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Unit 1 Chapter 1: Introduction to Emergency Medical Services Describe the impact of historical events on EMS evolution Describe the modern EMS healthcare system I.D. some organizations that have influenced EMS Understand the 4 elements of a good EMS system Compare the evolution of EMS & emergency medicine Defined as: a connective network of providers that function to provide a variety of medial services to people in need of emergent medical care Early Beginnings Dating back to ancient civilizations that sought out natural causes & cures of disease & injury Hippocrates believed that health was a state of “internal equilibrium” father of medicine Good Samaritan traditionally someone who would stop and help an injured traveler on the roadside The Military Driven by necessity & need Greatest contribution to out-of-field hospital! Napoleonic Wars Ambulances volante: “flying ambulances” ▪ vehicles considered to be the first ambulances used by Baron Larrey ▪ Retrieve injured soldiers ▪ Brought wounded to the surgeon ▪ Little to no first aid U.S. Civil War General McClellan ▪ Formed the Army Ambulance Corp Clara Barton– 1881 ▪ Founder of the American Red Cross ▪ Treatment at the scene of incident “treat them where they lie” The World Wars Introduced weapons of mass destruction ▪ Created more severe & critical injuries Used soldiers as first responders ▪ Self-care ▪ Buddy care ▪ Field “paramedics” Mechanized ambulances ▪ Dawning of the ambulance drivers Trauma care systems developed ▪ Soldiers were transferred from field hospitals to definitive care The Korean & Vietnam Wars Introduced technological advances ▪ Aeromedical evacuation ▪ Trauma hospitals moved closer to the injured ▪ Mobile Army Surgical Hospital (M*A*S*H) Civilian World Care of ill and injured in civilian sector lagged behind what was provided by the military Returning veterans, police, & fire departments began advancing the level of care provided in the U.S. 1966– more than 50% of ambulances in the U.S. were owned and operated by morticians ▪ Hearses provided primary transportation to hospitals (only vehicles equipped for horizontal transport) …finally in 1958, EMS was founded by J.D. “Deke” Farrington Father of EMS Trained Chicago fire department with prehospital care skills Wrote “Death in the Ditch” which exposed the poor state of EMS during this time period 1966: President Kennedy’s white paper A detailed report on any subject ▪ “Accidental Death and Disability: The Neglected Disease of Modern Society,” was written for Kennedy ▪ Groundwork for EMS legislation ▪ Showed better survival in Vietnam War than America’s streets National Highway Traffic Safety Administration (NHTSA) Act of 1966 Division of U.S. Department of Transportation that establishes standards for emergency services training EMS System Act of 1973 Identified 15 essential components of the EMS system ▪ Personnel ▪ Standardized record ▪ Training keeping ▪ Communication ▪ Public information & education ▪ Transportation ▪ System review & ▪ Emergency facilities evaluation ▪ Critical care facilities ▪ Disaster management ▪ Public safety agencies ▪ Mutual aid agreements ▪ Consumer participation ▪ Access to care ▪ Patient transfer Star of Life~1973 Six-pointed star with staff & serpent in the center Symbol of EMS Detection– first rescuers on the scene usually untrained civilians Reporting—call for professional help dispatch connected with victims Response– first rescuers provide first aid & immediate care to the extent of their capabilities On scene care– EMS personnel proceed to transfer patient to a hospital Transfer to definitive care—appropriate specialized care provided at the hospital American Ambulance Association (AAA) National organization represents interests of ambulance service industry Members provide EMS to 95% of America’s urban centers International Association of Fire Fighters (IAFF) One of the largest groups that represent firefighters About 80% of EMS provided by firefighters National Registry of Emergency Medical Technicians (NREMT) Represents EMTs to public & government Registration serves as proof of meeting minimum competency level needed for certification Public perception of EMS Remained unaware of improvements in the field of pre-hospital emergency medicine ▪ Emergency television series Johnny & Roy (1970’s) ▪ LA County firefighter-paramedics ▪ Exhibited expert care in the field ▪ Helped to raise public expectations & awareness Public perception of EMS Rescue 9-1-1 ▪ Reality-based TV series hosted by William Shatner ▪ 1989-1996 ▪ Was not originally intended as a teaching tool, but viewers used the knowledge they obtained from watching EMS is an essential component in health care system First step of a long journey from illness/injury to recovery & health There are 4 essential steps to