Introduction to Emergency Medical Services

hi everyone welcome to your first chapter introduction to Emergency Medical Services now sometimes these uh Preparatory uh introduction chapters aren't as interesting as others because you're not learning much about Medical Care however it is important to know the foundations of EMS where we've came from where we're going and the overall system so in this we're going to go over the EMS system the components of the system you want your roles and responsibilities will be our roles in public health research we'll just barely tap into that I don't want to distract away from what you need to know and any kind of special issues and that more refers to just an ADA or the American with Disabilities Act statement so EMS as a whole is pretty young as a system now you'll see 1790s and you're like well Rob that's not that oh that's very old uh however uh this is just some of the early documentation and Records we have of someone actually being transferred uh to a physician and this was in the 1790s during the French Revolutionary Wars you think of Napoleon and the war against Britain and Austria if you know anything about world history uh and you know a lot of people lost their lives in these wars it was almost like a little mini World War and this is some of the earliest documented cases we have of Battlefield medicine and people being removed from the battlefield to get to a physician so that's the foundation of EMS is patient transport uh in the Civil War uh some of you may have heard of Clara Barton I hope you have she helped found the American Red Cross and helped develop standards and transport and getting injured people uh help and this is some of the places I've added these pictures I wondered you see some of the places where we've been uh you see a hospital-based system in New York uh ran by Bellevue Hospital and then we see these Hearst like ambulances and even there you have Harpers Ferry West Virginia you have an old school box death trap ambulances and you have to remember early EMS you know was Private sometimes Hospital based and he even ran by uh local funeral homes and I always tease people it's like how would you like to know that the person who's transporting you is gets more money off of you if you're dead versus being alive so it's kind of scary and then over uh you know from the 20th century up we've been working at developing better EMS standards and now you have hospital-based volunteer core you have you know private ambulance agencies and a good chunk of cities who run EMS and then in World War one you had a volunteer Ambulance Corp so now we're starting to get that word ambulance involved okay and he even had some situations of air medical as well transporting uh injured Souls uh via air uh in Korea and Vietnam a helicopter transport of sick and injured patients we're talking about soldiers uh became a thing and in Korea the mash unit became really really popular in little pop-up you know kind of Trauma Centers uh near Battlefield so we had the greatest outcome for our soldiers so you know we EMS is new you know you're looking from the 70s and up have we started refining care in the pre-hospital setting before it was all about transport and a good chunk of what we do is still transport uh you know three quarters of the patients I treat I don't give any medications to as a paramedic I simply are getting them from point A to point B uh the safest way possible now if it's something I can address and fix uh especially life-saving interventions I'm going to do that but we're still such a young industry and there's a good look at what these early mass units look like if you didn't know Mash isn't just the name of a TV show it had to do with what they were doing in their little pop-up hospital if you ever watched three runs of that show and it's standard for mobile Army surgical hospital again little pop-up hospitals near battlefields so soldiers could have the best possible outcome and if you don't know this and hope you know most likely you don't because this is your intro and EMS in trauma there's not much we can do outside of stabilization in the field surgery is the end game and we're going to talk about something called the Golden hour or the time that trauma occurs the time that they're on the surgical table having it fixed by definitive care time time and distance are our greatest allies getting to the hospital in a timely manner and if we can cut that distance down by air medical or having facilities closer to us you know that's always a benefit diving further into history in 1966 the dot was charged with developing our standards in EMS uh so when I asked who do we kind of report to or where our standards come from it is the Department of Transportation believe it or not and uh as far as that goes uh Nitsa as well which is a faction of the uh Department of Transportation which is considered to be an executive branch of our government now in 1970 here comes the NRE EMT and we all know the nremt because it's the test we fear that we all have to take uh once if you're an EMT and hopefully you'll take it again if you decide to go on and get your paramedic so they were founded to kind of get us standardized and also standardized testing more more days now than not and really have a giant influence over EMS curriculum and there's some accreditation bodies now for like ALS programs that they're trying to merge over to BLS programs to ensure that we're all teaching the same thing and at a high quality with high passing rates in 1973 the National Emergency Medical Services systems Act was passed by Congress and even in the 70s they put in like 300 million dollars the government did into EMS research better training standard setting up better communication systems making sure that we're all like having facilities that are the best outcomes for patients so then comes Nissa right so Nitza comes into play you know I and I forget I think it was in the 70s or 60s when it was developed so it's the national highway traffic safety administration they deal highly in trauma and like vehicle standards however you know the best treatment of trauma believe it or not and it's a a Nitza executive would agree that the best prevention or prevention is the best for trauma right so you know simply not allowing trauma to occur will will will be the best thing we can do to protect citizens so Nitza does a lot of things outside of EMS like seat belt awareness and don't drink and drive and make sure you know you're going the speed limit and car seat awareness so this uh you'll see these commercials on you know NFL games and and uh on the radio broadcast so really pay attention a lot of times that you're listening to click it or ticket it may be sponsored and paid by the government or Nitza all right so what they do for EMS specifically though they're going to set up uh regulation and policy so Most states are going to in pretty much all states are going to govern their own EMS entity and Nitza kind of oversees that and we all report trauma data and things like that to Nitza Texas was one of the last states to do so and ensure that we have policies and procedures in place to govern uh state and local EMS so Texas also has some things there specifically now this class is taught through more of a national perspective because we're taking the National Registry but I do like you to be educated about where you're primarily going to be practicing in the state of Texas and in the state of Texas we have health and safety code 773 that gives us standards for how we should operate and we also have the Texas administrative codes 157 which is a very vast and gives us anything from EMS education standards to air Medical and how even you get in further in other chapters uh to how medical directors are required to function and what about Resource Management right ensuring that we have coordination and resources to transport patients human resources and training uh continuing education once you're in the medical field is a big part of what we do your initial education is not enough you do not come out of an EMT course knowing enough about the medical field your field training in combination with continuing education will keep you refreshed and updated to new standards and this is one of the things Nitsa will help with what about Transportation ensure ensuring that we have standards of transportation that it's not okay just to pick up a car and transport a patient in the back seat that we have some sort of standard from how stretchers operate to how they're secured down to the floor what about facilities we have to go from point A to point B let's talk about point B we have a philosophy in EMS as we typically try to transport our patients to the closest appropriate facility now I want you to pay attention to that word appropriate facility trauma victims need to go to a Trauma Center exactly burn victims go to the Burn Center OB patients need to go to a pace place with obstetrical capabilities cardiac patients to Cath Labs or cardiac facilities and so forth and so on there's so many specialty facilities out there to cater around different traumas trauma severities and medical severities that we you know ensure that our patients have the best possible outcome and if we don't go to the appropriate facility that offers a delay in care in the patient which results in worse patient outcomes and that's one of the main missions of Nitsa is to ensure that we have good patient outcomes and that's our mission as well we got into this industry to help people not for our own convenience sure as God isn't for the money what about Communications well we use the 911 system and now it's more of the enhanced now in one system to where someone calls we can identify where they're at their callback number in case we get disconnected and we can also do things like give pre-arrival instructions we can turn family members and Witnesses into First Responders by teaching them over the phone how to perform CPR open the airway give aspirin in cases and uh and when you believe the patient's having a heart attack or assist with the delivery until us the EMS providers can get there in addition to that it allows us to speak with each other on the ambulances to our First Responders and communicate with the hospitals so they know we're coming and can be prepared again so the patient may have the best possible outcome public information and education well we have our continuing education and standards will be required based on National Registry guidelines and uh if you're just State Certified then you'll go off of your state certification okay uh also they'll do public information they'll do car seat awareness classes and things like that they also again like I previously mentioned participate very uh heavily in vehicle information vehicle data and crash data and things like that medical Direction wise well EMS is pretty much a business of what we call delegated practice you are an designated agent of your medical director and the medical director is a medical physician who oversees your EMS agency and he or she is the overall Authority on what you're allowed to do how you should operate what's your scope of practice the standard of care of what you operate your protocols or guidelines and what you're allowed to do for that particular agency and even dictates how much training you should receive and what that training should be over now in the end you're also held accountable to National Registry and state standards but also within your organization your medical director should set a foundation and we'll talk about how we evaluate that on the next slide trauma systems are really important because one thing we know about trauma is that time is of the greatest Essence okay so we're going to have different kinds of trauma triage from how we determine whether the patient needs to go to what type of trauma uh Hospital capability to mass casually sizing up and uh delegation of resources to different treatment protocols and National standards through the American Academy of surgeons and things like that so evaluation wise we use what we call quality improvement this is what you see down there in qiqa or tqm that's quality improvement quality assurance a total quality management here at careflight in the academy we call this cqi within our organizations and other organizations also call it cqi and that's clinical quality improvement now this is the time where we get together and we review charts now we have a standard in which we review charts all 9-1-1 charts are a hundred percent audited and all ALS charts are 100 audited but like BLS transports the ones where not much cares being given we only audit a certain percentage of those because it's such an abundance and it's very basic care and we want to put our focus on the more emergent things and kind of triage our own calls and what we're going to use that data for is to improve get better as individuals as an agency and also to evaluate do we have the right resources and you use that by viewing your data and what kind of calls you run and what kind of problems you see and it's not just for bad either it's also can be very quite good you may get some data back that shows hey we're really good at this hey good job everybody or you may have had a call where you made a decision it was a really good decision your documentation was excellent and this could be a time for you to be recognized so don't look at quality assurance or quality improvement that's a bad thing again it can be utilized to show what you do well just as well as it could be used to show what you do bad now getting into the components of our EMS system we have to take these calls and delegate it to the closest appropriate ambulance so we use emergency medical dispatchers or emds to do this and they're a vital part in our system because they can see all they can see in the modern system where all their ambulances are located and ensure that when that call comes out that the closest Ambulance with the highest capabilities is headed towards that emergency all right so they can also give pre-arrival instructions to ensure that CPR victims have the best possible outcome because one thing we'll really focus on when you have a patient in Cardiac Arrest time on chest or time of CPR is everything from giving constant CPR to starting CPR as soon as possible so the patient has the chance to come back from it then we have our responders these could be volunteers or departments that will work with us all right and they can have a varying degree of certification from the lowest level emergency medical responder to all the way up to paramedic you'll work with people on volunteer agencies who have a broad spectrum of certification and some often may not they have first aid and CPR and they're almost off operating like a Good Samaritan but that agency's medical direction will set up what they can and can't do and if they're working under a private agency like careflight we dictate what they can and can't do or our doctor Dr Simonson does that then we have us as em Master spawners we come and pick the patients up from the First Responders and there's a handoff of care and then we get them to the hospital so it's EMS are spots in itself is very intricate you have the first response and then you have the EMS and there are going to be occasions where you work in areas where you do not have EMS response it's important that if you do work in a place that doesn't have like a volunteer fire department or a fire department's not interested in participating on medical calls that you talk to like police departments and see if they would like to train up and take first aid classes CPR classes and even things like EMR or emergency medical responder classes we've seen that in different cities and it's really had a great outcome for patients in the end we need to get these patients to definitive care and that's going to be the emergency department and hospitals as much of an ego as sometimes an EMT or a paramedic can have I have to understand we are a lower level of care in combination to doctors and nurses so we need to get to them so they can receive Imaging and Diagnostics to understand what's going on with them and most importantly begin the process of fixing them some of these specialized facilities we've already talked about Trauma Centers burn centers pediatric centers cardiac centers and stroke centers they all have Specialties in what they're allowed to do and there are a lot of facilities that are a little bit of everything just quite frankly outside of Pediatrics Parkland is a trauma center it's a burn center it can handle great cardiac and it can handle stroke so it's kind of a multi-faceted facilities and there's plenty of them out there and then we have one place that's in the Coffee County area like uh Baylor Scott and White Sunnyvale uh they don't do stroke but they do a lot of cardiac they don't do kids Burns or any kind of trauma they can do mild Orthopedic like if someone