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Chapter 1
EMS Systems
and Research
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Course Overview
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Objectives
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The Emergency Medical Responder
• Emergency Medical Responder (EMR)
– A member of the Emergency Medical
Services (EMS) team who
• Responds to emergency calls
• Provides efficient emergency care to ill or
injured patients
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The Emergency Medical Responder
• Emergency Medical Responders
– May be paid or volunteer personnel
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Goals of EMR Training
• When you successfully complete an Emergency
Medical Responder training program, you will
have gained the knowledge, attitude, and skills
to do the following:
– Recognize and assess the seriousness of a
patient’s condition or the extent of injuries to
determine the emergency medical care a
patient requires
– Safely and efficiently provide initial
emergency medical care for a victim of a
sudden illness or injury
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Origins of
Emergency Medical Services (EMS)
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Origins of EMS
• Emergency
– An unexpected illness or injury that
requires immediate action to avoid
risking the life or health of the person
being treated
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Origins of EMS
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Origins of EMS: 1900–1960
• Civilian ambulance services began
in Cincinnati and New York City
• Mid-1940s
– Rural communities recognized
need for local fire protection and
first aid
• 1950s
– Mobile Army Surgical Hospital
(MASH) units used helicopters
for evacuation in Korean War
• 1960
– Cardiopulmonary resuscitation
shown to be useful
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Origins of EMS: 1960–1970
•
Before 1966
– Volunteers untrained in emergency care
– Minimal stabilization at emergency scene
– Transport to nearest hospital often
provided by
•
•
•
Funeral homes
Taxis
Automobile-towing companies
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Origins of EMS
• 1966
– Accidental Death and Disability: The
Neglected Disease of Modern Society
• “The White Paper”
– Exposed inadequacies of prehospital
services
– Beginning of modern EMS
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Origins of EMS
Highway Safety Act of 1966
• Charged National Highway
Traffic Safety Administration
(NHTSA) with responsibility for
improving EMS
• Provided funding for programs
to reduce highway-accidentrelated deaths
• Established national standards
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Origins of EMS
1988 – 10 EMS System Components
1. Regulation and
policy
2. Resource
management
3. Human resources
and training
4. Communications
5. Transportation
6.
7.
8.
9.
Medical oversight
Trauma systems
Facilities
Public information
and education
10. Evaluation
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Origins of EMS – 1996
• 1996-EMS Agenda for the Future
– Proposed continued integration of EMS
into the healthcare system
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Origins of EMS-2006
• National EMS Scope of Practice Model which
confirmed the new label for the second level
of Emergency Medical Technician—Basic
(EMT-B) to EMT.
• Increases uniformity in EMS practice nationwide
and facilitates reciprocity between states.
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Origins of EMS-2009
• 2009-NHTSA National EMS Education
Standards
– Outlines the minimum objectives to be
covered by each level of EMS provider
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The Emergency Medical Services System
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The Emergency Medical Services System
• EMS system
– Coordinated network of resources
– Provides emergency care and
transportation to victims of sudden
illness or injury
• Healthcare system
– A network of people, facilities, and
equipment designed to provide for
the general medical needs of the
population
• EMS is a part of the healthcare system
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EMS System Components
Legislation & Regulation
• Each state must have
laws in place that
govern its EMS system
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EMS System Components
Communications
• An EMS system must
– Provide a means by which a citizen can
reliably access the EMS system (usually
by dialing 9-1-1)
– Allow contact between different agencies,
vehicles, and personnel
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EMS System Components
Communications
• 9-1-1
– Official national emergency number
in the United States and Canada
• Enhanced 9-1-1 (E9-1-1)
– Routes call to 9-1-1 center closest
to caller
– Automatically displays caller’s
phone number and address
– Most 9-1-1 systems today are
Enhanced 9-1-1 systems
