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Chapter 1
Introduction to
Emergency Medical Care
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 1
Case History
You respond to a call for a patient in cardiac
arrest. On arrival, you find a 52-year-old male
who is pulseless and not breathing. A family
member is performing CPR. The family states
that he collapsed 4 minutes before your
arrival.
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 2
Historical Perspective
Battlefields Lay the Foundation



Napoleonic Wars – Ambulance
volantes
Civil War – Horse-drawn
ambulances
World War I – Motorized
ambulances
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 3
Historical Perspective
Battlefields Lay the Foundation

Korean War – Helicopters
and MASH units


Mobile Army Surgical Hospital
Death rates from battle
casualties



8% WW I
4.5% Korea
2% Vietnam
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 4
Historical Perspective
Civilian Evolution
• Civilian evolution varied from region to
region in U.S.
• Rural areas – Undertakers

Fire departments and volunteer ambulance
replaced funeral directors
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 5
Historical Perspective
Civilian Evolution
• Civilian evolution varied from region to
region in U.S.
• Rural areas – Undertakers

Fire departments and volunteer ambulance
replaced funeral directors
• Urban areas




Hospital-based
Fire departments
Police departments
Independent ambulance companies
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 6
Historical Perspective
Civilian Evolution
• Mid-1860s – First
hospital-based
ambulance services
 Cincinnati General and
Bellevue Hospitals
• 1899 – The first
motorized ambulance
 Michael Reese Hospital
of Chicago
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 7
Trauma as an
Impetus for EMS Development
• Preventable injury
 Leading cause of death in ages 1 to 45
• Automobile caused surge in trauma deaths
 1900 – 7th leading
cause of death
 2000 – 4th leading
cause of death
 Automobiles account
for 50%
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 8
Knowledge and Technology
• 1960 – CPR developed
 Cardiopulmonary Resuscitation
• 1960s – Portable defibrillators
• First ALS units (Advanced Life Support)
 Belfast, Ireland
 St. Vincent’s Hospital (New York City)
 Only physicians provided advanced care
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Slide 9
Knowledge and Technology
• Late 1960s – Biotelemetry developed
 Space race
• Allowed EMS providers to deliver ALS
 Defibrillation
 Advanced airway
procedures
 Drug therapy
• “Johnny and Roy”
popularized paramedics
on TV show Emergency!
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 10
The Physician and EMS
• Physician societies
organized early EMS
programs
 American Academy of
Orthopaedic Surgeons
(AAOS)
 American College of Surgeons
(ACS)
• Worked with National
Highway and Traffic Safety
Administration (NHTSA)
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 11
The Physician and EMS
• Physician groups still involved
American
College of Emergency
Physicians (ACEP)
National Association of EMS
Physicians (NAEMSP)
National Association of State
EMS Medical Directors (NAEMSD)
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 12
The Landmark Paper – 1966


“Accidental Death and Disability: The Neglected
Disease of Modern Society”

Prompted federal money to develop EMS in 1973

“Provide safe handling and transportation of ill or injured.”
Provided impetus for rapid proliferation
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 13
EMS Agenda for the Future:
14 Components
1.
2.
3.
4.
5.
6.
7.
Integration of health
services
EMS research
Legislation and
regulation
System finance
Human resources
Medical direction
Education systems
8.
9.
10.
11.
12.
13.
14.
Public education
Prevention
Public access
Communication
systems
Clinical care
Information systems
Evaluation
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 14
Elements of a
Communications System


The dispatch system – Enhanced 911
Formal national program to train dispatchers


Emergency Medical Dispatch (EMD)
Ambulance-to-hospital
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

Radio
Cell phone
Landline
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 15
Levels of Training





Lay rescuer
First responder
EMT-Basic
EMT-Intermediate
EMT-Paramedic
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 16
Lay Rescuer

Carry little or no equipment

Recognize life-threatening illness or injuries

Provide lifesaving care until EMS arrives




CPR
Relief of airway obstruction
Use of an AED
Bleeding control
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 17
First Responders

Equipped with




Oxygen
AEDs
Airway equipment
Provide lifesaving
care until EMS arrives
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 18
EMT-Basic

Provide basic, noninvasive skills








Patient assessment
CPR
Airway adjuncts
AED use
Childbirth
Splinting
Spinal immobilization
Administration and assistance with medications
• Activated charcoal, metered-dose inhaler,
nitroglycerin, epinephrine

Use variety of transport devices
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 19
EMT-Intermediate

Provide same skills as EMT-B

Provide additional advanced skills,
including



Advanced airway techniques
ECG recognition
Intravenous fluid therapy
 Administration of multiple
medications
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 20
EMT-Paramedic

