INTRODUCTION TO THE EMS SYSTEM

© 2011 National Safety Council 1-1

INTRODUCTIONTO THE EMS SYSTEM

LESSON 1

© 2011 National Safety Council 1-2

Introduction

• Emergency Medical Responders (EMRs) are an essential part of Emergency Medical System (EMS) system

• First trained persons to reach ill or injured patient

• Individual summoned to provide care in an emergency

• Professional duty to respond and provide emergency care

• Usually have access to supplies and equipment for providing initial care

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Examples of Occupations of EMRs

• Law enforcement personnel

• Firefighters

• Industrial safety officers

• Prison guards

• Lifeguards

• Daycare attendants

• Athletic trainers

• Ski patrol members

• Civil defense personnel

• Disaster team members

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Medical Emergencies

• Situation where person suddenly needs medical care

• Often person is injured or experiences sudden illness

• May be life threatening

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United States Medical Emergency Statistics

• Heart disease results in about 616,000 deaths a year

• More than 1,250,000 heart attacks occur each year, resulting in over 132,000 deaths

• About 795,000 people a year have a stroke, resulting in about 136,000 deaths

• About 128,200 people a year die from unintentional injuries

• About 39 million visits a year are made to emergency departments because of injuries

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Sudden Illness

• Medical conditions that occur suddenly

• Person with non-emergency chronic illness may suddenly experience an emergency

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Common Causes of Injuries Treated in Emergency Departments (Annual)

• Falls – 8,551,037

• Struck by or against object – 4,492,287

• Overexertion – 3,278,300

• Motor vehicle occupants – 2,581,605

• Cut or pierced by object – 2,072,604

• Bites and stings (other than dog bites) – 993,923

• Poisoning (including drug overdose) – 732,316

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Unintentional Injuries Causing Deaths

• Poisoning (including drug overdose) accounts for most accidental injury deaths

• Followed by motor vehicle crashes, falls, choking, drowning, fire and smoke, and other injuries in the home, public places, and work

• Injuries may strike at any time

• EMRs provide care until patient receives advanced help

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Delivery of Prehospital Emergency Medical Care

• Fire department

• Hospital-based or volunteer system

• Private ambulance and Emergency Medical Services (EMS)

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Emergency Medical Services System

• Emergency Medical Services (EMS) Act of 1973 established nationwide system

• Sophisticated network of services

• Single call for help initiates responses to rush care to patient

Accessing EMS

• Activated when someone calls 9-1-1 or another local number

• Most communities have a centralized 9-1-1 system

• 9-1-1 calls reach dispatcher who then sends resources to scene

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9-1-1 Systems

• Callers identify name, location and phone number

• Enhanced 9-1-1 systems automatically provide dispatcher with caller’s phone number/location for landlines

• Caller may need to specify exact location

• With cellular calls, caller’s location is unknown

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Steps of EMS Response to Emergencies

1. Medical emergency occurs

2. Emergency recognized/EMS is activated

3. Citizen responder may give first aid/CPR on scene if trained

4. EMRs arrive and provide care

5. EMTs/Paramedics arrive and assume care

6. EMTs continue care measures begun by EMRs

7. Following stabilization and care, patient transported to hospital emergency department or specialty facility

8. Patient transferred to in-hospital emergency care team

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Response of EMRs

• Sent to scene by dispatcher after a citizen has activated EMS

• If on scene, initiate call to dispatcher to activate EMS

• Ensure EMS has been activated in all situations

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Types of Facilities Receiving Patients

• Hospital emergency departments

• Specialty facilities:

- Trauma centers

- Burn centers

- Pediatric centers

- Perinatal centers

- Cancer/Oncology centers

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Preparation of Equipment and Personnel

• Equipment used must be clean, complete and readily available for use

• Frequent checks of equipment and supplies:

- All equipment safe and in good working order

- Dated supplies checked and replaced before expiration

- Oxygen cylinders kept full

- Automated External Defibrillators (AED) charged and in working order

- Dressings and bandages replaced as soon as they are used

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Preplanning

• Preparing a plan in anticipation of different emergencies

• Many industrial plants have plans for response that identify:

- Key personnel

- Locations of supplies

- Mechanism for notifying EMS

- Evacuation routes

- Staging areas

• Fire departments/EMS systems preplan responses to areas of potential hazards

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Notification of Medical Emergencies

• Police department, fire department or other EMS providers receive the call

• Lifeguards, ski patrol members or athletic trainers may already be at scene

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Responding to the Call

• Gather medical equipment and go to scene

• Respond in the appropriate vehicle

• Fire, police and rescue personnel have vehicles equipped with necessary warning equipment

• If private vehicle, obey all traffic laws and signs

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10 Components of EMS Systems

1. Regulation and policy

2. Resource management

3. Human resources and training

4. Transportation

5. Facilities

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6. Communications

7. Public information and education

8. Medical oversight

9. Trauma systems

10. Evaluation

10 Components of EMS Systems (continued)

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• Dispatcher

• EMR

• EMT

• Paramedic

• Medical Director

EMS Professionals

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Dispatcher

• Called an Emergency Medical Dispatcher (EMD) or dispatch

• Receives most 9-1-1 calls

• Located in law enforcement agency, fire station or other site

• Trained to obtain information and determine what personnel and equipment are needed

