History of EMS • Developed during warfare in the 20th century • By 1960, domestic emergency care lagged behind • Staffed emergency departments were often linked to large urban areas • Funeral homes provided most emergency transport with no training
History of EMS • 1966 publication of Accidental death and Disability: The Neglected Disease of Modern Society recommended: • Development of training • Federal guidelines and policies • Provide emergency care and transport • Established staffed emergency rooms
History of EMS • Highway safety Act and the Emergency Medical Act created federal funding • DOT developed first National Standard Curriculum for EMT training (early 70’s) • By 1980 EMS is established in most of the United States
Layers of Training • Lay Responder • First Responder • EMT-Basic • EMT-Intermediate • EMT-Paramedic
King County King County coverage area map.
King County Dispatch Centers follow Criteria-Based Guidelines. • Seattle • Eastside Communications • Port of Seattle • Valley Communications • Enumclaw
King County Fire/EMS Agencies. • 38 Fire Departments • 4000 EMTs
King County Medic One. • 5 agencies • 250 paramedics
King County Hospitals • Medical control hospitals • Other hospitals
Layers of Care • Citizens • Emergency dispatchers • EMTs • Paramedics • Emergency Departments
Chain of Accountability • Washington State RCW and WAC • County Medical Program Director • Program Medical Directors • Emergency physicians at medical control hospitals • EMTs and paramedics
Roles & Responsibilities • Personal Safety • Safety of self, crew, patient, and bystanders • Patient Assessment • Patient car based on assessment findings • Lifting and moving patients safely • Transport and transfer of care • Record keeping/data collection • Patient Advocacy
10. Be Professional • Act the part • Focus on the patient’s problem • Listen to the patient! • Keep family informed • Bedside manner • Respect privacy of patient • Confidentiality
9. Always Be a Student • Certification every 3 years, on-going through CBT • EMS Online resource website • Remember every patient can teach you something • Don’t forget to talk with the doctor • The day you stop learning is the day you retire from this profession
8. Document Everything • Documentation is your friend and will protect you when you memory fails • Vital signs • Patient information • Descriptive narratives • Always document unusual situations • If you did not document it, it did not happen!
7. Embrace Change • New protocols and guidelines for CPR, FBAO, and resuscitation • ROC • SPHERE • Alert Cards • New protocols and procedures!
6. Follow Established Guidelines • US Department of Transportation curriculum • Washington State certification • King County guidelines (blue book protocols) • Local policies as outlined by agency
5. Seek Help • Stay humble • Help from your partners • Help from your paramedics • Help from hospital control
4. Be Safe • Above all else, your safety is tantamount to all that we do. • Take care of yourself • Remember to be proactive in the use of PPE/BSI • Drive safely…it’s not your emergency • Everyone goes home at the end of the shift
3. Stick to the Basics • SICK or NOT SICK! • Vital signs, MOI, NOI, IOS • Common sense and good judgment • Remember, it’s okay if you cannot diagnose what is wrong with the patient, it’s not okay if you fail to take care of what you know how to take care.
2. Take Pride in our System • International reputation • Highest cardiac arrest survival rate in the world • Highest rates of bystander CPR • Highest taxpayer support (Medic 1 Levy) • Highest trained paramedics in the world • Best EMT training
1. Take Pride in Yourself • Helping others is a proud and noble profession • Provide care, comfort, and compassion to all patients…equally • Exceed expectations, strive to be your best in every situation • Approach each day with courage and conviction
The Well- Being of the EMT • Personal health, safety, and well-being are vital to any EMS operation • Intrinsic dangers and hazards of our occupation vary greatly from call to call • You will be constantly faced with mental and physical stresses on the job • Even the most experienced provides have difficulty overcoming personal reactions
Understand the causes of stress to prevent it from negatively affecting you! Remember, if you cannot take care of yourself, how will you take care of others?
Stressful Situations • Death and dying • Mass-casualty incidents • Severe trauma • Abuse • Co-worker death or injury • Vehicle accident caused by EMS personnel • Violent scenes
Warning Signs • Physical • Fatigue • Changes in appetite • Headaches • Insomnia • Irritability
Warning Signs • Psychological: • Fear • Depression • Anger • Frustration • Inability to cope
Stress Management • Understand the effects of stress • Find balance in your life • Change or eliminate stressors • Avoid complaining or worrying about things you cannot change • Expand your social support system • Take care of yourself: diet, exercise, sleep
Stress Management Resources • Partners and co-workers • Be open with and aware of each other • Family members • Chaplains • Wellness Counseling and EAP • CISM
Critical Incident Stress Debriefing • Held within 48-72 hours of a major incident • All information is confidential • CISD leaders and mental health professionals offer suggestions for overcoming stress • Can be initiated by anyone
CISM System • Pre-incident stress education • Peer support • CISD • Follow-up services • Spouse and family support system
Scene Safety • Hazardous materials • Identification and isolation • Electricity • Live electricity is difficult to see • Power off at source • Fire • Protective gear • Do only what you have been trained to do!
Scene Safety • Violent Scenes • Civil disturbances, domestic disputes, crime scenes, large gatherings (mobs) • Motor vehicle accidents • Safety at scene • Highways, streets, and roads • Moving traffic is a major hazard!
Body Substance Isolation • Minimum protection on all calls: gloves and eye protection • Mask and gowns per RGT policy • Hand washing and sanitizer use • Sharps disposal
Body Substance Isolation • Always use Body Substance isolation precautions • Always us a barrier between yourself and the patient • Always wash/sanitize your hands after each patient contact • Make certain immunizations are up to date • Be careful handling sharps
Remember, to always take care of yourself first… ...BSI and Scene Safety