Hello everyone and welcome to chapter 1, the very first chapter of EMT school and it is EMS systems. So just a little introduction, this is the text uh it's going to be your primary resource for the MT course. It's right there on the left of your screencast. It's the 12th edition of emergency care and transportation of the sick and injured. it it's going to discuss what is going to be expected of you in the course and the requirements that you have to meet in order to be licensed or certified as an EMT in most states and we're going to discuss that throughout this lecture. So it discusses um also uh the differences between first aid training, department of transportation, your emergency medical responders uh training course and training courses uh as an EMT, advanced EMT and paramedic. So it's also going to talk about EMS as a system and chapter one is also going to discuss some key systems and components. Okay, so let's get into it. Your course description, EMS is a system. And so what does that mean? That means that it consists of a team of health care professionals and it's going to provide emergency care and transport. It's also governed by state laws and we're going to talk about some of those this evening or this morning, whenever you're watching this. So after you successfully complete this course, you're going to be able to take the national registry of EMTs exam and then your state certification exam. So after you pass the certification exam, you are going to be eligible to apply for your state license. So lensure is the process by which states ensure applicant competency in an exam setting. So this allows the states to manage who can function as a healthcare provider. Now in most states there's going to be four levels of training uh and lure levels. So you have the EMR, EMT, AEM and paramedic. And let's talk a little bit about these. So an EMR is very basic training. It provides care for um before the ambulance actually arrives and they also assist possibly when the ambulance is there an EMT and of course that's what you are guys are learning right now that is the training in basic life support and we say BLS so when you hear the word BLS that's what we mean basic life support it's going to include um AED so an automated external internal defibrillation. You're also going to learn some airway adjuncts and how to assist uh with certain medications for patients. Now, the AMT has training in specific aspects of advanced life support. So, we say ALS, so advanced life support um compared to BLS. you're going to be able to when you when you take the advanced EMT, intravenous uh therapy, so IV therapy also, you could administer a certain more amount of emergency medicines than an EMT. Okay. And then a paramedic. So a paramedic has extensive training and this includes um ET inhibition. So endotracheial in through the trachea emergency pharm pharmacology cardiac monitor and other advanced assessment and treatment skills. So we're going to talk more in depth to that coming up. Okay. All right. So let's talk a little bit about focus and requirements. EMTs are the backbone of the EMS system in the United States. They provide emergency care to the sick and injured. Now, as far as license requirements, it's not extremely exciting, but you guys have all gone through this and so you probably already know uh the requirements are going to vary from state to state. And they are generally uh the requirements are to be licensed and employed as an EMT you have to have a high school diploma or equivalent proof of an immunization successful completion of background check or drug and drug screening a valid driver's license. Also, you have to complete a basic life support uh CPR course. And um in order to be licensed, you have to complete a EMT course. You have to pass this certification exam and also a practical exam. And you have to demonstrate mentally that you're mentally and physically able to safely perform the task and functions of an EMT. and you have to be uh in compliance with other state and local and also employer provisions as well. Now there is American Disabilities Act and its ADA. You need to understand that it protects people with disabilities from being denied access to programs and services. Now this prohibits employers from failing to provide full and equal employment to the disabled. Now, specifically, title one protects EMTs with disabilities who are seeking employment under circumstances. Now, employers with a certain number of employees are required to adjust the process so that the candidate with a disability can be considered for a position and modify the work environment um or the job is uh how it's normally performed. So personnel background uh in accordance with state and criminal requirements. So states have various requirements prohibiting individuals who have either committed u misdemeanor or felonies from being EMS providers. All right. So let's now get into a little overview of EMS systems and in particular the history of EMS. So the origins of EMS include volunteer ambulances during World War I. Also field care during World War II and field medic and rapid helicopter evacuation in the Korean conflict. Now as recently as the 1960s and 1970s uh emergency ambulance services a and care they vary widely in the US. Now, EMS as we know it today originated in 1966 with the publication of the accidental death and disability, the neglected disease of modern society. And it's more commonly known as the white