Transcript Maine EMS On-Line Medical Control Training Program

Maine EMS On-Line
Medical Control
Training Program
Module 1: EMS systems
Module :
Module 1: EMS
Systems
• Objectives
– By the end of this module, you will be
able to:
• Identify at least 6 components of an EMS
system
• Differentiate between a Basic Life Support and
Advanced Life Support EMS Service
• Describe protocols
• Define scope of practice
• Describe the structure of Maine EMS
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Overview of EMS
• EMS
– Provision of care outside of hospital by
personnel with varying levels of training
– Personnel are physician extenders
• Not delegated practice
• Individually licensed
• Require physician endorsement
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16 Components
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Manpower
Training
Communication
Transportation
Emergency Facilities
Critical Care Units
Public Safety
Agencies
• Disaster Planning
• Medical Direction
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• Consumer
Participation
• Access to Care
• Patient Transfers
• Standardized Record
Keeping
• Public Information
and Education
• System Review and
Evaluation
• Mutual Aid
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Level of Practice
• Basic Life Support
– Staffing by EMT-Basics
• Defined by level of training
• Based on NHTSA / DOT National Standard
Curriculum
– Limited equipment
• Limited medications
• AED
• +/- Advanced Airway
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Level of Practice
• Advanced Life Support
– Either EMT-Intermediate, Critical Care
Technician or Paramedic
– Staffing by EMT-Paramedics
• Much more training (1000+ hours)
– Full complement of medications
– Cardiac monitor / defibrillation /
pacemaker / cardioversion
– Advanced airway (intubation)
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Protocols
• Written documents that guide the
EMT’s care
• Series of instructions
• Based on chief complaint or clinical
impression
• Define what interventions may / must
be done
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Protocols
• Protocols divided into 2 parts
– Standing orders
• Authorized by protocol
• EMT may perform these items if indicated
without contacting medical control
• Defined by service medical director
– Orders requiring on-line medical control
• EMT must contact and consult with medical
control before initiating these protocols
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Protocols
• Define care for majority of patients
• Some patients fall outside protocols
– Medical control may authorize EMT to
utilize any protocol
– Medical control may make orders
outside protocols if the orders fall in
EMT’s Scope of Practice
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Scope of Practice
• The breadth of practice of a provider
defined by licensure, education, and
medical director authorization
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Scope of Practice
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Scope of Practice
State
License
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Scope of Practice
Education
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Scope of Practice
Medical
Director
(System)
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Scope of Practice
State
License
Education
Medical
Director
(System)
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Overview of Maine
EMS
• Maine is relatively unique
– No requirement for ALS services to
have a medical director
• Medical direction carried out at
regional and state level
• Statewide protocols
• State QI
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State Level
Organization
Governor John Elias Baldacci
Board of EMS (17)
Regional EMS Offices
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Steven E. Diaz, MD
EMS Medical Director
Anne H. Jordan
Commissioner
Department of Public Safety
Jay Bradshaw
Director
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Board of EMS
Members
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Regional Councils (6)
Ambulance Services (2)
Non Transporting Services
Public (2)
Emergency Physician
Emergency Nurse (RN)
Emergency Medical Dispatch
Hospitals
Fire Services (2)
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Maine EMS Office
(MEMS)
• Director
– Jay Bradshaw
• Staff
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Training and Education: Jan Brinkman, RN EMT-P
Licensing Agent: Alan Leo, EMT
Licensing Agent: Dawn Kinney, EMT-P
Licensing Assistant: Karen Cutler
Data & Preparedness Coordinator: Jon Powers,
NREMT-P
– EMD Coordinator: Drexell White, EMT-P
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Contact Information
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Maine Emergency Medical Services
45 Commerce Drive
152 State House Station
Augusta, ME 04333
(207) 626-3860
[email protected]