Expanded scope of practice beyond EMT-B and EMT-I

Provides advanced techniques, such as

ECG interpretation
 Drug therapy
 Invasive airway techniques
 Defibrillation

Often have more standing orders in protocols than EMT-I
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 21
Chain of Survival
Early Access
Early CPR
Early Defibrillation
Early
Advanced Care
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 22
The Health Care System

Emergency departments

Specialty referral centers

Hospital personnel
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 23
Liaison with Other Public Safety
Workers

Conflicts may occur when overlaps with other public safety
personnel





Police take charge at crime scene, traffic and crowd control issues
Fire take charge at fire scene
EMS responsible for patient care
Cooperation is essential
Incident command system should be in place
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 24
Professional Attributes

Demonstrate skill and knowledge for the good of the
patient

Promote high standards of behavior

Add to your body of knowledge to continue to
advance in the profession
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 25
Professional Attributes

Appearance

A professional appearance and attitude help evoke a sense
of confidence in patients and family members.
• Clean and appropriate clothing

Attitude more important than outer appearance
• Show an interest in your job
• Possess a sensitive awareness of environment and needs
others
• Putting patient/family needs ahead of your own will protect and
preserve safety
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 26
EMT-Basic
Primary Responsibilities

Patient assessment

Personal safety and safety of
others

Patient care

Lifting and moving patients
safely

Transport/transfer of care
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 27
Other Responsibilities

Record keeping

Patient advocacy

Extrication

Communications

Vehicle and equipment
maintenance
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 28
Local, State, and National Issues

National Registry of Emergency Medical Technicians

National Association of Emergency Medical Technicians

The American Heart Association

Continuing education

Refresher courses

Record keeping/Data Collection
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 29
Quality Improvement:
Definition
A system of internal/external reviews
and audits of all aspects of an
emergency medical services system
that identifies aspects that need
improvement to ensure that the public
receives the highest quality of
prehospital care
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 30
Role of the EMT-Basic
in Quality Improvement

Documentation

Run reviews and audits

Gathering feedback from patients/hospital staff

Conducting preventive maintenance

Continuing education

Skills maintenance
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 31
Medical Direction

Accountability for the medical conduct of EMS
personnel by a physician knowledgeable in patient
care

Online medical direction


Direct real-time contact via telephone or radio
Offline medical direction

Written protocols, policies, procedures
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 32
Summary

EMT-Basic plays a key
role in EMS system

Teamwork with other
providers is essential for
effective patient care

Quality assurance is an
important role of the
EMT-Basic
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 33
Basic or Advanced?


Basic life support called BLS describes the
care given by First Responders and EMTBasics
Advanced life support, called ALS, is the
higher level of care performed by EMTIntermediates and Paramedics

Permitted to perform invasive procedures
• Procedures that introduce foreign substances or
equipment into the patient’s body
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 34
Training



The EMS provider is legally prohibited from
performing skills that are beyond his or her
level of training
Each group of skills requires the proper
certification
The length of time required for learning the
advanced skills is considerable
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 35
First Responder Training

Prerequisite: Health Care Professional level
CPR



8 hours
24-hour class
Three-year certification period

Certification is maintained with a refresher course
• 12 hours
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 36
EMT Basic Training

Prerequisite: Health Care Professional level
CPR


110-hour class plus


Five patient contacts
State certification application and fee


8 hours
$150.00
Two-year certification period



24-hour refresher course
28 hours of continuing education
$150.00 recertification fee
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 37
EMT Intermediate Training

Prerequisite: Health Care Professional level
CPR


8 hours
180-hour class plus


100 hours of clinical observations and skills
• 30 i.v. starts
• 10 intubations
100 hours of field observations and skills
• 10 i.v. starts
• 1 intubation
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 38
EMT Intermediate Training

State certification application and fee


State administered exam


$150.00
Minimum passing grade: 70%
Two-year certification period

24-hour refresher course
 28 hours of continuing education
 $150.00 recertification fee
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 39
EMT Paramedic Training



Prerequisite: Health Care Professional level
CPR & EMT-B certification
X contact hours as an EMT-B
400-hour class plus


200 hours of clinical observations and skills
• 60 i.v. starts
• 10 intubations
200 hours of field observations and skills
• 30 i.v. starts
• 1 intubation
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 40
EMT Paramedic Training

State certification application and fee


State administered exam


$150.00
Minimum passing grade: 70%
Two-year certification period

24-hour refresher course
 28 hours of continuing education
 $150.00 recertification fee
Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 41