Lesson 1 Introduction to Emergency Care

Revised April 22, 2011 Page 1

Lesson 1

Introduction to Emergency Medical Care

Duration: 1 hr and 15 minutes

Preparation: slides, overhead projector

OBJECTIVES

Cognitive:

1. Define Emergency Medical Services (EMS) systems.

2. Differentiate the roles and responsibilities of the EMT-Basic from other pre-hospital care providers.

3. Discuss the roles and responsibilities of the EMT-Basic towards the safety of self, the crew, the patient, and bystanders.

4. Define quality improvement and discuss the EMT-Basics role in the process.

5. Define medical direction and discuss the EMT-Basics role in the process

6. State the specific statutes and regulations in your place regarding the EMS system.

Affective:

7. Assess areas of personal attitude and conduct of the EMT-Basic

8. Characterize the various methods used to access the EMS system in your

community.


Visual Aids and

Other Materials

CONTENT

Time Elapsed

. INTRODUCTION

1) Introduce instructor and assistant instructor

2) Present lesson

3) Present lesson objectives

II. DEVELOPMENT

The student will use this information throughout the course to enhance his understanding and provide direction for the EMT-Basic's relationship to the individual components of the EMS system. The lesson will provide the student with a road map for learning the skill and knowledge domains of the EMT-Basic. This will likewise set the foundation for the remaining teaching/learning process. The students will be entering an exciting field of EMS. A positive, helpful attitude presented by the instructor is essential to assuring a positive attitude from the student.

1. Emergency Medical Services is a system consists of a team of health care professionals, who, in each area of jurisdiction, are responsible for and provide emergency care and transportation to

the sick and injured. Brady book page ..

2. Certification Requirements

< In other countries, certification and recertification of EMTs is a state function, subject to the laws and regulations of the state in which the EMT practices> < In the Philippines, once EMS Bill No 3579 is enacted, Registration and re-certification of EMTs in the Philippines shall be governed by the Technical Education and Skills Development Authority (TESDA) for non-degree courses, and by the Professional Regulation Commission (PRC) for degree courses, in accordance with PRC rules and regulations and without prejudice to the enactment of a licensure law for EMTs. A certification is valid for a period of three (3) years. TESDA and PRC shall re-certify Emergency Medical Technicians upon submission of a competency-based assessment statement from a recognized Emergency Medical Services Medical Director>

Cognitive Objectives


2. Differentiate the roles and responsibilities of the EMT-

Basic from other pre-hospital care providers.

3. Discuss the roles and responsibilities of the EMT-B

towards personal safety, safety of the crew, the patient

and bystanders.

4. Define quality improvement and discuss the EMT-

Basic's role in the process.

Emergency Medical Services

This is a system consists of a team of health care professionals, who, in each area of jurisdiction, are

responsible for and provide emergency care and

transportation to the sick and injured.


Visual Aids and

Other Materials

CONTENT

Time

Elapsed

Criteria for certification (US criteria) Ref: page 6 .... AAOS 1. Successful course completion 2. Mentally/physically meet criteria of safe and effective practice of job functions 3. Written examination 4. Practical examination 5. State and local provisions

3. History of EMS

Emergency care developed during warfare at the beginning of the 20th century.

By the 1960s, domestic emergency care lagged behind.

Staffed emergency departments were often limited to large urban areas.

Accidental Death and Disability: The Neglected Disease of Modern Society (1966)

Recommended:

Development of training

Development of federal guidelines and policies

Provide emergency care and transport

Establish staffed emergency departments

Highway Safety Act and the Emergency Medical Act created funding

DOT developed the first National Standard Curriculum for training EMTs in the early 1970s

EMS established in most of the United States by 1980

4. Levels of Training

< Remind students that our reference material is AAOS 9th Ed and try to compare with country practice)

AAOS page 8

a. First Responder individuals trained to initiate immediate care and assist the EMT on their arrival. (Law enforcement officers, fire fighters, park rangers or organized rescuers who often arrive at the scene before the ambulance).

History of Emergency Medical

Services (1 of 3)




Levels of Training

First Responder

EMT-Basic

EMT-Intermediate

EMT-Paramedic


Visual Aids and

Other Materials

CONTENT

Time

Elapsed

b. EMT-Basic requires a minimum of 110 hours and includes the essential

knowledge and skills required to provide basic emergency care in the field. (Skills included use of automated external defibrillator (AED), use of non-visualized airways such as Combitube, endotracheal intubation, and assisting patients with the use of their physician prescribed medications such as nitroglycerine, epinephrine and metered dose inhalers.

c. EMT- Intermediate this course is designed to add knowledge and

skills in specific aspects of ALS to individuals who have been trained and

have experience in providing emergency care as EMT-Bs.