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EMS System Components
Human Resources & Education
• Persons working in an EMS system are
expected to be trained to a minimum
standard
• National EMS Scope of Practice Model
– Defines four levels of EMS professionals
1. Emergency Medical Responder (EMR)
2. Emergency Medical Technician (EMT)
3. Advanced Emergency Medical Technician
(AEMT)
4. Paramedic
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EMS System Components
Human Resources & Education
• Emergency Medical
Responder (EMR)
– A person who has the basic
knowledge and skills necessary
to provide lifesaving emergency
care while waiting for the arrival
of additional EMS help
– Trained to assist other EMS
professionals
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EMS System Components
Human Resources & Education
• Emergency Medical
Technician (EMT)
– More skilled than an EMR
– Responds to emergency calls
– Provides efficient emergency
care to ill or injured patients
– Transports the patient to a
medical facility
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EMS System Components
Human Resources & Education
• Advanced EMT (AEMT)
– More skilled than an EMT
– Has additional training in skills including
the following:
• Patient assessment
• Giving intravenous (IV) fluids and medications
• Performing advanced airway procedures
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EMS System Components
Human Resources & Education
• Paramedic
– Can perform the skills of
an Advanced EMT
– Has had additional
instruction in
pathophysiology, physical
examination techniques,
assessing abnormal heart
rhythms using a heart
monitor, and invasive
procedures
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Right to Practice
• Statutes
• Certification
• Licensure
• Scope of practice
• Credentialing
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EMR Certification
• To be certified as an EMR, state agencies
require successful completion of an
approved EMR course
• National Registry of EMTs (NREMT)
requirements
• Participation in CE courses or an EMR
Refresher Course is required for
recertification
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Maintaining Knowledge and Skills
• An EMR’s education does not end with
completing the EMR course
• Must keep knowledge and skills current
– Continuing education (CE) courses
– Refresher courses
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EMS System Components
Transportation
• Safe transport
• Appropriately staffed and equipped vehicle
– Ground ambulance
– Air medical service
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EMS System Components
Medical Oversight
• Medical Oversight
– Process by which a physician
directs emergency patient care
provided by EMS personnel
– Every EMS system must have
medical oversight
– Physician who provides
medical oversight is called the
medical director
– Also referred to as medical
control or medical direction
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EMS System Components
Medical Oversight
• On-line medical direction
– Also called direct or concurrent medical
direction
– Direct communication with a physician
• Radio
• Telephone
• Face-to-face communication at the scene
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EMS System Components
Medical Oversight
• Off-line medical direction
– Also called indirect, prospective, or
retrospective medical direction
– Medical supervision through the use of:
•
•
•
•
•
Policies
Treatment protocols
Standing orders
Education
Quality management reviews
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EMS System Components
Medical Oversight
• Prospective medical direction
– Activities performed by a physician
medical director before an emergency
call
• Treatment protocols
• Standing orders
• Retrospective medical direction
– Actions performed by a physician after
an emergency call
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EMS System Components
Medical Oversight
• Treatment protocols
– List of steps to be followed during
provision of emergency care to an ill or
injured patient
• Standing orders
– Written orders authorizing EMS
personnel to perform certain medical
procedures before establishing direct
communication with a physician
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EMS System Components
Facilities
• An ill or injured patient receives definitive
care in the hospital
• Examples of specialty centers
–
–
–
–
–
–
–
–
–
Trauma centers
Burn centers
Heart/cardiovascular centers
Hyperbaric centers
Pediatric centers
Perinatal centers
Poison centers
Spinal cord injury centers
Stroke centers
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EMS System Components
Public Health & Injury Prevention
• Public health
– The science and practice of protecting and
improving the health of a community as a
whole.
• Healthcare professionals have a
responsibility to educate the public.
– Public education and injury prevention
programs often lead to more appropriate
use of EMS resources.
