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Current EMS System
Dr. Miada Mahmoud Rady EMS - 472
Define and enumerate the general principles of the current EMS system , its various component and various rule of each and every component.
Lecture Topics
1. Definition .
2. Introduction .
3. Component of the EMS .
4. Medical Direction.
5. EMS System Operation .
EMS system
Definition : A comprehensive network of
personnel, equipment, and resources , established to
deliver aid and emergency medical care to the
community.
EMS agenda for the future
• In 1996 NHTSA and Health Resources and Services
administration published Emergency Medical Services
Agenda for the Future
• The function of this Agenda is :
1. It is used to build common vision for future of EMS.
2. Help guide planning, decision making and policy for
EMS.
The agenda has 14 suggestion for the EMS:
1. Integration of health
services.
2. EMS research.
3. Legislation and regulation.
4. System finance.
5. Human resources.
6. Medical direction.
7. Education systems.
8. Public education.
9. Prevention.
10. Public access.
11. Communication systems.
12. Clinical care.
13. Information systems.
14. Evaluation.
Criteria of an efficient EMS Systems
1. Network of coordinated services.
2. Defined by NHTSA Technical Assistance program
Standards.
3. Ensures quick treatment.
4. Resources used efficiently.
5. Reduces health care costs.
NHTSA Technical Assistance program Standards
1. Regulation and Policy : Each state establishes laws, policies,
and regulations.
2. Resource Management : Centralized coordination of
emergency treatment and transport resources.
3. Human Resources and Training :Assure that all EMS
personnel are trained and certified to minimum standard by
qualified instructors
NHTSA Technical Assistance program Standards
4. Transportation : ability to provide safe, reliable
transportation (ground, air, or other means).
5. Facilities : The patient must be transported to closest
appropriate facility.
6. Communications : Universal access number (911), dispatch
to ambulance, ambulance to ambulance, ambulance to
hospital, hospital to hospital number.
NHTSA Technical Assistance program Standards
7. Trauma Systems : able to develop trauma triage, transport,
and treatment protocols
8. Evaluation : establish program for assessing and improving
quality of care provided .
9. Public Information and Education : Educate public about role
of EMS, increase public awareness, participate in injury
prevention programs
NHTSA Technical Assistance program Standards
10. Medical Direction : Medical director oversees, is accountable
for EMS personnel within system.
Components of the EMS system
1. Out of the hospital component : responsible for first phase
of medical care.
2. In the hospital component: responsible for the second phase
of the medical care.
3. Other specialized care facilities: responsible for definitive
phase of the medical care.
Out-Of-Hospital Components
1. Members of the community
2. Communications system
3. EMS providers
4. Public utilities
5. Poison control centres
6. Fire rescue, hazmat
In-Hospital Components
1. Emergency nurses
2. Emergency and specialty physicians
3. Ancillary services
4. Rehabilitation services
Other specialized care facilities
1.Trauma centers.
2.Burn centers.
3.Stroke centers.
4.Cardiac centers.
5.Labor and delivery/
pediatrics.
6.Poison control.
Chain of Human Resources in EMS System
Medical Direction
Definition : A medical director is a physician who is legally
responsible for all clinical aspects of the system.
EMS systems Must retain a medical director
Medical care provided by paramedics is considered an
extension of the medical director’s license.
Types of medical direction is either online medical control
and offline medical control.
On line medical direction
Definition : Its when the
medical director provide
direct on line guidance to
personnel on the field .
Role of the medical director
1. Educate and train personnel.
2. Participate in personnel and equipment selection.
3. Develop clinical protocols in cooperation with expert EMS
personnel.
4. Participate in quality improvement and problem resolution
5. Provide direct input into patient care.
Role of the medical director
6. Advocate within the community.
7. Serve as the medical conscience of the EMS system including
advocating for patient care.
8. Interface between the EMS system and other health care
agencies.
Offline Medical Direction
Refers to medical policies,
procedures, and practices that the
medical director has set up in
advance of the call.
Protocols are designed around
the four “T’s” of emergency care
(Triage , Treatment ,Transport
and Transfer.
Offline Medical Direction
Protocols are the policies and
procedures for all elements of
an EMS system.
Communications
A coordinated, flexible communications plan should
present in any good EMS system :
1. Citizen Access
2. Single Control Centre
3. Operation Communication Capabilities
4. Medical Communication Capabilities
5. Communications Hardware
6. Communications Software
Emergency Medical Dispatcher (EMD)
The activities of an EMD are crucial to the efficient operation
of EMS.
EMDS do not only response only to the call , they also make
sure that the system resources are always ready.
EMDs must be medically and technically trained.
Mutual Aid and Mass-Casualty Preparation
A formalized mutual aid agreement that ensures that help is
available when needed.
Agreements should be between neighboring departments,
systems, or territories
Each system should also put a disaster plan in place for
catastrophes that can overwhelm available resources.
EMS System Operation
1. Citizen activation .
2. Prehospital care .
3. Hospital care.
4. Rehabilitation .
Citizen Activation
• The EMS system begins with citizen involvement or citizen
activation.
• That is why the public needs to be taught on how to:
1. Recognize what is an emergency and what is not.
2. Activate the EMS system.
3. Provide basic care before EMS arrives (BLS).
Prehospital Care
Level and extent of the prehospital care given to patient depends
on :
1. Patient condition.
2. Resources available.
3. Level of paramedic training .
The range of prehospital care may include : comfort and
reassurance , BLS, ALS, I.V fluid and medication
administration.
Hospital Care
In the hospital setting the available resources , diagnostic tests
are performed and more advanced intervention are usually
done.
the resources may even extend beyond the emergency
department to include surgery , cardiac catheterization and
intensive care admissions.
Rehabilitation
Carried out after hospital delivery either before or after
hospital discharge
It may be in the form of education, physical or occupational
therapy
It Helps the patient maintain maximum independence after
incident.
So what are the factors that determine the patient survival in prehospital
setting??
1. Bystander care.
2. Dispatch (including prearrival directions).
3. Response (both mode and distance).
4. Prehospital care provided (level of EMS-trained personnel)
5. Transportation.
6. Emergency department care.
7. Definitive care.
8. Rehabilitation.
An EMS system must be designed to meet the needs of
the patient. Therefore, the only acceptable quality of an
EMS system is EXCELLENCE!
Quality Assurance and Improvement
Quality Assurance: is designed to maintain continuous
monitoring and measurement of the quality of
clinical care.
Continuous Quality Improvement (CQI) is designed to
refine and improve an EMS system, emphasizing customer
satisfaction.
Continuous Quality Improvement (CQI)
CQI – A Dynamic Process that aim at :
1. Identify Problems
2. Elaborate on the cause
3. Develop remedies
4. Lay out plan to correct problems
5. Enforce the plan
6. Reexamine the problem
Rules and Responsibilities of Paramedic Within EMS System
1. Preparation
2. Response
3. Scene size-up
4. Patient assessment
5. Treatment and
management.
6. Moving and lifting.
7. Disposition and transfer
8. Documentation.
9. Clean-up, maintenance and
review.
Rules and Responsibilities of Paramedic Within EMS System
Home work
• Define EMS system ?
• Enumerate the rules of medical director ?
Any questions
?