Additional skills include IV therapy, interpretation of cardiac rhythm and in many states, the knowledge and skills necessary to administer certain medications.

d. EMT- Paramedic has completed an extensive course of training that significantly increase knowledge and mastery of basic skills and covers wide range of ALS skills based on the 1999 Paramedic National Standard Curriculum. Ranges from 800- 1,500 hours of combined classroom and internship training. Skills taught:

ECG monitoring and interpretation of cardiac rhythms

Advance cardiac life support (ACLS) protocols and skills

Manual defibrillation and external cardiac pacing

Orotracheal and nasotracheal intubation

Needle cricothyroidtomy

Needle decompression for tension pneumothorax

IV therapy

Advanced pharmacology: drug calculations and medication administration

5. Components of the EMS System

(1) Access Easy access to help needed in an emergency is essential. In the US, an emergency communications centre that dispatches fire, police, rescue and EMS units can be reached by dialling 911.

At the communication center, trained dispatchers obtain the necessary information from the caller and following dispatch protocols, dispatch the ambulance crew and their equipment and responders that may be

needed.

< In the Philippines emergency units can be reached by dialing 117. Emphasize the need to know the emergency number in their localities>

10

EMS

OTHER PHYSICIAN OUTPUT

EQUIPMENT

ACCESS

ADMINISTRATION & POLICY

MEDICAL DIRECTION & CONTROL

QUALITY CONTROL &

IMPROVEMENT

REGULATION

AMBULANCE

SPECIALTY CENTERS

HOSPITAL STAFF


Visual Aids and

Other Materials

CONTENT

Time

Elapsed

(2) Administration and Policy - EMS is usually administered by a senior

EMS official, who oversees the daily operations and overall direction of the service. To provide clear guidelines, most services have written operating procedures and policies. Except for medical

matters, he or she operates as the chief of the EMS.

(3) Medical Direction and Control each EMS system has a physician medical director who authorizes the EMT in the service to provide

medical care in the field.

Role of Medical Director:

a. Responsible for the clinical and patient care aspects of an EMS

system.

b. Responsible for reviewing quality improvement

Types of medical direction (1) On-line or direct (a) Telephone (b) Radio (2) Off-line or indirect (a) Protocols

(b) Standing orders

Relationship of the EMT-Basic to medical direction a. Designated agent of the physician b. Care rendered is considered an extension of the medical Directors authority (varies by state law or in the Phil varies

from each agency).

(4) Quality Control and Improvement - a system of internal/external reviews and audits of all aspects of an EMS system so as to identify those aspects needing improvement to assure that the public receives the highest quality of pre-hospital care.

The role of the EMT-Basic in quality improvement a. Documentation b. Run reviews and audits c. Gathering feedback from patients and hospital staff d. Conducting preventative maintenance e. Continuing education

f. Skill maintenance

< As an EMT-B, you are part of the professional continuum of care provided

to patients who often have life-threatening conditions>

Role of the Medical Director

Responsible for the clinical and patient care aspects of an EMS system.

Responsible for reviewing quality improvement

Types of Medical Direction:

Online or Direct telephone and radio

Off-line or Indirect protocols, standing orders

10

Relationship of the EMT-Basic to medical

direction

Designated agent of the physician

Care rendered is considered an extension of the medical Directors authority

11

The role of the EMT-Basic in quality

improvement

Documentation

Run reviews and audits

Gathering feedback from patients and hospital staff

Conducting preventative maintenance

Continuing education

Skill maintenance

12


Visual Aids and

Other Materials

CONTENT

Time

Elapsed

(5) Other Physician Output Besides the supervision that the medical director and direct online medical control physicians provide, yoyr training and practices are based on input from many specialty professional associations (American Academy of Orthopedic

Surgeons-AAOS, American College of Emergency Physician ACEP)

(6) Regulation trainings, protocols and practices must conform with the EMT legislation, rules, regulations and guidelines.

< In the Philippines, once the EMS law is enacted this will be done by the

National Pre-Hospital Care Council>

(7) Equipment As an EMT-B you will use wide range of different emergency equipment.

(8) Ambulance - EMT-Bs must be familiar with the ambulance and its functions because as an EMT-B you may be called to drive the ambulance. Check all equipment, supplies, communication

equipment and fuel.

(9) Specialty centers aside from hospital emergency departments, many EMS systems include specialty centers which focus on specific types of care such as trauma, burns, poison or psychiatric conditions,

or specific types of patients such as children or the elderly.