paper. So, one more time I just want to repeat that the EMS as we know it today originated in 1966 through a publication known as the white paper. Now, EM emergency services act of 1973 created funding resources and programs in order to develop and improve prehosp emergency care and do so of transportation published the very first EMT training curriculum in 1970s and the American Academy of Orthopedic Surgeons prepared and published its first EMT textbook in 1971. Now, if you did not know it, that is the book that you have in the book that I showed on the very first slide. That is the 12th edition of that very first textbook. Efforts are underway to standardize uh EMS nationally. And um in the late 1970s, the DOT developed this recommended national standard curriculum. During 1980s, many areas uh advanced those national curriculums by adding EMTs with advanced levels of training who can provide key components of ALS care and advanced life-saving procedures. Then in the 1990s, the National Traffic Safety Administration developed the EMS agenda for the future. So this is a document with a plan to standardize the levels of EMS education and providers. Then in 2019, the NHSTA revised that agenda for the future and published the EMS agenda for 20150. Okay. So let's get into the levels of training. Now there's federal, state, and local level uh levels of training. And so just to understand it, the national EMS scope of practice model, it provides guidelines for EMS skills. And so the the document provides an overarching guideline for the minimum skills each level of EMS provider should be able to perform. Now, at the state level, those laws regulated EMS provider operations as well. Then finally at the local level it's the medical director who provides the daily oversight and the support to that EMS um personnel and this is going to this slide it shows you basically how the medical direction day-to-day national scope in the state EMS office now we practice directly in the center of that um of those circles colliding. Okay. So public BLS or basic life support and immediate aid. Millions of people are trained in BLS and CPR and they also uh AEDs. So external automated external defibrills are also used by uh lay people. EMRs. Now this is the emergency medical responders that we talked about earlier. We said we were going to um kind of get more in depth into that. Now, uh, law enforcement officers or say that you, um, went to fire school and you had to learn first responder. So, that's emergency medical responder, park rangers, ski patrol. EMR training provides these individuals with skills to immediate uh, initiate immediate medical care and assist with EMTs on their arrival. So the course focuses on providing immediate BLS and urgent care with limited equipment. And then the next level is going to be what uh we're here for and this is the emergency medical technician. It's a course that requires between 150 to 200 hours of um education. And the EMT possesses the knowledge and skills to provide a very basic um emergency care together with any other EMTs who have responded assumes responsibility for the assessment, care, packaging and transport of the patient. And that is what you're going to learn. Then you step up from the EMTs and you have an advanced EMT. That's the next level of training that is recognized. The advanced EMT course, it's going to add knowledge and skills specific to advanced life support. Remember we said ALS is advanced life support. This is going to be IV therapy, advanced airway adjuncts, and administration of a limited number of medicines. And then finally you have paramedics and that is the highest level of prehosp provider training. It is an extensive course and the course hours range from a,000 to more than300 hours. Now that's uh divided just like EMT um between course and internship training. The course may be offered within the context of an associates or a bachelor's degree program and it covers a wide range of advanced life support skills. Okay, so let's talk about the components of the EMS system. Remember in earlier in this uh screencast we said EMS is a system and so we're going to go through basically the components of that system. Now EMS agenda of the 2050 outlined five components. Uh and the first one is going to be a comprehensive quality and convenient care. The second one is evidence-based clinical care. Third is going to be well-rounded efficient care. Four is preventative and the fifth one is a comprehensive and easily accessible patient records. Now, public access is also um in the EMS system. So, obviously, if you think about it, you have to be able to easily access um emergency care. And so, the 911 system is the public safety access point. You're also going to hear a lot about EMD. Now, what that is is it's an emergency medical dispatch, and it's a system that has been developed to assist dispatchers in providing callers with medical instructions until EMS arrival. Also, you're going to have mobile apps, and they allow lay people trained in CPR to be alerted of a cardiac arrest maybe that's in their area or the location of nearest uh AED. Okay. So the next area in the EMS system is going to be human resources. And of course this focuses on the people that deliver the care and the EMS agenda of 2050. It encouraged the creation of the environment where people want to work and they turn their passion into a re rewarding career. Okay. So the next part of the EMS system we're going to talk