AN INTRODUCTION TO EMSEMS 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

Quality Improvement

• 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