Chapter 1: Emergency Medical Services Systems: …brainspew.com/advanced/medic/slides/Chapter_001.pdfPowerPoint Lecture Notes Chapter 1: Emergency Medical Services Systems: Roles and

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Chapter 1Chapter 1EMS Systems: Roles and ResponsibilitiesEMS Systems: Roles and Responsibilities

Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

ObjectivesObjectivesOutline key historic events in EMSOutline key historic events in EMS

Identify elements needed for effective EMS systems Identify elements needed for effective EMS systems operationsoperations

Differentiate between the four levels of EMS providersDifferentiate between the four levels of EMS providers

List benefits of professional association membershipList benefits of professional association membership

Describe benefits of continuing educationDescribe benefits of continuing education


ObjectivesObjectivesDifferentiate between professionalism, professional Differentiate between professionalism, professional licensure, certification, registrationlicensure, certification, registration

Describe the paramedicDescribe the paramedic’’s role in a patient care situations role in a patient care situation

Describe the benefits of offDescribe the benefits of off--line and online and on--line medical line medical directiondirection

Outline the components of an EMS QI programOutline the components of an EMS QI program

Identify key components and benefits of EMS researchIdentify key components and benefits of EMS research


Mosby, Inc. items and derived items © 2007, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.

Sanders: Mosby's Paramedic Textbook, Revised 3rd Edition PowerPoint Lecture Notes

Chapter 1: Emergency Medical Services Systems: Roles and Responsibilities

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ScenarioScenarioItIt’’s early morning when the driver of a lates early morning when the driver of a late--model SUV clutches his chest momentarily model SUV clutches his chest momentarily before losing consciousness and swerving before losing consciousness and swerving into a large tree while traveling at 50 miles into a large tree while traveling at 50 miles per hour.per hour.


DiscussionDiscussionWhat factors will influence his survival?What factors will influence his survival?

What resources will he need to maximize his chance to What resources will he need to maximize his chance to regain a productive life?regain a productive life?

What safeguards influence the quality of his care?What safeguards influence the quality of his care?

How will the care he received today differ from 50 years How will the care he received today differ from 50 years ago?ago?

What will determine which treatments are most effective What will determine which treatments are most effective for him?for him?


EMS System DevelopmentEMS System DevelopmentPrePre--20th century20th century

BiblicalBiblicalEdwin Smith papyrusEdwin Smith papyrusCode of HammurabiCode of HammurabiJean LarreyJean Larrey——Napoleonic WarsNapoleonic WarsAmerican Civil WarAmerican Civil War

•• Clara Barton, nurseClara Barton, nurse



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20th Century20th CenturyWWI and WWII developmentsWWI and WWII developments

Battlefield ambulance corps developedBattlefield ambulance corps developed

1950s and 1960s1950s and 1960sUrban, hospitalUrban, hospital--based systems develop into based systems develop into municipal servicesmunicipal servicesRural funeral homes develop into volunteer fire Rural funeral homes develop into volunteer fire and freestanding servicesand freestanding services


19661966National Academy of Sciences National Academy of Sciences -- National National Research Council reportResearch Council report

Accidental Death and Disability: The Neglected Accidental Death and Disability: The Neglected Disease of Modern Society (the White Paper)Disease of Modern Society (the White Paper)

•• Defined 10 critical pointsDefined 10 critical points


19661966Highway Safety Act of 1966Highway Safety Act of 1966

Created USDOT as a cabinetCreated USDOT as a cabinet--level departmentlevel departmentLegislative authority and funds to improve EMSLegislative authority and funds to improve EMS

•• More than $142 million between 1968 and 1979More than $142 million between 1968 and 1979

Early advanced life support pilot programsEarly advanced life support pilot programs



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Mortality ComparisonsMortality ComparisonsWWI to VietnamWWI to Vietnam

Advances in field care emerged for trauma Advances in field care emerged for trauma patientspatientsReduced deaths from similar traumaReduced deaths from similar trauma


1970s1970s1973 Emergency Medical Service Systems 1973 Emergency Medical Service Systems ActAct

Defined 15 required componentsDefined 15 required componentsRegional approach, trauma focusRegional approach, trauma focus