you know an adult broke their collarbone you know they probably handle that just fine without transferring it but anything else if they can't handle it the facility is going to have to transfer it to another facility and all you've done is delay patient care and it's not an easy transfer especially after covid you just can't go hey uh Parkland they brought us a burn and we need y'all to take that parkland's not going oh okay no through the Impala laws which we'll talk about at the end of this presentation um you know we can't um we can't just transfer someone from one facility to the other without there being uh you know a doctor the transferring doctor agreeing with the receiving doctor accepting the patient the hospital having the appropriate number of beds and staff to treat the patient there's a lot of intricate factors it could take hours and it can even take days to get someone out from one facility to the other so be very careful and don't do what we refer to as dumping and here we go there's a good example of a trauma center and the patient being worked on trauma patients need to go to Trauma Centers if they're going to have the best possible outcome so I want you to really think what kind of medical services are available in your community so we're in the Dallas Fort Worth Metroplex and we're real lucky because we have a vast amount of Trauma Centers cardiac centers and stroke centers so wherever you're going to work you need to figure out what are the specialized facilities what can the local facilities handle and not handle and even consider making yourself like an Excel spreadsheet that you can keep on your phone or on your person and encourage your agency to have that in like a protocol book or something so you understand what kind of capabilities at the end of the day you should have all the hospitals phone numbers then this can be gained through your preceptor or fto and before you make that move to transport call the facility you want to go to the patient's requesting say can you handle this or that remember the consequences for not going to the right facility is a delay in patient care which results in worse patient outcomes how does the EMS system work well we see it here if you have a patient some kind of incident I assume he's trauma because he's in a car and he's grabbing his neck someone calls 9-1-1 the emergency medical dispatcher gets the call gets the callback number and address of the location uh starts asking a series of questions typically on any kind of accreditated system and gets the emergency medical responders headed out that way for operations and First Response care we get there to provide care they hand off care to us we transport to the emergency departments and hopefully the patient will have the best possible outcome once at the hospital so 911 is that Universal number when you call 9-1-1 it's going to patch you into the local 9-1-1 um call center oftentimes these call centers like County call centers may not be the ambulance provider so and they may not have an emergency medical dispatcher it's just a standard dispatcher this person is not trained in like the emergency medical responder questions and algorithms so they forward them on like at carefight in Kaufman County oftentimes Kaufman County will receive that call and then they they find out where the address is so they can get First Responders going and then they forward it over to us so we can start the EMD process through Pro question and answers that ensure that we have the right amulets headed to them at the right speed and priority um and we can feed information to the crew so they're better prepared for what type of emergency they're operating on and the great news about this you know when I started in EMS we were still using routes and then we came up with enhanced 911 you'll saw a lot of places in tax is where you went from route to an actual County Road number this doesn't ensure that every house had an actual address that you just didn't live uh you know at 22 Route 1 and no one could identify you now you live at you know 252 County Road 306 when I totally made that up uh but back in the day I tell you it was confusing you would get dispatched to a call and they'd be like well you're going to look for the Red Barn after the Red Barn you're going to see a a dirt road to the right and you're going to go through a brown fence and it was like that and now you know now we have geolocating we can we don't have to use map books and map skills anymore which can take a long time to kind of uh figure out where you're going um you can you know use your phone or use computer animated systems in your truck to locate that call through Google Map and get there in the most timely manner as possible and so getting lost used to be very frequent uh now more and now nowadays it's you get lost still but not anywhere near the frequency so it's a great generation of EMS you're stepping into where technology really is driving us forward does EMR I'm sorry the emds they're so important in what we're going to do though they're going to give all that first responder information First Response information the other day I had a cardiac arrest right before I recorded this lecture and um you know I walk in the house and the first the EMD is given real loud and clear instructions to the patient's wife on how to give CPR and it was real clear you know the wife had the phone on speaker and she was doing CPR effectively at that to the patient she had no CPR training she I was just following the directions of the EMD so the EMD was doing a great job uh you know he did not have a great outcome though he sure as heck would have no possibility if we weren't giving clear instruction do you want to talk about a job that requires multitasking be careful and don't criticize your dispatcher you know there's always that internal war between you know police Fire EMS and their dispatchers you know we all think we have the better job but um you know some of these dispatchers may have 20 apparatus under their control they're trying to take a call because they're backed up at the call center and dispatch out their Fleet and my Lord look how many computer screens this lady has in front of her that's a lot to control and requires a ton of multitasking so don't criticize your EMD it's actually a difficult job so critical decision making I I find this is oftentimes the hardest thing to teach as an instructor as your critical thinking skills some of you will have it naturally that you can think on the Fly accurately every time you just kind of have to know your strengths and standards if you're one of those people who when it speeds up you start making mistakes then slow it down you don't want to be the fastest you want to be the most effective that means doing things in a timely manner but the right way the first time around and delegation also comes into here if you're the head of a crew and it's one of the hardest things to learn if leadership doesn't come natural to you is to delegate to all the resources you have on scene to ensure that everything gets done in a timely manner okay so you're going to use a lot of your natural senses in the process and your gut instinct comes into play real heavily but you also need to break things down and ensure that you're doing things in a systematic way this is where things like muscle memory come into play and try trading if you train heavily at something it becomes like muscle memory to where you don't make as many mistakes now if you don't know something as effectively when the adrenaline hits you're more likely to make a mistake so just because you know something doesn't mean that you don't need to train in it you need to be able to perform skills blindfolded because if you can perform them blindfolded you can perform them when someone's screaming in your ear to save their loved one questions and a good thorough assessment will also help with this and we'll talk about Assessments in later chapters but it's great you may know how to treat something but if you can't identify it that's a problem right so I often refer to that assessment is the foundation of our care and let's talk about homes and Foundations and I think everyone in this class even if you're not have a history of construction understand that if the foundation of a home is cracked then that home will eventually fall apart so make sure your foundation is strong in assessment and you will be able to make critical decisions when stress is high so different things should you take the patient to the closest hospital or to more distant Specialty Hospital that depends right that depends I'm sure mostly like well that depends so what's going on with the patient um yeah I have a trauma victim and they need to go to the trauma center the trauma center is 30 minutes away but the patient I can't get their airway open and they're not breathing do I want to try to go 30 minutes down the road or do I want to go across the street to the local hospital well they don't have the capabilities the patient needs they do have a physician in there who can establish an airway get to pay you know get the patient on a ventilator and help them breathe and then transport them out they're not going to live without their airway open effective breathing or intact circulatory system so sometimes yes we have to go to the closest facility regardless of what they need in the end and understanding they may be transferred out later but when the patient is not stable you go to where there's a doctor it is likely giving medications and there's not many Communications the EMT will give but you have to ask yourself we have the five rights of giving medication and one of the rights is the right patient is the right medication to give to the right patient is this going to help them it's going to improve and also knowing how those medications work that's part of critical decision making if you understand the why you'll never make as many mistakes because you understand the mechanism of action of of different treatments and medications you give but in the end there's one medication that we give that's better than any and it's that one right there Jed a diesel or unleaded fuel getting the patient to the hospital you're in the transport industry now getting them from point A to point B is the best medication we carry time and especially in trauma and Trauma I can stop bleeding I can lay them flat and protect against shock however I can't stop internal bleedings I'm not a surgeon so even as a paramedic I understand that getting the patient to the hospital in a timely manner will give them the best possible outcome let's break down our certification levels in the EMS system so we have four that are common and all four are recognized in the state of Texas and with the National Registry so you have the emrs up until recently EMR is the big difference between EMR and EMT was the ability to transport the sick and the injured the state of Texas now allows emrs to transport at the BLS level then you have the next step up is emergency medical technician which we're all going after which has a vast uh practice often referred to as the EMT basic we don't refer to it as the EMT basic anymore because there's nothing basic about the care you provide uh formerly known as the EMT intermediate we called the advanced EMT and some of the difference in the scope of practice or what you can do when we say that word scope or practice remember that's what you're allowed to do um of the aemt is going to be Innovation so Advanced Airway management uh IV and some medications then you get to the highest level in EMS and you have the paramedic level and formerly known as emtp EMT paramedic just called paramedic now they can do Advanced stairway management different various forms of access some services do surgical Airways and then you're looking the main big difference between paramedic and advanced EMT is going to be cardiac monitoring so EKG technology the ability to read translate and transmit uh and a lot of medications a lot of medications Advanced cardiac life support and things like that are so important because they you know the nurses and the doctor also carry the same certification the paramedics do so the patients who go into cardiac arrest in the field may have the greatest outcome I included this so you could see the different certification levels here in Texas you see the white patch that's ECA they still call it ECA here that's an EMR I refer to as EMR because I do National Registry staff you see the blue patch the EMT the advanced EMT formerly intermediate and then you have two different paramedic patches you have a certification patch and you have someone who is an LP or licensed paramedic the big difference here is they've had the same Foundation uh care the LPS had a has a degree in EMS so that's the only difference as far as what they learned it's the same but LP ensures they've had you know more training in like anatomy and physiology but um I I don't notice personally a difference out in the field uh it is good to have your LP and I recommend it and eventually it'll probably be required um but uh National Registry doesn't do anything this is just in the state of Texas and I'm not sure what other states do when it comes to degrees and licensure so what are your roles and responsibilities going to be when you get out there in the field well your safety number one thing we'll talk about in this class safety and this is the order of operations for safety your safety is first your partner safety is second the patient safety is third and then we'll worry about Witnesses and bystanders okay why the sick and the injured cannot save the sick and the injured if you go down then you put a strain on the EMS system think about it you're responding out to a house fire right you heard that there is an adult male inside that may be in there so you decide to be a hero and you run in this house you collapse now they call another Amy wants out for you and the missing victim so you went from one ambulance on scene to three with one being out of service and you possibly being dead how did you help anybody y'all there's a fine line between heroism and stupidity all right be smart while you're on scene and don't put other people's safety ahead of yours you cannot help them if you're down so you're gonna have to learn how to work with a multitude of personalities from law enforcement you're looking at sheriffs deputies or what we call so local police departments fire departments all right you have to be able to work with everybody you have to put your pride aside your reputation will carry across this industry meaning if you're rude to people and your responders it will catch up with you at some point in time in your career be a good person to everyone and put your pride away when other people are being nasty you know when our adrenaline gets up sometimes we say things and we snap you're going to have to have thick skin in this industry okay you will be snapped at at some point in time all right you should always talk respectfully to people but understand sometimes when the adrenaline's going we get a little excited we've already talked about the importance of patient assessment and being the foundation in our care you're also responsible for lifting and moving patients transporting them handing off care and the most important thing we do outside of our own safety is patient advocacy being that representative for the sick and the injured who cannot at times speak for themselves I refer to it as customer service I do not teach customer service in this course you are either a good person or you are not if you are a good person and you give good customer service you will continue on if you're not and you're rude to people and your patients you will not make it through because we do not want people like that in this industry so I want you to think about it for a minute you know how would it impact an older adult patient if they were transferred to the hospital without glasses and hearing aid or dentures well that's poor customer service uh how can you effectively assess and communicate with someone without these things right they need to be able to see you um they're going to be away from the house so not only is it just in transport with you but when they get there you know that's gonna they're gonna be very apprehensive they can't see what's happening around them what about hearing aid how can we communicate and properly assess and ask about their history of present illness if they can't hear us I don't want to scream at them all the way I had one time I always tell the story where I had a young man EMT working with me as a newer paramedic and I asked them to put the patient's hearing aid help them with their hearing aids he goes I don't know how to do that and I looked right in his face and I said well you're going to learn today so next time this won't be a problem and he was just like come on Rob and I'm like no don't I said to you you are an outpatient