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EMS System Components
Evaluation
• Quality management
– A system of internal and external
reviews and audits of all aspects of an
EMS system
– Used to identify areas of the EMS
system needing improvement and
ensure that patients receive the
highest quality medical care
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Your Role in the Quality Management Process
• Quality management includes:
– Obtaining information from the patient,
other EMS professionals, and facility
personnel about the quality and
appropriateness of the medical care you
provided
– Reviewing and evaluating your
documentation of an emergency call
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Your Role in the Quality Management Process
• Quality management includes evaluating:
– Your ability to perform skills properly
– Your professionalism during interactions
with the patient, EMS professionals, and
other healthcare personnel
– Your ability to follow policies and
protocols
– Your participation in continuing education
opportunities
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Phases of a
Typical EMS Response
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Phases of a Typical EMS Response
1. Detection of the emergency
2. Reporting
– Call made for assistance
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Phases of a Typical EMS Response
3. Dispatch/Response
– Medical resources sent to the scene
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Phases of a Typical EMS Response
• On arrival at the scene, perform scene
size-up
– Look for hazards or potential hazards
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Phases of a Typical EMS Response
4. On-scene care
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Phases of a Typical EMS Response
5. Care during transport
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Phases of a Typical EMS Response
6. Transfer to definitive care
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Characteristics of
Professional Behavior
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Professional Behavior
Integrity
• Integrity
– Honesty, sincerity,
truthfulness
– Assumed by public
– Single, most important
behavior
– Integrity in all actions
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Professional Behavior
Empathy
• Empathy
– Identifying with and
understanding the
feelings, situations,
and motives of others
– Demonstrate empathy
to patients, families,
and other healthcare
professionals
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Professional Behavior
Self-Motivation
• Self-Motivation
– Internal drive for excellence
– Must also be self-directed
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Professional Behavior
Appearance
• “You never get a second chance to make a
good first impression.”
• Presenting a neat, clean, professional
appearance:
– Invites trust
– Instills confidence
– Enhances cooperation
– Brings a sense of order to an emergency
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Professional Behavior
Hygiene
• Good personal hygiene
– Bathing daily
– Using a deodorant or an antiperspirant
– Making sure hair, nails, and teeth are clean
• Good grooming
– Uniform that is clean, mended, and fits well
– Shoes that are clean, comfortable, provide
support, fit properly
– Wear a watch that displays seconds
– Fragrances should not be worn
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Professional Behavior
Self-Confidence
• You will encounter situations involving:
– Minor injuries
– Life-threatening injuries
– Patients and family members who are upset
• Others will look to you as the person in
control
• You must be able to:
– Adapt to these situations
– Remain calm
– Display confidence
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Professional Behavior
Communication
• Communication
– The exchange of thoughts, messages, and
information
– You must be able to convey information to
others verbally and in writing.
– You must also be able to understand and
interpret verbal and written messages.
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Professional Behavior
Respect
• Feeling and showing polite regard,
consideration, and appreciation for others
• Introduce yourself to your patient
– “Hello. My name is ______, and I am an
Emergency Medical Responder. I am here
to help you. What is your name?”
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Professional Behavior
Time Management
• You must be able to prioritize tasks,
while simultaneously providing
patient care, and work quickly to
accomplish those tasks.
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Professional Behavior
Teamwork / Diplomacy
• Teamwork
– Ability to work with
others to achieve a
common goal
• Diplomacy
– Tact and skill in dealing
with people
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Professional Behavior
Patient Advocacy
• An advocate is a person who supports
another.
– You must protect the patient from further
injury.
– If the patient is unable to speak, you must
be his voice and act in his best interests.
– You must protect the patient’s rights,
privacy, and dignity.
