Transcript EMS - Wando High School

Unit 1
Chapter 1: Introduction to Emergency Medical Services
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Describe the impact of historical events on
EMS evolution
Describe the modern EMS healthcare system
I.D. some organizations that have influenced
EMS
Understand the 4 elements of a good EMS
system
Compare the evolution of EMS & emergency
medicine
 Defined as: a connective network of
providers that function to provide a
variety of medial services to people in
need of emergent medical care
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Early Beginnings
 Dating back to ancient civilizations that
sought out natural causes & cures of disease &
injury
 Hippocrates believed that health was a state
of “internal equilibrium”  father of medicine
 Good Samaritan traditionally someone who
would stop and help an injured traveler on the
roadside
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The Military
 Driven by necessity & need
 Greatest contribution to out-of-field hospital!
 Napoleonic Wars
 Ambulances volante: “flying
ambulances”
▪ vehicles considered to be the first
ambulances used by Baron
Larrey
▪ Retrieve injured soldiers
▪ Brought wounded to the surgeon
▪ Little to no first aid
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U.S. Civil War
 General McClellan
▪ Formed the Army
Ambulance Corp
 Clara Barton– 1881
▪ Founder of the American
Red Cross
▪ Treatment at the scene
of incident  “treat
them where they lie”
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The World Wars
 Introduced weapons of mass destruction
▪ Created more severe & critical injuries
 Used soldiers as first responders
▪ Self-care
▪ Buddy care
▪ Field “paramedics”
 Mechanized ambulances
▪ Dawning of the ambulance drivers
 Trauma care systems developed
▪ Soldiers were transferred from field hospitals to definitive
care
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The Korean & Vietnam
Wars
 Introduced
technological advances
▪ Aeromedical evacuation
▪ Trauma hospitals moved
closer to the injured
▪ Mobile Army Surgical
Hospital (M*A*S*H)
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Civilian World
 Care of ill and injured in civilian
sector lagged behind what was
provided by the military
 Returning veterans, police, & fire
departments began advancing the
level of care provided in the U.S.
 1966– more than 50% of
ambulances in the U.S. were owned
and operated by morticians
▪ Hearses provided primary
transportation to hospitals (only
vehicles equipped for horizontal
transport)
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…finally in 1958, EMS was
founded by J.D. “Deke”
Farrington
 Father of EMS
 Trained Chicago fire
department with prehospital care skills
 Wrote “Death in the Ditch”
which exposed the poor
state of EMS during this
time period
 1966: President Kennedy’s white paper
 A detailed report on any subject
▪ “Accidental Death and Disability: The Neglected
Disease of Modern Society,” was written for
Kennedy
▪ Groundwork for EMS legislation
▪ Showed better survival in Vietnam War than
America’s streets
 National Highway Traffic Safety
Administration (NHTSA) Act of 1966
 Division of U.S. Department of
Transportation that establishes standards
for emergency services training
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EMS System Act of 1973
 Identified 15 essential components of the EMS system
▪ Personnel
▪ Standardized record
▪ Training
keeping
▪ Communication
▪ Public information &
education
▪ Transportation
▪ System review &
▪ Emergency facilities
evaluation
▪ Critical care facilities
▪ Disaster management
▪ Public safety agencies
▪ Mutual aid agreements
▪ Consumer participation
▪ Access to care
▪ Patient transfer
 Star of Life~1973
 Six-pointed star
with staff &
serpent in the
center
 Symbol of EMS
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Detection– first rescuers on the scene  usually
untrained civilians
Reporting—call for professional help  dispatch
connected with victims
Response– first rescuers provide first aid &
immediate care to the extent of their capabilities
On scene care– EMS personnel proceed to transfer
patient to a hospital
Transfer to definitive care—appropriate
specialized care provided at the hospital
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American Ambulance Association (AAA)
 National organization  represents interests
of ambulance service industry
 Members provide EMS to 95% of America’s
urban centers
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International Association of Fire Fighters
(IAFF)
 One of the largest groups that represent firefighters
 About 80% of EMS provided by firefighters
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National Registry of Emergency Medical
Technicians (NREMT)
 Represents EMTs to public & government
 Registration serves as proof of meeting minimum
competency level needed for certification
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Public perception of EMS
 Remained unaware of
improvements in the field of
pre-hospital emergency
medicine
▪ Emergency television series 
Johnny & Roy (1970’s)
▪ LA County firefighter-paramedics
▪ Exhibited expert care in the field
▪ Helped to raise public expectations
& awareness
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Public perception of EMS
 Rescue 9-1-1
▪ Reality-based TV series
hosted by William
Shatner
▪ 1989-1996
▪ Was not originally
intended as a teaching
tool, but viewers used
the knowledge they
obtained from watching
 EMS is an essential component in
health care system
 First step of a long journey from
illness/injury to recovery & health
 There are 4 essential steps to the
continuous care of a patient…
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A. Continuum of Care
 Similar to AHA “chain of survival”
▪ Chain of Survival: multiple elements needed in a first
response system to have successful resuscitation
▪ Each element is connected with the others
▪ Strength of entire chain equally dependent on strength of
each link
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Recognize sudden cardiac
emergency
 Unresponsiveness
 Loss of consciousness
 Lack of pulse
 No breathing
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Immediate call to 911 helps
ensure advance life support
team will aid victim more
quickly
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Providing CPR keeps
oxygenated blood
flowing to heart &
brain
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Early CPR increases
victims chance of
survival
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Defibrillation is the
ONLY way to stop
sudden cardiac arrest
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Restarts the heart
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For each minute that
passes between collapse
and defibrillation,
survival chances
decreases by 10%
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After using the AED
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given by paramedics and
other highly trained
medical personnel on
scene and during
transport
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Help maintain a normal
heart rhythm after
successful defibrillation.