Regional system development 1974Regional system development 1974--19811981

1977 paramedic educational standards 1977 paramedic educational standards


1980s1980s--1990s1990sConsolidated Omnibus Budget Reconciliation Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1981Act (COBRA) of 1981

Preventive Health and Health Services Block Preventive Health and Health Services Block Grant consolidationGrant consolidationNHTSA effort to sustain the DHHS effort with NHTSA effort to sustain the DHHS effort with reduced funding and staffreduced funding and staffNHTSA's 10 system elementsNHTSA's 10 system elements



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EMS Agenda for the FutureEMS Agenda for the Future19961996

Integration of health Integration of health servicesservicesEMS researchEMS researchLegislation and Legislation and regulationregulationSystem financeSystem financeHuman resourcesHuman resourcesMedical directionMedical directionEducation systemsEducation systems

Public educationPublic educationPreventionPreventionPublic accessPublic accessCommunications Communications systemssystemsClinical careClinical careInformation systemsInformation systemsEvaluationEvaluation


EMS Agenda for the FutureEMS Agenda for the Future19961996


EMS in the 21st CenturyEMS in the 21st Century

2000 2000 -- EMS Education Agenda for the FutureEMS Education Agenda for the Future2004 2004 -- Rural & Frontier EMS Agenda for the Rural & Frontier EMS Agenda for the FutureFuture2005 2005 -- National EMS Scope of PracticeNational EMS Scope of Practice2006 2006 -- National EMS Core Content: The National EMS Core Content: The Domain of EMS PracticeDomain of EMS Practice



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Health Care ReformHealth Care ReformManaged careManaged care

Expanded scope of practiceExpanded scope of practice


Current EMS SystemCurrent EMS System

Network of Network of coordinated servicescoordinated services

Work as unified Work as unified wholewhole

NHTSA EMS system components


EMS System OperationEMS System OperationCitizen activationCitizen activation

DispatchDispatch

Prehospital carePrehospital care

Hospital careHospital care

RehabilitationRehabilitation



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EMS Provider LevelsEMS Provider LevelsDispatchersDispatchers

Emergency Medical ResponderEmergency Medical ResponderFirst ResponderFirst Responder

Emergency Medical TechniciansEmergency Medical TechniciansEMTEMT--BasicBasic

Advanced EMTAdvanced EMTEMTEMT--IntermediateIntermediate

ParamedicParamedicCopyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

DispatcherDispatcherReceives and processes callsReceives and processes calls

Dispatches and coordinates EMS resourcesDispatches and coordinates EMS resources

Relays medical informationRelays medical information

Coordinates with public safety agenciesCoordinates with public safety agenciesVarious technological capabilitiesVarious technological capabilitiesSome dispatchers give preSome dispatchers give pre--arrival instructionsarrival instructions


Emergency Medical Emergency Medical ResponderResponder

Includes FD, police, athletic trainers, industrial Includes FD, police, athletic trainers, industrial response teamsresponse teams

Trained toTrained toRecognize condition and injury extentRecognize condition and injury extentAssess need for EMSAssess need for EMSGive initial care for airway, breathing, circulationGive initial care for airway, breathing, circulationPerform safely Perform safely



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Emergency Medical Emergency Medical TechnicianTechnician

Trained in all phases of BLSTrained in all phases of BLS

Use of AEDUse of AED

May assist with administration of some May assist with administration of some medicationsmedications


Advanced EMTAdvanced EMTEMT with several additional skillsEMT with several additional skills

Practice varies by state: may includePractice varies by state: may includeAdvanced airway adjunctsAdvanced airway adjunctsIV therapyIV therapyDefibrillationDefibrillationECG interpretationECG interpretationSelected drug administrationSelected drug administration


ParamedicParamedicProvides emergency care based onProvides emergency care based on

Advanced assessment skillsAdvanced assessment skillsFormulation of a field impressionFormulation of a field impression

Advanced training inAdvanced training inECG interpretationECG interpretationDefibrillation and pacingDefibrillation and pacingDrug therapyDrug therapyAirway managementAirway management



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National EMS GroupsNational EMS GroupsLocal, state, nationalLocal, state, national