Advocate your job is to help the patient if I'm sorry you're an EMT I'm a paramedic we're both supposed to be able to think outside the box and help people and if I don't know how to put their hearing aid I'll work with them on learning how to put it in so next time that comes I come across a patient with hearing aid I know how to do it right like any skill I didn't know how to do every skill I learned I perfected it Dentures think about some of the problems we could run into there and this is chapter one so there's things you don't even know about I hope you all know what a bag valve mask is right it's a masked bag that we put over people that helps us breathe for them when they can't breathe for themselves what if I told you that that mask of the BVM is dependent on the patient's facial and dental structure so it's important to have their dentures in if they quit breathing because it provides structure to allow us to more effectively breathe for them also even if they're not that critical if I need to assess them it's easier to speak with them if they have their dentures in and how about this how about dignity we talk about advocacy and going hand in hand with advocacy is dignity give them their dignity so they can hear see and communicate with you so no excuse for poor customer service these patients are reaching out to you going I need your help 9-1-1 come help me and you have to be that servant who puts your personal needs and Views aside and helps them now on a routine call with taking time to gather items have a negative effect on patient care well that's dependent right what are you looking for if they're wanting you to dig for you know where's Waldo and it's taken five plus minutes yeah maybe but simply looking for their keys helping them put their dog outside if the dog's safe right you know I don't want Grandma to come back home and her house has been robbed uh or her dog's dead in its cage you know but within reason everything's within reason if you know you're working a cardiac arrest it's gonna be a little harder damn that I love that word advocacy you know I just love it I want you to stare at it I want you to ingrain it into your head you are a patient advocate you are here to protect your patients rights confidentiality through their personal health care information try to fix what's going on with them at least identify it get them from point A to point B with them feeling like you actually cared about them so what about the community what are some ways you can be a patient advocate to patients you've never met well participate in community outreach follow potential prevention programs for the elderly and simply when you have a patient you're running who's Fallen identify the way they fail you know do they have sliders on their walkers do they have proper clearance with their wheelchairs do they have proper wheelchair ramps and entry points and exit points into the residence is grandma wearing the wrong Footwear on you know linoleum flooring you know these are things you can do simple and then you can do things like uh car seat awareness programs and do public education as we see here get kids in the back of an ambulance as early as possible so they're not as apprehensive when they're having an emergency it's actually really fun to do as well makes you feel good so what are some physical traits we're going to need physical traits well we're going to the requirement and the EMS standard is lifting 125 pounds by yourself however that doesn't mean you should does that make sense it's like yeah the patient weighs 125 pounds but get someone to help you all right there's only so many lifts on your joints and back and save them you know my back I have scoliosis and I'm 41 years old at the time I'm recording this lecture and my back is hurts pretty bad frequently a couple times a week it has a lot to do with how I lift it I didn't always lift appropriately and you know what I pay for it now and it'll only get worse you do not want to take a rotator cuff or back injury in this industry because that can put you out quite a bit of time you're not getting 100 pay um and you'll feel those effects the rest of your life so take care of yourself one lift that's inappropriate it's too many lifts uh rare corrective lenses contacts surgeries if you need to remember we have to identify hazards and we don't have to identify patient addresses and road signs so you have to be able to see keenly uh what about color vision well I know people who are have color color blindness in our industry you just need to let somebody know some of the things we do like the medications oftentimes we identify the Boxes by their color not that we do not read to verify we always need to read our boxes for their names name of the drug and expiration dates however that first grab into our drug bag or box is often going to be based on color like I know epies that brownish grayish color and you know when I'm in a cardiac arrest situation I'm going to grab it verify the drug and date and go for it that initial grab saves me time or I know that D50 or dextrose 50 for diabetics a little sugar water it comes in a blue box right so when I grab that blue box then I verify its Dexter is 50 and it's got a good date uh even in like trauma triaging you know we have red yellow green and black if I can't see that I know I need to be governed more towards the priority on the tag because I can't see the color all right so let someone know so they're better prepared and like some places May set their systems up color based you want to ensure that there's a secondary system for you to identify all right you can't help the way you are you just have to work around it communication skills uh are very important and any relationship that goes wrong in your life typically has to do with communication all right so being able to orally and express yourself is important remember the three ways humans communicate is through content tone and Body Language believe it or not content's the least important of all those how you present a message is more important than the message itself so watch your body language watch your tone of voice you're also going to have certain like abbreviated forms and things like that whereas we have gone to electronic pcrs or patient care reports still good handwriting skills are important make sure you type things out when you just can't get around your handwriting all right take it slow everyone can write well if they just slow down some personal traits well be nice again I won't teach I won't teach you to be nice I will not teach you customer service I can encourage it but I can't teach it and the reason I say that is I just believe it's not that I I won't give you exercises in Communication customer service I will I say it to send an effect into you that you're like okay he's pretty Stern on customer service I I do I don't have any tolerance for poor customer service all right be sincere and at three in the morning it's hard to be sincere over you know back pain for 30 days it's you just gotta fake it all right fake it when you get back then you can blow off some steam at the station appropriately be cooperative there are times where you have to be a mom or a dad all right to these patients uh right before I recorded this lecture I mean literally within the same week of recording section I had a lady I've ran out multiple times and she is extremely rude to me and I like I do everything so right by her because I know she's difficult trying to win her over because I like the challenge uh and uh of trying to you know show someone I really care about them and not just flipping on them because they're rude and you know she's told me before she's not gonna answer any of my questions because it's just a waste of time but she wants me to take her to the hospital and far away too uh and this last time I ran over she started doing it again to me and I said ma'am I've ran on you before I don't know if you remember me she didn't I said and I understand you have a medical emergency and I'm gonna do everything I can for you okay I said however you are going to speak respectfully to me and I will speak respectfully to you we're not going to cost or shout at each other we're going to be polite I'm going to get you there and do what I can for you does that sound good she's like I'm not being rude with you I said yes ma'am you are and her own husband piped in sweetie you're being a little nasty you let the man do his job and she was okay after that she didn't really talked to me but I was real polite about saying I had to establish a standard with her so it's not how I like to operate but I will sometimes be that Dad to the patient because we're gonna we're gonna give you a good ride but you will be as equally as respectful as we are and they're allowed to have bad days don't get me wrong I don't mind getting snapped at but when you're constantly being nasty okay how do we feel about this young man for Acadian right good Ambulance Service Acadian uh he looks great y'all honestly he's got his eyewear on he's got gloves on he's going in with his equipment uh black boots uh properly groomed hair doesn't look dirty great looking new class A on he he is a model of how we should we should look so what are the personal traits be a self-stars greatest thing about our job right we don't have a boss over us all the time in this industry we are on our own so you have to come in and be responsible and be a self-starter for yourself check that truck off uh Light maintenance making sure fluids are topped off make sure that thing's cleaned up okay emotionally stable this can this can be a hard thing Believe It or Not especially after a bad call uh you have to be emotionally stable you have to be able to perform all types of calls just FYI some of you may be in this class going I can handle every call but a pediatric arrest I won't be able to do that call then quite frankly you can't be an EMS okay you have to be able to perform on every single call however it's what happens after the call that matters in these high stress situations meaning you are absolutely allowed to not be okay after a pediatric arrest or you know a mass casualty incident you're it's okay but you have to be emotionally stable enough to get through it operate as an effective provider after you're done take that ambulance out of service call your supervisor or officer and shut down and go do what you need to do to handle it whether that's what we're going to talk about clinical or critical incident stress debriefings or going seeing a therapist or just taking a day to hit the golf course and dissociate from work and that's okay but you have to be able to perform on all calls you have to be a leader a lot of people are like well I'm an EMT look okay oftentimes you and your partner will be split and this class is taught through the perspectives that your two EMTs on a truck so you could be the senior most provider you could be the senior most provider two months into your job you get a new person who shows up who has even less experience than you do all right and I've seen Grady and Veteran EMTs out there who are kind of the leader of their truck even though their paramedic has the higher level certification so leadership's important and that is something you can develop if you don't have it naturally being needing clean some of us need to be not be that person all right you need to groom yourself appropriately make sure your hands are taken care of make sure your uniform looks good and clean replace them as they become damaged okay watch your breath that's another thing keep gum on you and uh for those who like to wear colognes and perfumes please make sure they're not too loud those can have a reaction of people's allergies and respiratory emergencies how about being a good person a good person moral character all right we're gonna talk about ethics and morals in another chapter but just being a good person overall and on days where you're struggling you know consider do I need to take a mental health day or simple fact do I just need to fake it until I can get through this day and let my partner know hey I'm having kind of a bad middle day you want to help me out and take control and I'm gonna let you do the talking and I'll interject if I need to all right figure out creative ways to get through your day without uh cutting into patient advocacy and customer service try to be in control of any personal habits and especially personal views okay don't get into religious uh political conversations uh always just say I don't I'm here to treat you I don't really have any views over anything you're talking about all right because people will try to bait you into inappropriate conversations in the back of the ambulance all right uh be able to listen uh don't talk over people let them finish their statement before you have to continue that's not to say that sometimes elderly people while you're assessing them will get going and talk about a surgery that happened 10 years ago for 20 minutes and you may have to stop and say Miss Smith uh that sounds uh like you went through a lot during that surgery and I'm not trying to be rude but we're like five minutes away from the hospital and there's a lot of other questions related on what's going on today I need to talk to you about and usually they'll understand but it's all again about communication how you present that so you got to ask yourself how am I going to stay up to date well you're going to take things like refresher courses we call these continuing education or CE courses and the National Registry sets our standards for how often we recert which is two years by National Registry and that's always from um uh March 31st so let's say that you took this class in you know um this you passed the National Registry in December of 2022 your research date would probably March of 2025 because you're so close March 31st 2025. by that time you'll have to get online and see what kind of CE standards they have over that two-year period And do not procrastinate there's a lot of things you can do to gain CE in bulk too it's very interesting going to conference and seminars when hospitals bring in guest lectures and things like that oftentimes those things can be free go get yourself educated it's not only important to maintain your certification it's also important to maintain your education so you can give better patient care just be careful where you get your resources from all right make sure that you know where you're getting your resources from Facebook is a great a great uh asset for like discussions between EMS and First Responders uh however that's filled with opinions okay so no research no understand understand when something's a standard of care and research you know although there's some outgoing young EMTs and paramedics you think when they hear about a research that's now the standard of care and they should be doing it no it's research for a reason so what qualities would you look to see in an EMT who's caring for you well I I got to be honest with you how that provider looks is everything to me this is one job where it's acceptable for the patient to judge a book by their cover if you come in looking like crap and your ambulance is dirty you give crap care I've never met an EMT or paramedic who gives amazing care who keeps dirty equipment and unstocked Equipment laziness uh is laziness in the end so I would want to see a nicely professionally groomed individual who came to bedside prepared um you know I always call it the your mama test when you're doing something for a patient ask if it would be acceptable for your mother if the answer is no then you're doing the wrong thing this could be something like helping a paramedic with an EKG and then you pull the patient out the back and their chest is exposed to everyone in the ER Bay and in the hospital how would you feel if your grandmother was on your stretcher or on an EMS stretcher in nothing but their bra going through a hospital would you be okay with that I'd like to think you wouldn't be then why is it okay for your patient so always do that your mama test would this be acceptable care for my mother think about where you're going to work lots of places you can work as you can see here in the end you may figure out that this isn't something you want to do I hope you keep up with as long as a volunteer uh but I I find that most people once they start down this path they made up their mind and they want to do it not maybe people bow out of the program just because they don't want to be an EMS maybe years later they do they get enough of it burn out as high in this industry and this EMT is entry level into the medical field so they may want to move up nursing we've got a couple near doctors Pas all right I hope I hope this is your beginning step into the medical field there's lots of places you can work you can work rurally Urban uh transfer systems you can work in in hospital as a tech all right this certification will help you