(10) Inter-facility Transports may include transferring patient to and from hospitals, skilled nursing facilities, board and care homes or

even their home residence.

(11) Working with Hospital Staff As an EMT-B you will interact with hospital staff.

(12) Working with Public Safety Agencies Effective scene and patient management will result if you work together and recognize that each person has special talent and job to do. Remember that the best, most efficient patient care is achieved through cooperation among

agencies.

(13) Training The quality of care that you will provide depends on your ability and the quality of your training.


Visual Aids and

Other Materials

CONTENT

Time

Elapsed

Providing a Coordinated Continuum of Care

The emergency care of patients occurs in four progressive phases:

1. First phase early access

2. Second phase out of hospital care

3. Third phase emergency care department

.

4. Fourth phase definitive care

< These 4 phases must be provided in a coordinated continuum of care to maximize survival and reduce patient suffering and minimize lasting adverse effects>

The Star of Life The Emergency Care Symbol < article from Rescue-EMS Magazine, July-August 1992>

Just as pharmacists have the mortar and pestle and doctors have the caduceus, Emergency Medical Technicians have a symbol, its use is encouraged both by the American Medical Association and the Advisory Council within the Department of Health, Education and Welfare. The symbol applies to all emergency medical goods and services which are funded under the DOT/EMS program.

Designed by Leo R. Schwartz, Chief of the EMS Branch, National Highway Traffic Safety Administration (NHTSA), the "Star of Life" was created after the American National Red Cross complained in 1973 that they objected to the common use of an Omaha orange cross on a square background of reflectorized white which clearly imitated the Red Cross symbol. NHTSA investigated and felt the complaint was justified.

The newly designed, six-barred cross, was adapted from the Medical Identification Symbol of the American Medical Association and was registered as a certification mark on February 1, 1977 with the Commissioner of Patents and Trademarks in the name of the National Highway Traffic Safety and Administration. The trademark will remain in effect for twenty years from this date.

Providing a Coordinated

Continuum of Care

1st Phaseaccess to EMS system

2nd Phaseout of hospital care

3rd Phaseemergency department care

4th Phasedefinitive care

Star of Life

16

Early

Reporting 2

On Scene

Care

Early detection

1

Early

Response 3

On scene

care

4

Care in

transit

5

Transfer to

definitive care

6


Visual Aids and

Other Materials

CONTENT

Time Elapsed

The staff on the star represents Medicine and Healing.

The snake and staff in the center of the symbol portray the staff of Asclepius who, according to Greek mythology, was the son of Apollo (god of light, truth and prophecy). Supposedly Asclepius learned the art of healing from the centaur Cheron; but Zeus - king of the gods, was fearful that because of Asclepius' knowledge, all men might be rendered immortal. Rather than have this occur, Zeus slew Asclepius with a thunderbolt. Later, Asclepius was worshipped as a god and people slept in his temples, as it was rumoured that he effected cures of prescribed remedies to the sick during their dreams.

Asclepius was usually shown in a standing position, dressed in a long cloak, holding a staff with a serpent coiled around it. The staff has since come to represent medicine's only symbol. In the Caduceus, used by physicians and the Military Medical Corps, the staff is winged and has two serpents intertwined. Even though this does not hold any medical relevance in origin, it represents the magic wand of the Greek deity, Hermes, messenger of the gods.

The Bible, in Numbers 21:9, makes reference to a serpent on a staff: "Moses accordingly made a bronze serpent and mounted it on a pole and whenever anyone who had been bitten by a serpent looked at the bronze serpent, he recovered.

Each of the six "points" of the star represents an aspect of the EMS System.

1. Detection

2. Reporting

3. Response

4. On Scene Care

5. Care in Transit

6. Transfer to Definitive Care

1

2

3

4

5

6


Visual Aids and

Other Materials

CONTENT

Time Elapsed

7. Roles and Responsibilities of the EMT-B

a. Personal safety b. Safety of crew, patient and bystanders c. Patient assessment d. Patient care based on assessment findings e. Lifting and moving patients safely f. Transport/transfer of care g. Record keeping/data collection h. Patient advocacy (patient rights) - confidentiality

8. Professional Attributes of the EMT-B

a. Puts patient's needs as a priority without endangering self. b. Performs under pressure (stability under pressure) c. Treats patient and families with understanding, respect and compassion. d. Respects patients confidentiality. e. Maintains up-to-date knowledge and skills (Continuing education and Refresher Courses) f. Maintains current knowledge of local, state, and national issues

affecting EMS.

g. Maintains professional appearance and manner

- Neat - Clean - Positive image

Professional Appearance

Roles and Responsibilities

of the EMT-B (1 of 2)

Personal safety

Safety of crew, patient, and bystanders

Patient assessment

Patient care based on assessment findings

Professional Attributes

of the EMT-B

Puts patients needs as a priority without endangering self

Performs under pressure

Treats patients and families with understanding, respect, and compassion

Respects patient confidentiality

Maintains up-to-date knowledge and skills (Continuing education and Refresher Courses)

21


The EMT-B should maintain

a professional appearance and manner.