Involved in development, education, and implementation Involved in development, education, and implementation of EMSof EMS

Help set EMS standardsHelp set EMS standards

Promote professional status of EMSPromote professional status of EMS

Unified voice for EMS issuesUnified voice for EMS issues


Benefits of InvolvementBenefits of InvolvementNational associationsNational associations

Information sharingInformation sharingPromotes professionPromotes professionEnhances status of the professionEnhances status of the professionUnified voice on EMS issuesUnified voice on EMS issues


National Registry of EMTsNational Registry of EMTsProfessional standards developmentProfessional standards development

Verifies competency Verifies competency

ReciprocityReciprocity

Reduce costs of exam developmentReduce costs of exam development

Research in EMS professionResearch in EMS profession



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EMS StandardEMS Standard--Setting GroupsSetting Groups

Get input from profession and publicGet input from profession and public

Ensure public interest is served in standards Ensure public interest is served in standards development and implementationdevelopment and implementation

Protect public from unqualified providersProtect public from unqualified providers


Initial Paramedic EducationInitial Paramedic Education

National standard curriculumNational standard curriculumCompetenciesCompetenciesPrePre-- or coor co--requisitesrequisitesMinimum content for standardized program Minimum content for standardized program Cognitive, psychomotor, affective objectivesCognitive, psychomotor, affective objectivesClinical requirementsClinical requirementsLength of course definedLength of course defined


Paramedic Continuing EducationParamedic Continuing EducationMaintains core or minimal levels of knowledgeMaintains core or minimal levels of knowledge

Maintains fundamental technical/professional skillsMaintains fundamental technical/professional skills

Expands skills and knowledgeExpands skills and knowledge

Promotes awareness of advances in professionPromotes awareness of advances in profession



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LicensureLicensureLicense to practice a professionLicense to practice a profession

Occupational regulationOccupational regulation

Permission by competent authority to engage in a Permission by competent authority to engage in a business, profession, or activity otherwise unlawfulbusiness, profession, or activity otherwise unlawful

Involves governmental activityInvolves governmental activity

May be required for paramedic practiceMay be required for paramedic practice


CertificationCertificationAuthority to participate in an activity if qualifications Authority to participate in an activity if qualifications metmet

Fulfillment of requirements for practice in a fieldFulfillment of requirements for practice in a field

Usually refers to action of a nongovernmental entityUsually refers to action of a nongovernmental entity

May be required for paramedic practice May be required for paramedic practice


CertificationCertification

A “certification” granted by a state, conferring a right to engage in a trade or

profession, is in fact a “license”



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RegistrationRegistrationAct of registeringAct of registering

Enroll name in a Enroll name in a ““registerregister”” or book of recordor book of record

Can be licensed/certified and registeredCan be licensed/certified and registeredExample: State license and NREMT registrationExample: State license and NREMT registration


CredentialingCredentialingLocal processLocal process

Allows practice in a specific settingAllows practice in a specific setting

Usually guided by local medical directorUsually guided by local medical director


ProfessionalismProfessionalismProfessionProfession

Existence of a specialized body of knowledge or Existence of a specialized body of knowledge or expertiseexpertisePractitioners generally self regulatePractitioners generally self regulateMaintains standards Maintains standards Includes initial and continuing educational Includes initial and continuing educational requirementsrequirements



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Professionalism Professionalism Standards of conduct and performance for Standards of conduct and performance for the professionthe profession

Approved code of ethics Approved code of ethics


Health Care ProfessionalHealth Care ProfessionalConforms to standards of professionConforms to standards of profession

Provides quality patient careProvides quality patient care

Instills pride in professionInstills pride in profession

Strives for high standardsStrives for high standards

Earns respect of othersEarns respect of others

Meets professionMeets profession’’s expectations while on and off dutys expectations while on and off duty


Health Care ProfessionalHealth Care ProfessionalEMS personnel occupy positions of public EMS personnel occupy positions of public trusttrust

Unprofessional conduct hurts professionUnprofessional conduct hurts profession

Commitment to excellence is a daily activityCommitment to excellence is a daily activity



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Health Care ProfessionalHealth Care ProfessionalImage and behaviorImage and behavior