with a lot of things you work at dialysis clinics uh wound care therapy uh there's just a lot of places you may be able to utilize your ENT certification so don't give up on the medical field if you don't like EMS you know move forward in a direction of medical and health care that you'll need as the population grows and we all start to age you know we need to we need to ensure that we have enough Health Care Providers to go around and that's a problem right now there's not enough EMTs paramedics and nurses and doctors to go around oftentimes hospitals have enough bed they don't have enough staff covid has really done a number on the healthcare industry will feel the effects of this for a long time so the NR EMT the test you're going to take it's that uh that uh you know approves your Certification Texas is what you call a nationally registered recognition State meaning uh you still have to be State Certified to work here you just don't have to take any further state test there is no State tests in Texas just we they are they want the National Registry so in certain States they're full-on National Registry states that means you don't have to have state certification if you have your National Registry you're allowed to work there okay so we're a recognition state where you still have to have a state licensure but that's just a background check and fees if you have your you're in our EMT license then you will get approved um and that's for all levels uh and some of those levels will go between states the EMR is not it does not that's called reciprocity so like I can get my uh in our EMT in like Oklahoma and then I can move to Texas and apply for State licensure if that was the EMR level I wouldn't be able to do that unless they've changed a lot I'm just not aware of it you know for years EMR wasn't allowed to have reciprocity which if it's National Registry it's National Registry but that's their their decision not mine I would keep up with it if I were you and you ask yourself why wouldn't I keep up with my National Registry you don't have to in Texas as soon as you have your state licensure you can just use state of Texas guidelines and I'm gonna let you know laziness is the reason people don't do it because the NR EMT licensure has more strict guidelines for CE and it's every two years the status axis is every four years and I wouldn't say the state of Texas standards are not as strict um I'd say they feel less specific uh they still require a significant amount of hours that you need to keep up with but you have a four year period to obtain that so it in the end it's laziness uh please keep up with your certification you need to keep up with your training so you can be the best possible provider laziness and complacency will just breathe bad patient care y'all you have to understand that we've already talked about quality improvement and your overall role in quality improvement is just please write a legal and effective document all right you're a patient care report should be your a a picture of what happened on that call and by documenting accurately you will provide Qi data that helps your system progress forward so good written document be involved if you can when your agency has cqi clinical quality improvement make sure that you attend if you can or zoom in which most places do now offer feedback ask for your statistics say hey could you tell me how effective I am at IVs uh if you're not documenting them correctly though like documenting all your misses and makes um you know you're violating documentation guidelines but at the same time you know your data is irrelevant because it's inaccurate this is where your role comes into play and documenting correctly it also ensures that you have the appropriate equipment like say CPR Thumpers let's say that you work in an agency that's very rural and they notice that you're running a lot of CPR calls lately with long transport times they may using that Qi data go hey we're going to buy you all Thumpers okay so Qi looks at individuals uh within a system it looks at the overall system uh it determines like what kind of equipment and training is needed to progress forward so that they may see we run a lot of stroke calls so we need to kind of focus on these uh high frequency calls all right foreign again you are the designated agent for your medical director and here at careflight in the academy your medical directors Dr Robert Simonson awesome gentlemen and very smart uh very good teaching physician as well works over at Methodist and what his job here is it clarified is he's the ultimate say in patient care what we are as a designated agent is we are working under his medical license you wear a little extension of Dr Simon's license he's going to set up training with the clinical staff and he he signs off on all protocols says what he wants and doesn't want in those protocols our clinical team develops a lot of those things and then he overviews and says I want this and this added and please take this away this is why we're not going to do that and he's very open and he gives us a lot of flexibility at the same time there are certain things he's unwilling to move on because of his education and his time in EMS and in emergency care you know he he has he knows the outcome of a lot of these things and he also has access to being a physician it's a newer standards and things that are new standards of care in the field that we just don't have so he's going to have two things and I would highlight and start and underline this and write it down is offline and online medical Direction so he's going to set up some kind of standing order which we call protocols or clinical practice guidelines this is a book typically that all Ambience is required to carry let's say what you can and can't do for that agency and these are different interventions from IVs to medications to how much oxygen you should give when where and why uh those are standing orders all right occasionally you may have an order where it requires you to call in just to verify before giving a certain medication and we'll talk about some of those in class or you may be faced in a situation where you don't know what to do so you should always have online medical direction that is the ability to call a medical director to ask them a question live this doesn't have to be your medical director but another physician that works under the medical Direction like here at careflight we call Dr Simonson when he is unavailable that line goes to emergency room physician in Methodist who is aware of our treatment protocols and procedures so they don't try to give us something inappropriate all right and also here careful we have the ability to do telemedicine with only Dr Simonson where we can get him on FaceTime on his iPad and we can um communicate with him through video chat and even the patient can talk with him all right and that's online medical Direction offline is some kind of standing order online is when you're speaking to or video chatting with your medical director and again in the state of Texas we call this delegated practice the medical directors delegate what we can and can't do as an extension of their license AKA we are their designated agent now we've already talked about public health but I want you to really consider if you want to have a role in it and I like this picture right here because this is good fall prevention you know making sure that rugs have some kind of Underside to them that adhere to um slick flooring and that the appropriate Footwear is where for the elderly trip believe it or not you one of the most common trauma injuries you're going to run in a ground level falls from the elderly okay they're just not as coordinated injury prevention for the Youth this could be wearing appropriate sports gear or wearing A Bike Helmet or when they're skateboarding wearing the appropriate helmet and pads public vaccination programs and I did this during covet I helped out with a and some of my employees at careflight helped out with vaccination clinics for that and then disease surveillances and things like that and the CDC and other agencies may have something around and things for you to do but there's a lot of things you can do and a lot of different angles you can take in public health education and again just simply going to schools and doing public health fairs and participating in youth awareness and EMS care I don't want you to highly focus on these next few slides in EMS research I think the important thing to note here is just understand where you get your research from at the end of the day if you're not participating in your clinical team wherever you work then keep in mind that a lot of things you do is just research it's not um it's not the gold standard yet and your medical director and clinical team will set the standard of practice for your agency so I would not highly focus on these slides just because the simple fact as well I won't ask you any questions over it and uh neither would National or registry all right I just I find that a lot of places a lot of people get on Facebook and social media and they start talking about certain things that's coming that they're they're researching right now or certain things that their medical Direction wants them to do and suddenly that is the standard of care and it's just really not so just keep it keep it in perspective what you're doing not everything is created equal places like the American Heart Association you know they redevelop their standards about every five years and they come out with new things we should be doing in CPR from how fast we push on the chest to the ratio we give ventilations to CPR and then we have organizations like naemt who sets up different trauma standards with their class phtls that change every few years and some of these changes been quite fast uh so it's all about best patient outcomes so just keep yourself updated please read research understand our industry and understand patient care but just keep everything into perspective with the last slide I'm going to give you we'll talk about American with Disabilities Act uh I hope to God that uh if you have a disability that you let me know about it you have to especially if you're needing some kind of exception we need to know if you have hearing problems especially when it comes to taking vital signs if you have walking or lifting issues if you're in the academy then we've already done a Physical Agility Test for you please let me know about learning issues as well so I can be more accommodating to you there's accommodations I can make to help you out from time to isolated testing so you get the most out of this class all right but I cannot I do not have ESP and I cannot help you if you do not declare it so that is a one-on-one conversation or better yet an email to where we have documentation of everything quick chapter review so the EMS system has been developed to provide pre-hospital as well as emergency medical care again we're very young right now we use the 9-1-1 system the enhanced 911 system so people can access us and we can access them in the quickest amount of time giving pre-arrival care ensuring First Responders are headed there appropriately we're headed there appropriately and a good handoff and care at all levels now remember in EMS we must hand off care to a provider of equal or greater level typically it's going to be greater level when we get to the hospital to a nurse or a physician or even a physician's assistant a PA all right we have a lot of things we're required to do safety being number one with our foundation and patient assessment getting the patients to and from the ambulance and to our and from our uh carrying devices like the stretcher in safest manner possible we're gonna have to document and then transfer of care and then our second most important thing outside of safety is going to be patient advocacy good quality customer service make sure you look the part and make sure you act the part and you also have to keep up with your education through Continuing Education and Training make sure you know how to use every piece of equipment on that aimless even equipment you're not responsible for all right get with your ALS partner if you work on an ALS truck and ensure that they can talk you through that ask what those medications do now you can't exceed your scope of practice but it's nice to know how things work so you're a better provider and you can assist Advanced providers more effectively outside of being a young system the the government over the last 60 years has done a lot to put us in a position to be a an effective resource in pre-hospital care whereas before we were just a transport service uh an Uber essentially now we are medical providers and clinicians out in the field critical decision making is the hardest thing to teach but again slow yourself down and you'll figure it out practice as you play meaning when we're in the classroom setting study and practice when it's Hands-On sessions and skills you need to be practicing over and over again well I know that skill do it again and do it again to where you can do it blindfolded so when a critical decision hits you systematically know how to knock it out so just know that you are you are going to set and determine what provider you're going to be right you will determine that not us I open the door you walk through the door as a teacher oftentimes I don't even consider myself a teacher but a translator you can see the information in the book and the information that's before you I'm trying to relate it to you so you can understand its importance because as an adult learner validity understanding validity why something's valid to you is is is the is so important in your retention level okay so but being a self-starter and being self-motivated as a student is going to be the most important thing throughout this course so they ask you some questions and let's go ahead and do them so what Innovation was introduced in the Korean and Vietnam Wars that is now common in many EMS systems well that would be a pre-hospital trauma care and mass units helicopter EMS actually became a thing all right getting patients from the battlefield to the hospital that's close by close appropriate right that's what a matching it was so now we have that through Nitsa and the D.O.T we were able to get specialized facilities and ambulances with appropriate gear to take patients from point A to point B without there being delays in care what four levels are ems providers are there ready emergency medical responder also called ECA or emergency care attendant in Texas the EMT the advanced ENT and paramedic so you're going to get orders by radio frame your medical control what type of medical control contact you just make online remember if you were reading like your protocol book or it's a standard of care that is a offline if you're speaking with a physician By Radio FaceTime or whatever or phone that is online pretty it makes sense so your patient is hesitant to go outside because she's worried about her dog what can you do to assist the situation what part of your role as an EMT is this an example of well make sure it's safe please don't get bit by a dog but if it is let the dog out ask her what do we need to do with the dog is there a relative we can and this is an example of patient what's that a word my favorite word advocacy again personal safety comes first next important word and the overall system is advocacy I hope you enjoyed this I know these things get long and they're not always interesting listening to a YouTube voiceover but it's important it's important to learn it's important to grow it's important for me to read through the lines on these slides and give you additional information and stories and things that really help relate the curriculum to you and what you'll be doing so I hope you enjoyed it and I'll absolutely see you on chapter two

