EMS System Notes

The emergency department serves as the gateway for the rest of the services offered by the hospital.
When a patient is brought to the emergency department with serious injuries, care is given to stabilize the patient, and the operating room is ready to provide further life saving measures.

Some hospitals handle all routine and emergency cases, but have a specialty that sets them apart from other hospitals.
A trauma center is a specialty facility where the surgery teams capable of comprehensive treatment of trauma patients are available twenty four hours a day.
In addition to trauma centers, there are hospitals that specialize in care for specific conditions and patients, such as burn centers, pediatric centers, cardiac centers, and stroke centers.
As an EMT, you will become familiar with the hospital resources available in your area; many EMS regions have specific criteria for transporting patients with special needs.

Choosing the right hospital may actually be a lifesaving decision.
It is important to weigh the patient’s condition against the additional transport time that may be required to reach a specialized facility.
Online medical direction may be available to help with this decision.

For $99\%$ of the population, a 911 system provides telephone access to report emergencies.
A dispatcher answers the call, takes the information, and alerts EMS, the fire department, and law enforcement as needed.
According to the National Emergency Number Association, about $240{,}000{,}000$ calls are received by nine-one-one centers each year, and more than $80\%$ of those calls come from mobile devices.
Wireless carriers and nine-one-one centers are working together on two phases of development so that emergency dispatchers can see the number the mobile caller is calling from (phase 1) and identify the actual physical location of the mobile device (phase 2).
Success in developing this capacity will have a huge impact on locating and providing care to ill or injured callers.

VoIP (voice over Internet protocol) also poses challenges for communication centers in locating callers.
Technological solutions are in the works to address VoIP issues.
Enhanced nine-one-one centers have the capability of identifying the caller’s landline phone number and location automatically, and some have the additional capability of locating wireless callers.
This enables dispatchers to send emergency personnel to the scene even if the phone is disconnected or the patient loses consciousness.

Another development is the training and certification of emergency medical directors (EMDs).
EMDs are specially trained dispatchers who obtain the appropriate information from callers and provide medical instructions for emergency care, including CPR, artificial ventilation, bleeding control, and more.
Research has consistently pointed to the importance of early access and prompt initiation of emergency care and CPR.
The EMD is one example of the EMS system providing emergency care at the earliest possible moment.

There are four general levels of EMS training and certification; levels may vary slightly by region. Your instructor will explain regional variations.

1) Emergency Medical Responder (EMR)

This level is designed for people who are often first at the scene (e.g., many police officers, firefighters, and industrial health personnel).
Emphasis is on activating the EMS system, providing immediate care for life-threatening injuries, controlling the scene, and preparing for arrival of the ambulance.

2) Emergency Medical Technician (EMT)

In most areas, EMT certification is the minimum level for ambulance personnel.
EMTs provide basic level medical and trauma care and transportation to a medical facility, and frequently work with advanced level EMS providers.

3) Advanced Emergency Medical Technician (AEMT)

Like the EMT, the AEMT provides basic level care and transportation, but also provides some advanced level care.
Advanced care may include use of advanced airway devices and administration of some fluids or medications via intravenous (IV) or intraosseous routes.

4) Paramedic

The paramedic performs all of the skills of the EMT and AEMT plus additional advanced level assessment, decision making, and skills.
The paramedic provides the most advanced level of prehospital care.
In some states, specially trained registered nurses and physicians can also hold prehospital certification and provide even more advanced patient care as part of the prehospital EMS system.
Figure 1-3 (left): As an EMT, you will work with patients of many ages, from older adults to newborns. (Right): Specially trained physicians and RNs may provide advanced care as part of the prehospital care in some EMS systems. Some states have a prehospital EMS system that can provide more patient care at the scene.

A key concept: critical decision making is very important. It essentially means that an EMT takes information from the scene, the patient assessment, and other sources and makes appropriate decisions after synthesizing or interpreting all the information.
There are times when the information you obtain initially won’t be enough to be a basis for decision making.
When this happens, you will need to ask more questions and perform additional examinations to get everything you need to make a decision.
It may be difficult to see how this all fits together now, but you’ll be practicing patient assessment and care as you progress.
Examples of critical decision making in the assessment and care you will perform:
- Deciding which hospital to transport someone to: should you take the patient to the closest hospital or to a more distant specialty hospital?
- Deciding whether you should administer a medication to a patient: will it help the patient’s current condition? could it make the condition worse?
As you work with more experienced EMS providers, you will encounter many who are smart and know what to do and how to treat patients, both clinically and personally. These EMS professionals are good critical decision makers.

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