Personal appearance importantPersonal appearance importantEstablishes credibilityEstablishes credibilityInstills confidenceInstills confidenceHighly visible role modelHighly visible role model


Health Care ProfessionalHealth Care ProfessionalParamedics representParamedics represent

SelfSelfEMS agencyEMS agencyState/ county/ city/ district EMS officeState/ county/ city/ district EMS officePeersPeers


Attributes of ProfessionalismAttributes of ProfessionalismIntegrity Integrity EmpathyEmpathySelfSelf--motivation motivation Appearance and Appearance and personal hygienepersonal hygieneSelfSelf--confidence confidence CommunicationsCommunications

Time managementTime managementTeamwork and Teamwork and diplomacydiplomacyRespectRespectPatient advocacy Patient advocacy Careful delivery of Careful delivery of serviceservice



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Primary ResponsibilitiesPrimary ResponsibilitiesPreparationPreparationResponseResponseScene assessmentScene assessmentPatient assessmentPatient assessmentManagementManagementAppropriate dispositionAppropriate dispositionPatient transferPatient transferDocumentationDocumentationReturn to serviceReturn to service


Additional ResponsibilitiesAdditional ResponsibilitiesCommunity involvementCommunity involvement

Supporting primary care effortsSupporting primary care efforts

Citizen involvement advocacyCitizen involvement advocacy

Participation in leadership activitiesParticipation in leadership activities

Personal and professional developmentPersonal and professional development


Medical DirectionMedical DirectionMedical director serves asMedical director serves as

Medical leaderMedical leaderResourceResourcePatient advocatePatient advocate



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Role of Medical DirectionRole of Medical DirectionEMS system design/operationsEMS system design/operationsEducation Education Personnel selection processPersonnel selection processEquipment selectionEquipment selectionClinical protocol developmentClinical protocol developmentQuality improvement Quality improvement Problem resolutionProblem resolution


Role of Medical DirectionRole of Medical DirectionPatient care inputPatient care input

Interagency interfaces Interagency interfaces

EMS advocacy in medical communityEMS advocacy in medical community

““Medical conscienceMedical conscience”” of EMS systemof EMS system

Advocate for quality careAdvocate for quality care


Types of Medical DirectionTypes of Medical DirectionOnOn--line/directline/direct

OffOff--line/indirectline/indirect



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OnOn--Line Medical DirectionLine Medical DirectionImmediate and patient specific careImmediate and patient specific care

TelemetryTelemetry

Continuous quality improvement (CQI)Continuous quality improvement (CQI)

On sceneOn scene


OffOff--Line Medical DirectionLine Medical DirectionProspectiveProspective

Protocols/standing ordersProtocols/standing ordersTrainingTrainingEquipment, supplies, personnel selectionEquipment, supplies, personnel selection

RetrospectiveRetrospectivePatient care report reviewPatient care report reviewCQICQI


OnOn--Scene PhysicianScene PhysicianIf nonmedical direction physicianIf nonmedical direction physician

Follow established protocolsFollow established protocolsOnOn--line medical directionline medical directionPhysicians may jointly decide carePhysicians may jointly decide careLegal responsibility definedLegal responsibility definedConflict resolutionConflict resolution



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Improving System QualityImproving System QualityEMS continually evaluate and improve careEMS continually evaluate and improve care

CQICQIFocus is on system, not individualFocus is on system, not individualDynamic processDynamic processNot punitiveNot punitiveIdentify and correct problemsIdentify and correct problems


Continuous Quality ImprovementContinuous Quality ImprovementLooks at all areas of EMSLooks at all areas of EMS

Team approachTeam approach

Identifies cause of problemIdentifies cause of problem

Develops remediesDevelops remedies

Designs action planDesigns action plan

ReevaluatesReevaluates


Keys to Improving QualityKeys to Improving QualityLead by exampleLead by exampleUse data to find factsUse data to find factsStrategic quality planStrategic quality planHuman resource developmentHuman resource developmentExamine entire processExamine entire processEvaluate success of CQIEvaluate success of CQIMeasure satisfactionMeasure satisfaction



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EMS Research: BenefitsEMS Research: BenefitsEssential for future of EMSEssential for future of EMS

