History of EMSHistory of EMS
Developed during warfare in the 20Developed during warfare in the 20thth centurycentury
By 1960, domestic emergency care lagged By 1960, domestic emergency care lagged behindbehind
Staffed emergency departments were Staffed emergency departments were often linked to large urban areasoften linked to large urban areas
Funeral homes provided most emergency Funeral homes provided most emergency transport with no trainingtransport with no training
History of EMSHistory of EMS
1966 publication of 1966 publication of Accidental death and Accidental death and Disability: The Neglected Disease of Disability: The Neglected Disease of Modern SocietyModern Society recommended: recommended:– Development of trainingDevelopment of training– Federal guidelines and policiesFederal guidelines and policies– Provide emergency care and transportProvide emergency care and transport– Established staffed emergency roomsEstablished staffed emergency rooms
History of EMSHistory of EMS
Highway safety Act and the Emergency Highway safety Act and the Emergency Medical Act created federal fundingMedical Act created federal funding
DOT developed first National Standard DOT developed first National Standard Curriculum for EMT training (early 70’s)Curriculum for EMT training (early 70’s)
By 1980 EMS is established in most of the By 1980 EMS is established in most of the United StatesUnited States
Layers of TrainingLayers of Training
Lay ResponderLay Responder
First ResponderFirst Responder
EMT-BasicEMT-Basic
EMT-IntermediateEMT-Intermediate
EMT-ParamedicEMT-Paramedic
King CountyKing CountyDispatch Centers follow Criteria-Based Guidelines.• Seattle• Eastside
Communications• Port of Seattle• Valley
Communications• Enumclaw
Layers of CareLayers of Care
• Citizens
• Emergency dispatchers
• EMTs
• Paramedics
• Emergency Departments
Chain of AccountabilityChain of Accountability
• Washington State RCW and WAC
• County Medical Program Director
• Program Medical Directors
• Emergency physicians at medical control hospitals
• EMTs and paramedics
Roles & ResponsibilitiesRoles & Responsibilities
Personal SafetyPersonal Safety– Safety of self, crew, patient, and bystandersSafety of self, crew, patient, and bystanders
Patient AssessmentPatient Assessment– Patient car based on assessment findingsPatient car based on assessment findings
Lifting and moving patients safelyLifting and moving patients safely
Transport and transfer of careTransport and transfer of care
Record keeping/data collectionRecord keeping/data collection
Patient AdvocacyPatient Advocacy
10. Be Professional10. Be Professional
Act the partAct the part
Focus on the patient’s problemFocus on the patient’s problem
Listen to the patient!Listen to the patient!
Keep family informedKeep family informed
Bedside mannerBedside manner
Respect privacy of patientRespect privacy of patient– ConfidentialityConfidentiality
9. Always Be a Student9. Always Be a Student
Certification every 3 years, on-going Certification every 3 years, on-going through CBTthrough CBT
EMS Online resource websiteEMS Online resource website
Remember every patient can teach you Remember every patient can teach you somethingsomething
Don’t forget to talk with the doctorDon’t forget to talk with the doctor
The day you stop learning is the day you The day you stop learning is the day you retire from this professionretire from this profession
8. Document Everything8. Document Everything
Documentation is your friend and will Documentation is your friend and will protect you when you memory failsprotect you when you memory fails
Vital signsVital signs
Patient informationPatient information
Descriptive narrativesDescriptive narratives
Always document unusual situationsAlways document unusual situations
If you did not document it, it did not If you did not document it, it did not happen!happen!
7. Embrace Change7. Embrace Change
New protocols and guidelines for CPR, New protocols and guidelines for CPR, FBAO, and resuscitationFBAO, and resuscitation
ROCROC
SPHERESPHERE
Alert CardsAlert Cards
New protocols and procedures!New protocols and procedures!
6. Follow Established Guidelines6. Follow Established Guidelines
US Department of Transportation US Department of Transportation curriculumcurriculum
Washington State certificationWashington State certification
King County guidelines (blue book King County guidelines (blue book protocols)protocols)
Local policies as outlined by agencyLocal policies as outlined by agency
5. Seek Help5. Seek Help
Stay humbleStay humble
Help from your partnersHelp from your partners
Help from your paramedicsHelp from your paramedics
Help from hospital controlHelp from hospital control
4. Be Safe4. Be Safe
Above all else, your safety is tantamount Above all else, your safety is tantamount to all that we do.to all that we do.
Take care of yourselfTake care of yourself
Remember to be proactive in the use of Remember to be proactive in the use of PPE/BSIPPE/BSI
Drive safely…it’s not your emergencyDrive safely…it’s not your emergency
Everyone goes home at the end of the Everyone goes home at the end of the shiftshift
3. Stick to the Basics3. Stick to the Basics
SICK or NOT SICK!SICK or NOT SICK!
Vital signs, MOI, NOI, IOSVital signs, MOI, NOI, IOS
Common sense and good judgmentCommon sense and good judgment
Remember, it’s okay if you cannot Remember, it’s okay if you cannot diagnose what is wrong with the patient, diagnose what is wrong with the patient, it’s not okay if you fail to take care of what it’s not okay if you fail to take care of what you know how to take care.you know how to take care.
