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Chapter 1
Preparatory
National EMS Education
Standard (1 of 3)
Preparatory
Applies fundamental knowledge of the
emergency medical services (EMS) system,
safety/well-being of the emergency medical
technician (EMT), medical/legal, and ethical
issues to the provision of emergency care.
National EMS Education
Standard (2 of 3)
Public Health
Uses simple knowledge of the principles of
illness and injury prevention.
National EMS Education
Standard (3 of 3)
Pharmacology
Applies fundamental knowledge of the
medications that the EMT may
assist/administer to a patient during an
emergency.
Introduction
• EMS is an integrated system of care.
• This chapter discusses the changes and
improvements made in the EMS system in
recent years.
New Levels of EMS Training
(1 of 7)
• National EMS Scope of Practice Model
– Created by the National Highway Traffic Safety
Administration (NHTSA)
– Outlines the skills performed by various EMS
providers
Source:© Corbis
New Levels of EMS Training
(2 of 7)
• EMR has very basic training.
– Provides care before ambulance arrives
– May assist within ambulance
New Levels of EMS Training
(3 of 7)
• EMT has training in basic life support (BLS),
including:
– Automated external defibrillation
– Airway adjuncts
– Medication assistance
New Levels of EMS Training
(4 of 7)
• AEMT has training in advanced life support
(ALS), including:
– Intravenous (IV) therapy
– Administration of certain emergency
medications
New Levels of EMS Training
(5 of 7)
• Paramedic has extensive ALS training,
including:
– Endotracheal intubation
– Emergency pharmacology
– Cardiac monitoring
New Levels of EMS Training
(6 of 7)
• Certification and licensure of EMTs remains a
state function.
– Varies state-to-state
– National guidelines create a more consistent
delivery of EMS across the United States.
New Levels of EMS Training
(7 of 7)
• An EMT may perform a skill only if the state
has approved that skill as part of the EMT’s
scope of practice.
– The medical director can limit the scope of
practice, but he or she cannot expand it beyond
the boundaries set by law.
Public BLS and Immediate Aid
• Millions of laypeople are trained in
BLS/CPR.
• Many individuals have taken first aid
courses to provide immediate essential care.
• Automated external defibrillators (AEDs) are
used by laypeople.
Components of the
EMS System (1 of 2)
1. Public access
6. Prevention
2. Clinical care
7. EMS research
3. Medical direction
8. Communication
systems
4. Integration of
health services
5. Information
systems
9. Human resources
10. Legislation and
regulation
Components of the
EMS System (2 of 2)
11. Evaluation
12. System finance
13. Public education
14. Education systems
Information Systems
• Technology has improved.
– Allows EMS to document care
– Data can be analyzed to improve care.
• Use of information varies.
Public Health, Disease
Prevention and Education (1 of 2)
• Public health examines the health needs of
entire populations with the goal of
preventing health problems.
Public Health, Disease
Prevention and Education (2 of 2)
• EMS works with public health agencies on:
– Primary prevention
– Secondary prevention
EMS Research (1 of 2)
• Helps determine the shape and impact of
EMS on community
• EMTs may be involved in research through
gathering data.
• The results can then be shared with the rest
of the EMS community.
EMS Research (2 of 2)
• Evidence-based decision making is based
on research.
• It is important for EMS providers to stay upto-date on the latest advances in medicine.
• Be skeptical: Ask questions and conduct
your own research.
Wellness of the EMT (1 of 2)
• Nutrition
– Eat well-balanced meals.
• Exercise and
relaxation
– Exercise regularly to
handle stress more easily.
• Safe lifting practices
• Sleep
– Should be regular and
uninterrupted
Source: Courtesy of USDA
Wellness of the EMT (2 of 2)
• Disease prevention
– Know family health history
– Adjust lifestyle
– Smoking
• Harmful to your health and to the health of those
around you
• Balancing work, family, and health
– Take time to relax with family and friends.
Workplace Issues (1 of 3)
• Cultural diversity on the job
– Communicate respectfully.
– Use cultural diversity as a resource.
– Learn how to relate to and communicate with
people from different cultures.
Workplace Issues (2 of 3)
• Sexual harassment
– Two types
• Quid pro quo: request for sexual favors
• Hostile work environment: jokes, touching, etc.
– Most complaints are of the second type.
– Such behavior is unacceptable.
– Report harassment to supervisor immediately
and keep notes.
Workplace Issues (3 of 3)
• Substance abuse
– May result in the revocation of driving privileges
and/or loss of licensure
– Seek help, or find a way to confront an addicted
coworker.
– Employee assistance programs (EAPs) are often
available.
Emotional Aspects of
Emergency Care
• Even experienced
health care providers
have difficulty
overcoming personal
reactions.
• The struggle to remain
calm contributes to the
emotional stress of the
job.
© James Schaffer/PhotoEdit, Inc.
Dealing with the Death of a
Child
• Help the family in any way you can.
• Provide information about follow-up
counseling and support services.
Helping the Family
• Acknowledge the death in a private place.
• Let the parents hold the child if possible.
• If the parents want to see the child, prepare
them for what they will see.
• Nonverbal communication may be valuable.
Emotional Care During
Stressful Situations (1 of 2)
• Use extreme care in words and actions.
• Present a professional demeanor.
• Bring a sense of order and stability to the
situation.
• Explain your plan of action.
• Inform the patient that you need his or her
help.
Emotional Care During
Stressful Situations (2 of 2)
• Be compassionate but allow professional
judgment to take priority.
• Allow patients to express fears/concerns.
• Be discreet and diplomatic.
• Transport parents with their children.
• Try to accommodate requests regarding
religious customs.
Emergency Pharmacology
(1 of 2)
• Many departments have strict controls on
when an EMT is allowed to administer a
medication.
– Peer-assisted
– Patient-assisted
– EMT-administered
Emergency Pharmacology
(2 of 2)
• The list of medications that may be
administered by EMTs has changed over the
years.
– The exact list of medications that is allowed is
controlled by the state government, the public
safety department, and the medical director.
– Always follow local protocols.
Credits
• Unless otherwise indicated, all photographs
and illustrations are under copyright of Jones
& Bartlett Learning, courtesy of Maryland
Institute for Emergency Medical Services
Systems, or have been provided by the
author(s).