hello class and welcome to chapter 1 ems systems of emergency care and transportation of the sick and injured 12th edition after you complete this chapter in the related coursework you will understand the origins and present day structure of the emergency medical care delivery system the emergency medical technicians roles responsibilities and relationships to the emergency medical services system as well as emt's role in the quality improvement process is going to be explained and other levels of ems providers are described the foundations necessary for being a competent efficient caring and ethical emt are presented the interrelationships of the national highway traffic safety administration's 14 components of the ems system per the ems agenda for the future are outlined also we will describe an emt's impact on research data collection and evidence-based decision-making as well as the emt's responsibilities as a student and a practitioner we're going to talk about ems systems and the history roles and responsibilities quality improvement and patient safety and also research and public health so this text is the primary research for the emt course it discusses what will be expected of you during the course and what requirements you will have to meet to be licensed or certified as an emt in most states you will learn the differences between first aid training a department of transportation emr training course and the training courses for an emt a emt and paramedic you also talk about how ems is a system and in chapter one this chapter one discusses the system's key components so let's talk about ems as a system it consists of teams of healthcare professionals and provides emergency care and transportation and is governed by state laws after you successfully complete this course you should be able to take either the national registry of emt's exam or your state's certification exam so after you pass the certification exam you are eligible to apply for state licensure licensure is the process by which the state ensures the applicant's competency in an examination setting this allows the states to manage who can function as a healthcare provider in most states there are four training and licensure levels there is the emr the emt and the aemt and then there's the paramedic okay so now let's discuss the differences in those four so an emr is an emergency medical responder and they have very basic training they provide care before the ambulance arrives and they may also assist with the ambulance these are people such as law enforcement officers are trained as emr and then an emt and an emt of course uh has the basic training in life support so basic life support and this includes an automatic external defibrillation so aeds airway adjuncts and assisting with certain medications then there's the aemt and they have training in specific aspects of advanced life support including they have iv iv access therapy and administration of a limited number of emergency medicines and then the paramedic and they have extensive advanced life support training it includes endotracheal innovation emergency pharmacology cardiac monitoring and other advanced assessment and treatment skills so the emt course includes four types of learning activities there will be reading assignments step-by-step demonstrations summary skill sheets and case presentations and scenarios emt training is focus and requirements so emts are the backbone of the ems system in the united states they provide emergency care to the sick and injured there's licensure requirements and so requirements do differ from states of state but generally the requirements to be licensed and employed as an emt are you need to have a high school diploma or equivalent proof of immunization against certain communicable diseases you need to successfully complete a background check and drug screening and have a valid driver's license you must also have successful completion of a recognized healthcare provider basic life support cardiopulmonary resuscitation course successful completion of a state-approved emt course successful completion of a state recognized written exam you must successfully complete a state recognized practical exam demonstrate mental and physical abilities necessary to safely and properly perform all these tasks and functions described in the defined role of an emt and you must be compliant with other state local and employer provisions okay so let's talk a little bit about the americans with disabilities act and it'll also be known as the ada act of 1990 this protects people who have a disability from being denied access to programs and services that are provided by state or local governments it prohibits employers from failing to provide full and equal employment to the disabled now title 1 protects emts with disabilities who are seeking gainful employment under many circumstances employers with a certain number of employees are required to adjust process is so that the candidate with a disability can be considered for the position and modify the work environment or how the job is normally performed and as a licensure requirement there is also personal background uh in information in accordance with state criminal requirements so states have various requirements prohibiting individuals who have committed either misdemeanors or felony felonies from becoming ems providers okay so let's do an overview of the ems system but first we need to talk about the history origins of ems include volunteer ambulances in world war 1 field care in world war ii and field medic and rapid helicopter evacuation in the korean conflict as recently as 1960s and early 1970s emergency ambulance service and care varied widely in the united states ems as we know it today originated in 1966 with the publication of accidental death and disability the neglected disease of modern society more commonly known as the white paper now emergency services act in 1973 created funding sources and programs to develop improved systems of pre-hospital emergency care