Block 01 - Chapter 01

Block 01 - Chapter 01

EMS Systems

Poll

How do you feel about this chapter?

• Let's gooo!

• Well, let's find out.

• Umm....I'll try!

• Don't hurt me!

• ​Team of health care professionals

• Is governed by state laws

• After you complete this course, you are eligible to take either:

  • The National Registry of EMTs exam

  • Your state’s certification exam

EMS is a system.

• Most states have four training and licensure levels:

  • EMR

  • EMT

  • AEMT

  • Paramedic

Levels of Training

• Abilities vary by level.

• EMR is the lowest and Paramedic is the highest

• Some certifications beyond Paramedic, NOT in NREMT.

Levels of Training

• An EMR has very basic training.

• Provides care before ambulance arrives

• May assist in ambulance

• Usually cannot run their own calls

Levels of Training - EMR

• Include law enforcement officers and firefighter

• Initiate immediate care and assist EMTs on their arrival

• Focus on providing BLS and urgent care with limited equipment

Levels of Training - EMR

• An EMR has very basic training.

• Provides care before ambulance arrives

• May assist in ambulance

• Usually cannot run their own calls

Levels of Training - EMR

• An EMT has training in basic life support (BLS), including:

  • Automated external defibrillation

  • Airway adjuncts

  • Assisting patients with certain medications

Levels of Training - EMT-Basic

• EMT course requires about 150–200 hours.

• The EMT has knowledge and skills to provide basic emergency care.

• The EMT assumes responsibility for assessment, care, packaging, and transport of the patient.

• Usually the lowest level that can run an ambulance.

Levels of Training - EMT-Basic

• An AEMT has training in specific aspects of advanced life support (ALS), including:

  • Intravenous (IV) therapy

  • Administration of a limited number of emergency medications

Levels of Training - Advanced EMT

• A paramedic has extensive ALS training, including:

  • Endotracheal intubation

  • Emergency pharmacology

  • Cardiac monitoring

  • Other advanced assessment and treatment skills

Levels of Training - Paramedic

• Extensive training

• 1,000 to more than 1,300 hours in the classroom and in internships

• Training covers a wide range of ALS skills.

Levels of Training - Paramedic

Multiple Choice

Which of the following descriptions most accurately portrays emergency medical services (EMS)?

• A vast network of advanced life support (ALS) providers who provide definitive emergency care in the prehospital setting

• A team of health care professionals who are responsible for providing emergency care and transportation to the sick and injured

• A system composed exclusively of emergency medical responders (EMRs) and emergency medical technicians (EMTs) who are responsible for providing care to sick and injured patients

• A team of paramedics and emergency physicians who are responsible for providing emergency care to critically injured patients

Multiple Choice

An EMS provider who has extensive training in various aspects of advanced life support (ALS) is called a(n):

• EMT

• Paramedic

• Advanced EMT

• EMR

Multiple Choice

EMT training in nearly every state meets or exceeds the guidelines recommended by the:

• National Registry of EMTs.

• individual state’s EMS protocols.

• National Association of EMTs.

• National Highway Traffic Safety Administration (NHTSA).

• Vary from state-to-state

• Generally:

  • HS Diploma

  • Course Completion

  • BG and 10-panel checks

  • Drivers License

  • Some states require NREMT

Licensure Requirements

Origins include:

• Volunteer ambulances in World War I

• Field care in World War II

• Field medic and rapid helicopter evacuation in Korean conflict

History of EMS

• 1966

  • Accidental Death and Disability: The Neglected Disease of Modern Society established EMS

• Early 1970s

  • DOT published the first EMT training curriculum.

• 1973

  • Emergency Medical Services Act

• 1971

  • AAOS published the first EMT textbook.

History of EMS

National standardization efforts

• 1970s – DOT’s National Standard Curriculum

• 1980s – Advanced levels of EMTs

• 1990s – NHTSA’s EMS Agenda for the Future

• 2019 – NHTSA’s EMS Agenda 2050

History of EMS

• Federal level:

  • National EMS Scope of Practice Model provides guidelines.

• State level:

  • Laws regulate EMS operations.

• Local level:

  • Medical director provides oversight and support.

EMS Oversight

• Comprehensive, quality, convenient care

• Evidence-based clinical care

• Efficient, well-rounded care

• Preventive care

• Comprehensive and easily accessible patient records

Components of the EMS System

• 9-1-1 system

• Access public safety

• Dispatchers

• Obtain information and dispatch resources

• Emergency medical dispatch (EMD) system

• Provides medical instruction

• Mobile apps assist with layperson CPR and AED location

Public Access

• Physician medical director

  • Authorizes EMTs to provide medical care in field

• Standing orders and protocols

  • Describe appropriate care

  • Establish medical direction for providers

Medical Direction

Medical control can be off-line or online.

• Off-line (indirect)

  • Standing orders, training, supervision

• Online (direct)

  • Physician directions given over the phone or radio

Medical Direction

• Prehospital care is coordinated with hospital care.

