Emergency Medical Services

Intro to EMS What Is EMS?

• “Planned configuration of community resources and personnel necessary to provide immediate care to patients with sudden/unexpected injury/illness.”

Intro to EMSWhere did EMS come from?

• War• 1st Ambulances

• Napoleonic War• Baron Dominique Jean

Larrey - 1793

• “Flying Field Hospitals”• Troops taken off

battlefield for treatment

Intro to EMSWhere did EMS come from?

• Civil War• Horse Drawn Ambulances

• WWI• Motorized Ambulance• Splinting fractures

• Korean War• Helicopter evacuation to

MASH units• Vietnam

• Reinforced helicopter evacuation

• Field medics

Intro to EMSWhere did EMS come from?

• Civilians • Rural

• Undertakers

• Urban• Hospitals/FD/Police/

Private companies

Intro to EMSWhere did EMS come from?

• Trauma • # 1 COD 1-45 y/o• MVA= ½ of all traumatic

deaths• Battle physicians saw

need • On scene care=

increased survivability

Intro to EMSWhere did EMS come from?

• The “White Paper”- 1966• “Accidental Death and Disability: The Neglected

Disease of Modern Society”• National Academy of Science

• Prompted federal grants• “Safe Transport and Handling of ill/injured people”

• National Highway Safety Act - 1966• Established National Highway Safety Administration

(NHSTA) under U.S. D.O.T.• Improve EMS education/est. EMS system

Intro to EMSWhere did EMS come from?

Wedworth-Townsend Paramedic Act -1970 – Senator James Q. Wedworth

Assemblyman Larry Townsend– Pilot Paramedic program

Los Angeles County Function without doctor/nurse

Overview of the EMS System…

• 911• Access to ALL components of

EMS

• Enhanced 911• Exact location of caller

• Emergency Medical Dispatch • Dispatchers provide basic 1st aid

instructors • U.S. D.O.T. Curriculum

• Non 911 systems• Separate numbers separate

services

Overview of the EMS system…

• Levels of training• First responder• EMT-Basic• EMT-Enhanced• EMT-Intermediate• EMT-Paramedic

The Healthcare System

• Emergency Department/Medicine • Intersection of prehopsital/hospital care• Young specialty

• AMA recognition 1975

• Specialty Centers• Trauma Centers• Burn Centers• Pediatric Centers• Poison Centers

Hospital Personnel

• Physicians• Overall management of

pt care

• Nurses• Coordinates pt care

• Others• Radiology, Respiratory,

Techs, etc.

Other Public Safety Workers

• Firefighters • Fire• Extrication• AED

• Police• Crime scenes• Traffic control• Violent patients• Notifies family

Roles and Responsibilities of the EMT

• Safety• Personal• Crew• Bystander• Pt.

• Pt assessment • Vital signs, History, Physical assessment

Roles and Responsibilities of the EMT

• Pt care• Based on assessment

findings• Lifting/moving pt

• Movement based on pt needs

• Transport/transfer of care• Record keeping

• PPCR= ONLY source of info from the scene

• CYA…• Pt. Advocacy

• 1st provider at scene= the pt looks to YOU!

Professional Attributes

• Appearance• Neat • Clean• Positive image

• Maintain up to date knowledge/skills• Continuing Ed (CE)

• Local/state/national conventions• EMS journals and classes• Handout on Va EMT CE requirements

• Refresher courses

Category 1(Required Topic) Area # Hours Required

Patient Assessment 2 3

Airway Management w/Practical 3 3

Trauma Emergencies w/Scenarios 4 4

Medical Emergencies w/Scenarios 5 4 Infection Control 6 2

Medical Legal 7 1

Infants and Children 8 2

Practical Skills 9 3

AED 10 2

TOTAL: 24 Hours

Category 2 (Other) .

TOTAL: Up to 12 Hours

Category 3(Multimedia) .

TOTAL: Up to 10 Hours

Total Category 2 + Category 3 .

TOTAL: 12 Hours

TOTAL EMT RECERTIFICTION HOURS .

TOTAL: 36 Hours

Neat….

Not so neat…

Quality Improvement

• “A system of internal/external reviews and audits of all aspects of an EMS system so as to identify those aspects needing improvement to assure the public receives the highest quality of prehospital care.”

• Anyone else think that’s a terribly long definition??

The Role of the EMT in QI

• Documentation• Run reviews and audits• Pt and hospital

feedback• Preventative

maintenance• Counting Ed (CE)• Skill maintenance

Maintain skills so you don’t do this…

Medical Direction

• “A physician responsible for the clinical and pt care aspects of the EMS system”

• EVERY EMS system MUST have one• We are extensions of the OMD

Types of Medical Direction

• On-Line• DIRECT communication

with physician• Telephone• Radio

• Off-Line• Medical direction without

direct communication• Protocol • Standing Orders

Extra Credit to ANYONE who can tell me who these guys are and why they ROCK!!!

That does it. Come back next time for more…