Introduction to Emergency Medical Services (EMS)

Overview

Importance of understanding the foundations of EMS.
Topics covered: EMS system components, roles, and responsibilities, public health, special issues (e.g., ADA).

1790s: Early documentation of patient transport during French Revolutionary Wars.
Civil War: Clara Barton and the American Red Cross set standards for transport.
20th Century: Evolution of EMS from hospital-based to volunteer corps, and private ambulance services.
World War I & WWII: Development of volunteer ambulances and MASH units (Mobile Army Surgical Hospital).
Korea & Vietnam: Introduction of air medical transport.

1970s: The rise of EMS care standards.
- DOT charged with developing standards.
- Formation of NREMT for standardized testing.
1973: National Emergency Medical Services Systems Act passed; $300 million into EMS research and training.
Creation of NHTSA for trauma and vehicle standards.
- Initiatives like "Click it or Ticket" for prevention and safety.

Regulation and Policy: NHTSA's role.
- States govern their EMS entities with NHTSA oversight.
Resource Management: Coordination and transport of patients.
Human Resources and Training: Continuing education and field training.
Transportation: Standards for safe transport.
Facilities: Transport to closest appropriate facility (e.g., trauma centers, burn centers).
Communication: Enhanced 911 system for accurate dispatch and pre-arrival instructions.
Public Info & Education: Car seat classes, vehicle safety awareness.
Medical Direction: Delegated practice under a medical director.
Trauma Systems: Importance of time in trauma care; the "Golden Hour."
Quality Improvement: Regular evaluation for improving EMS care.

Patient incident -> 911 call -> dispatch -> first responder -> EMS transport -> emergency department.
Use of the enhanced 911 system for precise and timely response.
Examples of accurate instructions leading to better outcomes (e.g., CPR guidance).

EMR: Emergency Medical Responder.
EMT (Basic): Extensive practice for basic care.
AEMT: Advanced EMT with skills like advanced airway management, IVs, and medications.
Paramedic: Highest level, includes cardiac monitoring, advanced life support.
State and National Registry distinctions for certification and standards.

Safety: Priority order - your safety, partner's safety, patient's safety, bystanders’ safety.
Teamwork: Work well with law enforcement, fire departments, and other responders.
Patient Care: Assess, lift, move, transport, and hand off care efficiently.
Patient Advocacy: Representing patient needs and maintaining dignity.
Community Involvement: Public education, prevention programs, and outreach.
Physically and Emotionally Prepared: Requires lifting ability, keen senses, stable emotions.
Professional Conduct: Good personal habits, communication, presentation, and customer service.
Continuing Education: Important for high-quality care and certification maintenance.

Offline Medical Direction: Standing orders and protocols.
Online Medical Direction: Real-time instructions via phone or video from a medical director.
Designated Agent: EMS providers operate as extensions of medical director’s license.

Emphasis on continuous improvement and quality assurance in EMS.
The importance of being prepared physically, emotionally, and professionally to provide the best patient care.
Encouragement to stay updated with the latest protocols, standards, and research.

EMS is a young but rapidly evolving field critical to public health.
The integration of standards, advanced medical transport, and continuous education ensures better patient outcomes.
The role of EMTs is not just transportation but includes sophisticated pre-hospital care.