Chapter 1: EMS Systems of Emergency Care and Transportation of the Sick and Injured (12th Edition)

Key Objectives

• Understand the origins and present-day structure of the emergency medical care delivery system.
• Explain the roles, responsibilities, and relationships of EMTs within the EMS system.
• Describe the EMT’s role in the quality improvement process and other levels of EMS providers.
• Learn the foundations necessary for being a competent, efficient, caring, and ethical EMT.
• Outline the National Highway Traffic Safety Administration's 14 components of the EMS system per the EMS Agenda for the Future.
• Describe the EMT’s impact on research, data collection, and evidence-based decision-making, as well as their responsibilities as students and practitioners.

EMS Systems Overview

• EMS as a System: Teams of healthcare professionals providing emergency care and transportation, governed by state laws.
• **Four Training and Licensure Levels: EMR, EMT, AEMT, Paramedic: **
  • EMR: Basic training, care before ambulance arrives, assists ambulance.
  • EMT: Basic life support, AEDs, airway adjuncts, assisting with certain medications.
  • AEMT: Advanced life support, IV therapy, administration of emergency medicines.
  • Paramedic: Extensive advanced life support training, endotracheal intubation, emergency pharmacology, cardiac monitoring.
• Course Requirements: Reading assignments, step-by-step demonstrations, summary skill sheets, case presentations, scenarios.

Licensure Requirements

• High school diploma/equivalent.
• Proof of immunization.
• Background check and drug screening.
• Valid driver’s license.
• Basic Life Support (CPR) course completion.
• State-approved EMT course completion.
• State-recognized written and practical exams.
• Demonstrate mental and physical abilities.
• Comply with state and employer provisions.

Americans with Disabilities Act (ADA)

• Protects from access denial to state or local government-provided programs.
• Prohibits employment denial based on disability.
• Requires adjustments to consider candidates with disabilities.

History of EMS

• WWI: Volunteer ambulances.
• WWII: Field care and medics.
• Korean War: Rapid helicopter evacuation.
• 1960s-1970s: Varied ambulance services, EMS as known today began in 1966 (White Paper).
• 1973: Emergency Medical Services Act for funding and development.
• 1970s-1980s: Training curriculum development and enhanced EMT training.
• 1990s: EMS Agenda for the Future for standardization.
• 2019: Revised agenda for 2050.

EMS Organizational Levels

• Federal Level: National EMS scope of practice model.
• State Level: Laws regulate EMS provider operations.
• Local Level: Medical direction for daily oversight and support.

EMS System Components

1. Public Access: 911 systems, emergency medical dispatch (EMD), mobile apps for CPR/AED alerts.
2. Human Resources: Creating rewarding careers for EMS personnel.
3. Medical Direction: Ongoing liaison between medical community, hospitals, and EMS.
4. Legislation and Regulation: Adherence to state laws, EMS official for administrative tasks.
5. Integration of Health Care Services: Continuity of care from pre-hospital to hospital.
6. Mobile Integrated Health Care (MIH): Community-based care, improving access.
7. Information Systems: Document patient care, improve system performance.
8. Evaluation: Continuous Quality Improvement (CQI), audits, minimizing errors.
9. System Finance: Variable financial systems, new CMS pilot program (ET3).
10. Education Systems: National standards for training programs, continuous education.
11. Prevention and Public Education: Focus on public health, primary and secondary prevention.
12. EMS Research: Evidence-based medicine, national guidelines for clinical protocols.

EMT Roles and Responsibilities

• Keep vehicles and equipment ready.
• Ensure safety of self, partners, patients, bystanders.
• On-scene leadership, patient assessment, administrative support.
• Continuous professional development and community relations.

Professional Attributes of an EMT

• Integrity: Adherence to honest behavior.
• Empathy: Be thoughtful and aware of others' needs.
• Self-motivation: Solve problems without direction.
• Appearance and Hygiene: Project trust, professionalism.
• Self-confidence: Know limits and ask for help.
• Time Management: Efficient and safe multitasking.
• Communications: Clear understanding and being understood.
• Teamwork and Diplomacy: Work well with others, communicate respectfully.
• Respect: Hold others in high regard.
• Patient Advocacy: Patient needs at the center of care.
• Careful Delivery of Care: Attention to detail, safe care delivery.

Patient Confidentiality

• HIPAA: Patient privacy protection, only share information with those involved in care, or as legally required.