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Oregon’s EMS SystemOregon’s EMS System

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Objectives

Describe the environment in which the first

‘ambulances’ responded

Identify the first volunteer ambulance

Identify the agency that was tasked,

through Legislation, with developing the

Emergency Medical Services

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Objectives State when Legislation was passed to

develop Oregon’s Trauma System

List the Oregon Revised Statutes and Oregon Administrative Rules that outline the responsibilities of Oregon’s EMS Office

List three things an EMT can do to assist the EMS Office in providing service to him/her

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Objectives

State the difference between Level 1, Level 2, Level 3 and Level 4 Trauma Hospitals in Oregon

List three reportable actions defined in OAR 333-265-0160

Identify three functions of the Medical Director

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Way Back

Napoleonic War

– Horse drawn wagons

Civil War

NYC 1869

1899 – The first

motorized ambulance

– Chicago

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In the beginning…

1913 – Ben C. Buck started the nation’s first private ambulance service in Portland, Oregon

1918 – Mr. Buck donated one of the few motorized ambulances used in WW-I

1920 – First volunteer ambulance service, Roanoke, Virginia

1942 – Buck Ambulance became the first to carry oxygen as standard equipment

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More Recent CPR, 1960s

– Dr. Leonard Rose, Cardiac Tech

8% WWI, 4.5% Korea,

2% Vietnam Accidental Death & Disability, The Neglected

Disease of American Society, 1966

1966 – DOT – EMS

America’s deaths from influenza were greater than the number of U.S. servicemen

killed in any war

0

100

200

300

400

500

600

700

800

900

Civil WWI 1918-19 WWII Korean Vietnam

War Influenza War War

Thousands

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Historical PerspectiveCivilian Evolution

• Civilian evolution varied from Civilian evolution varied from region to region in U.S.region to region in U.S.

• Rural areas – UndertakersRural areas – Undertakers Fire departments and volunteer Fire departments and volunteer

ambulance replaced funeral ambulance replaced funeral directorsdirectors

• Urban areasUrban areas Hospital-basedHospital-based Fire departmentsFire departments Police departmentsPolice departments Independent ambulance Independent ambulance

companiescompanies

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More Modern Times

1973-82 Title 12 Grants

– $12 million to Oregon

June 30, 1981

1987 Trauma System

1989 BME OHD- Now DHS-EMS

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State EMS Office(DHS, Emergency Medical Services and Trauma Systems)

Statutory responsibility– Oregon Revised Statutes Chap. 682, 431

– Oregon Administrative Rules Chap. 333-200, 250, 255, 260, 265, Chap. 847

State EMS office

State EMS Committee– Subcomm. EMT Cert. and Discipline

STAB, ATAB

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State EMS Office

Charge – minimum standards– FR– EMTs– Ambulance vehicles– Ambulance services– Trauma hospitals

Certification, CME Accreditation process

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State EMS Office

Be nice to them Do your research Start locally Read, then follow directions Know your responsibilities Document, conduct business in writing Don’t shop for answers

Things in the works!• “Certification” of First Responders

• Revision of Oregon EMT-Intermediate Curriculum (rethinking)

• ACEP/OHD-EMS Supervising Physician Course

• 40 Hour Oregon Version DOT National Standard EMS Instructor Course

• National Registry Exam

• Manage Grant Programs

Total of All Certification Levels as of March 17, 2006

EMT-B 4187 51.31%

EMT-I 1422 17.43%

EMT-P 2551 31.26%

TOTAL EMTS ALL LEVELS 8160

Oregon’s EMTs All Levels by ZIP code

Oregon’s EMT-Basics by ZIP code

4075

51.23%of total EMTs

Oregon’s EMT-Intermediates by ZIP code

1472

18.51%of total EMTs

Oregon’s Paramedics by ZIP code

2407

30.16% of total EMTs

Statewide ALL EMS Agencies

N = 654

Statewide Transport Agencies

N = 136

Statewide Non-transport Agencies

N = 518

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Trauma Section

State wide trauma system

Hospital designation 1-4

Data gathering

Triage criteria

911 System

Revised 3/20/02

Oregon Trauma System Hospitals

Revised: 1/23/04

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1

2

4

III

IV

1. Legacy Emanuel Hospital & Health Center, Portland2. Oregon Health & Science University, Portland

3. Good Samaritan Regional Medical Ctr., Corvallis4. Sacred Heart Medical Center, Eugene5. St. Alphonsus Regional Medical Center, Boise, ID *6. St. Charles Medical Center, Bend7. SW Washington Medical Center, Vancouver, WA *