about is the actual medical director. Now this is really a major component to the system. It is the physician who authorizes the EMT to provide the medical care in the field. Now the medical director is the ongoing working liaison between the medical community, hospitals and EMTs in the service. So appropriate care is described in standing orders and protocols. Now protocols are described in a comprehensive guide detailing our scope of practice. So the EMT scope of practice whereas standing orders are part of protocols and designate what the EMT is required to do for a specific complaint or condition. Providers are not required to consult medical direction before implementing standing orders. So there are medical control can either be offline or online and it's exactly how it sounds. If it's offline, it's going to be standing orders indirect and um through training and supervision. And online is direct. Basically, it's directly when a physician gives you directions over the phone or a radio. The next part of the EMS system is going to be the legislation and regulation. And so although each EM system medical direction and training programs has some latitude in its training protocols and practices, most have to follow state legislation, rules, regulations, and guidelines. So, uh, a senior EMS official is usually in charge of necessary administrative tasks such as scheduling, personnel budgets, purchasing, vehicle maintenance, and daily operations of the ambulances and the crews. The next part of the EMS system is the integration of the health services. Because we are prehosp care, we should care should be continued in the emergency department to ensure that the patient receive the con comprehensive continuity of that care. This is something that is um is developing in the United States. So this is a mobile integrated health care and basically it's a method of delivering health care that utilizes prehosp spectrum they say. So mobile integrated health care is evolved with the goal to facilitate uh improved access to health care at affordable price. And so basically health care is provided within the community rather than at a physician's office or hospital by this team of health care professionals. Okay. So um talking a little bit more about the mobile integrated healthcare. It's a branch of healthcare and it's a evolution uh causing basically of additional training levels for EMS providers. So there is a community parame medicine. This is which experienced paramedics receive advanced training to equip them to provide services within their community. So this is still developing. In addition to the patient care um as that the paramedic would provide they provide services by community paramedics including like health evaluations or monitoring chronic illnesses also maybe obtaining lab samples or administering immunizations. Okay. So EMS as a system also includes information systems and this is the computers used to document the patient care and electronically they could be s stored information used to improve care and evaluation is part of the system. This is done usually by the medical director because they're responsible for it for maintaining quality assurance program and uh not just a culture but it promotes a learning culture that holds employees accountable for behavioral choices by balancing fairness and accountability. So we're going to talk a little bit more about that. Now CQI it is continuous quality improvement and basically what it does um like I said the medical director is responsible for ensuring that this happens. It reviews and performs um basically an audit of that of the whole system. It identifies areas of improvement and it can also help with training. So it um basically identifies and tries to minimize uh errors and that's the goal and it uses a plan do study act cycle basically. So it's a um evaluate uh plan study and actually uh train. All right. So patient safety to minimize medical errors that occur as a result of rulesbased failure or a knowledgebased failure or skills-based failure or any combination of them. So it requires the efforts of both EMS agency and EMS um personnel and then the system as an EMS system it also has to be financed. So um finance systems they vary depending on which organization is involved obviously. So personnel may be paid, they could be volunteer or they could be a mix of paid and volunteers. And EMTs, they also can be asked um part of that system financed as you might have to gather insurance information or get signatures um or sign documents about HIPPA notifications. also obtain written personnel or permission from the patients to bill maybe their uh health insurance company. So that is part of the EMS systems as well. Okay, talking a little bit more about system finance. Um, just a little need to know. In n in 2020, the Centers for Medicare and Medicaid implemented a program called emergency triage, treat, and transport. So, it's ET3. And basically, it was for reimbursing EMS systems for providing the right patient care at the right time. So it was set up a payment model for patient transport to alternative destinations such as urgent care or doctor's office or onseen treatment with no transport. Okay. Now we're going to talk in the EMS system. You also have the educational part of that of course and that's what you're going through right now. And it consists of EMS instructors which are licensed in most states and EMS training programs. So they have to adhere to