www.maine.gov/dps/ems
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Regional Offices
Board of Directors
Education Coordinator
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Regional Coordinator
Medical Director
Quality Improvement Coordinator
Administrative Support
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Medical Directions
and Practice Board
• State Medical Director
– Steve Diaz MD
• Medical Direction and Practice Board
– State Medical Director
– 6 regional medical directors
– Maine ACEP representative
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Medical Directions
and Practices Board
• Reviews and establishes Protocols
• Reviews/approves certain medical
devices
• Establishes Quality Assurance
benchmarks
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Quality Improvement
• Centralized function
• Services send data to region
– Goes to state
– Entered in statewide database
– QI committees
– Hospital QI nurse / coordinator
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MEMS
• Other Committees
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York, Cumberland, &
Sagadahoc
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Southern Maine EMS
496 Ocean St.
So. Portland, ME 04106
(207) 741-2790
[email protected]
Donnell Carroll, Regional Coordinator
Tony Bock, MD, Medical Director
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Androscoggin,
Franklin, & Oxford
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Tri County EMS
300 Main St.
Lewiston, ME 04240
(207) 795-2880
[email protected]
Joanne LeBrun, Regional Coordinator
Kevin Kendall MD, Medical Director
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Kennebec &
Somerset
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Kennebec Valley EMS
71 Halifax St
Winslow, ME 04901
(207) 877-0936
[email protected]
Rick Petrie, Regional Coordinator
Timothy Pieh MD, Medical Director
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Hancock, Penobscot,
Piscataquis, &
Washington
Northeast EMS
354 Hogan Rd
Bangor, ME 04401
(207) 974-4880
[email protected]
Rick Petrie, Regional Coordinator
Jonnathan Busko MD, Medical Director
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Aroostook
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Aroostook EMS
111 High St.
Caribou, ME 04736
(207) 492-1624
[email protected]
Steve Corbin, Regional Coordinator
Peter Goth MD, Medical Director
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Lincoln, Waldo, &
Knox
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Mid Coast EMS
P O Box 610
Union, ME 04862
(207) 785-5000
[email protected]
Bill Zito, Regional Coordinator
Colin Coor MD, Medical Director
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Local EMS Services
in Maine
• 285 licensed agencies
• Transporting (Ambulance)
– Ground
– Fixed wing (Airplane)
– Rotor wing (Helicopter)
• Non-transporting
• Unregulated industrial / private first
response agencies (e.g. ski patrols)
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Maine EMS Service
License Levels
• Basic Life Support
• Advanced Life Support
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Service Levels of
Performance
• First Responder
• Emergency Medical Technician
(EMT)
• EMT-Intermediate
• Paramedic permit
• Paramedic service
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State Levels of
Certification / Practice
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First responder (282)
Licensed ambulance attendant (15)
EMT (3,952)
EMT Intermediate (841)
EMT-Critical Care (27)
EMT- Paramedic (1,016)
PIFT
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Basic Life Support
• First responder
• Ambulance Attendant*
• Emergency Medical Technician (EMT)
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Advanced Life
Support
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EMT-Intermediate
EMT-Critical Care*
EMT-Paramedic
Paramedic Interfacility Transfer
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Federal Grants /
Projects
• Rural Access to Emergency Devices:
$1m (4 years)
– Free AEDs to rural responders and
community centers
– Discounted AEDs available statewide
– ~ 10,000 people trained in CPR/AED
– Ended 8/31/06
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Trauma / EMS
• Maine EMS Trauma Plan
– 1990: Federal Trauma System Grant
– Trauma Advisory Committee
established
– October 1996: Trauma Plan
Implemented
– 2004: Technical Assistance Teams
– Formerly supported by federal grant
($40,000/yr)
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Emergency Medical
Service for Children
• DHHS/MCHB funded $115,000/year
– Injury prevention projects
• Playground safety
• CPS
• Health & Safety Fairs
– EMS for SHCN patients
– Data collection (NEMSIS)
– Pediatric Equipment, training, and
medical control
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Statewide Protocols
• Universal protocols statewide
• All paramedics practice under the
same protocols
• Regional variants
– Research / Pilot projects by region
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CPAP in several Regions
Mid Coast EMS: Stroke protocol
Regions 1 & 4: New PIFT
IO: now ubiquitous
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Summary
• EMS is not ED Care
• All EMS agencies are not the same
• Maine EMS
– Oversees
– Monitors
– Supports
• Statewide protocols
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End of Module 1
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