Chapter 1: EMS Systems

EMS Systems: Introduction

• Introduction to Emergency Medical Services (EMS)

  • Apply fundamental knowledge of emergency medical care.

  • Address safety, well-being, medical, legal, and ethical issues.

  • Overview of the EMS system's history, responsibilities, and roles.

  • Discuss quality improvement and patient safety.

  • Explore the impact of research, EMR (Electronic Medical Record), data collection, evidence-based decision-making, and public health.

Key System Components

• EMS is a system comprised of healthcare professionals who provide emergency care and transport, governed by state laws (e.g., Virginia Office of EMS).

• EMT's are part of a larger team including firefighters and traffic directors working together at the scene.

Levels of Certification

• Four Levels of Certification

  • Emergency Medical Responder (EMR)

    • Basic training, often seen in police officers.

    • Provide care before ambulance arrival and assist EMTs.

  • Emergency Medical Technician (EMT)

    • Training in Basic Life Support (BLS), including AED, airway adjuncts.

  • Advanced EMT (AEMT)

    • Training in specific aspects of Advanced Life Support (ALS), such as starting IVs and administering more medications.

  • Paramedic

    • Extensive ALS training, including endotracheal intubation, advanced medications, and cardiac monitoring.

Airway Adjuncts

• Airway adjuncts are used to control and manage the airway.

• Nasopharyngeal airway: goes down into the nose.

• Oropharyngeal airway: goes into the mouth.

Medications

• Oxygen: The number one medication given by EMTs.

• Oral Glucose: Given to diabetic patients.

• Albuterol: Assisted medication for respiratory issues (e.g., asthma).

• Aspirin: Given for chest pain related to a heart condition (angina).

• Naloxone (NARCAN): Used for drug overdoses.

EMT Course Activities

• Learning activities include reading assignments, lectures, classroom discussions, step-by-step demonstrations, skill sheets, and case presentations and scenarios.

EMT Requirements

• High school diploma or equivalent.

• Proof of immunization.

• Successful completion of background check and drug screening.

• Valid driver's license.

• Completion of required course and certification exam.

• Demonstration of medical, mental, and physical abilities.

• Compliance with state and local employee provisions.

History of EMS

• Developed during wartime due to mass casualties.

  • World War I: volunteer ambulances.

  • World War II: field care.

  • Korean War: introduction of field medics and surgical facilities near the battlefield.

  • The use of helicopters to transport injured people from the battlefield evolved into the concept of the "golden hour".

• Accidental Death and Disability: The Neglected Disease of Modern Society (the "white paper") established EMS due to inadequate prehospital care, especially for car accident victims.

EMS Development

• Early 1970s: DOT (Department of Transportation) published the first EMT training curriculum due to auto accidents.

• 1973: Emergency Medical Service Act provided federal funding for states to set up EMS systems.

• 1971: AAOS (American Academy of Orthopaedic Surgeons) produced the first EMT textbook.

Local Level

• Each jurisdiction has a medical director (e.g., Dr. Clifford) who provides oversight and support.

• The medical director must sign off on documentation for students to take the certification exam.

Standards

• Medical direction from the medical director.

• EMS administration and regulatory roles at the state level.

• Scope of practice determined nationally.

Emergency Medical Responders

• Emergency medical responders (law enforcement) initiate immediate care and assist EMTs.

• Their training focuses on providing BLS, such as controlling bleeding and performing CPR and AED.

• The EMT course requires approximately 150 to 200 hours.

EMT Responsibilities

• Assume responsibility for assessment, care, packaging, and transport of patients.

• Advanced EMTs can perform IV therapy and use advanced airway adjuncts.

• Paramedics receive additional training (1000-1300 hours) in the classroom, clinical settings, and field training.

Components of EMS System

• Comprehensive quality and convenient care.

• Evidence-based clinical care.

• Efficient and well-rounded care.

• Preventative care.

• Comprehensive and easily accessible patient records.

• Public Access: 911 system

• Dispatchers: Gather information, dispatch resources, and provide guidance to callers.

• Emergency Medical Dispatchers (EMDs) are certified to provide pre-arrival instructions.

Medical Director Authority

• Physician provides medical direction and grants authority to function under their license.

• Standing orders and protocols allow EMTs to perform certain tasks independently.

• Medical control can be offline (standing orders) or online (direct communication with a physician).

• Legislation and regulations: Training protocols follow state legislation.

• Senior EMS officials handle administrative tasks, such as personnel, budget, purchasing, and vehicle maintenance.

Integration of Health Services

• Prehospital care is coordinated with hospital care and continues in the emergency department.

• Mobile Integrated Health Care (MIH) addresses chronic medical conditions to reduce 911 calls and ED visits; community paramedics stabilize patients at home.

Information Systems

• Computerized systems are used to document patient care, improve overall status in the jurisdiction and make sure that providers are properly documenting patient care.

• Important concept: Who is responsible for mainting quality control? The medical director.

Quality Improvement

• Promotes a learning culture that holds employees accountable for behavioral choices and balancing CQI reviews and performs audits.

• EMS systems review run reports to ensure proper care and identify areas for improvement.

• Focus on minimizing medical errors, through rules based failure,skill based failure, or knowledge based failure

• Positive reinforcement is preferred over negative reinforcement.

System Finance

• Finance systems depend on the organization is involved with.

• Collecting billing information.

• EMS Billing: insurance companies pay if documentation is correct.

• 2020: Centers for Medicare and Medicaid implemented a pilot program to reimburse EMS systems for providing the right care.

Education Systems

• EMS instructors must be licensed in the state and certified as education coordinators (ECs).

• Continuing education: Recertification is required every two years, involving a certain amount of continuing education hours.

Public Education and Prevention

• Emphasis on prevention through child safety seats, bicycle helmets, and safe storage of medications.

Accomplishments

• Seat belt laws, tobacco use restrictions in restaurants, and helmet laws.

EMS Research

• Evidence Based Medicine (EBM): Studies determine the effectiveness of EMS practices.

• Example: The esophageal obturator airway (EOA) was found to be harmful and is no longer used.

Roles and Responsibilities

• Keep vehicles and equipment ready.

• Ensure safety.

• Be familiar with EMS operations.

• Arrive on scene leadership and perform scene evaluation.

• Call for additional resources.

• Gain patient access.

• Perform patient assessment.

• Provide medical care.

• Give emotional support.

• Maintain continuity of care.

• Resolve emergencies.

• Uphold medical and legal standards.

Personal Attributes

• Integrity, empathy, self-motivation, professional appearance and hygiene, and self-confidence are vital.

• Trial management, communications, teamwork, diplomacy, and respect are essential professional attributes.

• Patient advocacy means fighting for the best possible care for the patient.

• Every patient is entitled to compassion, respect, and the best possible care.

Patient Confidentiality

• Maintaining patient confidentiality is important.

• HIPAA is what keeps people's patient information safe.