Hi and welcome to EMT Basic. On behalf of RC Health Services, my name is Sean Holt and I wanted to welcome you to the class. We're going to start today with Chapter 1, which is EMS Systems. The text is the primary resource for the EMT course. It discusses what will be expected of you during the course and what other requirements you will have to meet to be licensed or certified.
as an EMT in most states. You will learn the differences between first aid training, a Department of Transportation EMR training course, and the training courses for an EMT, an AEMT, and paramedic. EMS is a system. Chapter 1 discusses that system's key components.
So an EMS system consists of a team of healthcare professionals, provides emergency care and transport, and is governed by state laws. After you successfully complete this course, you should be eligible to take either the National Registry of EMTs exam or your state's certification exam. After you pass the certification exam, you are eligible to apply for state licensure.
Licensure is a process by which state ensure applicant competency in an examination setting. This allows states to manage who can function as a health care provider. In most states, there are four training and licensure levels. One, EMR.
Two, EMT. Three, AEMT. And at the highest level, four, paramedic.
An EMR has very basic training. They provide care before ambulance arrives, and they may assist in ambulance operations. An EMT has training in basic life support, including the use of automated external defibrillators, airway adjuncts, and assisting patients with certain medications. An AEMT or advanced EMT has training in specific aspects of advanced life support or ALS, including intravenous therapy or IV therapy, administration of a limited number of emergency medications.
And a paramedic has extensive ALS training, including endotracheal innovation, emergency pharmacology, cardiac monitoring, and other advanced assessment and treatment skills. The EMT course includes four learning activities, reading assignments, lecture presentations, and classroom discussions, step-by-step demonstrations, summary skill sheets, case presentations, and scenarios. EMTs are the backbone of the EMS system in the United States.
They provide emergency care to the sick and injured. Requirements differ from state to state. Generally, the requirements to be licensed and employed as an EMT are a high school diploma or equivalent, proof of immunizations against certain communicable diseases, and successful completion of a background check and drug screening and a valid driver's license.
Successful completion of a recognized healthcare provider BLS cardiopulmonary resuscitation course. Successful completion of a state-approved EMT course. Successful completion of a state-recognized written certification exam. Successful completion of a state-recognized practical certification exam.
Demonstration of the mental and physical abilities necessary to safely and properly perform all the tasks and functions. described in the defined role of an EMT, and compliance with other state, local, and employer provisions. The Americans with Disabilities Act of 1990 does multiple things for us.
It protects people who have a disability from being denied access to programs and services that are provided by state or local governments, prohibits employers from failing to provide full and equal benefit for employment to the disabled. and Title I protects EMTs with disabilities who are seeking gainful employment under many circumstances. Employers with a certain number of employees are required to adjust processes so that a candidate with a disability can be considered for a position and modify the work environment or how the job is generally performed.
Personal background in accordance with state criminal requirements, states have various requirements. requirements for prohibiting individuals who have committed either misdemeanors or felonies from becoming EMS providers. An overview of the EMS systems.
Volunteer ambulance in World War I, field care in World War II, and field medic and rapid helicopter evacuation in the Korean conflict. As recently as the 1960s and early 1970s, emergency ambulance service and care varied widely in the United States. EMS as we know it today originally made it in 1966 with the publication of accidental death and disability, the neglected disease of modern society, also more commonly known as the white paper.
The Emergency Services Act of 1973 created funding sources and programs to develop improved systems of pre-hospital emergency care. The DOT established the first, published the first EMT training curriculum in the 1970s. The American Academy of Orthopedic Surgeons prepared and published the first EMT textbook in 1971. Efforts are underway to standardize levels of EMS education nationally.
In the late 1970s, the DOT developed a recommended national standard curriculum. During the 1980s, many areas enhanced the EMT national standard curriculum by adding EMTs with advanced levels of training who could provide key components of ALS care and advanced life. saving procedures.
In the 1990s, the National Highway Traffic Safety Administration, the NHTSA, developed the EMS Agenda for the Future, a document with a plan to standardize the levels of EMS education and providers. And in 2019, NHTSA revised the EMS Agenda for the Future and published the EMS Agenda for 2050. The federal level, the National EMS Scope of Practice Model provides guidelines for EMS skills. This document provides overarching guidelines for the minimum skills each level of EMS provider should be able to perform.
The state level, laws regulate EMS provider operations. And at the local level, the medical director provides daily oversight and support to EMS personnel. The figure on the slide illustrates the hierarchies of the National EMS Scope of Practice model. Millions of laypeople are trained in BLS and CPR. Automated external defibrillators, or AEDs, are used by laypeople.
Emergency medical responders, or EMRs, can be law enforcement officers, firefighters, park rangers, ski patrollers. EMR training provides these individuals with the skills necessary to initiate immediate care and assist EMTs upon their arrival. The course focuses on providing immediate BLS and urgent care with limited equipment. Emergency medical technicians. The EMT course requires about 150 to 200 hours.
