Chapter 1: EMS Systems of Emergency Care and Transportation of the Sick and Injured

Overview

• Understand the origins and structure of the emergency medical care system.
• Explore the roles and responsibilities of EMTs and their relation to the EMS system.
• Discuss the quality improvement process and levels of EMS providers.
• Present the foundations necessary for a competent, efficient, caring, and ethical EMT.
• Highlight the interrelationships of the NHTSA's EMS system components per the EMS Agenda for the Future.

Key Topics

EMS as a System

• Teams of healthcare professionals providing emergency care and transportation.
• Governed by state laws.
• Completion of the course allows for National Registry of EMTs exam or state certification.

Licensure and Training Levels

• Four levels: EMR, EMT, AEMT, Paramedic.
  • EMR (Emergency Medical Responder): Basic training, care before ambulance arrival.
  • EMT: Basic life support, AEDs, airway adjuncts, medication assistance.
  • AEMT: Advanced life support aspects like IV therapy, emergency medicine.
  • Paramedic: Extensive training including intubation, pharmacology, cardiac monitoring.

EMT Course Components

• Reading assignments, demonstrations, skill sheets, case presentations.
• EMTs as backbone of the US EMS system.

Licensure Requirements

• High school diploma or equivalent.
• Immunization proof, background check, valid driver's license.
• Completion of basic life support cardiopulmonary resuscitation and a state-approved EMT course.
• Written and practical exam completion, demonstrating necessary mental and physical abilities.

Americans with Disabilities Act (ADA)

• Protects disabled individuals from being denied access to employment.
• Requires process adjustments for candidates with disabilities.
• State criminal background checks for licensure.

History of EMS

• Volunteer ambulances in WWI, field care in WWII, Korean conflict evacuation.
• Modern EMS originated in 1966 with Accidental Death and Disability: The Neglected Disease of Modern Society.
• 1973 Emergency Services Act funded improved pre-hospital emergency care systems.

EMS Education and Standardization

• National standard curriculum developed in the 1970s-1980s.
• 1990s NHTSA's EMS Agenda for Future.

EMS System Components

Federal, State, and Local Levels

• National EMS Scope of Practice Model provides minimum skill guidelines.
• State laws regulate EMS operations.
• Local medical directors offer day-to-day oversight.

Public Access and Human Resources

• 911 system serves as the Public Safety Access Point.
• EMD system provides medical instructions.
• EMTs and EMRs provide immediate care with limited equipment.

Medical Direction and Legislation

• Physicians authorize EMT interventions.
• Medical direction can be offline (protocols) or online (direct orders).
• Training protocols must follow state legislation and regulations.

Integration with Healthcare Services

• Mobile Integrated Healthcare (MIH) focuses on community-based healthcare delivery.
• Community paramedicine involves extended training for patient health evaluations and chronic condition monitoring.

Information Systems and Evaluation

• Computer systems document patient care to improve services.
• Continuous Quality Improvement (CQI) reviews EMS performance.

EMS Finance

• Varies by organization; personnel may be paid or volunteer.
• EMS systems now explore alternative payment models like ET3 for right care, right time delivery.

Education and Public Health

• EMS instructors licensed; courses adhere to national standards.
• Continuing education and public health collaborations focus on prevention strategies.

EMS Research

• Evidence-based medicine guides EMS community impact and structure.

EMT Roles and Responsibilities

• Vehicle readiness, scene safety, emergency vehicle operation.
• On-scene leadership, patient assessment, care delivery.
• Continuous professional development and community relations.

Professional Attributes of an EMT

• Integrity, empathy, self-motivation, hygiene, self-confidence.
• Time management, communication, teamwork, respect.
• Patient advocacy and careful care delivery.

Patient Confidentiality and HIPAA

• Patient privacy must be protected; HIPAA governs disclosure.

✅ALS = Advanced procedures : such as (Intravenous = IV) therapy,advanced airway management ,and the administration of certain emergency medications.

✅ BLS = Basic lifesaving intervention, such as CPR

✅Medical Control = Physician direction to an EMS

✅ CQI = A proactive process of development that capitalize on strength and addresses challenges

✅ MIH = Mobile integrated health care = providing health care within the community rather than the office

Review Questions

• Examples cover standing orders, quality control responsibility, scene safety, and professional responsibilities.

Conclusion

• Understand the EMS system structure, roles, licensure, and the importance of professional attributes in providing quality emergency care.