hi everyone welcome to your first chapter introduction to Emergency Medical Services now sometimes these uh Preparatory uh introduction chapters aren&#39;t as interesting as others because you&#39;re not learning much about Medical Care however it is important to know the foundations of EMS where we&#39;ve came from where we&#39;re going and the overall system so in this we&#39;re going to go over the EMS system the components of the system you want your roles and responsibilities will be our roles in public health research we&#39;ll just barely tap into that I don&#39;t want to distract away from what you need to know and any kind of special issues and that more refers to just an ADA or the American with Disabilities Act statement so EMS as a whole is pretty young as a system now you&#39;ll see 1790s and you&#39;re like well Rob that&#39;s not that oh that&#39;s very old uh however uh this is just some of the early documentation and Records we have of someone actually being transferred uh to a physician and this was in the 1790s during the French Revolutionary Wars you think of Napoleon and the war against Britain and Austria if you know anything about world history uh and you know a lot of people lost their lives in these wars it was almost like a little mini World War and this is some of the earliest documented cases we have of Battlefield medicine and people being removed from the battlefield to get to a physician so that&#39;s the foundation of EMS is patient transport uh in the Civil War uh some of you may have heard of Clara Barton I hope you have she helped found the American Red Cross and helped develop standards and transport and getting injured people uh help and this is some of the places I&#39;ve added these pictures I wondered you see some of the places where we&#39;ve been uh you see a hospital-based system in New York uh ran by Bellevue Hospital and then we see these Hearst like ambulances and even there you have Harpers Ferry West Virginia you have an old school box death trap ambulances and you have to remember early EMS you know was Private sometimes Hospital based and he even ran by uh local funeral homes and I always tease people it&#39;s like how would you like to know that the person who&#39;s transporting you is gets more money off of you if you&#39;re dead versus being alive so it&#39;s kind of scary and then over uh you know from the 20th century up we&#39;ve been working at developing better EMS standards and now you have hospital-based volunteer core you have you know private ambulance agencies and a good chunk of cities who run EMS and then in World War one you had a volunteer Ambulance Corp so now we&#39;re starting to get that word ambulance involved okay and he even had some situations of air medical as well transporting uh injured Souls uh via air uh in Korea and Vietnam a helicopter transport of sick and injured patients we&#39;re talking about soldiers uh became a thing and in Korea the mash unit became really really popular in little pop-up you know kind of Trauma Centers uh near Battlefield so we had the greatest outcome for our soldiers so you know we EMS is new you know you&#39;re looking from the 70s and up have we started refining care in the pre-hospital setting before it was all about transport and a good chunk of what we do is still transport uh you know three quarters of the patients I treat I don&#39;t give any medications to as a paramedic I simply are getting them from point A to point B uh the safest way possible now if it&#39;s something I can address and fix uh especially life-saving interventions I&#39;m going to do that but we&#39;re still such a young industry and there&#39;s a good look at what these early mass units look like if you didn&#39;t know Mash isn&#39;t just the name of a TV show it had to do with what they were doing in their little pop-up hospital if you ever watched three runs of that show and it&#39;s standard for mobile Army surgical hospital again little pop-up hospitals near battlefields so soldiers could have the best possible outcome and if you don&#39;t know this and hope you know most likely you don&#39;t because this is your intro and EMS in trauma there&#39;s not much we can do outside of stabilization in the field surgery is the end game and we&#39;re going to talk about something called the Golden hour or the time that trauma occurs the time that they&#39;re on the surgical table having it fixed by definitive care time time and distance are our greatest allies getting to the hospital in a timely manner and if we can cut that distance down by air medical or having facilities closer to us you know that&#39;s always a benefit diving further into history in 1966 the dot was charged with developing our standards in EMS uh so when I asked who do we kind of report to or where our standards come from it is the Department of Transportation believe it or not and uh as far as that goes uh Nitsa as well which is a faction of the uh Department of Transportation which is considered to be an executive branch of our government now in 1970 here comes the NRE EMT and we all know the nremt because it&#39;s the test we fear that we all have to take uh once if you&#39;re an EMT and hopefully you&#39;ll take it again if you decide to go on and get your paramedic so they were founded to kind of get us standardized and also standardized testing more more days now than not and really have a giant influence over EMS curriculum and there&#39;s some accreditation bodies now for like ALS programs that they&#39;re trying to merge over to BLS programs to ensure that we&#39;re all teaching the same thing and at a high quality with high passing rates in 1973 the National Emergency Medical Services systems Act was passed by Congress and even in the 70s they put in like 300 million dollars the government did into EMS research better training standard setting up better communication systems making sure that we&#39;re all like having facilities that are the best outcomes for patients so then comes Nissa right so Nitza comes into play you know I and I forget I think it was in the 70s or 60s when it was developed so it&#39;s the national highway traffic safety administration they deal highly in trauma and like vehicle standards however you know the best treatment of trauma believe it or not and it&#39;s a a Nitza executive would agree that the best prevention or prevention is the best for trauma right so you know simply not allowing trauma to occur will will will be the best thing we can do to protect citizens so Nitza does a lot of things outside of EMS like seat belt awareness and don&#39;t drink and drive and make sure you know you&#39;re going the speed limit and car seat awareness so this uh you&#39;ll see these commercials on you know NFL games and and uh on the radio broadcast so really pay attention a lot of times that you&#39;re listening to click it or ticket it may be sponsored and paid by the government or Nitza all right so what they do for EMS specifically though they&#39;re going to set up uh regulation and policy so Most states are going to in pretty much all states are going to govern their own EMS entity and Nitza kind of oversees that and we all report trauma data and things like that to Nitza Texas was one of the last states to do so and ensure that we have policies and procedures in place to govern uh state and local EMS so Texas also has some things there specifically now this class is taught through more of a national perspective because we&#39;re taking the National Registry but I do like you to be educated about where you&#39;re primarily going to be practicing in the state of Texas and in the state of Texas we have health and safety code 773 that gives us standards for how we should operate and we also have the Texas administrative codes 157 which is a very vast and gives us anything from EMS education standards to air Medical and how even you get in further in other chapters uh to how medical directors are required to function and what about Resource Management right ensuring that we have coordination and resources to transport patients human resources and training uh continuing education once you&#39;re in the medical field is a big part of what we do your initial education is not enough you do not come out of an EMT course knowing enough about the medical field your field training in combination with continuing education will keep you refreshed and updated to new standards and this is one of the things Nitsa will help with what about Transportation ensure ensuring that we have standards of transportation that it&#39;s not okay just to pick up a car and transport a patient in the back seat that we have some sort of standard from how stretchers operate to how they&#39;re secured down to the floor what about facilities we have to go from point A to point B let&#39;s talk about point B we have a philosophy in EMS as we typically try to transport our patients to the closest appropriate facility now I want you to pay attention to that word appropriate facility trauma victims need to go to a Trauma Center exactly burn victims go to the Burn Center OB patients need to go to a pace place with obstetrical capabilities cardiac patients to Cath Labs or cardiac facilities and so forth and so on there&#39;s so many specialty facilities out there to cater around different traumas trauma severities and medical severities that we you know ensure that our patients have the best possible outcome and if we don&#39;t go to the appropriate facility that offers a delay in care in the patient which results in worse patient outcomes and that&#39;s one of the main missions of Nitsa is to ensure that we have good patient outcomes and that&#39;s our mission as well we got into this industry to help people not for our own convenience sure as God isn&#39;t for the money what about Communications well we use the 911 system and now it&#39;s more of the enhanced now in one system to where someone calls we can identify where they&#39;re at their callback number in case we get disconnected and we can also do things like give pre-arrival instructions we can turn family members and Witnesses into First Responders by teaching them over the phone how to perform CPR open the airway give aspirin in cases and uh and when you believe the patient&#39;s having a heart attack or assist with the delivery until us the EMS providers can get there in addition to that it allows us to speak with each other on the ambulances to our First Responders and communicate with the hospitals so they know we&#39;re coming and can be prepared again so the patient may have the best possible outcome public information and education well we have our continuing education and standards will be required based on National Registry guidelines and uh if you&#39;re just State Certified then you&#39;ll go off of your state certification okay uh also they&#39;ll do public information they&#39;ll do car seat awareness classes and things like that they also again like I previously mentioned participate very uh heavily in vehicle information vehicle data and crash data and things like that medical Direction wise well EMS is pretty much a business of what we call delegated practice you are an designated agent of your medical director and the medical director is a medical physician who oversees your EMS agency and he or she is the overall Authority on what you&#39;re allowed to do how you should operate what&#39;s your scope of practice the standard of care of what you operate your protocols or guidelines and what you&#39;re allowed to do for that particular agency and even dictates how much training you should receive and what that training should be over now in the end you&#39;re also held accountable to National Registry and state standards but also within your organization your medical director should set a foundation and we&#39;ll talk about how we evaluate that on the next slide trauma systems are really important because one thing we know about trauma is that time is of the greatest Essence okay so we&#39;re going to have different kinds of trauma triage from how we determine whether the patient needs to go to what type of trauma uh Hospital capability to mass casually sizing up and uh delegation of resources to different treatment protocols and National standards through the American Academy of surgeons and things like that so evaluation wise we use what we call quality improvement this is what you see down there in qiqa or tqm that&#39;s quality improvement quality assurance a total quality management here at careflight in the academy we call this cqi within our organizations and other organizations also call it cqi and that&#39;s clinical quality improvement now this is the time where we get together and we review charts now we have a standard in which we review charts all 9-1-1 charts are a hundred percent audited and all ALS charts are 100 audited but like BLS transports the ones where not much cares being given we only audit a certain percentage of those because it&#39;s such an abundance and it&#39;s very basic care and we want to put our focus on the more emergent things and kind of triage our own calls and what we&#39;re going to use that data for is to improve get better as individuals as an agency and also to evaluate do we have the right resources and you use that by viewing your data and what kind of calls you run and what kind of problems you see and it&#39;s not just for bad either it&#39;s also can be very quite good you may get some data back that shows hey we&#39;re really good at this hey good job everybody or you may have had a call where you made a decision it was a really good decision your documentation was excellent and this could be a time for you to be recognized so don&#39;t look at quality assurance or quality improvement that&#39;s a bad thing again it can be utilized to show what you do well just as well as it could be used to show what you do bad now getting into the components of our EMS system we have to take these calls and delegate it to the closest appropriate ambulance so we use emergency medical dispatchers or emds to do this and they&#39;re a vital part in our system because they can see all they can see in the modern system where all their ambulances are located and ensure that when that call comes out that the closest Ambulance with the highest capabilities is headed towards that emergency all right so they can also give pre-arrival instructions to ensure that CPR victims have the best possible outcome because one thing we&#39;ll really focus on when you have a patient in Cardiac Arrest time on chest or time of CPR is everything from giving constant CPR to starting CPR as soon as possible so the patient has the chance to come back from it then we have our responders these could be volunteers or departments that will work with us all right and they can have a varying degree of certification from the lowest level emergency medical responder to all the way up to paramedic you&#39;ll work with people on volunteer agencies who have a broad spectrum of certification and some often may not they have first aid and CPR and they&#39;re almost off operating like a Good Samaritan but that agency&#39;s medical direction will set up what they can and can&#39;t do and if they&#39;re working under a private agency like careflight we dictate what they can and can&#39;t do or our doctor Dr Simonson does that then we have us as em Master spawners we come and pick the patients up from the First Responders and there&#39;s a handoff of care and then we get them to the hospital so it&#39;s EMS are spots in itself is very intricate you have the first response and then you have the EMS and there are going to be occasions where you work in areas where you do not have EMS response it&#39;s important that if you do work in a place that doesn&#39;t have like a volunteer fire department or a fire department&#39;s not interested in participating on medical calls that you talk to like police departments and see if they would like to train up and take first aid classes CPR classes and even things like EMR or emergency medical responder classes we&#39;ve seen that in different cities and it&#39;s really had a great outcome for patients in the end we need to get these patients to definitive care and that&#39;s going to be the emergency department and hospitals as much of an ego as sometimes an EMT or a paramedic can have I have to understand we are a lower level of care in combination to doctors and nurses so we need to get to them so they can receive Imaging and Diagnostics to understand what&#39;s going on with them and most importantly begin the process of fixing them some of these specialized facilities we&#39;ve already talked about Trauma Centers burn centers pediatric centers cardiac centers and stroke centers they all have Specialties in what they&#39;re allowed to do and there are a lot of facilities that are a little bit of everything just quite frankly outside of Pediatrics Parkland is a trauma center it&#39;s a burn center it can handle great cardiac and it can handle stroke so it&#39;s kind of a multi-faceted facilities and there&#39;s plenty of them out there and then we have one place that&#39;s in the Coffee County area like uh Baylor Scott and White Sunnyvale uh they don&#39;t do stroke but they do a lot of cardiac they don&#39;t do kids Burns or any kind of trauma they can do mild Orthopedic like if someone you know an adult broke their collarbone you know they probably handle that just fine without transferring it but anything else if they can&#39;t handle it the facility is going to have to transfer it to another facility and all you&#39;ve done is delay patient care and it&#39;s not an easy transfer especially after covid you just can&#39;t go hey uh Parkland they brought us a burn and we need y&#39;all to take that parkland&#39;s not going oh okay no through the Impala laws which we&#39;ll talk about at the end of this presentation um you know we can&#39;t um we can&#39;t just transfer someone from one facility to the other without there being uh you know a doctor the transferring