The EMT possesses the knowledge and skills to provide basic emergency care. The EMT, together with any other EMTs who have responded, assume the responsibility for the assessment, care, packaging, and transport of the patient. Advanced Emergency Medical Technicians, or AEMTs, The AEMT course adds knowledge and skills in specific aspects of ALS including IV therapy, advanced airway adjuncts, and administration of a limited number of medications. In paramedics, with an extensive course of training, course hours range from 1,000 to more than 1,300 hours divided between classroom and internship training.
Course may be offered within the context of an associate's or bachelor's degree College Program. Training covers a wide range of ALS skills. The EMS Agenda 2050 outlines five components of an EMS system. Comprehensive quality convenient care, evidence-based clinical care, efficient well-rounded care, preventative care, and comprehensive and easily accessible patient records.
The easy access to help in an emergency is essential. The 911 system is the public safety access point. An emergency medical dispatch system has been developed to assist dispatchers in providing callers with vital medical instructions until EMS arrives. Mobile apps allow laypeople trained in CPR to be alerted of a cardiac arrest in their area and the location. of the nearest public AED.
Human resources focus on the people who deliver the care. The EMS Agenda 2050 encourages the creation of environment where talented people want to work and turn their passion into a rewarding career. Medical direction. A physician medical director authorizes EMTs to provide medical care in the field. The medical director is the ongoing working liaison between the medical community, hospitals, and the EMTs in the service.
Appropriate care is described in standing orders and protocols. Protocols are described in a comprehensive guideline, I'm sorry, guide, comprehensive guide delineating the EMT scope of practice. Standing orders are part of protocols and designate what the EMT is required to do for a specific complaint or condition. Providers are not required to consult medical direction before implementing standing orders. Medical control can be offline or online.
Offline would be indirect. That would be standing orders, training, and supervision. And online or direct would be a physician directions given over the phone or radio.
Legislation and regulation, although each EMS system medical direction and training program has some latitude, its training protocols and practices must follow state legislation, rules, regulations, and guidelines. A senior EMS official is usually in charge of necessary administrative tasks, such as scheduling, personnel, budgets, purchasing, and vehicle maintenance, and the daily operations of the ambulance and crews. Pre-hospital care should be continued in the emergency department to ensure that the patient receives comprehensive continuity of care. Mobile integrated health care, method of delivering health care that utilizes the pre-hospital spectrum.
MIH evolved with the goal to facilitate improved access to health care at an affordable price. In the MIH model, healthcare is provided within the community rather than the physician's office or hospital by an integrated team of healthcare professionals. This branch of healthcare is causing the evolution of additional training levels for EMS providers. Community paramedicine in which experienced paramedics receive advanced training to equip them to provide services within a community.
In addition to the patient care services a paramedic would typically provide, services provided by community paramedics may include performing health evaluations, monitoring chronic illnesses or conditions, obtaining laboratory samples, and administering immunizations. Information systems. Computer systems are used to document patient care. Electronically stored information can be used to improve care.
Evaluation. The medical director is responsible for maintaining quality control within the EMS system. Adopting a just culture promotes a learning culture that holds employees accountable for behavioral choices by balancing fairness and accountability. Continuous quality improvement, or CQI.
Reviews and performs audits of the EMS system to identify areas of improvement and or assign remedial training. Minimizing errors is the goal. Uses a plan, do, study, act cycle.
Patient safety. Minimize medical errors that occur as a result of a rules-based failure, a knowledge-based failure, or a skill-based failure, or any combination of these. Requires the efforts of both the EMS agency and EMS personnel. System finance. Finance systems vary depending on which organization is involved.
Personnel may be paid, volunteer, or a mix of paid and volunteer. EMTs may be asked to gather insurance information from patients, secure signatures on certain documents such as HIPAA notifications, obtain written permission from the patients to build their insurance company. In 2020, the Centers for Medicare and Medicaid Services implemented a pilot program called Emergency Triage, Treat, and Transport. ET3 strives to reimburse EMS systems for providing the right patient care at the right time.
It sets up a payment model for patient transport to alternative destinations, such as urgent care centers or doctor's offices, or on-scene treatment with no transport. EMS instructors are licensed in most states. Most EMS training programs must adhere to national standards. established by two accrediting organizations, the Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions, or COAEMSP, and Commission of Accreditation of Allied Health Education Programs, or CAAHEP.
Frequent continuing education, refresher courses, and computer-based or online learning. Mannequin-based self-education exercises are measures intended to maintain and update an EMT's skills and knowledge. Prevention in public education. Aspects of EMS where the focus is on public health.
Public health examines the health needs of the entire populations with the goal of preventing health problems. EMS works with public health agencies in two ways. Primary prevention focuses on strategies that will prevent the event from ever happening, for example, educating the community on pool safety and car seat installation.
And secondary prevention occurs after the event has already happened. The question then is, how can we decrease the effects of the event? Helmets and seatbelts are examples of secondary prevention.