the dot or department of transportation published the first emt training curriculum in early 1970's the american academy of orthopedic surgeons prepared and published the first emt book in 1971. now efforts are underway to standardize levels of ems education nationally in late 1970s the dot developed a recommended national standard curriculum during the 1980s many areas enhanced the emt national standard curriculum by adding emts with advanced levels of training who could provide key components of advanced life support care and advanced life support procedures in the 1990s the national highway traffic safety administration or nhtsa developed the ems agency for future a document with a plan to standardize the levels of ems education and providers and in 19 or 2019 nhtsa revised the ems agenda for the future and published ems agenda for 2050 levels of field training okay so there's the federal level and at this federal level the national ems scope of practice model provides guidelines for ems skills this document provides overarching guidelines for the minimum skill level of an ems provider should be able to perform at the state level there is laws that regulate ems provider operations and then at the local level you have the medical director which provides daily oversight and support to ems personnel now this is a slide and it illustrates the hierarchies of that ems scope of practice model you see the medical direction which is day-to-day the state ems offices and then the national ems scope of practice public basic life support and immediate aid millions of lay people are trained in bls cpr and there's also aeds or automated external defibrillators and those are used by lay people and then there's the emergency medical responders or emrs like we talked about earlier those are the law enforcement sometimes firefighters park rangers ski patrollers emr training provides these individuals with the skill necessary to initiate immediate care and assist emts upon arrival the course focuses on providing immediate bls and urgent care with limited equipment and then emt the course you're in so the emt course requires about 150 to 200 hours the emt possesses the knowledge and skills to provide basic emergency care the emt together with any other emts who have responded assumes responsibility for the assessment care packaging and transport of the patient advanced emergency medical conditions technicians so this is an aemt the aemt course adds knowledge and skill in specific aspects of advanced life support including iv therapy advanced airway adjuncts and administration of limited number of medicines then there are the paramedics this is an extensive course of training course hours range from 1 000 to more than 1300 hours divided between classroom and internship training courses may be offered within the context of an associate's or bachelor's degree college program training requires a wide range of advanced life support skills so then let's talk about the components of the ems system the ems agenda 2050 it outlines five components of the ems system the five components are comprehensive quality and convenient care evidence-based clinical care efficient well-rounded care preventative care and comprehensive and easily accessible patient records public access so easy access to help in an emergency is essential the 911 system is the public safety asset access point an emergency medical dispatch or emd system has been developed to assist dispatchers in providing callers with vital medical instructions until ems personnel arrives so mobile apps have also allowed lay people trained in cpr to be alerted of a cardiac arrest in the area and the location of the nearest public aed human resources so human resources as a component of ems it focuses on the people who deliver the care the ems agenda 2015 encourages the creation of an environment where talented people want to work and turn their passion into a rewarding career then medical direction a physician is a medical director and he authorizes emts to provide medical care in the field the medical director is an ongoing working liaison between the medical community hospitals and the emts in service so appropriate care is described in standing orders and protocols now protocols are described in a comprehensive guide and this tells the emt's scope of practice and standing orders are part of protocols and designate what the emt is required to do for a specific complaint or condition providers are not required to consult medical direction before implementing standing orders medical control can be offline or online and so medical control offline is indirect and that is the standing orders or training or supervision what we just spoke about online though is a direct order and this is a physician's directions and given over the phone or a radio and that is considered online medical control next component is the legislation and regulation so although each ems system medical direction and training program has latitude training protocols and practices must follow state legislation rules regulations and guidelines a senior ems official is usually in charge of necessary administrative tax such as scheduling personnel budgets purchasing and vehicle maintenance and the daily operations of ambulances and crews okay so integration of health care services so pre-hospital care should be continued in the emergency department to ensure that the patient receives comprehensive continuity of care then there's the mobile integrated health care so method it's a method of delivering healthcare that utilizes the pre-hospital spectrum and mobile integrated healthcare is otherwise known as mih and it's evolved with the goal to facilitate improved access to health care at an affordable price in the mih model health care is provided within the community rather than at a hospi a physician's hospice office or hospital by an integrated team of health care professionals this branch of healthcare is using the evolution of additional training levels for ems providers this includes