Visual Aids and

Other Materials

CONTENT

Time Elapsed

III. REVIEW

Review lesson objectives on page 1.

IV. EVALUATION

1) Verify that the objectives of the lesson have been met. 2) Give the participants 5 minutes to answer the lesson evaluation

V. CLOSE







and bystanders.




EMT-B Lesson Evaluation

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If you need additional space, please use the back of the sheet.

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Thank you for your help. Your input is valuable. Please turn in this completed form to the instructor.


Introduction to Emergency Medical Care







and bystanders.




5. Define medical direction and discuss the EMT-Basic's

role in the process.

6. State the specific statutes and regulations in your

state regarding the EMS system.

7. Assess areas of personal attitude and conduct of the

EMT-Basic.

8. Characterize the various methods used to

access the EMS system in your community.

Affective Objectives

Emergency Medical Services

This is a system consists of a team of health care professionals, who, in each area of jurisdiction, are

responsible for and provide emergency care and

transportation to the sick and injured.


Services (1 of 3)





Services (2 of 3)

Accidental Death and Disability: The Neglected Disease of Modern Society (1966)

Recommended:

Development of training

Development of federal guidelines and policies

Provide emergency care and transport

Establish staffed emergency departments



Services (3 of 3)

Highway Safety Act and the Emergency Medical Act created funding

DOT developed the first National Standard Curriculum for training EMTs in the early 1970s

EMS established in most of the United States by 1980

Levels of Training

First Responder

EMT-Basic

EMT-Intermediate

EMT-Paramedic

TRAINING

PUBLIC SAFETY AGENCIES

HOSPITAL STAFF

INTER-FACILITYTRANSPORT

AMBULANCEEQUIPMENT

REGULATION

MEDICAL DIRECTION & CONTROL

ACCESS ADMINISTRATION & POLICY

EMS

OTHER PHYSICIAN OUTPUT

QUALITY CONTROL &

IMPROVEMENT

SPECIALTY CENTERS

Role of the Medical Director

Responsible for the clinical and patient care aspects of an EMS system.

Responsible for reviewing quality improvement

Types of Medical Direction:

Online or Direct telephone and radio

Off-line or Indirect protocols, standing orders

10

Relationship of the EMT-Basic to medical

direction

Designated agent of the physician

Care rendered is considered an extension of the medical Directors authority

11

The role of the EMT-Basic in quality

improvement

Documentation

Run reviews and audits

Gathering feedback from patients and hospital staff

Conducting preventative maintenance

Continuing education

Skill maintenance

12


Providing a Coordinated

Continuum of Care

1st Phaseaccess to EMS system

2nd Phaseout of hospital care

3rd Phaseemergency department care

4th Phasedefinitive care

Star of Life

14

Early

Reporting 2

On Scene

Care

Early detection

1

Early

Response 3

On scene

care

4

Care in

transit

5

Transfer to

definitive care

6



Personal safety

Safety of crew, patient, and bystanders

Patient assessment

Patient care based on assessment findings



Lifting and moving patients safely

Transport and transfer of care

Record keeping/data collection

Patient advocacy/confidentiality


of the EMT-B

Puts patients needs as a priority without endangering self

Performs under pressure

Treats patients and families with understanding, respect, and compassion

Respects patient confidentiality

Maintains up-to-date knowledge and skills (Continuing education and Refresher Courses)


of the EMT-B

Maintains current knowledge of local, state, and national issues affecting EMS.

Maintains professional appearance and manner

- Neat

- Clean

- Positive image


19


The EMT-B should maintain

a professional appearance and manner.







and bystanders.




5. Define medical direction and discuss the EMT-Basic's

role in the process.

6. State the specific statutes and regulations in your

state regarding the EMS system.

7. Assess areas of personal attitude and conduct of the

EMT-Basic.

8. Characterize the various methods used to

access the EMS system in your community.

Affective Objectives

Documents

Lesson 1 Introduction to Emergency Care