doctor agreeing with the receiving doctor accepting the patient the hospital having the appropriate number of beds and staff to treat the patient there&#39;s a lot of intricate factors it could take hours and it can even take days to get someone out from one facility to the other so be very careful and don&#39;t do what we refer to as dumping and here we go there&#39;s a good example of a trauma center and the patient being worked on trauma patients need to go to Trauma Centers if they&#39;re going to have the best possible outcome so I want you to really think what kind of medical services are available in your community so we&#39;re in the Dallas Fort Worth Metroplex and we&#39;re real lucky because we have a vast amount of Trauma Centers cardiac centers and stroke centers so wherever you&#39;re going to work you need to figure out what are the specialized facilities what can the local facilities handle and not handle and even consider making yourself like an Excel spreadsheet that you can keep on your phone or on your person and encourage your agency to have that in like a protocol book or something so you understand what kind of capabilities at the end of the day you should have all the hospitals phone numbers then this can be gained through your preceptor or fto and before you make that move to transport call the facility you want to go to the patient&#39;s requesting say can you handle this or that remember the consequences for not going to the right facility is a delay in patient care which results in worse patient outcomes how does the EMS system work well we see it here if you have a patient some kind of incident I assume he&#39;s trauma because he&#39;s in a car and he&#39;s grabbing his neck someone calls 9-1-1 the emergency medical dispatcher gets the call gets the callback number and address of the location uh starts asking a series of questions typically on any kind of accreditated system and gets the emergency medical responders headed out that way for operations and First Response care we get there to provide care they hand off care to us we transport to the emergency departments and hopefully the patient will have the best possible outcome once at the hospital so 911 is that Universal number when you call 9-1-1 it&#39;s going to patch you into the local 9-1-1 um call center oftentimes these call centers like County call centers may not be the ambulance provider so and they may not have an emergency medical dispatcher it&#39;s just a standard dispatcher this person is not trained in like the emergency medical responder questions and algorithms so they forward them on like at carefight in Kaufman County oftentimes Kaufman County will receive that call and then they they find out where the address is so they can get First Responders going and then they forward it over to us so we can start the EMD process through Pro question and answers that ensure that we have the right amulets headed to them at the right speed and priority um and we can feed information to the crew so they&#39;re better prepared for what type of emergency they&#39;re operating on and the great news about this you know when I started in EMS we were still using routes and then we came up with enhanced 911 you&#39;ll saw a lot of places in tax is where you went from route to an actual County Road number this doesn&#39;t ensure that every house had an actual address that you just didn&#39;t live uh you know at 22 Route 1 and no one could identify you now you live at you know 252 County Road 306 when I totally made that up uh but back in the day I tell you it was confusing you would get dispatched to a call and they&#39;d be like well you&#39;re going to look for the Red Barn after the Red Barn you&#39;re going to see a a dirt road to the right and you&#39;re going to go through a brown fence and it was like that and now you know now we have geolocating we can we don&#39;t have to use map books and map skills anymore which can take a long time to kind of uh figure out where you&#39;re going um you can you know use your phone or use computer animated systems in your truck to locate that call through Google Map and get there in the most timely manner as possible and so getting lost used to be very frequent uh now more and now nowadays it&#39;s you get lost still but not anywhere near the frequency so it&#39;s a great generation of EMS you&#39;re stepping into where technology really is driving us forward does EMR I&#39;m sorry the emds they&#39;re so important in what we&#39;re going to do though they&#39;re going to give all that first responder information First Response information the other day I had a cardiac arrest right before I recorded this lecture and um you know I walk in the house and the first the EMD is given real loud and clear instructions to the patient&#39;s wife on how to give CPR and it was real clear you know the wife had the phone on speaker and she was doing CPR effectively at that to the patient she had no CPR training she I was just following the directions of the EMD so the EMD was doing a great job uh you know he did not have a great outcome though he sure as heck would have no possibility if we weren&#39;t giving clear instruction do you want to talk about a job that requires multitasking be careful and don&#39;t criticize your dispatcher you know there&#39;s always that internal war between you know police Fire EMS and their dispatchers you know we all think we have the better job but um you know some of these dispatchers may have 20 apparatus under their control they&#39;re trying to take a call because they&#39;re backed up at the call center and dispatch out their Fleet and my Lord look how many computer screens this lady has in front of her that&#39;s a lot to control and requires a ton of multitasking so don&#39;t criticize your EMD it&#39;s actually a difficult job so critical decision making I I find this is oftentimes the hardest thing to teach as an instructor as your critical thinking skills some of you will have it naturally that you can think on the Fly accurately every time you just kind of have to know your strengths and standards if you&#39;re one of those people who when it speeds up you start making mistakes then slow it down you don&#39;t want to be the fastest you want to be the most effective that means doing things in a timely manner but the right way the first time around and delegation also comes into here if you&#39;re the head of a crew and it&#39;s one of the hardest things to learn if leadership doesn&#39;t come natural to you is to delegate to all the resources you have on scene to ensure that everything gets done in a timely manner okay so you&#39;re going to use a lot of your natural senses in the process and your gut instinct comes into play real heavily but you also need to break things down and ensure that you&#39;re doing things in a systematic way this is where things like muscle memory come into play and try trading if you train heavily at something it becomes like muscle memory to where you don&#39;t make as many mistakes now if you don&#39;t know something as effectively when the adrenaline hits you&#39;re more likely to make a mistake so just because you know something doesn&#39;t mean that you don&#39;t need to train in it you need to be able to perform skills blindfolded because if you can perform them blindfolded you can perform them when someone&#39;s screaming in your ear to save their loved one questions and a good thorough assessment will also help with this and we&#39;ll talk about Assessments in later chapters but it&#39;s great you may know how to treat something but if you can&#39;t identify it that&#39;s a problem right so I often refer to that assessment is the foundation of our care and let&#39;s talk about homes and Foundations and I think everyone in this class even if you&#39;re not have a history of construction understand that if the foundation of a home is cracked then that home will eventually fall apart so make sure your foundation is strong in assessment and you will be able to make critical decisions when stress is high so different things should you take the patient to the closest hospital or to more distant Specialty Hospital that depends right that depends I&#39;m sure mostly like well that depends so what&#39;s going on with the patient um yeah I have a trauma victim and they need to go to the trauma center the trauma center is 30 minutes away but the patient I can&#39;t get their airway open and they&#39;re not breathing do I want to try to go 30 minutes down the road or do I want to go across the street to the local hospital well they don&#39;t have the capabilities the patient needs they do have a physician in there who can establish an airway get to pay you know get the patient on a ventilator and help them breathe and then transport them out they&#39;re not going to live without their airway open effective breathing or intact circulatory system so sometimes yes we have to go to the closest facility regardless of what they need in the end and understanding they may be transferred out later but when the patient is not stable you go to where there&#39;s a doctor it is likely giving medications and there&#39;s not many Communications the EMT will give but you have to ask yourself we have the five rights of giving medication and one of the rights is the right patient is the right medication to give to the right patient is this going to help them it&#39;s going to improve and also knowing how those medications work that&#39;s part of critical decision making if you understand the why you&#39;ll never make as many mistakes because you understand the mechanism of action of of different treatments and medications you give but in the end there&#39;s one medication that we give that&#39;s better than any and it&#39;s that one right there Jed a diesel or unleaded fuel getting the patient to the hospital you&#39;re in the transport industry now getting them from point A to point B is the best medication we carry time and especially in trauma and Trauma I can stop bleeding I can lay them flat and protect against shock however I can&#39;t stop internal bleedings I&#39;m not a surgeon so even as a paramedic I understand that getting the patient to the hospital in a timely manner will give them the best possible outcome let&#39;s break down our certification levels in the EMS system so we have four that are common and all four are recognized in the state of Texas and with the National Registry so you have the emrs up until recently EMR is the big difference between EMR and EMT was the ability to transport the sick and the injured the state of Texas now allows emrs to transport at the BLS level then you have the next step up is emergency medical technician which we&#39;re all going after which has a vast uh practice often referred to as the EMT basic we don&#39;t refer to it as the EMT basic anymore because there&#39;s nothing basic about the care you provide uh formerly known as the EMT intermediate we called the advanced EMT and some of the difference in the scope of practice or what you can do when we say that word scope or practice remember that&#39;s what you&#39;re allowed to do um of the aemt is going to be Innovation so Advanced Airway management uh IV and some medications then you get to the highest level in EMS and you have the paramedic level and formerly known as emtp EMT paramedic just called paramedic now they can do Advanced stairway management different various forms of access some services do surgical Airways and then you&#39;re looking the main big difference between paramedic and advanced EMT is going to be cardiac monitoring so EKG technology the ability to read translate and transmit uh and a lot of medications a lot of medications Advanced cardiac life support and things like that are so important because they you know the nurses and the doctor also carry the same certification the paramedics do so the patients who go into cardiac arrest in the field may have the greatest outcome I included this so you could see the different certification levels here in Texas you see the white patch that&#39;s ECA they still call it ECA here that&#39;s an EMR I refer to as EMR because I do National Registry staff you see the blue patch the EMT the advanced EMT formerly intermediate and then you have two different paramedic patches you have a certification patch and you have someone who is an LP or licensed paramedic the big difference here is they&#39;ve had the same Foundation uh care the LPS had a has a degree in EMS so that&#39;s the only difference as far as what they learned it&#39;s the same but LP ensures they&#39;ve had you know more training in like anatomy and physiology but um I I don&#39;t notice personally a difference out in the field uh it is good to have your LP and I recommend it and eventually it&#39;ll probably be required um but uh National Registry doesn&#39;t do anything this is just in the state of Texas and I&#39;m not sure what other states do when it comes to degrees and licensure so what are your roles and responsibilities going to be when you get out there in the field well your safety number one thing we&#39;ll talk about in this class safety and this is the order of operations for safety your safety is first your partner safety is second the patient safety is third and then we&#39;ll worry about Witnesses and bystanders okay why the sick and the injured cannot save the sick and the injured if you go down then you put a strain on the EMS system think about it you&#39;re responding out to a house fire right you heard that there is an adult male inside that may be in there so you decide to be a hero and you run in this house you collapse now they call another Amy wants out for you and the missing victim so you went from one ambulance on scene to three with one being out of service and you possibly being dead how did you help anybody y&#39;all there&#39;s a fine line between heroism and stupidity all right be smart while you&#39;re on scene and don&#39;t put other people&#39;s safety ahead of yours you cannot help them if you&#39;re down so you&#39;re gonna have to learn how to work with a multitude of personalities from law enforcement you&#39;re looking at sheriffs deputies or what we call so local police departments fire departments all right you have to be able to work with everybody you have to put your pride aside your reputation will carry across this industry meaning if you&#39;re rude to people and your responders it will catch up with you at some point in time in your career be a good person to everyone and put your pride away when other people are being nasty you know when our adrenaline gets up sometimes we say things and we snap you&#39;re going to have to have thick skin in this industry okay you will be snapped at at some point in time all right you should always talk respectfully to people but understand sometimes when the adrenaline&#39;s going we get a little excited we&#39;ve already talked about the importance of patient assessment and being the foundation in our care you&#39;re also responsible for lifting and moving patients transporting them handing off care and the most important thing we do outside of our own safety is patient advocacy being that representative for the sick and the injured who cannot at times speak for themselves I refer to it as customer service I do not teach customer service in this course you are either a good person or you are not if you are a good person and you give good customer service you will continue on if you&#39;re not and you&#39;re rude to people and your patients you will not make it through because we do not want people like that in this industry so I want you to think about it for a minute you know how would it impact an older adult patient if they were transferred to the hospital without glasses and hearing aid or dentures well that&#39;s poor customer service uh how can you effectively assess and communicate with someone without these things right they need to be able to see you um they&#39;re going to be away from the house so not only is it just in transport with you but when they get there you know that&#39;s gonna they&#39;re gonna be very apprehensive they can&#39;t see what&#39;s happening around them what about hearing aid how can we communicate and properly assess and ask about their history of present illness if they can&#39;t hear us I don&#39;t want to scream at them all the way I had one time I always tell the story where I had a young man EMT working with me as a newer paramedic and I asked them to put the patient&#39;s hearing aid help them with their hearing aids he goes I don&#39;t know how to do that and I looked right in his face and I said well you&#39;re going to learn today so next time this won&#39;t be a problem and he was just like come on Rob and I&#39;m like no don&#39;t I said to you you are an outpatient Advocate your job is to help the patient if I&#39;m sorry you&#39;re an EMT I&#39;m a paramedic we&#39;re both supposed to be able to think outside the box