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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

EMS Systems

Heather Davis, MS, NREMT-P


About the case study

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

EMS System Components

  • Prehospital component

  • Hospital Component

  • Support Personnel


The prehospital component

The Prehospital Component

  • Lay persons trained in CPR

  • First Responders

  • EMTs

  • Paramedics


Hospital component

Hospital Component

  • Emergency nurses

  • Emergency physicians

  • Specialty physicians

  • Surgery

  • Rehab


Support personnel

Support Personnel

  • Emergency Medical Dispatchers

  • Law enforcement

  • Firefighters

  • Public-safety workers

  • Respiratory therapists

  • Other allied health technicians


The systems approach

The Systems Approach

  • System Administration

  • Medical Control

  • Public Information and Education

  • EMS Communications

  • EMD

  • Education and Certification

  • Patient Transportation


The system continued

The System Continued

  • Quality Assurance and Improvement

  • Research

  • Receiving Facilities

  • Mutual Aid/MCI Preparation

  • System Financing


System administration the local ems agency

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

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

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

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

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

EMS Communications

  • Easy citizen access

  • Communications center

  • Operational network

  • Medical communications

  • Communications hardware

  • Communications software


Emergency medical dispatch

Emergency Medical Dispatch

  • Interrogation protocols

  • Response configurations

  • System status management

  • Pre-arrival instructions

  • Dispatcher training

  • Desired response times


Education certification

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

Patient Transportation

  • Transport to appropriate facility

  • Ground transportation

  • Air transportation


Quality assurance

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

Quality Improvement

  • Focuses on customer perceptions of service

  • Emphasizes customer satisfaction

  • Recognizes, rewards, and reinforces good performance


Research

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

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

MCI & Mutual Aid Requirements

  • Central coordinating agency

  • Integration of system components

  • Frequent drills

  • Expansion of communications

  • Standardized regional resources


System financing

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

Any questions about systems approach to EMS?


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