chapter 1

Class Year Requirements & Documentation

• If graduated high school: Submit a copy of your diploma.

• If still in high school: Submit proof of 11th-grade math and English completion (transcript).

• Valid driver's license required.

• All forms provided must be returned.

• Centralized Record Keeping: Instructor maintains a folder for each student to track records throughout the class.

Email Communication

• Consolidate documents (driver's license, immunizations, diploma) into a single email.

• Use your name as the email subject.

Americans with Disabilities Act (ADA)

• Licensing Requirement: Compliance with ADA is mandatory.

• Reasonable Accommodations: Must be offered to individuals with disabilities that don't prevent job performance.

• Examples of disabilities recognized by the government:

  • Blindness

  • Deafness

  • Autism (Example: a highly skilled autistic paramedic who requires a social partner for patient/family interaction)

  • ADHD

  • Diabetes

  • Post-childbirth (temporary, requiring accommodations for pumping)

• Title I of ADA: Protects EMTs with disabilities seeking employment; requires adjustments to work environment or job duties.

Background Checks

• Required for Clinicals: Performed to comply with state regulations.

• Transparency is Important: Disclose any records to the instructor to assess potential issues with state testing eligibility.

• Misdemeanors and Felonies: Can prevent state licensure in most states.

EMS Training and Licensure Levels

• Four Levels:

  • Emergency Medical Responder (EMR)

  • Emergency Medical Technician (EMT): This class is for EMT basic.

  • Advanced Emergency Medical Technician (AEMT)

  • Paramedic

• Emergency Medical Responder (EMR)

  • Skills: Trained in basic first aid and utilizing available resources for emergency care until EMS arrival.

  • Role: Often members of rescue squads.

• Emergency Medical Technician (EMT)

  • Skills: Basic life support, AEDs, airway adjuncts, assisting with medications, patient care, packaging, and transport.

  • Training: Ambulance operation and driving.

• Advanced Emergency Medical Technician (AEMT)

  • Differences from EMT: Expanded drug pool, can initiate IVs, and intubate.

• Paramedic

  • Skills: Advanced medical interventions, including intubation, IV starts, drilling into the bone, administering all medications, and cardiac monitoring with the ability to shock based on rhythm interpretation.

  • Note: They can perform many procedures that doctors can but receive less pay.

  • EMT vs. Paramedic: EMTs use AEDs that advise on shock, while paramedics interpret cardiac rhythms to determine the necessity of a shock.

EMS System Overview

• Team of healthcare professionals providing emergency care and transport.

• Core Principle: "Do no harm."

• Goal: Improve the patient's condition.

• Reality: Patient conditions may worsen despite best efforts.

• Humility is Essential: Avoid overconfidence and prioritize continuous learning.

• Mistakes Happen: Focus on correcting errors and learning from them.

State Laws and Regulations

• Govern actions through standard operating procedures, policies, and protocols.

• EMT Role: Backbone of EMS in the United States due to high numbers compared to other levels.

• Paramedic Shortage: Nation-wide scarcity.

• AEMT: Many agencies prioritize EMT or Paramedic levels instead.

History of EMS

• Early EMS: Funeral homes provided ambulance services, transporting both the living and the deceased.

• Volunteer Ambulances: World War I, Red Cross involvement.

• Combat Medics: Korean War, field medics, and helicopter evacuations improved field care.

• 1966: "Accidental Death and Disability: The Neglected Disease of Modern Society" (The White Paper) highlighted EMS deficiencies, revealing higher mortality rates than war zones.

• Early 1970s: Department of Transportation (DOT) established first EMT training.

• EMS Classification: Congress classifies EMS as medical taxis under DOT, not fire or law enforcement.

• 1971: American Association of Orthopedic Surgeons (AAOS) partnered with DOT to create the first Nancy Caroline textbook.

• 1973: Emergency Medical Services Act provided funding for developing systems and required training.

Standardization of Efforts

• EMS Standardization: Not yet standardized despite curriculum implementation in 1970. Nursing standardization began around 1860 and took approximately 60 years.

• Variability: Policies, procedures, and protocols differ across counties.

• 1970s: National standard curriculum created by DOT.

• 1980s: Enhanced EMT training with advanced-level content.

• 1990s: National Highway Traffic Safety Administration (NHTSA) developed EMS Agenda for the Future to standardize EMS by 2050.

• 2019: The agenda was finalized, focusing on HR involvement and encouraging field work.

