EMS System - ANSWER Team of Healthcare Professionals
*provide emergency care and transport
*Governed by the State Laws
Levels of Certification - ANSWER Most states have 4 training and licensure levels
1. Emergency
...
EMS System - ANSWER Team of Healthcare Professionals
*provide emergency care and transport
*Governed by the State Laws
Levels of Certification - ANSWER Most states have 4 training and licensure levels
1. Emergency Medical Responder (EMR)
2. EMT
3. Advanced EMT (AEMT)
4. Paramedic
Texas Levels of Certification - ANSWER 5 Levels:
1. Emergency Care Attendant(ECA)
2. EMT
3. EMT- Intermediate (AEMT under national registry)
4. Paramedic
5. Licensed Paramedic
Emergency Medical Responder (EMR) - ANSWER Very basic training:
-Provides care before ambulance arrives
-May assist within an ambulance
-Skills limited to immediate need
Emergency Care Attendant (ECA) - ANSWER -Able to function as part of ambulance crew
-Has almost all skills of an EMT
-initiate immediate care and assist EMTs on their arrival
-Training usually delivered to policemen, fire fighters, park rangers, ski patrol,
Emergency Medical Technician - ANSWER Has training in BLS including:
-AED
-Airway Adjuncts
-Medication Assistance
- IN 49 states, EMT is a minimum certification level to operate an ambulance (TX allows ECAs to transport)
- course requires about 150 hours
-upon arrival, EMT assumes responsibility for assessment, care, package, and transport of patient
EMT-Intermediate (AEMT) - ANSWER has training in advanced life support (ALS) including:
-IV therapy
-Administration of certain emergency medications
-limited advanced airway skills
Paramedic - ANSWER Has extensive ALS training including:
-Endotracheal intubation and other advanced airway skills
-expanded use of pharmacology
-ECG Interpretation
-Cardiac monitoring
-no longer using EMT-P, just Paramedic
-800 to 1500 hours or more
-Truly involved in "Practice of Medicine"
Licensed Paramedic - ANSWER Requires an Associates Degree in EMS (or any bachelors degree)
EMT Licensure Requirements in Texas - ANSWER 1. Complete EMT Training course
2. Pass national Registry exam
3. High school diploma or equivalent
4. 18 years of age
5. Pass Criminal Background Check (many felonies disqualify certification: drug convictions, physical assault, sexual crimes)
Beginning of EMS system - ANSWER WW1: volunteer ambulances
WW2: Field Care
Korean: Field Medic and rapid helicopter evacuation
EMS originated in - ANSWER 1966:
-Publication of: Accidental Death and Disability: The Neglected Disease of Modern Society
Published First EMT training Curriculum in - ANSWER Department of Transportation; 1970
Prepared first EMT textbook in - ANSWER American Academy of Orthopedic Surgeons (AAOS); 1971
-orange book
-still trying to standardize levels of EMS education nationally
National Scope of Practice - ANSWER -attempting to standardize training and services
-Sets "definitions" of licensure (lowest)
-Sets "ceilings" of licensure (highest)
Texas does not have Scope of Practice - ANSWER -Delegated Practice state
-Medical Director determines "scope"
ex: rural providers may be able to perform more advanced procedures than urban
people who are usually trained in BLS/CPR - ANSWER -teachers, coaches, child care providers, etc.
