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Tiered response
Sending multiple levels of emergency care personnel to the same incident
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Napoleon's chief physician implements a prehospital system designed to triage and transport the injured from the field to aid stations.
1797
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Civilian ambulance services begin in Cincinnati and NYC.
1860s
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Dr. Friedrich Maass performs the first equivocally documented chest compression in humans.
1891
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First-known air medical transport occurs during the retreat of the Serbian army from Albania.
1915
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First volunteer rescue squads organize in Roanoke, VA, and along the New Jersey coast.
1920
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Claude Beck develops first defibrillator and first human saved with defibrillation.
1947
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Dr. Peter Safar demonstrates the efficacy of mouth-to-mouth ventilation.
1958
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Cardiopulmonary resuscitation (CPR) is shown to be efficacious.
1960
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J. Frank Pantridge converts an ambulance into a mobile coronary care unit with a portable defibrillator and recorded ten prehospital resuscitations with a 50% long term survival rate.
1965
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The National Academy of Sciences, National Research Council publishes Accidental Death and Disability; The Neglected Disease of Modern Society. (The White Paper)
1966
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The Emergency Medical Services Program in the Department of Transportation is established with this act.
Highway Safety Act of 1966
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Star of Life is patented by the American Medical Association.
1967
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AT&T designates 911 as its new national emergency number.
1968
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National Registry of EMTs is founded.
1970
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Television show Emergency! debuts on NBC.
1972
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Department of Health, Education, and Welfare allocates $16 million to EMS demonstration programs in five states.
1972
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The Emergency Medical Services Systems (EMSS) Act provides additional federal guidelines and funding for the development of regional EMS systems; the law establishes 15 components of EMS systems.
1973
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National Association of Emergency Medical Technicians (NAEMT) is organized.
1975
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Field automated external defibrillators (AEDs) become available.
1979
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The Omnibus Budget Reconciliation Act consolidates EMS funding into state preventive health and health services block grants, and eliminates funding under the EMSS act.
1981
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Prehospital Trauma Life Support (PHTLS) is developed.
1981
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International Trauma Life Support (ITLS), formerly basic trauma life support (BTLS), is developed.
1981
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The EMS for Children (EMSC) program, under the Public Health Act, provides funds for enhancing the EMS system to better serve pediatric patients.
1984
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National Research Council publishes Injury in America: A Continuing Public Health Problem, describing deficiencies in the progress of addressing the problem of accidental death and disability.
1985
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The National Highway Traffic Safety Administration initiates the Statewide EMS Technical Assessment program based on ten key components of EMS systems.
1988
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The Trauma Care Systems and Development Act encourages development of inclusive trauma systems and provides funding to states for trauma system planning, implementation, and evaluation.
1990
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The Institute of Medicine publishes Emergency Medical Services for Children, which points out deficiencies in our health care system's ability to address the emergency medical needs of pediatric patients.
1993
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Congress does not reauthorize funding under the Trauma Care Systems and Development Act.
1995
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President Clinton signs bill designating 911 as national emergency number.
1999
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Health Insurance Portability and Accountability Act (HIPAA) becomes effective, strictly regulating the flow of confidential information. (written in 1996)
2003
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The National Highway Traffic Safety Administration publishes Emergency Medical Services: Agenda for the Future, to guide the development of EMS in the United States in the twenty-first century.
2006
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The EMS Agenda for the Future (1966) proposed continued development of 14 core EMS attributes:
- Integration of health services
- EMS research
- Legislation and regulation
- System finance
- Human resources
- Medical direction
- Education systems
- Public education
- Prevention
- Public access
- Communication systems
- Clinical care
- Information systems
- Evaluation
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The National Academics Institute of Medicine published Emergency Medical Services: At the Crossroads (2006). This paper was critical of many EMS practices and found problems at the federal and governmental levels. The key areas covered were:
- Insufficient coordination
- Limited coordination of transport within regions
- Disparities in response times
- Uncertain quality of care
- Lack of readiness for disasters
- Divided professional identity
- Limited evidence base
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AHA Chain of Survival
- 1. Immediate recognition and activation of the EMS system
- 2. Early CPR
- 3. Rapid defibrillation
- 4. Effective Advanced Life Support (ALS)
- 5. Integrated post-cardiac arrest care
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A qualified physician gives direct orders to a prehospital care provider by radio or phone.
On-Line medical direction
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The four T's of emergency care:
- Triage
- Treatment
- Transport
- Transfer
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"Sudden death" arrests are deaths that occur within how long of the start of symptoms?
2 hours
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Defibrillation is most effective when delivered within _____ minutes or less after patient collapse.
4 minutes
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National EMS Education Instructional Guidelines published by the U.S. DOT establish the minimum content for paramedic programs across the country. Guidelines cover three specific areas:
- Cognitive - facts or information knowledge
- Affective - assign emotions, values, and attitudes
- Psycomotor - hands on skills
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The process by which an agency or association (or state) grants recognition to an individual who has met its qualifications.
Certification
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A government agency (usually a state agency) grants permission to engage in a given trade or profession to an applicant who has attained the degree of competency required to ensure the public's protection.
Licensure
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In 1974, in response to a request from the DOT, the General Services Administration (GSA) developed the "KKK-A-1822 Federal Specifications for Ambulances". The act defined the following basic types of ambulance:
Type I - conventional cab and chassis on which a module ambulance body is mounted, with no passageway between the driver and patient's compartments
Type II - A standard van, body, and cab form an integral unit. Most have a raised roof.
Type III - This is a specialty van with forward cab and integral body. It has a passageway from the driver's compartment to the patient's compartment.
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The rules or standards that govern the conduct of members of a particular group or profession.
Ethics
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High-risk areas of EMS practice have been identified by the Institute of Medicine of the National Academies of Sciences in the paper titled To Err is Human: Building a Safer Health System. The three areas identified as highest risk include:
- Skills-based failures
- Rules-based failures
- Knowledge-based failures
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Primum non nocere
first, do no harm
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High risk areas of EMS:
- Hand-off - failure to provide essential info
- Communications issues
- Medication issues - wrong med, dose, etc
- Airway issues
- Dropping patients
- Ambulance crashes
- Spinal immobilizations
- Death pronouncements
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