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EMS Systems of Emergency Care

Jun 4, 2024

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

Overview

  • Text: Primary research for EMT course. Discusses course expectations and requirements for EMT licensure.
  • Origins and Structure: Understanding the evolution and present-day functioning of the emergency medical care system.

Key Topics Covered

  • EMS Roles and Responsibilities: EMT's roles within the EMS system, quality improvement processes, and relationships with other EMS providers.
  • EMS Levels: Differences between first aid, EMR, EMT, AEMT, and paramedic training courses.

Sections of the Lecture

EMS as a System

  • Teams of healthcare professionals governed by state laws providing emergency care and transportation.
  • Post-course: Take National Registry of EMT's exam or state certification exam for licensure.

Training and Licensure Levels

  • EMR (Emergency Medical Responder): Basic training, care before ambulance arrives.
  • EMT (Emergency Medical Technician): Basic life support, AEDs, airway adjuncts, medication assistance.
  • AEMT (Advanced EMT): Advanced life support, IV therapy, limited emergency medicines.
  • Paramedic: Extensive advanced life support, endotracheal intubation, emergency pharmacology, cardiac monitoring.

EMT Course Components

  • Reading assignments
  • Step-by-step demonstrations
  • Summary skill sheets
  • Case presentations and scenarios

Licensure Requirements

  • High school diploma or equivalent.
  • Proof of immunization against certain diseases.
  • Successful completion of background check and drug screening.
  • Valid driver’s license.
  • Completion of healthcare provider BLS CPR and state-approved EMT course.
  • Passing state-recognized written and practical exams.
  • Demonstration of mental and physical abilities required for the role.

Key Legislation: ADA Act of 1990

  • Protects people with disabilities from being denied access to programs and services provided by state/local governments.
  • Ensures full and equal employment to the disabled under certain circumstances.

History of EMS System

  • Origins: Volunteer ambulances (WWI), field care (WWII), helicopter evacuation (Korean Conflict).
  • 1966: Publication of "The White Paper: Accidental Death and Disability." Developed EMS standards.
  • 1973: The DOT's first EMT training curriculum.
  • 1971: The American Academy of Orthopedic Surgeons publishes the first EMT book.
  • 1990s: NHTSA developed EMS agenda for the future.
  • 2019: NHTSA revised EMS agenda and published "EMS Agenda for 2050."
  • Standardization: Standard levels of training and education nationwide.

Scope of Practice Model Hierarchy

  • Federal Level: NEMS scope of practice model - minimum skill set guidelines for EMS providers.
  • State Level: Regulates EMS provider operations.
  • Local Level Medical Director: Daily oversight and support to EMS personnel.

Levels of Field Training

  • EMR Course: 150-200 hours, basic emergency care, patient assessment, care, packaging, and transport.
  • Paramedic Course: 1000-1300 hours, advanced life support training.

EMS System Components (EMS Agenda 2050)

  • Comprehensive, quality, and convenient care.
  • Evidence-based clinical care.
  • Efficient, well-rounded care.
  • Preventative care.
  • Comprehensive and easily accessible patient records.

Public Access

  • 911 system and mobile apps for CPR-trained laypeople and AED locations.

Human Resources

  • Focus on creating a supportive work environment for EMS personnel.

Medical Direction

  • Physician oversight.
  • Protocols and standing orders.
  • Online (direct) vs. Offline (indirect) medical control.

Legislation and Regulation

  • State laws ensure quality control and compliance.

Integration of Health Care Services

  • Collaboration with hospitals for continuity of care.

Mobile Integrated Health Care (MIH)

  • Health care delivery within communities via EMS providers.
  • Community paramedics perform health evaluations, chronic illness monitoring, and immunizations.

Information Systems

  • Computer-based patient care documentation.

Evaluation Components

  • Continuous Quality Improvement (CQI) and patient safety measures.

System Finance

  • Varied models including paid and volunteer personnel.
  • Implementing the Emergency Triage, Treat, and Transport (ET3) pilot program.

Education Systems

  • National standards and accrediting organizations (CoAEMSP, CAAHEP).
  • Ongoing education to update EMT skills.

Public Health and Prevention

  • Strategies for preventing and mitigating health problems.
  • Primary vs. Secondary prevention.

EMS Research

  • Evidence-based medicine and clinical guidelines from NAEMSO.
  • Impact of research on shaping EMS practices.

Professional Attributes of EMTs

  • Integrity, empathy, self-motivation, appearance, hygiene, self-confidence, time management, communication, teamwork, respect, patient advocacy, careful delivery of care.

Patient Confidentiality

  • Protected under HIPAA.
  • Information only shared with treating personnel or as required by law.

Continuous Quality Improvement (CQI)

  • Reviews and audits to improve EMS system performance.

Review Questions

  • Practice questions to test understanding of key concepts and knowledge.
  • Emphasis on safety, importance of personal and patient safety, ongoing education, and adherence to legal and ethical standards.

Conclusion

  • Overview of EMS systems, training, protocols, and professional responsibilities.
  • Emphasis on safety, continuous improvement, and quality of patient care.

Full transcript