EMT Chs. 1-4

EMS system

team of health care professionals that provides prehospital emergency care and transport and is governed by state laws

Licensure

process by which states ensure applicant competency and manage who can function as a health care provider

Four levels of EMS licensure

EMR - EMT - AEMT - Paramedic

EMR (emergency medical responder)

first responder such as a police officer or firefighter trained to give immediate BLS and urgent care with limited equipment and assist EMTs on arrival

EMT

backbone of the US EMS system who provides basic emergency care and on arrival assumes responsibility for assessment and care and packaging and transport of the patient

EMT course length

approximately 150 to 200 hours

AEMT

adds IV therapy and advanced airway adjuncts and a limited number of medications to EMT skills

Paramedic

highest level with 1000 to more than 1300 training hours covering endotracheal intubation and emergency pharmacology and cardiac monitoring

EMT licensure requirements

high school diploma or equivalent - immunizations - background check and drug screening - valid driver's license - BLS CPR course - state-approved EMT course - written exam - practical exam - mental and physical ability to perform the job

Americans with Disabilities Act (ADA) of 1990

protects people with disabilities from being denied access to government programs and services and prohibits employers from denying equal employment

Title I of the ADA

protects EMTs with disabilities seeking employment and may require modifying the work environment or how the job is performed

Origins of EMS

volunteer ambulances in World War I - field care in World War II - field medic and rapid helicopter evacuation in the Korean conflict

The White Paper

1966 publication Accidental Death and Disability: The Neglected Disease of Modern Society that is the origin of EMS as we know it today

Emergency Medical Services Act of 1973

created funding sources and programs to develop improved systems of prehospital emergency care

First EMT curriculum

published by the DOT in the early 1970s

First EMT textbook

prepared and published by the American Academy of Orthopaedic Surgeons in 1971

National Standard Curriculum

recommended curriculum developed by the DOT in the late 1970s

EMS Agenda for the Future

1990s NHTSA document with a plan to standardize levels of EMS education and providers

EMS Agenda 2050

2019 NHTSA revision of the EMS Agenda for the Future describing a people-centered EMS system

National EMS Scope of Practice Model

federal guidelines for the minimum skills each level of EMS provider should be able to accomplish

State role in EMS

laws regulate EMS provider operations

Local role in EMS

medical director provides daily oversight and support to EMS personnel

Agenda 2050 components

comprehensive quality convenient care - evidence-based clinical care - efficient well-rounded care - preventive care - comprehensive and easily accessible patient records

Public access

easy access to help in an emergency with 9-1-1 as the public safety access point

Emergency medical dispatch (EMD)

system that helps dispatchers give callers vital medical instructions until EMS arrives

Human resources (EMS component)

focuses on the people who deliver the care

Medical director

physician who authorizes EMTs to provide medical care in the field and acts as ongoing liaison between the medical community and hospitals and EMTs

Protocols

comprehensive guide that outlines the EMT scope of practice

Standing orders

part of protocols that designate what the EMT is required to do for a specific complaint or condition

Standing orders and medical direction

providers are not required to consult medical direction before implementing standing orders

Off-line medical control (indirect)

standing orders and training and supervision

Online medical control (direct)

physician directions given over the phone or radio

Legislation and regulation

EMS training and protocols and practices must follow state legislation and rules and guidelines

Integration of health services

prehospital care continues in the emergency department to ensure continuity of care

Mobile integrated healthcare (MIH)

delivering health care within the community rather than at a physician office or hospital by an integrated team to improve access at an affordable price

Community paramedicine

experienced paramedics receive advanced training to provide community services such as health evaluations and monitoring chronic illness and obtaining lab samples and giving immunizations

Information systems

computer systems used to document patient care and store data that can improve care

Just Culture

promotes a learning culture that holds employees accountable for behavioral choices by balancing fairness and accountability

Continuous quality improvement (CQI)

reviews and audits the EMS system to find areas of improvement or assign remedial training with the goal of minimizing errors

CQI cycle

plan-do-study-act

Types of medical errors

rules-based failure - knowledge-based failure - skill-based failure

System finance EMT tasks

gather insurance information - secure signatures such as HIPAA notifications - obtain written permission to bill the patient's insurance

ET3 (Emergency Triage Treat and Transport)

2020 CMS pilot program that reimburses EMS for the right care at the right time including transport to alternative destinations or on-scene treatment with no transport

EMS education accrediting organizations

CoAEMSP and CAAHEP

Public health

examines the health needs of entire populations with the goal of preventing health problems

