment orders over the radio

what is an example of congruent medical direction?

the role of medical direction is to decide what care may be provided by each level of EMS and to identify the care that does or does not require direct contact with medical direction.

what is the importance of the medical direction component required of EMS systems?

the use of ambulances and helicopters, and a variety of trauma care theories and techniques used in EMS today arose from military experience.

what is the relationship between battlefield medicine and civilian EMS systems?

EMS providers can make and reports a number of observations about health and safety in their communities, and they can take an active role in education and prevention programs.

what roles can EMS play in public health?

prevent, identify, and find solutions for health problems in communities.

Public Health systems exist to:

Public Safety Answering Point (PSAP)

The dispatch center that receives calls requesting emergency services.

National Registry of Emergency Medical Technicians (NREMT)

a National organization that was established to ensure uniform credentialing standards for EMS personnel.

public safety answering point

a centralized location at which all requests for emergency services in a certain area are received is called a (n):

System Status Management (SSM)

a computerized ambulance and personnel deployment system

National Highway Traffic Safety Administration (NHTSA)

a division of the U.S. Department of Transportation that oversees many aspects of safely dash related travel on U.S. roads and highways, including the availability of emergency medical services.

National Standards Curriculum (NSC)

a document that prescribes the content, process, and structure for a particular level of EMS training; NSC at all levels is being phased out as the national EMS education standards are implemented.

Accreditation

a formal process by which a professional body assesses whether or not a program or institution has met the established standards of the profession and formally recognizes that the standards have been met.

medical direction

a licensed physician medical director is required in every EMS system to oversee patient care.

continuous quality improvement (CQI)

a management process that uses benchmarks to ensure and better the value of a product or service.

American Heart Association (AHA)

a non-profit organization that supports efforts to reduce death and disability from heart disease and stroke, and establishes standards for emergency cardiac care.

in response to an unacceptably high number of highway traffic deaths, Federal legislation in 1966 established a national agency (NHTSA) to address highway safety, including the provision of emergency medical services. EMS has since diversified to include response to many different types of emergencies. arguments could be made for placing EMS under the direction of a more directly health focused government agency to reflect this diversification. and the absence of a federal office of ems, however, EMS is unlikely to be a perfect fit under any existing agency.

how did EMS come to be under the direction of the national highway traffic safety administration? if EMS were to be placed under the direction of a different agency, what should it be, and why

the IOM report emergency medical services: at the crossroads made recommendations for EMS in the following areas the evolving role of EMS as an integral component of the overall healthcare system;EMS systems planning, preparedness, and coordination at the federal, state, and local levels; EMS funding and infrastructure investment; EMS workforce trends and professional education; and EMS research priorities and funding.

how does the institute of medicine (IOM) influence the direction of ems?

regulation and policy, resource management, human resources and training, transportation, facilities, communications, Medical direction, trauma systems, evaluation

in 1988, the NHTSA published statewide technical assistance program assessment standards that specify the components of States EMS systems (NHTSA, 1996). The 10 components are:

Third Service

in EMS, a service that is a third branch of the cities or counties Public Safety services, in addition to the fire service and law enforcement.

continuing

in advanced EMT who attends a program to learn about a new medication that will be introduced for use in his or her EMS service is participating in __________education.

Joseph D. "Deke" Farrington

in the 1950s he promoted vehicle extrication and established a first aid training curriculum that served as a prototype for the first EMT ambulance curriculum.

a tiered response

in the city of Avon, a BLS rescue squad that can reach a patient in 2 to 3 minutes is dispatched at the same time as a transporting advanced EMT ambulance that can reach the patient in 5 to 7 minutes. this is best described as:

refresher education

instruction that takes place after initial competence has been established to ensure ongoing minimum competence.

continuing education (CE)

instruction that takes place after initial competence has been established.

Peter Safar, MD

introduced the concept of airway, breathing, and circulation (ABC) and CPR in the 1950s. he founded the freedom House ambulance service and training program in pittsburgh, and continued research in hypothermic therapy and resuscitation until his death in 2003.