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EMS Systems. Heather Davis, MS, NREMT-P. About the Case Study. Why is the role of ordinary citizens important in this scenario? How many behind the scenes people can be credited with saving Mr... Chlopek’s life? IF E-911 would not have been in place, what delays might have occurred?.

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EMS Systems

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EMS Systems

Heather Davis, MS, NREMT-P


About the Case Study

  • Why is the role of ordinary citizens important in this scenario?

  • How many behind the scenes people can be credited with saving Mr... Chlopek’s life?

  • IF E-911 would not have been in place, what delays might have occurred?


EMS System Components

  • Prehospital component

  • Hospital Component

  • Support Personnel


The Prehospital Component

  • Lay persons trained in CPR

  • First Responders

  • EMTs

  • Paramedics


Hospital Component

  • Emergency nurses

  • Emergency physicians

  • Specialty physicians

  • Surgery

  • Rehab


Support Personnel

  • Emergency Medical Dispatchers

  • Law enforcement

  • Firefighters

  • Public-safety workers

  • Respiratory therapists

  • Other allied health technicians


The Systems Approach

  • System Administration

  • Medical Control

  • Public Information and Education

  • EMS Communications

  • EMD

  • Education and Certification

  • Patient Transportation


The System Continued

  • Quality Assurance and Improvement

  • Research

  • Receiving Facilities

  • Mutual Aid/MCI Preparation

  • System Financing


System Administration:The Local EMS Agency

  • Sets local policies

  • Hires a medical director

  • Manages local resources

  • Assures quality of service


System Administration:The State EMS Agency

  • Allocates state and federal funding

  • Works for EMS legislation

  • Certifies and licenses personnel

  • Enforces rules and regulations


Medical Control:Medical Director Qualifications

  • Experienced in emergency medicine

  • Completed a training program in EMS system

  • Board certified in emergency medicine

  • Frequently rides with field crews


Medical Control:Responsibilities

  • Direct communication with field crews

  • Intervener physician guidelines

  • Protocol development: triage, treatment, transport, transfer, special situations

  • Oversee training and education

  • Ensure quality assurance through chart review, audit, and evaluation


Public Information/Education

  • Patient denial of symptoms

  • Targeting coronary/stroke patients

  • System access

  • Bystander BLS in CPR, bleeding control, C-spine stabilization

  • Future involvement (bystander defib)


EMS Communications

  • Easy citizen access

  • Communications center

  • Operational network

  • Medical communications

  • Communications hardware

  • Communications software


Emergency Medical Dispatch

  • Interrogation protocols

  • Response configurations

  • System status management

  • Pre-arrival instructions

  • Dispatcher training

  • Desired response times


Education & Certification

  • Original program requirements: 300 didactic, 100 clinical, 300 field

  • Continuing ed: refresher courses, in-services, seminars

  • Certification levels: EMT-B,I,P

  • Additional certification: ACLS, PALS, PHTLS, BTLS


Patient Transportation

  • Transport to appropriate facility

  • Ground transportation

  • Air transportation


Quality Assurance

  • Monitors quality of clinical care

  • Evaluation of clinical data

  • Documents effectiveness of care provided

  • Identifies weaknesses in system

  • Often viewed negatively


Quality Improvement

  • Focuses on customer perceptions of service

  • Emphasizes customer satisfaction

  • Recognizes, rewards, and reinforces good performance


Research

  • What field tx reduces morbidity and mortality?

  • Are the benefits worth the risks?

  • What is the cost/benefit ratio of prehospital medicine?

  • Is field stabilization possible?


Receiving Facilities

  • Hospital categorization

  • Specialty centers

  • Requirements: MD on duty, surgical facility, ICU, lab, x-ray, blood bank, participation in EMS system, reception of all patients, QA procedures, MCI plan participation


MCI & Mutual Aid Requirements

  • Central coordinating agency

  • Integration of system components

  • Frequent drills

  • Expansion of communications

  • Standardized regional resources


System Financing

  • System design: hospital based, fire department, municipal third service, private business, volunteer, combo

  • Funding options: tax subsidized, contributions, fundraising, corporate sponsorship, subscriber plans, prepaid HMO, Medicare, Medicaid, private medical or auto insurance, user pay, public utility


Any questions about systems approach to EMS?


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