the continuous care of a patient… A. Continuum of Care Similar to AHA “chain of survival” ▪ Chain of Survival: multiple elements needed in a first response system to have successful resuscitation ▪ Each element is connected with the others ▪ Strength of entire chain equally dependent on strength of each link Recognize sudden cardiac emergency Unresponsiveness Loss of consciousness Lack of pulse No breathing Immediate call to 911 helps ensure advance life support team will aid victim more quickly Providing CPR keeps oxygenated blood flowing to heart & brain Early CPR increases victims chance of survival Defibrillation is the ONLY way to stop sudden cardiac arrest Restarts the heart For each minute that passes between collapse and defibrillation, survival chances decreases by 10% After using the AED given by paramedics and other highly trained medical personnel on scene and during transport Help maintain a normal heart rhythm after successful defibrillation. Step 1? Step 2? Step 3? Step 4? B. Universal Access 9-1-1: 3 digit access number for emergency services in the U.S. Public Safety Access Point (PSAP): answering location for all calls made to 9-1-1 in a specific area Emergency Dispatcher: specially trained person who answers calls for emergency assistance at PSAP C. Emergency Medical Dispatch (EMD) Organized group of trained providers who take emergency calls Give first aid instructions to callers Prioritize responding unit Becoming standard of care for EMS dispatching ▪ ▪ ▪ ▪ ▪ First –first responders Medically driven dispatch protocols Prioritization Appropriate use of resources System-status management D. First Responder: first person to arrive on the scene of an incident may refer to the level of medical training provided to persons who expect to be put in this position during their daily routine ▪ (firefighters, police offices, security guards, athletic trainers, etc) First responder continued… Early first aid courses ▪ Bystander training Professionals ▪ Law enforcement officers (LEOs) ▪ Fire service ▪ Police/security guards Training ▪ ▪ ▪ ▪ ▪ ▪ Basic assessment Simple airway management Oxygen administration Bleeding control CPR defibrillation Emergency Medical Technician- Basic (EMT-B): person has completed primary pre-hospital medical training most common level in U.S. Includes CPR, defibrillation, airway management, and basic medical/trauma care ▪ Original curriculum for ambulance attendants ▪ Modern training includes basics of common illnesses & care during transport ▪ Diverse group ▪ Ambulance ▪ Soldier ▪ Firefighters Emergency Medical Technician-Intermediate (EMT-I): person has completed second level of prehospital care training beyond that of an EMT-B Includes training in intravenous (IV) therapy, advanced airway & cardiac arrest management, and trauma care ▪ More advanced skills and knowledge ▪ Cardiac arrest “managers” ▪ Called intermediate life support (ILS) Emergency Medical Technician- Paramedic (EMT-P): person has completed highest level of pre-hospital care medical training Includes advanced airway management, IV access techniques, defibrillation, cardiac pacing, and advanced pharmacology ▪ Health care professional ▪ College-level education Just as pre-hospital emergency care evolved to the needs of our changing society so did in-hospital care Early “accident rooms” ▪ Doctors were “moonlighters” ▪ Became the hospital’s emergency medical center ▪ Available 24/7 Emergency medicine Physicians began specializing in “emergency medicine” Emergency physician: specifically trained to provide care to acutely ill and injured patients in an emergency department setting ▪ American College of Emergency Medicine ▪ Professional organization Modern emergency department Trauma Center: specially designated hospital that is experienced in and capable of caring for patients with severe emergencies http://www.scdhec.go v/health/ems/trauma. htm Aeromedical transport Intended for critical care transportation Ground specialty teams EMS has evolved rapidly over 35 years Continued changes needed to accommodate shifting needs of populations it serves Adjust to new financial and medical developments A. Aging Americans Baby boomers growing older B. Homelessness Increasing population of mentally ill ▪ Development of Psychotropic medications ▪ Deinstitutionalization C. Human Resources Decreased volunteerism, an American tradition ▪ Economic pressure ▪ Changing ethics D. Financial restrictions Limited budgets of volunteer organizations Equipment Training Insurance E. Accountability Consumers demand quality Governmental regulation ▪ Continuous quality improvement Accreditation ▪ Ambulance services ▪ EMS education programs Legal action ▪ Liability suits for negligence History of EMS if filled with examples of heroism & leadership Future of EMS depends on assessment & management of many challenges