Step 1?
Step 2?
Step 3?
Step 4?
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B. Universal Access
 9-1-1: 3 digit access number for emergency
services in the U.S.
 Public Safety Access Point (PSAP): answering
location for all calls made to 9-1-1 in a specific
area
 Emergency Dispatcher: specially trained person
who answers calls for emergency assistance at
PSAP
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C. Emergency Medical Dispatch (EMD)
 Organized group of trained providers who take
emergency calls
 Give first aid instructions to callers
 Prioritize responding unit
 Becoming standard of care for EMS dispatching
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First –first responders
Medically driven dispatch protocols
Prioritization
Appropriate use of resources
System-status management
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D. First Responder: first person to arrive on
the scene of an incident
 may refer to the level of medical training
provided to persons who expect to be put in this
position during their daily routine
▪ (firefighters, police offices, security guards, athletic
trainers, etc)
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First responder continued…
 Early first aid courses
▪ Bystander training
 Professionals
▪ Law enforcement officers (LEOs)
▪ Fire service
▪ Police/security guards
 Training
▪
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▪
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Basic assessment
Simple airway management
Oxygen administration
Bleeding control
CPR
defibrillation
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Emergency Medical Technician- Basic (EMT-B):
person has completed primary pre-hospital
medical training  most common level in U.S.
 Includes CPR, defibrillation, airway management, and
basic medical/trauma care
▪ Original curriculum for ambulance attendants
▪ Modern training includes basics of common illnesses & care
during transport
▪ Diverse group
▪ Ambulance
▪ Soldier
▪ Firefighters
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Emergency Medical Technician-Intermediate
(EMT-I): person has completed second level of prehospital care training beyond that of an EMT-B
 Includes training in intravenous (IV) therapy, advanced
airway & cardiac arrest management, and trauma care
▪ More advanced skills and knowledge
▪ Cardiac arrest “managers”
▪ Called intermediate life support (ILS)
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Emergency Medical Technician- Paramedic
(EMT-P): person has completed highest level of
pre-hospital care medical training
 Includes advanced airway management, IV access
techniques, defibrillation, cardiac pacing, and
advanced pharmacology
▪ Health care professional
▪ College-level education
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Just as pre-hospital emergency care evolved to the
needs of our changing society so did in-hospital
care
 Early “accident rooms”
▪ Doctors were “moonlighters”
▪ Became the hospital’s emergency medical center
▪ Available 24/7
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Emergency medicine
 Physicians began specializing in “emergency
medicine”
 Emergency physician: specifically trained to
provide care to acutely ill and injured patients in an
emergency department setting
▪ American College of Emergency Medicine
▪ Professional organization
 Modern emergency department
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Trauma Center:
specially designated
hospital that is
experienced in and
capable of caring for
patients with severe
emergencies
http://www.scdhec.go
v/health/ems/trauma.
htm
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Aeromedical
transport
 Intended for critical
care transportation
 Ground specialty
teams
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EMS has evolved rapidly over 35 years
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Continued changes needed to accommodate
shifting needs of populations it serves
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Adjust to new financial and medical
developments
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A. Aging Americans
 Baby boomers growing older
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B. Homelessness
 Increasing population of mentally ill
▪ Development of Psychotropic medications
▪ Deinstitutionalization
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C. Human Resources
 Decreased volunteerism, an American tradition
▪ Economic pressure
▪ Changing ethics
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D. Financial restrictions
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Limited budgets of volunteer organizations
Equipment
Training
Insurance
E. Accountability
 Consumers demand quality
 Governmental regulation
▪ Continuous quality improvement
 Accreditation
▪ Ambulance services
▪ EMS education programs
 Legal action
▪ Liability suits for negligence
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History of EMS if filled with examples of
heroism & leadership
Future of EMS depends on assessment &
management of many challenges