May prove/disprove benefits of careMay prove/disprove benefits of care

Can change standards, training, equipment, proceduresCan change standards, training, equipment, procedures

May affect fundingMay affect funding

Enhances recognition and respect for EMS professionalsEnhances recognition and respect for EMS professionals


Research TypesResearch TypesDescriptiveDescriptive

ExperimentalExperimental

ProspectiveProspective

RetrospectiveRetrospective

CrossCross--sectionalsectional


EMS ResearchEMS ResearchIdentify problem or questionIdentify problem or question

Develop hypothesisDevelop hypothesis

Decide measurement types/methodsDecide measurement types/methods

Define populationDefine population

Identify limitationsIdentify limitations

Get review board approvalGet review board approval



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EMS Research EMS Research Obtain consentObtain consent

Gather dataGather data

Analyze dataAnalyze data

PublishPublish

PresentPresent

FollowFollow--up studiesup studies


Basic Research PrinciplesBasic Research PrinciplesPopulationPopulation——groupgroup

Randomization and controlRandomization and controlSampleSample

•• Systematic samplingSystematic sampling•• Alternative time samplingAlternative time sampling•• Convenience samplingConvenience sampling

Sampling errorSampling error


Basic Research PrinciplesBasic Research PrinciplesParameterParameter

Nuisance variablesNuisance variables

BlindingBlindingUnblindedUnblindedSingle blindedSingle blindedDouble blindedDouble blindedTriple blindedTriple blinded



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Basic StatisticsBasic StatisticsDescriptiveDescriptive

QualitativeQualitativeQuantitativeQuantitative

•• MeanMean•• MedianMedian•• ModeMode•• Standard deviationStandard deviation


Inferential StatisticsInferential StatisticsNull hypothesisNull hypothesis

Research hypothesisResearch hypothesis

ConfidenceConfidence

Level of significanceLevel of significance


Research EthicsResearch EthicsInstitutional review board (IRB)Institutional review board (IRB)

Risks to subjects minimizedRisks to subjects minimizedRisks to subjects outweighed by benefitRisks to subjects outweighed by benefitSelection of subjects equitableSelection of subjects equitable



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Research Consent TypesResearch Consent TypesConsent at a distanceConsent at a distanceConsent by proxyConsent by proxyStepped consentStepped consentCohort consentCohort consentDeferred consentDeferred consentSurrogate consentSurrogate consentConsent juryConsent jury


Research FormatResearch FormatIntroductionIntroduction

MethodsMethods

ResultsResults

DiscussionDiscussion

ConclusionConclusion


Evaluating and Interpreting ResearchEvaluating and Interpreting Research

Was the research peer reviewed?Was the research peer reviewed?

What was the hypothesis?What was the hypothesis?

Was the study approved by an institutional review Was the study approved by an institutional review board and conducted ethically?board and conducted ethically?

What was the population being studied?What was the population being studied?

What were the entry/exclusion criteria for the study?What were the entry/exclusion criteria for the study?



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What sampling method was used?What sampling method was used?

How many groups were there?How many groups were there?

How were the groups assigned?How were the groups assigned?

What data were gathered?What data were gathered?

Did the study have enough patients enrolled?Did the study have enough patients enrolled?



Were any potential variables not accounted for?Were any potential variables not accounted for?

Were the data properly analyzed?Were the data properly analyzed?

Is the conclusion logical based on the data?Is the conclusion logical based on the data?

Does the conclusion apply in local EMS systems?Does the conclusion apply in local EMS systems?

Are the study patients similar to those in the local Are the study patients similar to those in the local EMS system?EMS system?


ConclusionConclusionThe role of the paramedic is different from The role of the paramedic is different from that of the that of the ““ambulance driverambulance driver”” of the past. of the past. TodayToday’’s paramedics work in sophisticated s paramedics work in sophisticated

EMS systems. EMS systems.



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Questions?Questions?



Documents

Chapter 1: Emergency Medical Services Systems: …brainspew.com/advanced/medic/slides/Chapter_001.pdfPowerPoint Lecture Notes Chapter 1: Emergency Medical Services Systems: Roles and