• Prehospital care is continued in the emergency department (ED).

• Integration ensures comprehensive continuity of care for the patient.

Medical Direction

• Training, protocols, and practices follow state legislation.

• Various EMS official handles administrative tasks:

  • Scheduling

  • Personnel

  • Budgets

  • Purchasing

  • Vehicle maintenance

Legislation and Regulation

• Prehospital care is coordinated with hospital care.

• Prehospital care is continued in the emergency department (ED).

• Integration ensures comprehensive continuity of care for the patient.

Integration of Health Services

• Method of delivering health care

• Utilizes the prehospital spectrum

• Evolved with the goal to facilitate improved access to health care at an affordable price

• Health care provided within the community by team of EMS and other professionals

Mobile Integrated Health Care

Multiple Choice

The standards for prehospital emergency care and the individuals who provide it are typically regulated by the:

• state office of EMS.

• regional trauma center.

• American Heart Association.

• National Registry of EMTs.

Multiple Choice

If an EMT candidate has been convicted of a felony or misdemeanor, he or she should:

• wait at least 24 months before taking another state-approved EMT class.

• send an official request to the National Registry of EMTs (NREMT) to seek approval to take the EMT exam.

• recognize that any such conviction will disqualify him or her from EMT licensure.

• contact the state EMS office and provide its staff with the required documentation.

• MIH created additional training levels for EMS providers, including community paramedicine.

• Paramedics receive advanced training to provide services within a community.

• Community paramedics provide additional services.

Mobile Integrated Health Care

• Computer systems are used for documentation of patient care.

• Electronically stored information can be used to improve care.

• Healthcare organizations of all kinds are targets of cyberattacks.

Information Systems

• Reviews and performs audits of the EMS system to identify areas of improvement and/or assign remedial training

• Minimizing errors is the goal.

• Uses a plan-do-study-act cycle

Continuous Quality Improvement (CQI)

• Minimize medical errors that occur as a result of a rules-based failure, a knowledge-based failure, or a skill-based failure (or a combination).

• Requires the efforts of both the EMS agency and EMS personnel

Patient Safety

• Finance systems vary depending on the organization involved.

• Personnel may be paid, volunteer, or a mix.

• EMTs may be asked to:

  • Gather insurance information.

  • Secure signatures.

  • Obtain permission from patients to bill insurance.

System Finance

• In 2020, the Centers for Medicare and Medicaid Services (CMS) implemented a pilot program called Emergency Triage, Treat, and Transport (ET3).

• Reimburse EMS systems for providing the right patient care at the right time.

• Set up a payment model for patient transport to alternative destinations.

System Finance

• Prevention and public education

  • Two components of the EMS system with a focus on public health

• Emphasis is on prevention.

• EMS works with public health agencies on:

  • Primary prevention

  • Secondary prevention

Prevention and Public Education

Prevention and Public Education

• Helps determine the shape of EMS

• Evidence-based medicine (EBM)

  • 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 State EMS Officials.

  • Based on a review of current research and expert consensus

EMS Research

• Keep vehicles and equipment ready.

• Ensure safety.

• Be familiar with emergency vehicle operation.

• Provide on-scene leadership.

• Perform scene evaluation.

Roles and Responsibilities of the EMT

• Call for additional resources as needed.

• Gain patient access.

• Perform a patient assessment.

• Give emergency medical care while awaiting additional medical resources.

Roles and Responsibilities of the EMT

• Give emotional support.

• Maintain continuity of care.

• Resolve emergency incidents.

• Uphold medical and legal standards.

• Ensure and protect patient privacy.

Roles and Responsibilities of the EMT

• Integrity

• Empathy

• Self-motivation

• Appearance and
  hygiene

• Self-confidence

Professional Attributes

• Time management

• Communications

• Teamwork and diplomacy

• Respect

• Patient advocacy

• Careful delivery of care

Professional Attributes

• Every patient is entitled to compassion, respect, and the best care.

• EMTs are bound by patient confidentiality.

• Be familiar with requirements of the Health Insurance Portability and Accountability Act (HIPAA).

Professional Attributes

Multiple Choice

Which of the following statements regarding the EMS medical director and an EMT’s scope of practice is correct?

• The EMS medical director can expand the EMT’s scope of practice but cannot limit it without state approval.

• The EMS medical director can expand or limit an individual EMT’s scope of practice without state approval.

• An EMT’s scope of practice is exclusively regulated by the state EMS office, not the EMS medical director.

• An EMT’s scope of practice may be expanded by the medical director after proper training and state approval.

Multiple Choice

Which type of medical direction do standing orders and protocols describe?

• Radio

• Online

• Off-Line

• Direct

Multiple Choice

The continuous quality improvement (CQI) process is designed to:

• administer punitive actions to EMTs who do not follow local protocols.

• identify areas of improvement and provide remedial training if needed.

• ensure that all EMTs maintain licensure through the state EMS office.

• focus specifically on the quality of emergency care provided to the patient.