Primary prevention

strategies that prevent the event from ever happening such as pool safety and car seat education

Secondary prevention

occurs after the event has happened and aims to decrease its effects such as using helmets and seat belts

Evidence-based medicine (EBM)

focuses on procedures that have proven useful in improving patient outcomes

National Model EMS Clinical Guidelines

guidelines from NASEMSO based on current research and expert consensus

EMT roles and responsibilities

keep vehicle and equipment ready - ensure safety of self and partner and patient and bystanders - operate the vehicle - lead on scene - evaluate the scene - call for resources - gain patient access - assess the patient - give emergency care - give emotional support - maintain continuity of care - uphold medical and legal standards - protect privacy

Integrity

adhering to a code of fair and honest behavior

Empathy

being aware of and thoughtful toward the needs of others

Self-motivation

discovering problems and solving them without someone directing you

Appearance and hygiene

using your persona to project trust and professionalism and knowledge and compassion

Self-confidence

knowing what you know and what you do not know and being able to ask for help

Time management

performing or delegating multiple tasks while ensuring efficiency and safety

Communications (attribute)

understanding others and making yourself understood

Teamwork and diplomacy

working with others and knowing your place within a team and communicating with respect for the listener

Respect

placing others in high regard and understanding that others are more important than you

Patient advocacy

constantly keeping the needs of the patient at the center of care

Careful delivery of care

paying attention to detail and making sure care is done as safely as possible

Patient confidentiality

patient findings and disclosures are discussed only with those treating the patient or as required by law with police or social service agencies

HIPAA (Health Insurance Portability and Accountability Act)

law that protects patient privacy

Wellness

active pursuit of a state of good health

Resilience

capacity of an individual to cope with and recover from distress

Eustress

positive stress response that increases focus and short-term energy and long-term job satisfaction

Distress

negative stress response

Stress management

tactics shown to alleviate or eliminate stress reactions

Ways to increase resilience

healthy diet - 7 to 9 hours of sleep - positive relationships - peer relationships - daily exercise - mindfulness and positivity

Complex carbohydrates

pasta and rice and vegetables that are reliable sources of long-term energy

Fats and diet

easily converted to energy but too much can lead to obesity and cardiac disease

Best fluid for hydration

water

Exercise recommendation

at least 30 minutes of moderate or vigorous activity 5 days per week including cardio and strength and flexibility

Recommended adult sleep

minimum 7 to 9 hours per night

Short-term effects of sleep deprivation

medical errors and vehicle crashes and harm to patients and bystanders and providers

Long-term effects of sleep deprivation

hypertension and sleep apnea and respiratory issues and diabetes and depression

Fatigue management guidelines

shifts shorter than 24 hours - access to caffeine - opportunity to nap on duty - fatigue education and training - fatigue measuring instruments

Nap recommendation for shift work

20 to 30 minute naps or rest breaks where allowed

Disease prevention

focuses on medical care to avoid or reduce the effect of disease on an individual

Health promotion

focuses on personal practices and social habits to improve health

Smokeless tobacco

associated with cancers of the throat and mouth and pancreas

Acceptable alcohol consumption

one drink per day for women and two drinks per day for men

Infectious disease

disease caused by harmful organisms within the body

Communicable disease

disease that can be spread from person to person or from one species to another

Pathogen

microorganism capable of causing disease in a susceptible host

Contamination

presence of pathogens or foreign bodies on or in objects such as dressings or water or food or needles or wounds or a patient's body

Exposure

contact with blood or body fluids or tissues or airborne particles in a manner that may allow disease transmission

Personal protective equipment (PPE)

protective equipment worn to prevent exposure to a pathogen or other hazardous condition

Direct contact transmission

spread through direct contact such as bloodborne pathogens

Indirect contact transmission

spread through a contaminated object such as needlesticks

Airborne transmission

spread through the air such as sneezing

Foodborne transmission

spread through contaminated food

Vector-borne transmission

spread by an animal or insect such as fleas

OSHA

develops and publishes and enforces guidelines to reduce hazards in the workplace

Standard precautions

CDC protective measures that treat every person as potentially infected to prevent contact with blood and body fluids and other risks

Universal precautions

OSHA term for the same concept as standard precautions

Donning

putting on PPE in a consistent sequence

Doffing

taking off PPE in a consistent sequence

Common PPE components

mask - eyewear or full face shield - gloves - gown

Hand hygiene

simplest and most effective way to control disease transmission - wash before and after patient contact even if gloves are worn