and help people and if I don&#39;t know how to put their hearing aid I&#39;ll work with them on learning how to put it in so next time that comes I come across a patient with hearing aid I know how to do it right like any skill I didn&#39;t know how to do every skill I learned I perfected it Dentures think about some of the problems we could run into there and this is chapter one so there&#39;s things you don&#39;t even know about I hope you all know what a bag valve mask is right it&#39;s a masked bag that we put over people that helps us breathe for them when they can&#39;t breathe for themselves what if I told you that that mask of the BVM is dependent on the patient&#39;s facial and dental structure so it&#39;s important to have their dentures in if they quit breathing because it provides structure to allow us to more effectively breathe for them also even if they&#39;re not that critical if I need to assess them it&#39;s easier to speak with them if they have their dentures in and how about this how about dignity we talk about advocacy and going hand in hand with advocacy is dignity give them their dignity so they can hear see and communicate with you so no excuse for poor customer service these patients are reaching out to you going I need your help 9-1-1 come help me and you have to be that servant who puts your personal needs and Views aside and helps them now on a routine call with taking time to gather items have a negative effect on patient care well that&#39;s dependent right what are you looking for if they&#39;re wanting you to dig for you know where&#39;s Waldo and it&#39;s taken five plus minutes yeah maybe but simply looking for their keys helping them put their dog outside if the dog&#39;s safe right you know I don&#39;t want Grandma to come back home and her house has been robbed uh or her dog&#39;s dead in its cage you know but within reason everything&#39;s within reason if you know you&#39;re working a cardiac arrest it&#39;s gonna be a little harder damn that I love that word advocacy you know I just love it I want you to stare at it I want you to ingrain it into your head you are a patient advocate you are here to protect your patients rights confidentiality through their personal health care information try to fix what&#39;s going on with them at least identify it get them from point A to point B with them feeling like you actually cared about them so what about the community what are some ways you can be a patient advocate to patients you&#39;ve never met well participate in community outreach follow potential prevention programs for the elderly and simply when you have a patient you&#39;re running who&#39;s Fallen identify the way they fail you know do they have sliders on their walkers do they have proper clearance with their wheelchairs do they have proper wheelchair ramps and entry points and exit points into the residence is grandma wearing the wrong Footwear on you know linoleum flooring you know these are things you can do simple and then you can do things like uh car seat awareness programs and do public education as we see here get kids in the back of an ambulance as early as possible so they&#39;re not as apprehensive when they&#39;re having an emergency it&#39;s actually really fun to do as well makes you feel good so what are some physical traits we&#39;re going to need physical traits well we&#39;re going to the requirement and the EMS standard is lifting 125 pounds by yourself however that doesn&#39;t mean you should does that make sense it&#39;s like yeah the patient weighs 125 pounds but get someone to help you all right there&#39;s only so many lifts on your joints and back and save them you know my back I have scoliosis and I&#39;m 41 years old at the time I&#39;m recording this lecture and my back is hurts pretty bad frequently a couple times a week it has a lot to do with how I lift it I didn&#39;t always lift appropriately and you know what I pay for it now and it&#39;ll only get worse you do not want to take a rotator cuff or back injury in this industry because that can put you out quite a bit of time you&#39;re not getting 100 pay um and you&#39;ll feel those effects the rest of your life so take care of yourself one lift that&#39;s inappropriate it&#39;s too many lifts uh rare corrective lenses contacts surgeries if you need to remember we have to identify hazards and we don&#39;t have to identify patient addresses and road signs so you have to be able to see keenly uh what about color vision well I know people who are have color color blindness in our industry you just need to let somebody know some of the things we do like the medications oftentimes we identify the Boxes by their color not that we do not read to verify we always need to read our boxes for their names name of the drug and expiration dates however that first grab into our drug bag or box is often going to be based on color like I know epies that brownish grayish color and you know when I&#39;m in a cardiac arrest situation I&#39;m going to grab it verify the drug and date and go for it that initial grab saves me time or I know that D50 or dextrose 50 for diabetics a little sugar water it comes in a blue box right so when I grab that blue box then I verify its Dexter is 50 and it&#39;s got a good date uh even in like trauma triaging you know we have red yellow green and black if I can&#39;t see that I know I need to be governed more towards the priority on the tag because I can&#39;t see the color all right so let someone know so they&#39;re better prepared and like some places May set their systems up color based you want to ensure that there&#39;s a secondary system for you to identify all right you can&#39;t help the way you are you just have to work around it communication skills uh are very important and any relationship that goes wrong in your life typically has to do with communication all right so being able to orally and express yourself is important remember the three ways humans communicate is through content tone and Body Language believe it or not content&#39;s the least important of all those how you present a message is more important than the message itself so watch your body language watch your tone of voice you&#39;re also going to have certain like abbreviated forms and things like that whereas we have gone to electronic pcrs or patient care reports still good handwriting skills are important make sure you type things out when you just can&#39;t get around your handwriting all right take it slow everyone can write well if they just slow down some personal traits well be nice again I won&#39;t teach I won&#39;t teach you to be nice I will not teach you customer service I can encourage it but I can&#39;t teach it and the reason I say that is I just believe it&#39;s not that I I won&#39;t give you exercises in Communication customer service I will I say it to send an effect into you that you&#39;re like okay he&#39;s pretty Stern on customer service I I do I don&#39;t have any tolerance for poor customer service all right be sincere and at three in the morning it&#39;s hard to be sincere over you know back pain for 30 days it&#39;s you just gotta fake it all right fake it when you get back then you can blow off some steam at the station appropriately be cooperative there are times where you have to be a mom or a dad all right to these patients uh right before I recorded this lecture I mean literally within the same week of recording section I had a lady I&#39;ve ran out multiple times and she is extremely rude to me and I like I do everything so right by her because I know she&#39;s difficult trying to win her over because I like the challenge uh and uh of trying to you know show someone I really care about them and not just flipping on them because they&#39;re rude and you know she&#39;s told me before she&#39;s not gonna answer any of my questions because it&#39;s just a waste of time but she wants me to take her to the hospital and far away too uh and this last time I ran over she started doing it again to me and I said ma&#39;am I&#39;ve ran on you before I don&#39;t know if you remember me she didn&#39;t I said and I understand you have a medical emergency and I&#39;m gonna do everything I can for you okay I said however you are going to speak respectfully to me and I will speak respectfully to you we&#39;re not going to cost or shout at each other we&#39;re going to be polite I&#39;m going to get you there and do what I can for you does that sound good she&#39;s like I&#39;m not being rude with you I said yes ma&#39;am you are and her own husband piped in sweetie you&#39;re being a little nasty you let the man do his job and she was okay after that she didn&#39;t really talked to me but I was real polite about saying I had to establish a standard with her so it&#39;s not how I like to operate but I will sometimes be that Dad to the patient because we&#39;re gonna we&#39;re gonna give you a good ride but you will be as equally as respectful as we are and they&#39;re allowed to have bad days don&#39;t get me wrong I don&#39;t mind getting snapped at but when you&#39;re constantly being nasty okay how do we feel about this young man for Acadian right good Ambulance Service Acadian uh he looks great y&#39;all honestly he&#39;s got his eyewear on he&#39;s got gloves on he&#39;s going in with his equipment uh black boots uh properly groomed hair doesn&#39;t look dirty great looking new class A on he he is a model of how we should we should look so what are the personal traits be a self-stars greatest thing about our job right we don&#39;t have a boss over us all the time in this industry we are on our own so you have to come in and be responsible and be a self-starter for yourself check that truck off uh Light maintenance making sure fluids are topped off make sure that thing&#39;s cleaned up okay emotionally stable this can this can be a hard thing Believe It or Not especially after a bad call uh you have to be emotionally stable you have to be able to perform all types of calls just FYI some of you may be in this class going I can handle every call but a pediatric arrest I won&#39;t be able to do that call then quite frankly you can&#39;t be an EMS okay you have to be able to perform on every single call however it&#39;s what happens after the call that matters in these high stress situations meaning you are absolutely allowed to not be okay after a pediatric arrest or you know a mass casualty incident you&#39;re it&#39;s okay but you have to be emotionally stable enough to get through it operate as an effective provider after you&#39;re done take that ambulance out of service call your supervisor or officer and shut down and go do what you need to do to handle it whether that&#39;s what we&#39;re going to talk about clinical or critical incident stress debriefings or going seeing a therapist or just taking a day to hit the golf course and dissociate from work and that&#39;s okay but you have to be able to perform on all calls you have to be a leader a lot of people are like well I&#39;m an EMT look okay oftentimes you and your partner will be split and this class is taught through the perspectives that your two EMTs on a truck so you could be the senior most provider you could be the senior most provider two months into your job you get a new person who shows up who has even less experience than you do all right and I&#39;ve seen Grady and Veteran EMTs out there who are kind of the leader of their truck even though their paramedic has the higher level certification so leadership&#39;s important and that is something you can develop if you don&#39;t have it naturally being needing clean some of us need to be not be that person all right you need to groom yourself appropriately make sure your hands are taken care of make sure your uniform looks good and clean replace them as they become damaged okay watch your breath that&#39;s another thing keep gum on you and uh for those who like to wear colognes and perfumes please make sure they&#39;re not too loud those can have a reaction of people&#39;s allergies and respiratory emergencies how about being a good person a good person moral character all right we&#39;re gonna talk about ethics and morals in another chapter but just being a good person overall and on days where you&#39;re struggling you know consider do I need to take a mental health day or simple fact do I just need to fake it until I can get through this day and let my partner know hey I&#39;m having kind of a bad middle day you want to help me out and take control and I&#39;m gonna let you do the talking and I&#39;ll interject if I need to all right figure out creative ways to get through your day without uh cutting into patient advocacy and customer service try to be in control of any personal habits and especially personal views okay don&#39;t get into religious uh political conversations uh always just say I don&#39;t I&#39;m here to treat you I don&#39;t really have any views over anything you&#39;re talking about all right because people will try to bait you into inappropriate conversations in the back of the ambulance all right uh be able to listen uh don&#39;t talk over people let them finish their statement before you have to continue that&#39;s not to say that sometimes elderly people while you&#39;re assessing them will get going and talk about a surgery that happened 10 years ago for 20 minutes and you may have to stop and say Miss Smith uh that sounds uh like you went through a lot during that surgery and I&#39;m not trying to be rude but we&#39;re like five minutes away from the hospital and there&#39;s a lot of other questions related on what&#39;s going on today I need to talk to you about and usually they&#39;ll understand but it&#39;s all again about communication how you present that so you got to ask yourself how am I going to stay up to date well you&#39;re going to take things like refresher courses we call these continuing education or CE courses and the National Registry sets our standards for how often we recert which is two years by National Registry and that&#39;s always from um uh March 31st so let&#39;s say that you took this class in you know um this you passed the National Registry in December of 2022 your research date would probably March of 2025 because you&#39;re so close March 31st 2025. by that time you&#39;ll have to get online and see what kind of CE standards they have over that two-year period And do not procrastinate there&#39;s a lot of things you can do to gain CE in bulk too it&#39;s very interesting going to conference and seminars when hospitals bring in guest lectures and things like that oftentimes those things can be free go get yourself educated it&#39;s not only important to maintain your certification it&#39;s also important to maintain your education so you can give better patient care just be careful where you get your resources from all right make sure that you know where you&#39;re getting your resources from Facebook is a great a great uh asset for like discussions between EMS and First Responders uh however that&#39;s filled with opinions okay so no research no understand understand when something&#39;s a standard of care and research you know although there&#39;s some outgoing young EMTs and paramedics you think when they hear about a research that&#39;s now the standard of care and they should be doing it no it&#39;s research for a reason so what qualities would you look to see in an EMT who&#39;s caring for you well I I got to be honest with you how that provider looks is everything to me this is one job where it&#39;s acceptable for the patient to judge a book by their cover if you come in looking like crap and your ambulance is dirty you give crap care I&#39;ve never met an EMT or paramedic who gives amazing care who keeps dirty equipment and unstocked Equipment laziness uh is laziness in the end so I would want to see a nicely professionally groomed individual who came to bedside prepared um you know I always call it the your mama test when you&#39;re doing something for a patient ask if it would be acceptable for your mother if the answer is no then you&#39;re doing the wrong thing this could be something like helping a paramedic with an EKG and then you pull the patient out the back and their chest is exposed to everyone in the ER Bay and in the hospital how would you feel if your grandmother was on your stretcher or on an EMS stretcher in nothing but their bra going through a hospital would you be okay with that I&#39;d like to think you wouldn&#39;t be then why is it okay for your patient so always do that your mama test would this be acceptable care for my mother think about where you&#39;re going to work lots of places you can work as you can see here in the end you may figure out that this isn&#39;t something you want to do I hope you keep up with as long as a volunteer uh but I I find that most people once they start down this path they made up their mind and they want to do it not maybe people bow out of the program just