-people who regularly accompany groups on trips to remote locations
-AED can be used by laypeople
14 Components of the EMS System (Agenda for the Future) - ANSWER 1. Public Access
2. Communication Systems
3. Clinical Care
4. Human Resources
5. Medical Direction
6. Legislation and regulation
7. Integration of Health Services
8. Evaluation
9. Information Systems
10. System Finances
11. Education Systems
12. Prevention
13. Public Education
14. EMS research
EMS System - ANSWER 1. Incident recognition
2. Access 9-1-1
3. Dispatch
4. First Responder
5. BLS
6.ALS
7. Transport Ground/Air
8. Emergency Department/ Facilities
9. Specialty Care ( Trauma, cardiac/stroke, poison, pediatrics, etc.)
10. patient rehabilitation
11. Prevention awareness
12. Public Education
Public Access - ANSWER -Easy access to help in an emergency is essential
- 9-1-1 system is public safety access point
-Emergency medical dispatch (EMD) systems give callers medical instructions until EMS arrives
Communication systems - ANSWER -from caller info, dispatcher selects appropriate EMS response
- May require first response and assistance from Police, Fire, Haz-mat
-New technology (like GPS) helps responders locate patients
Clinical Care - ANSWER -Describes pieces of equipment
-describes scope of practice for using that equipment
-Familiarizes EMTs with ambulance controls and with their primary service area (PSA)
Human Resources - ANSWER 1. Focuses on people who deliver care:
-compensation: getting paid
-interaction with other members of the medical community (know your medical terminology)
-Well-being
2. State to State reciprocity:
-national registry lets you apply for licensure in any state
Medical Direction - ANSWER -Physician medical director authorizes EMTs to provide medical care in the field
-Appropriate care is described in standing orders and protocols
-medical control can be off-line or on-line
Off-line (indirect) - ANSWER -standing orders, training, supervision (you're trained to a level where you can just act)
On-line (direct) - ANSWER Physician Directions given over the phone or radio
Legislation and Regulation - ANSWER -Training, protocols, and practice follow state legislation
-Senior EMS official handles administrative tasks: Scheduling, personnel, budgets, purchasing, vehicle maintenance
Integration and Health Services - ANSWER -Prehospital care by EMT is coordinated with care administered by hospital
-Care simply continues in emergency department
-Ensures patient receives comprehensive continuity of care
**you are in charge of informing the hospital what happened to allow seamless transition**
Evaluation - ANSWER -Medical Director maintains quality control
-Continuous quality improvement (CQI) reviews and audits EMS system
-refresher training or continuing education are important
-minimizing errors is goal
Information Systems - ANSWER -Used to document care provided (charting)
-once stored electronically, can be used to improve care
-can help determine:
1. Average on-scene time for trauma patients
2. Need for educational sessions
3. national trends
System Finances - ANSWER -Finance systems vary depending on organization involved
-Personnel may be paid, volunteer, or mix
-EMTs may be involved with:
1. gathering insurance info
2. attending fun-raisers
3.Other Activities to secure finances
Educations Systems - ANSWER -EMS instructors are licensed in most states
-ALS training is provided in college, adult career center, or hospital settings
-Continuing education is needed to update knowledge and refresh skills
Prevention and Public Education - ANSWER -Prevention and public education are two components of EMS system with focus on public health
-Emphasizes on prevention (ex. Seatbelts)
-EMS works with public health agencies on:
1. Primary prevention (immunizations)
2. secondary prevention (treatment)
EMS Research - ANSWER -Helps determine shape/impact of EMS community
-EMTs may be involved in research through gathering data
-Evidence-based decision making based on research
Roles and Responsibilities - ANSWER -Keep vehicles/equipment ready for emergency
-ensure safety of yourself, partner, bystanders and patient (can help no one if you yourself aren't safe)
- operate an emergency vehicle
-Be an on-scene leader
-perform evaluation of scene (scene size up)
-call for additional resources as needed
-gain patient access
-perform patient assessment (fundamental)
-give emergency medical care to patient while awaiting arrival of additional medical services
-only move patients when absolutely necessary to preserve life
-give emotional support to patient, family and other responders
-maintain continuity of care by working with medical professionals
-resolve (arrive and make a decision) emergency incidents
-uphold medical and legal standards
-ensure and protect patient privacy (HIPAA)
-Give administrative support
-Constantly continue professional development (continuing education)
-cultivate and sustain community relations
-give back to the profession
HIPAA - ANSWER Health Insurance Portability and Accountability Act
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