8. Bay Area Hospital, Coos Bay9. Columbia Memorial Hospital, Astoria10. Good Shepherd Medical Center, Hermiston11. Grande Ronde Hospital, La Grande12. Holy Rosary Medical Center, Ontario13. McKenzie-Willamette Hospital, Springfield14. Mercy Medical Center, Roseburg15. Merle West Medical Center, Klamath Falls16. Mid-Columbia Medical Center, The Dalles17. Peace Harbor Hospital, Florence18. Pioneer Memorial Hospital, Prineville19. Providence Hood River Memorial Hospital, Hood River20. Providence Medford Medical Center, Medford21. Rogue Valley Medical Center, Medford22. Salem Hospital, Salem23. Samaritan Albany General Hospital, Albany24. Samaritan Lebanon Community Hospital, Lebanon25. St. Anthony Hospital, Pendleton26. St. John Medical Center, Longview, WA *27. St. Mary Medical Center, Walla Walla, WA *28. Three Rivers Community Hospital, Grants Pass29. Tillamook County General Hospital, Tillamook30. Walla Walla General Hospital, Walla Walla, WA *31. Willamette Valley Medical Center, McMinnville

32. Ashland Community Hospital, Ashland33. Blue Mountain Hospital, John Day34. Central Oregon Community Hospital, Redmond35. Coquille Valley Hospital, Coquille36. Curry General Hospital, Gold Beach37. Harney District Hospital, Burns38. Lake District Hospital, Lakeview39. Lower Umpqua Hospital, Reedsport40. Mountain View Hospital, Madras41. Pioneer Memorial Hospital, Heppner42. Providence Newberg Hospital, Newberg43. Samaritan North Lincoln Hospital, Lincoln City44. Samaritan Pacific Communities Hospital, Newport45. Santiam Memorial Hospital, Stayton46. Silverton Hospital, Silverton47. St. Elizabeth Health Services, Baker City48. Sutter Coast Hospital, Crescent City, CA49. Wallowa Memorial Hospital, Enterprise50. West Valley Community Hospital, Dallas

Level I

Level II

Level III

Level IV

* ID WA Designated

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TOTRAUMAHOSPITAL 

 VITAL SIGNS & LEVEL OF CONSCIOUSNESS:Systolic blood pressure <90 mmHg; orRespiratory distress with rate<10 or >29; or Airway management required; orGlasgow Coma Scale <12 

 

 ANATOMY OF INJURY:Penetrating injury of the head, neck, torso, or groin; orAmputation above the wrist or ankle; orSpinal cord injury with limb paralysis; orFlail chest; orTwo or more obvious long-bone (humerus/femur) fractures. 

 

YES→MANDATORYTRAUMA SYSTEM ENTRY

 MECHANISM OF INJURY:Death of a same car occupant; orEjection of patient from an enclosed vehicle; orHeavy extrication time >20 minutes. 

 

TRIAGE CRITERIA AND DECISION SCHEME

 

NO↓ 

  

    

 HIGH ENERGY TRANSFER SITUATIONS:Falls >20 feet; orPedestrian hit at 20 mph or thrown 15 feet; orRollover; orMotorcycle, ATV or bicycle crash; orSignificant impact or intrusion into occupant space of vehicle.

 

 YES

→DISCRETIONARYTRAUMA SYSTEM ENTRY

    These criteria shall cause a high index of suspicion that a patient may have sustained a severe injury. Trauma system entry for patients meeting two or more of these criteria is strongly encouraged.

 CO-MORBID FACTORS:Extremes of age <5 or >55 years; orPatient with bleeding disorder or patient on anticoagulants; orMedical illness: cardiac or respiratory disease, insulin-dependentdiabetes, cirrhosis, or morbid obesity; orPregnancy; orImmunosuppressed patients; orPresence of intoxicants.

 

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Prehospital Standards

Reporting criteria (ORS 682.220(4)) Applications and recertification. Backgrounds E-4 The nasty stuff

– Sexual assault elderly– Walking around in sox– Diverting drugs to owner– Convicted double homicide

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Medical Directors

Under BME Standing orders (protocols) Advocate, training Scope of Practice

– Don’t violate

Only under an agency's protocols Teamwork

Questions??