EMS Systems Paramedic Profession

EMS System OperationCitizen activationDispatchPrehospital careHospital careRehabilitation

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EMS Provider LevelsDispatchersEmergency Medical Responder

First ResponderEmergency Medical Technicians

EMT-BasicAdvanced EMT

EMT-IntermediateParamedic

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DispatcherReceives & processes callsDispatches & coordinates EMS resources

Relays medical informationCoordinates with public safety agencies

Various technological capabilitiesSome dispatchers give pre-arrival instructions

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Emergency Medical ResponderIncludes FD, police, athletic trainers, industrial response teams, etc.

Trained to:Recognize condition & injury extentAssess need for EMSGive initial care for airway, breathing, circulation (CAB)

Perform safely.

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Emergency Medical Technician

Trained in all phases of BLS

Use of AED (automated external defibrillator)

May assist with administration of some medications

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EMT-IEMT with several additional skillsPractice varies by state, may include:

Advanced airway adjunctsIV therapyDefibrillationECG interpretationSelected drug administration

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EMT-Paramedic Provides emergency care based on

Advanced assessment skillsFormulation of a field impression

Advanced training inECG interpretationDefibrillation & pacingDrug therapyAirway management

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National EMS GroupsLocal, state, nationalInvolved in development, education, & implementation of EMS

Help set EMS standardsPromote professional status of EMSUnified voice for EMS issues

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Benefits of InvolvementNational associations

Information sharingPromotes professionEnhances status of the profession

Unified voice on EMS issues

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National Registry of EMTsProfessional standards development

Verifies competency Reciprocity (agreement to exchange

privileges)Reduce costs of exam developmentResearch in EMS profession

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EMS Standard-Setting GroupsGet input from profession & public

Ensure public interest is served in standards development & implementation

Protect public from unqualified providers

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Initial Paramedic EducationNational standard curriculum

CompetenciesPre- or co-requisitesMinimum content for standardized program Cognitive, psychomotor, affective objectivesClinical requirementsLength of course defined

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Paramedic Continuing EducationMaintains core or minimal levels of knowledge

Maintains fundamental technical & professional skills

Expands skills & knowledgePromotes awareness of advances in profession

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

License to practice a profession

Part of Occupational regulation

Involves governmental activity

May be required for paramedic practice

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CertificationAuthority to participate in an activity if qualifications met

Fulfillment of requirements for practice in a field

Usually refers to action of a non-governmental entity

May be required for paramedic practice

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A “certification” granted by a state, conferring a right to

engage in a trade or profession, is in fact a

“license”

RegistrationAct of registeringEnroll name in a “register” or book of record

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

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CredentialingLocal processAllows practice in a specific setting (EMT-P, CCRN)

Usually guided by local medical director

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ProfessionalismProfession

Existence of a specialized body of knowledge or expertise

Practitioners generally self regulateMaintains standards Includes initial & continuing educational requirements

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Professionalism

Standards of conduct & performance for the profession

Approved code of ethics

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Health Care ProfessionalConforms to standards of profession

Provides quality patient careInstills pride in professionStrives for high standardsEarns respect of othersMeets profession’s expectations while on & off duty

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Health Care ProfessionalEMS personnel occupy positions of public trust

Unprofessional conduct hurts profession

Commitment to excellence is a daily activity

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Health Care ProfessionalImage & behavior

Personal appearance important

Establishes credibilityInstills confidenceHighly visible role model

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Health Care ProfessionalParamedics represent

SelfEMS agencyState/ county/ city/ district EMS office

Peers25

Attributes of ProfessionalismIntegrity (honesty)

EmpathySelf-motivation Appearance & personal hygiene

Self-confidence Communications

Time management

Teamwork & diplomacy

RespectPatient advocacy Careful delivery of service

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Primary ResponsibilitiesPreparationResponseScene assessmentPatient assessmentManagementAppropriate dispositionPatient transferDocumentationReturn to service

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Additional ResponsibilitiesCommunity involvementSupporting primary care effortsCitizen involvement advocacyParticipation in leadership activities

Personal & professional development

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Medical DirectionMedical director serves as

Medical leaderResourcePatient advocate

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Role of Medical DirectionEMS system design/operationsEducation Personnel selection processEquipment selectionClinical protocol developmentQuality improvement Problem resolution