very strict national standards which are established by two accreditating agencies. So there's the committee on accreditation of educational programs for emergency medical professionals that's co-amps and the commission on accreditation of allied health education programs. So frequent continuing education refresher courses and computer-based or mannequinbased education exercises are measures that are also intended to maintain and update an EMT skills and knowledge. Now we talked a little bit about the next part of the EMS system but it is prevention and public education and this is included in that EMS system. So aspects of EMS are focused on public health. Public health examines the health needs of the entire population with the goals of preventing the problems from occurring. And EMS works with the public health agencies in two ways. So the primary prevention focuses on strategies to prevent the event from ever happening. So maybe you know pool safety or installing car seats. And then the secondary prevention occurs after the event has already happened. So the question is how can we decrease the emp you know the efforts uh or sorry effects of the event like helmets and seat belts are examples of secondary prevention. Okay. And here's some examples of some um public health accomplishments. So, vaccination programs um helmet laws, sewage systems, um and you could see on the the table. Okay. And another part of EMS as a system is going to be the research. And so, basically, this helps determine how to shape and impact the EMS um on the community. It's evidence-based and it focuses on procedures that uh have proven useful in improving patient outcomes. So many EMS systems and states consult the national model EMS clinical guidelines from the National Association of State EMS officials and these guidelines are based on the review of current research and expert um consensus. All right. So, let's talk about what you're here for and some roles and responsibilities of the EMT. And all I said it earlier, they're healthc care professionals either if they're paid or volunteers. And the roles and responsibilities of an EMT are you have to keep the vehicles and equipment ready for emergency, ensure the safety of yourself, your partner, the patient, and then bystanders. So um you have to be familiar with the emergency vehicle operations, be an onseen leader, perform an evaluation also on scene. You have to call for additional resources and we're going to talk through that throughout the chapters. You have to gain access to the patient, also perform a patient assessment. You have to give emergency care to a patient while waiting the arrival of additional medical resources. Also give emotional support to the patient. You have to maintain continuity of care by working with other medical professionals. So then passing over care to the paramedic or passing it over to the nurse or to the physician. You have to uphold your medical and legal standards. Ensure and protect patient privacy. You have to give support to the admin and constantly continue your development professionally. You have to cultivate and sustain community relations and give back to profession. All right. So now the professional attributes you have to have integrity. So you have to act consistently and maintain a adherence to the code of honest behavior. You have to have empathy. You have to be aware of and thoughtful towards the needs of others. You have to be self-motivated and solve problems without someone directing you to. You have your appearance and hygiene um has to be so that you project a sense of trust, professionalism, knowledge and compassion. And then self-confidence. So you have to you have to know and knowing what you know, what you need to know and be able to ask for help when you don't know. You have to have time management and communications. You have to be able to understand and make yourself understood to others. You have to have teamwork and uh diplomacy and be able to work with others and know your place within the team. You have to have respect. Hold others to high regard or importance and understand that others are more important than you. And you have to be a patient advocate constantly keeping the needs of the patient at the center of care and careful delivery of care. So you have to pay attention to the details and make sure that what is being done for the patient is done as safely as possible. Okay. So most patients are going to treat you with respect, but some might not. Yet every patient is entitled to compassion, respect, and the best care you could provide. As health care professionals, EMTs are bound by patient confidentiality. And what this means is that the patient privacy must be protected. Findings or disclosures made by the patient should be discussed only with those treating the patient and in limited situations as required by law with police or other social agencies and we're going to talk about that later in the chapters. Protection of patient privacy has drawn national attention with the passage of the health insurance portability and accountability act. So get to know that it's HIPPA and once again that's the Health Insurance Portability and Accountability Act. Okay, so this concludes the chapter 1. Uh and I appreciate all of you uh listening to the screencast. If you have any questions or comments, go ahead and just put it down in the comment section and I will answer it um as soon as I see it. And uh thank you for this evening.