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Overview of the EMS System:
French began transporting wounded soldiers away from the scene of the battle to physicians
1790s
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Overview of the EMS System:
non military ambulance services began
1900s
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Overview of the EMS System:
Smaller communities developed ambulance services
1940s
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Overview of the EMS System:
EMS (Emergence Medical Services) began
1960s
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Overview of the EMS System:
The National Highway Safety Act charged DOT ( The United States Department of Transportation) with developing EMS standards and assisting the states to upgrade the quality of their prehospital emergency care.
1966
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Overview of the EMS System:
National Registry of Emergency Medical Technicians was founded to establish professional standarda
1970
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Overview of the EMS System:
Congress passed the National EMergency Medical Services Act as the cornerstone of a federal effort to implement and improve EMS systems across the United States.
1973
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NHTSA Set Standards:
NHTSA (National Highway Traffic Safety Administration) initiates an EMS Technical Assessment Program based on 10 key components of EMS with a set of standards for EMS systems.
- Regulation and policy
- Resource management
- Human resources and training
- Transportation
- Facilities
- Communications
- Public information and education
- Medical direction
- Trauma systems
- Evaluation
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NHTSA Set Standards:
Regulation and Policy
- Each states' EMS System must have in place:
- enabling legislation (laws allowing the system to exist)
- a lead EMS agency
- a funding mechanism
- regulations
- policies
- procedures
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NHTSA set standards:
Resource management
- there must be centralizes coordination resources so that all victims of trauma or medical emergencies have equal access to:
- basic emergency care and transport by certified personnel
- a licensed and equipped ambulance
- an appropriate facility
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NHTSA set standards:
Human resources and training
At a minimum, all transporting prehospital personnel (those who ride the ambulances) should be trained to the EMT-B level using a standardized curriculum taught by qualifies instructors.
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NHTSA set standards:
Tramsportation
- Safe, reliable ambulance transportation is a critical component
- Most patients can be effectively transported by ground ambulances
- Some patients require rapid transportation. or transportation from remote areas, by helicopter or airplane.
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NHTSA set standards:
Facilities
The seriously ill or injured patient must be delivered in a timely manner to the closest appropriate facility
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NHTSA set standards:
Communications
- There must be an effective communications system, beginning with:
- the universal system access number (911),
- dispatch-to-ambulance
- ambulance-to-ambulance
- ambulance-to-hospital
- hospital-to-hospital
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NHTSA set standards:
Public information and education
- EMS personnel may participate in efforts to educate the public about:
- their role in the system
- their ability too access the system
- prevention of injuries
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NHTSA set standards:
Medical direction
- Each EMS system must have have a physician as medical director accountable for the activities of EMS personnel within that system.
- The Medical Director delegates medical practice to non-physician providers and must be involved in all aspects of the patient care system
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NHTSA set standards:
Trauma systems
- in each state, enabling legislation must exist to develop a trauma system including:
- one or more trauma centers
- triage and transfer guidelines for trauma patients
- rehabilitation programs
- data collection
- mandatory autopsies (examination of bodies to determine cause of death)
- means for managing and assuring the quality of the system
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NHTSA set standards:
Evaluation
- Each state must have a program for:
- evaluating and improving the effectiveness of the EMS system, known as a quality improvement (QI) program
- a quality assurance (QA) program
- or total quality management (TQM)
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Components of the EMS System:
Pre-hospital care
- First responders
- EMT-B
- EMT-I
- EMT-P
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Components of the EMS System:
Emergency departments
- Patient care technicians
- Nurses
- Physicians
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Components of the EMS System:
Speciality Facilities
- Cardiac Centers
- Stroke Centers
- Trauma Centers
- Burn Centers
- Pediatric Centers
- Poison Control Centers
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Accessing the EMS System:
911
- A system for telephone access to report emergencies.
- A dispatcher takes the information and alerts EMS or the fire or police departments as needed
- Toll-free number
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Accessing the EMS System:
Enhanced 911
Has the capability to automatically identify the caller's phone number and location
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Accessing the EMS System:
Communities without 911
Standard seven-digit number to reach EMS
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Accessing the EMS System:
Chain of the EMS human resources
- Patient
- Citizen calls 911
- 911 dispatcher
- First responders
- EMTs
- Emergency department staff
- Allied health staff
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Roles and Responsibilities:
- Personal safety
- Safety of the crew, patient, and bystanders
- Patient assessment
- Lifting and moving
- Transport
- Transfer of care
- Patient advocacy
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Roles and Responsibilities:
Role of the EMT:
- Careful documentation
- Becoming involved in the QI process
- Obtaining hospital feedback from hospital staff
- Maintaining equipment
- Continuing education
- Maintaining skills
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Traits of a Good EMT:
Professional Attributes and Traits
- Maintains a presentable appearance
- Keeps knowledge and skills up-to-date
- Makes patients' needs a priority without endangering self or others
- Maintains current knowledge of local, state, and national issues affecting EMS
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Definitions:
Quality Improvement
A process of continuous self-review with the purpose of identifying and correcting aspects of the system that require improvement
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Definitions:
Medical Director
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