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Professional Behavior
Careful Delivery of Service
• Deliver the highest quality of patient care
with careful attention to detail
• Critically evaluate performance and attitude
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Duties as an
Emergency Medical Responder
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Standard of Care
• No matter where they work, EMRs are
expected to provide the same standard of
care in an emergency
• Standard of care
– Minimum level of care expected of
similarly trained healthcare professionals
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Your Obligations as an EMS Professional
• Respect each patient as an individual
• Provide emergency medical care to every
patient to the best of your ability
• Listen attentively to your patients
• Provide clear explanations
• Provide patients with emotional support
• Preserve each patient’s dignity during
examinations
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Your Obligations as an EMS Professional
• The emergency medical care you provide
must be based on need and without regard to
the patient’s:
–
–
–
–
–
–
–
–
–
Race
Ethnicity
National origin
Religion
Gender
Age
Mental or physical disability
Sexual orientation
Ability to pay for the care provided
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Primary Duties
Preparation and Safety
• Physical demands
– Stamina and endurance
– Walking, standing, and assisting in lifting
and carrying ill or injured patients
– Climbing and balancing may be required
– Patients may be accessible only if you
stoop, kneel, crouch, or crawl
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Primary Duties
Preparation and Safety
• Maintain your health by exercising regularly
– Improves muscle tone and circulation
– Provides physical release for stress
• Get adequate sleep and rest
• Practice good nutrition and keep
immunizations up to date
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Primary Duties
Preparation and Safety
• Appropriate equipment and supplies
• Adequate knowledge and skill maintenance
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Primary Duties
Preparation and Safety
• Safety
1. Personal
2. Crew
3. Patient
4. Bystanders
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Primary Duties
Response
• Safety
• Timeliness
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Primary Duties
Scene Assessment
• Size up the scene before initiating patient
care.
– Determine if the scene is safe.
– Identify the mechanism of injury or the
nature of the illness.
– Identify the total number of patients.
– Request additional help if necessary.
• Put on appropriate personal protective
equipment before approaching the patient.
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Primary Duties
Gaining Access
• Additional resources may be needed
– Law enforcement personnel
– Fire department
– Utility company
– Special rescue team
• Notify dispatch if resources are needed
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Primary Duties
Patient Assessment
• Perform a systematic patient assessment
• Obtain vital signs
• Gather information about the emergency
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Primary Duties
Emergency Care
• Give emergency medical care based on your
assessment findings.
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Primary Duties
Emergency Care
• Lifting and moving patients safely
– You must know the following:
• Body mechanics
• Lifting and carrying techniques
• Principles of moving patients
– You must be also familiar with equipment
used for lifting and moving
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Primary Duties
Emergency Care
• Once you begin emergency care, you must continue
that care until:
– An individual with medical training equal to or
greater than your own assumes responsibility for
the patient, or
– You are physically unable to continue providing
care because of exhaustion, or
– There is a change in the scene that weakens or
endangers your physical well-being or
– When an adult patient, of adequate mental
capabilities and fully informed of the risks and
benefits of treatment, elects to terminate care
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Primary Duties
Transfer of Care
• Identify yourself as an EMR
• Report the patient’s age, gender, primary problem,
and current condition
• Describe what happened and the position in which
the patient was found
• Describe pertinent assessment findings, including
vital signs
• Report any medical history obtained
• Describe the emergency medical care that you gave
• Describe the patient’s response to the treatment
given
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Verbal Report
•
Remember “The Four Cs” when giving a
verbal report:
1. Courteous
2. Clear
3. Complete
4. Concise
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Primary Duties
Documentation
• Documentation is an important part of
prehospital care
• Documentation must be:
– Accurate
– Complete
– Concise
• Documentation should reflect:
– What you saw and heard at the scene
– The emergency care you gave
– The patient’s response to that care
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Primary Duties
Returning to Service
• Rapidly prepare for the next call
– Clean equipment as needed
– Restock any disposable equipment used
– Return equipment to its storage area
• Know policies regarding restocking of
supplies
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Additional Duties
Community Involvement
• Become actively involved in public education
– How to access the EMS system
– Injury prevention programs
•
•
•
•
•
Bicycle safety
Use of child safety seats
Poisoning prevention
Drowning prevention
CPR and first aid programs
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Additional Duties
Personal Professional Development
• Healthcare professionals are responsible for
their personal professional development.
• Examples:
–
–
–
–
Participating in continuing education activities
Mentoring
Getting involved in professional organizations
Supporting and participating in research activities
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EMS Research
• Research is the foundation for medical
practice decisions and changes in patient
management.
• If you are asked to participate:
– Approach this responsibility seriously
– Complete the task assigned to the best of
your ability
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Questions?
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