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 and the related coursework, you will understand the origins and present-day structure of the emergency medical care delivery system, the emergency medical technician's 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 in 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, AEMT, and paramedic. You will also talk about how...
EMS is a system. And in Chapter 1, this Chapter 1 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 EMTs 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 health care 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, 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...
Okay. AEMT. And they have training in specific aspects of advanced life support, including they have 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 intubation, 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 back 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 state to 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 I protects EMTs with disabilities who are seeking gainful employment under many circumstances. Employers with a certain number of employees are required to adjust processes 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 information in accordance with state criminal requirements. So states have various requirements prohibiting individuals who have committed either misdemeanors or 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 I, 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 EMS.
EMT training curriculum in early 1970s. 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 1990, or 2019 NHTSA revised the EMS agenda for the future and published EMS agenda for 2050 levels of field training.
Okay, so there's a 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 the 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 medicine. Then there are the paramedics. This is an extensive course of training.
Course hours range from 1,000 to more than 3,000. 1,300 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 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 EMTs 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 do so.
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 a latitude, training protocols and practices must follow state legislation, rules, regulations, and guidelines. A senior EMS official is usually in charge of necessary administrative tasks, such as scheduling, personnel budgets, purchasing, and vehicle maintenance, and the daily operations of ambulances and crews. 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 it's a method of delivering health care that utilizes the pre-hospital spectrum. Mobile Integrated Healthcare is otherwise known as MIH, and it's evolved with the goal to facilitate improved access to healthcare at an affordable price. In the MIH model, healthcare is provided within the community rather than at a physician's office or hospital by an integrated team of healthcare 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 care. health evaluations.
They can monitor chronic illnesses and conditions or conditions. They can obtain lab samples and also administer immunizations. And then the next component we're going to talk about is the information systems. And this is the 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 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 are 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 failure, 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, obtain 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 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 a 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 Professions, and that is also known as COAMPS, and the Commission of Accreditation of Allied Health Education Programs, or CAAHEP, Frequent Continuing Education, Refresher Courses, and Compute. 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 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 installation. 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 seatbelts are examples of secondary prevention. The table on this slide lists 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, seatbelt 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 focuses on procedures that have proven useful in improving patient outcomes. Many EMS 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 EMT are health care 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. So we have to give administrative 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 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 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 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 B. So standing orders, a form of offline, it's indirect medical control.
This involves performing certain life-saving interventions. And so the answer was the EMT defibrillates a 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 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 what we do. Okay, moving along. So all of the following are the responsibilities of an EMS director except, so are they responsible for evaluating patient insurance information, serving as a liaison, ensuring that the appropriate standard is met, or ensuring appropriate EMT 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 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 EMT'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's safety, bystander's 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?
A, 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 requires cardiac monitoring. who could provide that.
Number nine, which of the following is a professional responsibility of an EMT? And so are EMTs 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 care occurs in progressive phases. What occurs first? Is it the activation of EMS?
Is it the initial pre-hospital care? Is it the patient received 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. Hope you have a good day.