2. Take Pride in our System2. Take Pride in our System
International reputationInternational reputation
Highest cardiac arrest survival rate in the Highest cardiac arrest survival rate in the worldworld
Highest rates of bystander CPRHighest rates of bystander CPR
Highest taxpayer support (Medic 1 Levy)Highest taxpayer support (Medic 1 Levy)
Highest trained paramedics in the worldHighest trained paramedics in the world
Best EMT trainingBest EMT training
1. Take Pride in Yourself1. Take Pride in Yourself
Helping others is a proud and noble Helping others is a proud and noble professionprofession
Provide care, comfort, and compassion to Provide care, comfort, and compassion to all patients…equallyall patients…equally
Exceed expectations, strive to be your Exceed expectations, strive to be your best in every situationbest in every situation
Approach each day with courage and Approach each day with courage and convictionconviction
The Well- Being of the EMTThe Well- Being of the EMT
Personal health, safety, and well-being are Personal health, safety, and well-being are vital to any EMS operationvital to any EMS operation
Intrinsic dangers and hazards of our Intrinsic dangers and hazards of our occupation vary greatly from call to calloccupation vary greatly from call to call
You will be constantly faced with mental You will be constantly faced with mental and physical stresses on the joband physical stresses on the job
Even the most experienced provides have Even the most experienced provides have difficulty overcoming personal reactions difficulty overcoming personal reactions
Understand the causes of stress Understand the causes of stress to prevent it from negatively to prevent it from negatively
affecting you!affecting you!
Remember, if you cannot take Remember, if you cannot take care of yourself, how will you care of yourself, how will you
take care of others?take care of others?
Stressful SituationsStressful Situations
Death and dyingDeath and dyingMass-casualty incidentsMass-casualty incidentsSevere traumaSevere traumaAbuseAbuseCo-worker death or injuryCo-worker death or injuryVehicle accident caused by EMS Vehicle accident caused by EMS personnelpersonnelViolent scenesViolent scenes
Warning SignsWarning Signs
PhysicalPhysical
– FatigueFatigue
– Changes in Changes in appetiteappetite
– HeadachesHeadaches
– InsomniaInsomnia
– IrritabilityIrritability
Warning SignsWarning Signs
Psychological:Psychological:
– FearFear
– DepressionDepression
– AngerAnger
– FrustrationFrustration
– Inability to copeInability to cope
Stress ManagementStress Management
Understand the effects of stressUnderstand the effects of stress
Find balance in your lifeFind balance in your life
Change or eliminate stressorsChange or eliminate stressors
Avoid complaining or worrying about Avoid complaining or worrying about things you cannot changethings you cannot change
Expand your social support systemExpand your social support system
Take care of yourself: diet, exercise, sleepTake care of yourself: diet, exercise, sleep
Stress Management ResourcesStress Management Resources
Partners and co-workersPartners and co-workers– Be open with and aware of each otherBe open with and aware of each other
Family membersFamily members
ChaplainsChaplains
Wellness Counseling and EAPWellness Counseling and EAP
CISMCISM
Critical Incident Stress DebriefingCritical Incident Stress Debriefing
Held within 48-72 hours of a major incidentHeld within 48-72 hours of a major incident
All information is confidentialAll information is confidential
CISD leaders and mental health CISD leaders and mental health professionals offer suggestions for professionals offer suggestions for overcoming stressovercoming stress
Can be initiated by anyoneCan be initiated by anyone
CISM SystemCISM System
Pre-incident stress Pre-incident stress educationeducation
Peer supportPeer support
CISDCISD
Follow-up servicesFollow-up services
Spouse and family Spouse and family support systemsupport system
Scene SafetyScene Safety
Hazardous materialsHazardous materials– Identification and isolationIdentification and isolation
ElectricityElectricity– Live electricity is difficult to seeLive electricity is difficult to see– Power off at sourcePower off at source
FireFire– Protective gearProtective gear– Do only what you have been trained to do!Do only what you have been trained to do!
Scene SafetyScene Safety
Violent ScenesViolent Scenes– Civil disturbances, domestic disputes, crime Civil disturbances, domestic disputes, crime
scenes, large gatherings (mobs)scenes, large gatherings (mobs)
Motor vehicle accidentsMotor vehicle accidents– Safety at sceneSafety at scene
Highways, streets, and roadsHighways, streets, and roads– Moving traffic is a major hazard!Moving traffic is a major hazard!
Body Substance IsolationBody Substance Isolation
Minimum protection Minimum protection on all calls: gloves on all calls: gloves and eye protectionand eye protection
Mask and gowns per Mask and gowns per RGT policyRGT policy
Hand washing and Hand washing and sanitizer usesanitizer use
Sharps disposalSharps disposal
Body Substance IsolationBody Substance Isolation
Always use Body Substance isolation Always use Body Substance isolation precautionsprecautions
Always us a barrier between yourself and Always us a barrier between yourself and the patientthe patient
Always wash/sanitize your hands after Always wash/sanitize your hands after each patient contacteach patient contact
Make certain immunizations are up to dateMake certain immunizations are up to date
Be careful handling sharpsBe careful handling sharps