community paramedicine in which an experienced paramedic receives advanced training to equip them to provide services within the community in addition to the patient care services a paramedic would typically provide services providing the community paramedics with and they can perform health evaluations they can monitor chronic illnesses and conditions or conditions they can obtain lab samples and also administer immunizations and then the the next component we're going to talk about is the information systems and this is the commuter computer systems which are used to document patient care they are electronically stored information and can be used to improve care then evaluation so the medical director is responsible for maintaining quality control within the ems system and they it's adapting a just culture so this promotes a learning culture that holds employees accountable for behavioral choices by balancing fairness and accountability okay so the next thing we're going to talk about is a continuous quality improvement and this you'll hear it called cqi within this component there reviews and performs audits of the ems system to identify areas of improvement and or assign remedial training minimizing errors is the goal and it uses a plan do study act cycle patient safety so to minimize medical errors that occur as a result of rules-based failure a knowledge-based failure or a skills-based feral or any combination of these three this requires the efforts of both the ems agency and ems personnel next we're going to talk about the system finance aspect of the ems system and so a finance system it varies depending on which organization is involved and so personnel may be paid they can be volunteer or a mix of paid and volunteers so emts may be asked to gather insurance information from patients secure signatures on documents such as hipaa notifications obtained written permission from patients to bill their health insurance company in 2020 the centers for medicare and medicaid services or cms implemented a pilot program called emergency triage treat and transport et3 et3 strives to reimburse ems systems for providing the right patient care at the right time set up a payment model for patient transport to alternative destinations such as an urgent care center or doctor's office or on scene treat with no transport next we're going to talk about the education systems so ems instructors are licensed in most states most states training programs must adhere to national standards established by two accrediting organizations these include the committee on accreditation of educational programs for the emergency medical services profession professions and that is um also known as co co-amps and the commission of accreditation of allied health education programs or c-a-a-h-e-p frequent continuing education refresher courses and computer-based or mannequin based self-education exercises are measures intended to maintain and update emt skills and knowledge prevention and public education and within this aspect is of ems is where the focus is on public health and public health examines the needs health needs of the entire population with the goal of preventing health problems ems works with public health agencies in two ways and so the primary prevention focuses on strategies that will prevent the event from ever happening so for example educating the community on pool safety and car seat insulation the second prevention occurs after the event has already happened the question then is how can we decrease the effects of this event so for example helmets and seat belts are examples of secondary prevention the table on this slide list examples of public health accomplishments so you can see vaccination programs fluoride helmet laws sewage systems formation of food and drug administration clean drinking water seat belt laws tobacco use laws restaurant inspections and prenatal screenings next we're going to talk about the ems research and this helps determine the shape and impact of ems on the community evidence-based medicine it focuses on procedures that have proven useful in for improving patient outcomes many ema systems and states consult the national model ems clinical guidelines from the national association of ems officials these guidelines are based on a review of current research and expert consensus roles and responsibilities of an emt are what we're going to talk about next and so an emts are healthcare professionals whether paid or volunteer the roles and responsibilities of an emt include keeping the vehicles and equipment ready for an emergency ensure the safety of yourself your partner the patient and then bystanders be familiar with emergency vehicle operation be an on scene leader perform an evaluation of the scene call for additional resources we need to gain access to patients perform a patient assessment give emergency medical care to the patient while awaiting the arrival of additional medical resources also have to give administrative resp support we have to constantly continue our professional development cultivate and sustain community relations and give back to the profession okay so professional attributes of an emt and these include integrity we have to act consistently maintain a firm adherence to the code of honest behavior we have to have empathy being aware of and thoughtful towards the needs of others self-motivation so discovering problems and solving them without someone directing you appearance and hygiene using your persona to project a sense of trust professionalism knowledge and compassion their self-confidence so this includes knowing what you know and knowing what you do not know and being able to ask for help you have to have time management performing or delegating multiple tasks while insurance ensuring efficiency and safety communications including understanding others and making yourself understood teamwork and diplomacy include being able to work with others knowing your place in the team communicating while giving respect and also respect so holding