Instructor Requirements

• Restrictions: Instructors need a bachelor's, master's, or Ph.D. and paramedic certification with national accreditation.

EMS Institutions Requirements

• National Standards: EMS institutions must adhere to national standards and submit annual audits.

Continuing Education

• Con Ed: Continuing education and refresher courses improve knowledge.

• Refresher Courses: Review base knowledge.

• Con Ed Courses: Required every four years for recertification to update and expand knowledge; documented in a transcript.

National EMS Scope of Practice

• Three Levels Involved:

  • Federal Level: Develops comprehensive guidelines.

  • State Level: Adapts federal guidelines.

  • Local Level: Medical directors (physicians) create protocols for the county.

• Medical Director: A physician who partners with the EMS agency at the county level.

• Licensure: EMTs operate under the medical director's license.

• Responsibilities: The medical director is responsible for the actions performed by EMTs.

• Standing Orders: Actions that EMTs can take without permission.

• Liaison: The medical director acts as a liaison between medical community and other agencies.

• Coordination: Local-level protocols are based on hospital care.

Quality Assurance and Improvement (QA/QI)

• Medical Director Responsibility: Based on evidence-based treatment with documentation for every patient interaction.

• Documentation

  • Detailed documentation is essential due to potential lawsuits up to 7 years after patient contact, ensuring clear records of actions and outcomes.

• Purpose: Chart reviews to assess treatment appropriateness and ways to improve and develop standing orders.

• Example: Gaston County EMS lost intubation privileges due to a low success rate (13% versus 72% state average).

EMS Finance and Personnel

• Personnel: Paid, volunteer, or a combination.

• Billing Limitations: Can only bill if drugs are given or transport is performed; abuse occurs.

• Centers for Medicare & Medicaid Services (CMS): In 2020, The CMS implemented Emergency Triage, Treat, and Transport (ET3), reimburses based on their opinion of appropriate care, affecting agency finances if care is deemed unnecessary.

EMT Responsibilities

• Insurance Information: Collect and obtain signatures and permissions for billing and HIPAA compliance (ensuring patient privacy).

• Primary Prevention: Prevent events from occurring.

  • Example: Community education on safety & car seat installation.

• Secondary Prevention: Strategies implemented after an event.

  • Example: Motorcycle helmet and seat belt laws.

• Vehicle and Equipment Readiness: Preparedness for emergency response.

• Safety: Prioritize personal, partner, and patient safety.

• Scene Evaluation: Assess and lead on-scene.

• Resource Management: Call for additional resources if needed.

• Patient Access: Gain access to the patient.

• Assessment: Perform thorough patient assessments.

• Emergency Care: Provide emergency medical care while awaiting additional resources.

• Emotional Support: Offer emotional support to patients.

• Incident Resolution: Resolve emergency incidents effectively.

• Continuity of Care: Maintain continuity of care.

• Medical and Legal Standards: Uphold these standards.

  • HIPAA: Health Insurance Portability and Accountability Act; protects patient privacy.

    • Confidentiality: Protect health records, age, name, date of birth, and address.

    • Law Enforcement: Cannot disclose patient information to law enforcement without permission (even in cases like drunk driving).

    • Consequences: HIPAA violations can lead to lawsuits and credential loss.

• Administrative Support: Provide administrative support.

• Community Relations: Foster relations with patients and agencies.

• Getting Back to Profession: Promote the profession.

HIPAA Clarification

• Law enforcement must obtain information independently, but it's permissible to ask the patient directly for permission to share information.

• Non-Violation Example: Moving an item to conceal it during treatment.

• Honesty: Be honest with patients about limitations and ask for permission to share sensitive information.

• Prioritize Patient Care: Patient care prevails.

Review Questions Overview

• Standing Orders: An example is administering oxygen to a patient with difficulty breathing, as it doesn't require permission; instead, these are actions that EMT's can take without permisssion.

• Quality Control: EMS system is is responsible for the Medical Director.

• Domestic Dispute: Prioritize personal safety by securing the scene.

• Continuous Quality Improvement (CQI): Focuses on positive feedback loops, ensuring and maintaining standards of care by run report reviews & improve through remedial training for personal.

• Medical Director Responsibilities: Ensuring appropriate EMS education and continued training.

• Disqualification: Driving under the influence (DUI) would disquality someone for EMS.

• EMT Priority: Ensuring personal safety.

• Cardiac Monitoring: Requires a paramedic.

• Professional Responsibility: Maintaining a professional demeanor in stressful situations.

• Emergency Care Phases: Incident recognition is first.