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Role of Medical DirectionPatient care inputInteragency interfaces EMS advocacy in medical community

“Medical conscience” of EMS system (principles, ethics)

Advocate for quality care31

Types of Medical Direction

On-line/directOff-line/indirect

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On-Line Medical DirectionImmediate and patient specific care

TelemetryContinuous quality improvement (CQI)

On scene

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Off-Line Medical DirectionProspective

Protocols/standing ordersTrainingEquipment, supplies, personnel selection

RetrospectivePatient care report reviewCQI (Continuous Quality Improvement)

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On-Scene PhysicianIf non-medical direction physician

Follow established protocolsOn-line medical directionPhysicians may jointly decide care

Legal responsibility definedConflict resolution

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Improving System QualityEMS continually evaluate & improve care

CQIFocus is on system, not individualDynamic processNot punitiveIdentify & correct problems

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Continuous Quality Improvement

Looks at all areas of EMSTeam approachIdentifies cause of problemDevelops remediesDesigns action planReevaluates

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Keys to Improving QualityLead by exampleUse data to find factsStrategic quality planHuman resource developmentExamine entire processEvaluate success of CQIMeasure satisfaction

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Challenging QuestionsBeing a paramedic is not just a job you work during a shift. You are always a paramedic, being a role model for the public at all times .

With the increase in television shows that do not always accurately depict the roles of health care providers, do you feel it is your responsibility to educate the public in every situation possible as to what the EMS field is truly like, correct misconceptions, & give an accurate portrayal of what you are responsible for and capable of as a paramedic?

Rationale:It is ABSOLUTELY important to feel this way. Without community education, misconceptions can be

widespread among the public. Some people may even feel they have the knowledge to stop at an accident they witness and provide “medical help” from TV shows they’ve seen until EMS arrives, doing more harm than good. Some may call 9-1-1 for an emergency, and then be uncooperative when they think you’re not doing what you should be, based on something they’ve seen or heard that is untrue.

Every chance you get, help educate small community groups, teach a class, talk with school classes, anything you can do to help public education.

Question?You are called to the scene of a two-car crash with serious injuries to the drivers and passengers of both vehicles. You call for additional assistance, but know it will be several minutes until more help arrives. Someone stops, and offers his assistance. He does seem to be knowledgeable in what needs to be done for the victims of the accident .

Q: Should you enlist his help in stabilizing your patients? Why or why not?

Rationale:If that particular person is not a physician and not

willing to accept full responsibility for the patient and accompany you to the hospital to sign papers, then letting that person do any more than be a helping hand in lifting or some other non-patient care event would be a possible threat to your own job.

Basic help with lifting, holding c-spine, or other non-EMS patient care is acceptable only.

You are under the direction of medical control in your area, your area’s protocols must be followed, and YOU are ultimately responsible for all care of patients involved.

EMS Research: BenefitsEssential for future of EMSMay prove/disprove benefits of careCan change standards, training, equipment, procedures

May affect fundingEnhances recognition & respect for EMS professionals

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What is research Generally, research is a systematic inquiry

that use orderly, disciplined methods to answer questions .

Systematic: a logically progression through a series of steps according to a specified plan

Control: imposing conditions.

Mainly in scientific approach and NOT nursing research, the investigator used an

empirical evidence (evidence that is rooted in objective reality and gathered using humane

senses)

Scientific approach of knowledge is a set of orderly, systematic and controlled procedures

to acquire information Scientific research is the application of the

scientific approach

Importance of health research:.1Solid foundation.2Develop, refine, extend the base of nursing

knowledge .3Define the parameters of health.4Evaluation of health interventions

Source of knowledge TraditionsAuthorityExperienceLogical reasoning (inductive vs. deductive) Disciplined research (borrowed research)

Purpose of ResearchIDENTIFICATIONDESCRPITIONEXPOLRATIONEXPLANATIONPREDICTION & CONTROL

Examples Identification What is social preference of paramedic

students at PHACS ?Description What is demographic characteristics of

cigarette smokers at PHACS ?

ExamplesExploration What are the factors that affect application of

systematic care plan at the Jordanian hospitals ?

Explanation What is the relationship between increasing in

blood pressure and brain embolism?

