Chapter 1 Emergency Care

Modern Health Care

-complex

-rapidly changing

-specialized providers

How is modern health care rapidly changing?

through new research, practice guidelines, and position statements

Examples of specialized providers

-pharmacists

-diagnosticians

Collaborative Practice

multiple HCPs from different professional backgrounds work together with patients, families, caregiver, and communities to deliver care

Team-Based Health Care

health care services provided by at least two HCPs

Examples of health care teams

-disaster response

-emergency procedure

-hospital team

-home health care team

Characteristics of a good team

team members including the patient…

-communicate

-know their roles and roles of others

-interact with one another to achieve a common goal

-act as a collective unit

Guiding principles of inter professional collaborative health care team

-shared goals

-clear roles

-mutual trust

-effective communication

-measurable processes and outcomes

An AT is a HCP that…

-collaborates with physicians

-provides acute and emergency care

-develops and implements EAPs

-evaluates, recognizes, diagnoses, refers, and treats injuries

-established criteria and implements safe RTP

-plans and implements injury prevention programs

-operates and maintains treatment facilities

-maintains accurate medical records

Role of EMR — First Responder

-work alongside other EMS and HCPs

-provide initial immediate life-saving care to critical patients (CPR, stop the bleed, etc.)

-work under medical oversight

EMR Skills

-AED, CPR, and first aid

-administering unit dose auto-injectors

-bleeding control

-extrication procedures

Role of EMT

-mid-level pre-hospital care provider

-provides basic emergency medical care and transportation

-transports all emergency patients to appropriate medical facilities

-works under medical oversight

EMT Skills

-insertion of oral- or nasal- pharyngeal or supraglottic airways

-positive pressure ventilation

-administers over-the-counter medications with appropriate medical oversight

-application and inflation of PASG for fracture stabilization

Role of AEMT

-provide basic and limited advanced emergency medical care and transportation

-commonly found in fire departments as non-transporting first responders

-work under medical oversight

AEMT Skills

-establish and maintain peripheral intravenous access or intraosseous access in pediatric patients

-administer (non medicated) intravenous fluid

-administer sublingual nitroglycerine, epinephrine, and narcotic antagonist

Role of Paramedic

-HCP in pre-hospital and out-of-hospital setting

-scope of practice includes autonomous decision making

-competent in skills of an EMT and AEMT, as well as more advanced skills

Paramedic Skills

-airway — emergent percutaneous techniques

-pharmacological —-insert intraosseous cannula, administer medication by IV, maintain blood or blood products infusion

-cardiac care — perform cardioversion, manual defibrillation, and transcutaneous pacing

-does NOT include surgical access using a scalpel

Are ER and ED the same?

NO

-ED encompass many specialities to care for critical or emergency patient conditions

Anesthesiology/ist

-difficult airway

-pain relief

-care of patient before, during, and after surgery

Cardiology/ist

-heart attack

-insert stents

-pacemakers

-valves

Cardiothoracic surgery

-chest tube

-surgery for trauma to heart, lungs, large vessels

Critical/Intensive Care

-diagnose and manage life-threatening conditions

-resuscitation

-sophisticated organ support

-invasive monitoring

Emergency Psychiatry

-identify and treat attempted suicide

-drug dependence

-alcohol intoxication

-acute depression

Neurology/ist

-manage TBI

-strokes

-epilepsy

Obstetrics and Gynecology (OBGYN)

-diagnose a pregnant patient with vaginal bleeding

Pediatric Emergency Medicine

-care of undifferentiated acute illnesses or injuries in children

Plastic Surgery

-suture a complex laceration

-reconstructive surgery

-craniofacial surgery

-hand surgery

-microsugery

-burn treatment

Trauma Surgery

-initial reconstruction and stabilization of traumatic injuries

-leads trauma team

Marriage and Family Therapist (MFT)

-provides psychotherapy for families and couples

Social Worker

-assesses psychosocial functioning of patients and families

Speech Language Pathologist (SLP)

-evaluates, diagnoses, and treats communication, cognition, voice, and swallowing disorders

Types or Errors

system and human

System Error

-action does not occur as intended

-action is wrong

Human Error

-rule based

-knowledge based