An Introduction to ems. EMS Systems, Research, and Public Health Scott Craig CCEMT-P, I/C (p) Johnson County Community College One of the Top Programs in the US. The History of EMS.
An Introduction to ems EMS Systems, Research, and Public Health Scott Craig CCEMT-P, I/C (p) Johnson County Community College One of the Top Programs in the US
The History of EMS • Nearly every mode of transportation ever invented has been used for the transport of the sick and injured, but much of what we do is derived from war • Civil War- horse and buggy, field hospitals • Prussian War- hot-air balloons! • Korea and Vietnam- Jeeps and helicopters*** • Need to change how we get patients to the hospital, and what we do for them before we get there. • The “White Paper” (1966) - Accidental Death and Disability: The Neglected Disease of Modern Society
The White Paper • Identified severe deficiencies in the delivery of prehospital care in the US and made recommendations to improve and regulate ambulance services • Highway Safety Act of 1966- mandated states implement highway safety programs, including EMS and focused upon education of providers • EMS Act of 1973- $$$$$$$$ • AHA and CPR • Education and practice blueprints • Systems approaches • National Scope of Practice-2006 • The result?
Standards • Regulation and policy- laws and regulations to govern EMS system • Resource Management- equal distribution of resources (reciprocity, assist contracts)*** • Human Resources and Training • Transportation- safe, reliable • Facilities- timely delivery • Communication systems • Public information and education • Medical Direction and Trauma Systems • Evaluation- getting better
Access to EMS • E- 911 • An enhanced system designed to give dispatchers numbers (ANI) and locations (ALI) and give callers instructions for providing lifesaving care • Nearly instantaneous dispatch-even when callers cannot speak • Easy to remember number • Cell phones pose some difficulty • Non-911 • Difficult to remember number, not used very much • Walk-ins/flag downs
National EMS Scope of Practice • 4 levels of certification • Emergency Medical Responder- immediate life-saving stabilization until more highly-trained personnel can arrive • EMT- some emergency medications, transport capabilities, child birth • AEMT- Advanced EMT • Paramedic- skills of all others plus invasive monitoring and treatment techniques, medications, limited surgical interventions • In Kansas…….
The Healthcare system • EMS is only one cog in the wheel • Prehospital versus “out-of-hospital” • Our decisions/actions can have a profound effect on patients • ED/hospitals • Specialty Centers • Trauma • Burn • OB/Peds • Poison • Stroke/Cardiac • Hyperbarics • Psych
Roles and Responsibilities of the EMT • Over the course of the next four months you will learn much • Personal safety and the safety of others- #1 priority • Patient assessment and emergency care • Safe lifting and moving • Transport and transfer of care • Record keeping and data collection • Patient advocacy-they may not have anyone else
Professional Attributes of the EMT • Appearance • Knowledge and skills- in addition to healthcare • Use and maintenance of all equipment • Cleaning and disinfecting of equipment and rig • Safety and security • Knowledge of terrain and localities • State and local laws (traffic) • Physical Demands • Strength/conditioning • Written/verbal communication
Professional attributes, cont. • Personal Traits • Calm and reassuring • Leadership • Good judgment/moral character • Stability/Adaptability • Able to listen • Improvise, adapt, overcome- USMC • Ability to work as part of a TEAM!
Medical Oversight • Medical director- physician who is legally responsible for clinical aspects of the EMS system • Develops and establishes guidelines under which providers function (protocols/standing orders) • Off-line medical direction • On-line medical direction
QualityImprovement • A system of internal and external reviews and audits of all aspects of an EMS system • Known as QI or CQI
The First Attempts at Resuscitation Care to take a guess what saying we got from this??? How have we gotten here from there?
Research • Evidence-based medicine • Formulate a question • Search and research existing literature • Check evidence for reliability and validity • Change how we practice • Advantages to this method? • Disadvantages?
Public Health • Attempts to reduce the morbidity and mortality of illness and injury through preventative strategies geared at protecting, promoting, and improving the health of a population • Notable achievements • Vaccinations • Motor vehicle and workplace safety • Control of infectious disease- antimicrobial, clean water • Reduced mortality for heart attack and stroke • Safer, healthier foods • Decrease in maternal and infant mortality • Decreased tobacco usage • Safe sex practices