because they don&#39;t want to be an EMS maybe years later they do they get enough of it burn out as high in this industry and this EMT is entry level into the medical field so they may want to move up nursing we&#39;ve got a couple near doctors Pas all right I hope I hope this is your beginning step into the medical field there&#39;s lots of places you can work you can work rurally Urban uh transfer systems you can work in in hospital as a tech all right this certification will help you with a lot of things you work at dialysis clinics uh wound care therapy uh there&#39;s just a lot of places you may be able to utilize your ENT certification so don&#39;t give up on the medical field if you don&#39;t like EMS you know move forward in a direction of medical and health care that you&#39;ll need as the population grows and we all start to age you know we need to we need to ensure that we have enough Health Care Providers to go around and that&#39;s a problem right now there&#39;s not enough EMTs paramedics and nurses and doctors to go around oftentimes hospitals have enough bed they don&#39;t have enough staff covid has really done a number on the healthcare industry will feel the effects of this for a long time so the NR EMT the test you&#39;re going to take it&#39;s that uh that uh you know approves your Certification Texas is what you call a nationally registered recognition State meaning uh you still have to be State Certified to work here you just don&#39;t have to take any further state test there is no State tests in Texas just we they are they want the National Registry so in certain States they&#39;re full-on National Registry states that means you don&#39;t have to have state certification if you have your National Registry you&#39;re allowed to work there okay so we&#39;re a recognition state where you still have to have a state licensure but that&#39;s just a background check and fees if you have your you&#39;re in our EMT license then you will get approved um and that&#39;s for all levels uh and some of those levels will go between states the EMR is not it does not that&#39;s called reciprocity so like I can get my uh in our EMT in like Oklahoma and then I can move to Texas and apply for State licensure if that was the EMR level I wouldn&#39;t be able to do that unless they&#39;ve changed a lot I&#39;m just not aware of it you know for years EMR wasn&#39;t allowed to have reciprocity which if it&#39;s National Registry it&#39;s National Registry but that&#39;s their their decision not mine I would keep up with it if I were you and you ask yourself why wouldn&#39;t I keep up with my National Registry you don&#39;t have to in Texas as soon as you have your state licensure you can just use state of Texas guidelines and I&#39;m gonna let you know laziness is the reason people don&#39;t do it because the NR EMT licensure has more strict guidelines for CE and it&#39;s every two years the status axis is every four years and I wouldn&#39;t say the state of Texas standards are not as strict um I&#39;d say they feel less specific uh they still require a significant amount of hours that you need to keep up with but you have a four year period to obtain that so it in the end it&#39;s laziness uh please keep up with your certification you need to keep up with your training so you can be the best possible provider laziness and complacency will just breathe bad patient care y&#39;all you have to understand that we&#39;ve already talked about quality improvement and your overall role in quality improvement is just please write a legal and effective document all right you&#39;re a patient care report should be your a a picture of what happened on that call and by documenting accurately you will provide Qi data that helps your system progress forward so good written document be involved if you can when your agency has cqi clinical quality improvement make sure that you attend if you can or zoom in which most places do now offer feedback ask for your statistics say hey could you tell me how effective I am at IVs uh if you&#39;re not documenting them correctly though like documenting all your misses and makes um you know you&#39;re violating documentation guidelines but at the same time you know your data is irrelevant because it&#39;s inaccurate this is where your role comes into play and documenting correctly it also ensures that you have the appropriate equipment like say CPR Thumpers let&#39;s say that you work in an agency that&#39;s very rural and they notice that you&#39;re running a lot of CPR calls lately with long transport times they may using that Qi data go hey we&#39;re going to buy you all Thumpers okay so Qi looks at individuals uh within a system it looks at the overall system uh it determines like what kind of equipment and training is needed to progress forward so that they may see we run a lot of stroke calls so we need to kind of focus on these uh high frequency calls all right foreign again you are the designated agent for your medical director and here at careflight in the academy your medical directors Dr Robert Simonson awesome gentlemen and very smart uh very good teaching physician as well works over at Methodist and what his job here is it clarified is he&#39;s the ultimate say in patient care what we are as a designated agent is we are working under his medical license you wear a little extension of Dr Simon&#39;s license he&#39;s going to set up training with the clinical staff and he he signs off on all protocols says what he wants and doesn&#39;t want in those protocols our clinical team develops a lot of those things and then he overviews and says I want this and this added and please take this away this is why we&#39;re not going to do that and he&#39;s very open and he gives us a lot of flexibility at the same time there are certain things he&#39;s unwilling to move on because of his education and his time in EMS and in emergency care you know he he has he knows the outcome of a lot of these things and he also has access to being a physician it&#39;s a newer standards and things that are new standards of care in the field that we just don&#39;t have so he&#39;s going to have two things and I would highlight and start and underline this and write it down is offline and online medical Direction so he&#39;s going to set up some kind of standing order which we call protocols or clinical practice guidelines this is a book typically that all Ambience is required to carry let&#39;s say what you can and can&#39;t do for that agency and these are different interventions from IVs to medications to how much oxygen you should give when where and why uh those are standing orders all right occasionally you may have an order where it requires you to call in just to verify before giving a certain medication and we&#39;ll talk about some of those in class or you may be faced in a situation where you don&#39;t know what to do so you should always have online medical direction that is the ability to call a medical director to ask them a question live this doesn&#39;t have to be your medical director but another physician that works under the medical Direction like here at careflight we call Dr Simonson when he is unavailable that line goes to emergency room physician in Methodist who is aware of our treatment protocols and procedures so they don&#39;t try to give us something inappropriate all right and also here careful we have the ability to do telemedicine with only Dr Simonson where we can get him on FaceTime on his iPad and we can um communicate with him through video chat and even the patient can talk with him all right and that&#39;s online medical Direction offline is some kind of standing order online is when you&#39;re speaking to or video chatting with your medical director and again in the state of Texas we call this delegated practice the medical directors delegate what we can and can&#39;t do as an extension of their license AKA we are their designated agent now we&#39;ve already talked about public health but I want you to really consider if you want to have a role in it and I like this picture right here because this is good fall prevention you know making sure that rugs have some kind of Underside to them that adhere to um slick flooring and that the appropriate Footwear is where for the elderly trip believe it or not you one of the most common trauma injuries you&#39;re going to run in a ground level falls from the elderly okay they&#39;re just not as coordinated injury prevention for the Youth this could be wearing appropriate sports gear or wearing A Bike Helmet or when they&#39;re skateboarding wearing the appropriate helmet and pads public vaccination programs and I did this during covet I helped out with a and some of my employees at careflight helped out with vaccination clinics for that and then disease surveillances and things like that and the CDC and other agencies may have something around and things for you to do but there&#39;s a lot of things you can do and a lot of different angles you can take in public health education and again just simply going to schools and doing public health fairs and participating in youth awareness and EMS care I don&#39;t want you to highly focus on these next few slides in EMS research I think the important thing to note here is just understand where you get your research from at the end of the day if you&#39;re not participating in your clinical team wherever you work then keep in mind that a lot of things you do is just research it&#39;s not um it&#39;s not the gold standard yet and your medical director and clinical team will set the standard of practice for your agency so I would not highly focus on these slides just because the simple fact as well I won&#39;t ask you any questions over it and uh neither would National or registry all right I just I find that a lot of places a lot of people get on Facebook and social media and they start talking about certain things that&#39;s coming that they&#39;re they&#39;re researching right now or certain things that their medical Direction wants them to do and suddenly that is the standard of care and it&#39;s just really not so just keep it keep it in perspective what you&#39;re doing not everything is created equal places like the American Heart Association you know they redevelop their standards about every five years and they come out with new things we should be doing in CPR from how fast we push on the chest to the ratio we give ventilations to CPR and then we have organizations like naemt who sets up different trauma standards with their class phtls that change every few years and some of these changes been quite fast uh so it&#39;s all about best patient outcomes so just keep yourself updated please read research understand our industry and understand patient care but just keep everything into perspective with the last slide I&#39;m going to give you we&#39;ll talk about American with Disabilities Act uh I hope to God that uh if you have a disability that you let me know about it you have to especially if you&#39;re needing some kind of exception we need to know if you have hearing problems especially when it comes to taking vital signs if you have walking or lifting issues if you&#39;re in the academy then we&#39;ve already done a Physical Agility Test for you please let me know about learning issues as well so I can be more accommodating to you there&#39;s accommodations I can make to help you out from time to isolated testing so you get the most out of this class all right but I cannot I do not have ESP and I cannot help you if you do not declare it so that is a one-on-one conversation or better yet an email to where we have documentation of everything quick chapter review so the EMS system has been developed to provide pre-hospital as well as emergency medical care again we&#39;re very young right now we use the 9-1-1 system the enhanced 911 system so people can access us and we can access them in the quickest amount of time giving pre-arrival care ensuring First Responders are headed there appropriately we&#39;re headed there appropriately and a good handoff and care at all levels now remember in EMS we must hand off care to a provider of equal or greater level typically it&#39;s going to be greater level when we get to the hospital to a nurse or a physician or even a physician&#39;s assistant a PA all right we have a lot of things we&#39;re required to do safety being number one with our foundation and patient assessment getting the patients to and from the ambulance and to our and from our uh carrying devices like the stretcher in safest manner possible we&#39;re gonna have to document and then transfer of care and then our second most important thing outside of safety is going to be patient advocacy good quality customer service make sure you look the part and make sure you act the part and you also have to keep up with your education through Continuing Education and Training make sure you know how to use every piece of equipment on that aimless even equipment you&#39;re not responsible for all right get with your ALS partner if you work on an ALS truck and ensure that they can talk you through that ask what those medications do now you can&#39;t exceed your scope of practice but it&#39;s nice to know how things work so you&#39;re a better provider and you can assist Advanced providers more effectively outside of being a young system the the government over the last 60 years has done a lot to put us in a position to be a an effective resource in pre-hospital care whereas before we were just a transport service uh an Uber essentially now we are medical providers and clinicians out in the field critical decision making is the hardest thing to teach but again slow yourself down and you&#39;ll figure it out practice as you play meaning when we&#39;re in the classroom setting study and practice when it&#39;s Hands-On sessions and skills you need to be practicing over and over again well I know that skill do it again and do it again to where you can do it blindfolded so when a critical decision hits you systematically know how to knock it out so just know that you are you are going to set and determine what provider you&#39;re going to be right you will determine that not us I open the door you walk through the door as a teacher oftentimes I don&#39;t even consider myself a teacher but a translator you can see the information in the book and the information that&#39;s before you I&#39;m trying to relate it to you so you can understand its importance because as an adult learner validity understanding validity why something&#39;s valid to you is is is the is so important in your retention level okay so but being a self-starter and being self-motivated as a student is going to be the most important thing throughout this course so they ask you some questions and let&#39;s go ahead and do them so what Innovation was introduced in the Korean and Vietnam Wars that is now common in many EMS systems well that would be a pre-hospital trauma care and mass units helicopter EMS actually became a thing all right getting patients from the battlefield to the hospital that&#39;s close by close appropriate right that&#39;s what a matching it was so now we have that through Nitsa and the D.O.T we were able to get specialized facilities and ambulances with appropriate gear to take patients from point A to point B without there being delays in care what four levels are ems providers are there ready emergency medical responder also called ECA or emergency care attendant in Texas the EMT the advanced ENT and paramedic so you&#39;re going to get orders by radio frame your medical control what type of medical control contact you just make online remember if you were reading like your protocol book or it&#39;s a standard of care that is a offline if you&#39;re speaking with a physician By Radio FaceTime or whatever or phone that is online pretty it makes sense so your patient is hesitant to go outside because she&#39;s worried about her dog what can you do to assist the situation what part of your role as an EMT is this an example of well make sure it&#39;s safe please don&#39;t get bit by a dog but if it is let the dog out ask her what do we need to do with the dog is there a relative we can and this is an example of patient what&#39;s that a word my favorite word advocacy again personal safety comes first next important word and the overall system is advocacy I hope you enjoyed this I know these things get long and they&#39;re not always interesting listening to a YouTube voiceover but it&#39;s important it&#39;s important to learn it&#39;s important to grow it&#39;s important for me to read through the lines on these slides and give you additional information and stories and things that really help relate the curriculum to you and what you&#39;ll be doing so I hope you enjoyed it and I&#39;ll absolutely see you on chapter two

Transcript for:Introduction to Emergency Medical Services

Transcript for:
Introduction to Emergency Medical Services