• Sends appropriate EMS unit(s) to the scene

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Emergency Medical Responder (EMR)

• Previously called a first responder

• Usually first person to arrive at emergency

• Takes over care of patient from those giving first aid

• Gathers information concerning the patient

• Controls scene

• Prepares for arrival of ambulance

• Provides care until more advanced professionals arrive

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EMTs and Paramedics

• Arrive in ambulance equipped for basic or advanced life support

• Take over care and transport patient for definitive medical care

• EMTs with different levels of training perform different medical treatments

• Paramedics have highest level of training

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Medical Director

• Physician within EMS system oversees EMRs and EMTs

• Establishes protocols for medical care

• Available for consultation by radio or telephone

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Categories of Emergency Medical Responders’ Responsibilities

• General responsibilities

• Patient care responsibilities

• Responsibilities at the scene

• Personal responsibilities and characteristics

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General Responsibilities

1. Maintain readiness of emergency equipment

2. Respond in safe, rapid manner

3. Maintain personal safety

4. If emergency requires special personnel or equipment, contact EMS

5. Gain access to patient

6. Give care to the patient

7. Document emergency and actions to meet local recordkeeping requirements

8. Maintain good community relations

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Patient Care Responsibilities

1. Give care needed for life-threatening problems

2. Activate EMS system

3. Further assess patient to detect medical problems and life threats

4. Provide care, remain with patient

5. Assist other EMS personnel as needed

6. Provide emotional support to patient, family members or others at scene

7. Maintain the patient’s privacy and confidentiality

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Responsibilities at the Scene

1. Identify safety issues, determine number of patients, determine resources needed

2. It may be necessary to access patient

3. Maintain safety of self, patient and others at scene

4. Assist personnel as required or requested

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Responsibilities at the Scene (continued)

5. Cooperate with other public safety workers

6. Other responsibilities may include:

- Assist in directing traffic

- Summon other appropriate help

- Control, direct or ask bystanders for help

- Other responsibilities as dictated by your job or specific EMS system

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Personal Responsibilitiesand Characteristics

• Maintain a caring and professional attitude

• Respect all patients, family

• Maintain composure

• Maintain a professional appearance

• Maintain personal fitness and health

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Medical Oversight

• Responsibility of physician overseeing prehospital emergency care

• Medical director leads response team and decides how care is delivered

• Includes direct and indirect medical control

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Direct Medical Control

• Medical director involved by instructing prehospital care providers

• Medical director stays in contact with care providers

• Medical director can authorize specific patient treatment outside of standard protocols

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Indirect Medical Control

• Refers to offline direction provided by the medical director

• Medical director responsible for developing protocols

• Includes EMS system design, standards of training and quality assurance programs

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Legal Responsibility of Medical Director

• In many states, EMRs function under guidance and control of medical director

• EMRs generally considered agents of the medical director

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EMR Education and Training

• Training in accordance with state’s EMS office, if applicable

• Preparation begins with training and continues

• Keep your skills and knowledge up to date

• Infrequently used skills should be practiced

• Attend continuing education programs and refresher training

• Read professional publications

• Maintain a current knowledge of issues affecting EMS

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Quality Improvement

• Process to monitor and evaluate quality of prehospital patient care

• Goal is to make improvements wherever possible and correct any problems never to blame or punish

• Formal quality improvement programs vary among states and localities

• EMRs may participate in quality improvement programs by helping collect data or other activities

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Quality Improvement (continued)

Help minimize the chance of errors occurring:

• Be thoughtful as you provide care

• Do not make assumptions about patient’s condition

• Use a pocket reference guide or other materials to remember information

• Never hesitate to ask others in the EMS system for help

• Debrief every call and your actions, thinking about whether you might do anything differently next time

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Research in EMS

• EMS system advances based on scientific research and quality improvement research

• EMR skills based on the most current research

• EMRs may participate in a research study

• Your participation helps ensure patients receive best possible care

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Public Health

• Government programs to improve the health of citizens

• Focus is to promote good health and prevent disease

• EMS has a critical role in health promotion and the prevention of injury and illness

• Functions include education and communication

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Public Health (continued)

Examples of health promotion, illness and injury prevention:

• Primary prevention: preventing disease by encouraging recommended vaccinations and educating about good health practices

• Secondary prevention: reducing the complications or progression of disease

• Disease surveillance: documenting information related to epidemics of disease

• Injury prevention

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Public Health – Injury Prevention

• Using safety equipment

• Educating others about the importance of:

- Using car seats for infants and young children

- Using seat belts and shoulder straps in vehicles

- Wearing a helmet on bicycles and in sports activities

- Not driving under the influence of alcohol or other drugs

- Using safety practices to prevent falls, fires and burns, drowning, and poisoning