others to a high regard or importance understanding that others are more important than you patient advocacy and constantly keep the needs of the patient at the center of the care careful delivery of care and this includes paying attention to details making sure that what is being done for the patient is done as safely as possible most patients will treat you with respect but some will not yet every patient is entitled to compassion respect and the best care you can provide as ems care professionals and emts are bound by patient confidentiality this includes patient privacy it must be protected findings or disclosures made by the patient should be discussed only with those treating the patient in limited situations as required by law with the police or other social agencies protection of patient patient privacy has drawn national attention with the passage of hipaa and this is the health insurance portability and accountability act so get used to that word okay so now we're to the review questions and at the end of the chapters there are review questions and we'll go ahead and go over these the first one is which of the following is an example of care that is provided using standard orders okay so which of the following is an example of care that is provided using standard orders i'll let you read through these is it medical care is contacted by the emt after the patient with chest pain refuses an emt defibrillates a patient in cardiac arrest a physician gives the emt an order via radio or following an overdose the emt contacts medical director for permission it is being so standing orders a form of offline it's indirect medical control this involves performing certain life safe life-saving interventions and so the answer was the emt defibrillates the patient in cardiac arrest begins cpr and then contacts medical control okay two quality control in the ems system is the ultimate responsibility of is it the paramedic the emt the medical director or the ems administrator and we said this directly in the slides it is the responsibility of the medical director and he for maintaining that quality control and it ensures that all staff members who are involved in caring for patients meet this standard on every single call okay number three upon arriving at the scene of a domestic dispute you hear yelling and the sound of breaking glass from inside the residence what should you do should you immediately gain access should you carefully enter the house should you retreat to a safe place until the police arrive or should you tell the patient to exit the residence and so you know that your safety is a paramount paramount and never enter a scene in which the signs of violence are present and so c was the answer then this included a retreat to a safe place until the police arrive which of the following is not a component of the continuous quality improvement so c q i and do you do review of run reports so we're looking for not the component discuss the needs for improvement negative feedback given to those who make mistakes or remedial training is deemed necessary now we know that we do not give negative feedback so the purpose of the cqi is to ensure the standard is provided this involves reviewing and discussing the needs but we do positive feedback should be provided during this process and so negative feedback given to those who make mistakes while on the call is not not what we do okay moving along so all of the following are the responsibilities of an ems director accept so are they responsible for evaluating patient insurance information serving as a liaison ensuring that the appropriate standard is met or ensuring appropriate empty education and so we know b c and d are correct and so the correct answer the medical director does not have anything to do with evaluating patient insurance information okay so which of the following situations would most likely qualify a person for in ems certifications so disqualified so a is a misdemeanor b is driving under the influence c is possessing a valid driver's license a or d is a mild hearing impairment and so in most states a person may be denied ems certification for being convicted of a felony such as driving under the influence or drugs and so we know that b was the answer number seven which of the following should the emts be the mt's highest priority and so we know that patients are very important however our own personal safety is the most important and so d always personal safety is the utmost concerned remember it's our safety our partner safety by standard safety and then patient safety okay okay a patient who requires cardiac monitoring in the field would require at a minimum level which level so which level 8 or is it emr emt paramedic or advanced emt and we know that of all the levels the paramedic is the one that's trained in the cardiac monitoring okay so the paramedic is the only one who is uh requires cardiac monitoring who could provide that number nine which of the following is a professional responsibility of an emt and so are emt's responsible for telling a family of the dying member that everything will be okay well we don't do that do we maintain only the skills that he or she feels comfortable with no absolutely not do we maintain a professional demeanor in even the most stressful situations absolutely and do we advise an emergency department nurse that the patient reports are only given to the physician absolutely not so we know that c is the responsibility and it's because the public relies on that emt to remain calm when others cannot okay okay and number 10 emergency patient cares uh occurs in progressive phases what occurs first is it the activation of ems is it the initial pre-hospital care is that the patient receives definitive care and so that means surgery or fixing of the problem and d instant recognition so d someone has to recognize there's an emergency before ems can even be activated so d is the correct answer okay and thank you for joining me for chapter one ems systems um i hope you have a good day