ExamplesPrediction Is the number of upper respiratory tract

infection cases among newborns on ventilators affected if we increased the

number of suctioning using normal saline per shift ?

Methods of ResearchQUANTITATIVE

Associated with positivismUse a scientific approachMainly to understand the phenomenon of

interestQUALITATIVE

Mainly to understand the human experienceFlexibleRich and in-depth information

Research TermsStudy SubjectsResearcher

(investigator, principal

investigator)

Addressing a problem

Study participants (respondents &/or

informantsA person who

conduct the study

Research TermsTheoretical vs. Conceptual

Theory: is a systematic abstract explanation of the relationship between the concepts

Conceptual model (also conceptual framework, conceptual

scheme )Less formal attempt at organizing phenomenon

than theory .

Research TermsTheoretical vs. Conceptualboth use concepts as building blocks, and used

to generate hypothesisConceptual models lack the deductive system

of propositions that asserts the relationship between the concepts

Conceptual model is not directly testable by the researcher

Conceptual models represent the perspective of the designers .

Quantitative research The major phases :.1Conceptual phase .2Design and planning phase.3Empirical phase .4The analytical phase.5Dissemination phase

Cont…Quantitative Phase 1: Conceptual phase .1Formulating and delimiting the problem .2Reviewing the literature.3Defining the theoretical framework.4Formulating the hypothesis

Cont…QuantitativeDesign and planning phase.1Selecting a research design.2Identifying the population to be studies.3Specifying methods to measure the research

variables .4Designing the sampling plan.5Finalizing & reviewing research plan

Cont…QuantitativeEmpirical phase.1Collecting data.2Preparing the data for analysis

Cont…QuantitativeThe analytical phaseAnalyzing data Interpreting the results

Cont…QuantitativeDissemination phase.1Communicating the findings.2Utilizing the data

Qualitative research Contrast to quantitative the research process

goes in a circle rather than a linear straight line

The researcher continually examines and interprets data and proceeds based on what

he discovers.The researchers do not have a full knowledge

on how possibly the study will flow

Qualitative researchFor example, the researcher may not review

the literature until conducting a preliminary analysis of the collected data

OR, may decide to select the design in the middle of the study

WHY, BECAUSE QUALITATIVE RESEARCH IS FLEXIBLE

Ethical Consideration Historical background:.1Nazi medical experiment.2Tuskegee syphilis study“not only were experimental subjects, they

were are also have no choice

Codes of Ethics Nuremberg code: the first international effortDeclaration of Helsinki, the world most

notably (1964, revised 1975)Belmont report by the national research Act

(1978, USA)

Belmont PrinciplesA. Principle of beneficence:

.1Freedom from harm

.2Freedom from exploitation

.3Benefits from research

.4Risk/benefits ratio

Belmont PrinciplesB. The Principle of respect and human

dignity .1Right for self-determination.2Right to full disclosure

Belmont Principles

C. The principle of Justice .1The right to fair treatment.2The right to privacy

Informed consent Content:Participant statusStudy purposeType of dataNature of the commitmentSponsorshipParticipants selection Procedures

Informed consentPotential risks and costsPotential benefitsConfidentiality pledgeVoluntary consentRight to withdrawAlternativesContact information

Vulnerable subjects ChildrenMentally and emotionally disabled Physically disabledInstitutionalized peoplePregnant women

IRB (Institutional Review Board)

A committee to review research proposal, procedures and protocols to protect

participants’ rights .Exempt review (no apparent risk at all) Expedited review: (has minimal risk and

reviewed by the committee chairperson)Full board review

Evaluating & Interpreting ResearchWas the research peer reviewed?What was the hypothesis?Was the study approved by an IRB and conducted ethically?

What was the population being studied?

What were the entry/exclusion criteria for the study?

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Evaluating & Interpreting Research

What sampling method was used?

How many groups were there?How were the groups assigned?What data were gathered?Did the study have enough patients enrolled?

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Evaluating & Interpreting Research

Were any potential variables not accounted for?

Were the data properly analyzed?Is the conclusion logical based on the data?Does the conclusion apply in local EMS systems?

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

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Conclusion The role of the paramedic is

different from that of the “ambulance driver” of the past.

Today’s paramedics work in sophisticated EMS systems.

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