The table on the slide lists examples of public health accomplishments. EMS research helps determine the shape and impact of EMS on the community. Evidence-based medicine focuses on procedures that have proven useful in improving patient outcomes.
And many EMS systems and states consult the National Model EMS clinical guidelines from the Association of State EMS Officials. Guidelines are based on a review of current research and expert consensus. Roles and responsibilities of the EMT. EMTs are healthcare professionals, whether paid or volunteer.
The roles and responsibilities of an EMT are keep vehicles and equipment ready for an emergency, ensure the safety of yourself, your partner, the patients, and bystanders, be familiar with emergency vehicle operation, be an on-scene leader, and perform an evaluation of the scene. Call for additional resources as needed, gain patient access, perform a patient assessment, and give emergency medical care to the patient while awaiting the arrival of additional medical resources. Give emotional support to the patient, to the patient's family, and other responders.
Maintain continuity of care by working with other medical professionals. Resolve emergency incidents. Uphold medical and legal standards.
And ensure that and protect patient privacy. They give an administrative support, constantly continue their professional development, cultivate and sustain community relations, and give back to the profession. Professional attributes, integrity, acting consistently, maintaining a firm adherence to a code of honest behavior.
Having empathy, being aware of and thoughtful towards the needs of others. Self-motivation, discovering problems and solving them without someone directing you. Appearance and hygiene, using your persona to project a sense of trust, professionalism, knowledge, and compassion.
And self-confidence, knowing what you know and knowing what you do not know, being able to ask for help. Time management, performing or delegating multiple tasks while ensuring efficiency and safety. Communications, understanding others and making yourself understood to others. Teamwork and diplomacy, being able to work with others, knowing your place within the team, communicating while giving respect to the listener. Respect, holding others in high regard or importance, understanding that others are more important than you, and patient advocacy.
and constantly keeping the needs of the patient at the center of care. and careful delivery of care, paying attention to details, making sure that what is being done for the patient is done as safely as possible. Most patients will treat you with respect, but some will not.
Yet every patient is entitled to compassion, respect, and the best care you can provide. As healthcare professionals, EMTs are bound by patient confidentiality. Patient privacy must be protected. Findings or disclosures made by the patient should be discussed only with those treating the patient.
and in limited situations as required by law with the police or other social agencies. Protection of privacy, patient privacy has drawn national attention with the passage of the Health Insurance Portability and Accountability Act, also known as HIPAA. Some review questions. Which of the following is an example of care that is provided using standing orders?
And your answer is B. Standing orders, a form of offline, indirect medical control, involves performing certain life-saving interventions, such as CPR, defibrillation, or bleeding control, before contacting a physician for further instructions. Number two, quality control in an EMS system is the ultimate responsibility of the what?
Your answer is C. The medical director is responsible for maintaining quality control, which ensures that all staff members who are involved in caring for patients meet the standard of care on every call. Number three, upon arriving at the scene of a domestic dispute, you hear yelling and the sound of breaking glass from inside the residence. You should Correct answer is C.
Never enter a scene in which signs of violence are present, including yelling, screaming, or the sound of breaking glass. Law enforcement must secure the scene prior to the EMT's entry. Number four.
Which of the following is not a component of continuous quality improvement, or CQI? Your answer is going to be C. The purpose of CQI is to ensure that the standard of care is provided on all calls. This involves periodic run report reviews, discussing needs for improvement, and providing remedial training as deemed necessary by the medical director.
Positive feedback should be provided during this process. Number five, all of the following are responsibilities of the EMS medical director, except. Your answer is going to be A.
Responsibilities of the medical director include serving as the liaison to the medical community, ensuring that appropriate standards are met by EMS personnel, and ensuring appropriate EMT education and continuing training. Insurance matters are handled by the EMS billing department. Number six, which of the following situations would most likely disqualify a person for EMS certification? Your answer is B.
In most states, a person may be denied EMS certification for being convicted of a felony, such as driving under the influence of alcohol or other drugs. Number seven, which of the following should be the EMT's highest priority? Correct answer is D.
Personal safety is of utmost concern for the EMT. This involves sizing up a scene to determine whether the scene is safe to enter. This will ensure the safety of all personnel. Number eight, a patient who requires cardiac monitoring in the field would require, at a minimum, which level of EMS provider? Your answer is C.
Of all of the EMS providers, the paramedic is trained in advanced medical care, including cardiac monitoring, IV therapy, and administration of a variety of emergency medications. Number nine, which of the following is a professional responsibility of the EMT? The correct answer is going to be C, because the public relies on the EMT to remain calm when others cannot. He or she must project a professional and calm demeanor even when under extreme stress.
Number 10, emergency patient care occurs in progressive phases. What occurs first? Your correct answer is D. Someone must recognize an emergency before EMS can be activated.
And that's all we have for Chapter 1. Thank you for attending. My name is Sean Holt, and on behalf of RCL Services, again, welcome to EMT Basics.