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Paleerat Jariyakanjana, MD
Faculty of Medicine
Naresuan University
Emergency Medical Services & Disaster ResponseEmergency Medical Services & Disaster Response
EMERGENCY MEDICAL SERVICES
EMS is the extension of emergency medical care into the prehospital setting.
History
ช่�วงเวลาที่ 1 สภาอุ�ณาโลมแดงแห่�งช่าติ�สยาม ม�ลนิ�ธิ�ป่�อุเติ�กติ� ง & ม�ลนิ�ธิ�ร่�วมกติ"ญญู�
ช่�วงเวลาที่ 2 ติ%าร่วจจร่าจร่ช่�วยเห่ล'อุผู้�)ป่�วยฉุ�กเฉุ�นิ ศู�นิย,ก�)ช่พนิเร่นิที่ร่
ช่�วงเวลาที่ 3 พ"ฒนิาร่ะบบบร่�การ่การ่แพที่ย,ฉุ�กเฉุ�นิ ให่)ลงไป่ส��ร่ะด"บ
ช่�มช่นิ และมความคร่อุบคล�มพ'4นิที่ที่" วป่ร่ะเที่ศู Tsunami
Key elements
Manpower
Training
initial provider trainingcontinuing education
Communications
1. collect the necessary information from the caller, dispatch appropriate medical resources, and offer first aid information or prearrival instructions
2. Ambulance personnel should also be able to communicate with the destination hospital
3. online medical control
Transportation
BLS ambulances carry equipment appropriate for personnel
trained at the EMT-B level oxygen, bag-mask ventilation devices,
immobilization and splinting devices, and dressings for wound care and hemorrhage control
do not carry medication and cannot transport patients requiring IVs or cardiac monitoring, although some may carry AEDs
BLS ambulances
Transportation
ALS ambulances equipped for EMT-Ps or other advanced
health care personnel IV supplies, IV medication, intubation devices,
cardiac monitoring and defibrillation, and equipment for other specialized techniques unique to specific areas, such as hypothermia application after cardiac resuscitation
ALS ambulances
Transportation
http://www.manafeth.com/index.php/en/products/view/Ambulance-Type-I#
Air transport
Facilities and Critical-Care Units
closest appropriate hospital or to the hospital of the patient's choice
divert patients to other hospitals ED overcrowding
Public Safety Agencies
strong ties with police and fire departments
1. providing scene security
2. provide first responder services
Consumer Participation
encourage representation of the general public on the membership of regional EMS councils
public can participate by volunteering for local EMS agencies
Access to Care
no barriers or disincentives preventing timely access to the system
Patient Transfer
all patients must receive a medical screening exam and be stabilized before transfer to another facility
explicit acceptance of the transfer by the receiving hospital
Coordinated Patient Record Keeping
Standardization of EMS medical records
Public Information and Education
train the public how to access them when needed and how to use them appropriately
convey to the public is the importance of learning CPR, first aid, and basic disaster preparedness principles
Review and Evaluation
radio communications, response times, scene times, and patient care records
Outcome: cardiac arrest, stroke, and traumaEMS research
Disaster Plan
written policies and proceduresstockpiling suppliesparticipating in regional disaster drills with
other emergency response agencies and hospitals
Mutual Aid
mutual aid agreements with neighboring jurisdictions so that uninterrupted emergency care is available when local agencies are overwhelmed or unable to provide services
Phases of EMS response
DISASTER RESPONSE
Definition
Major Incidents: any incident where the number, severity, type or location of live casualties requires extraordinary resources
Disaster: need > resourceMass casualty incident: Healthcare need >
resource
Disaster Management Cycle
Major Incident Medical Management and Support (MIMMS)
major incident training course
systematic, 'all hazards' approach to the principles of pre-hospital, multiple-casualty incident medical management
Management and Support Principles
CommandSafetyCommunicationAssessmentTriageTreatmentTransport
Command
CSCATTT
Safety
The 1-2-3 of Safety
1. Staff
2. Situation
3. Survivors
CSCATTT
Communication
CSCATTT
Assessment
My call sign/Major incident declaredExact location: Grid ref.Type of incidentHazards: Present/PotentialAccess: Roads, Landing areaNumber of casualties: Type, SeverityEmergency services: Present and Required
CSCATTT
Triage
CSCATTT
Triage sieve
CSCATTT
Triage sort
CSCATTT
Triage sort
CSCATTT
Treatment
Aim: “do the most for the most”
CSCATTT
Transport
Aim: get the right casualty to the right place in the right time
Casualties should be dispersed to different hospitals, most appropriate to their need.
Mechanism of injuryInjury found or suspectedSigns (vital signs)Treatment given
CSCATTT
Take home message
EMS is the extension of emergency medical care into the prehospital setting.
Disaster response: CSCATTT
Reference
Tintinalli's Emergency Medicine, 7th editionhttp://www.emsworld.com/article/10319356/th
e-star-of-lifehttps://sites.google.com/site/dimersarred/disa
ster-management-cyclehttps://sites.google.com/site/sarbook1/excerp
t-incident-command
ANY QUESTIONS?
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