Brave Training SolutionsCopyright 2017

www.bravetraining.comEMT-1 V2

INTRODUCTION TOEMERGENCY MEDICAL CARE

&RESERACH IN EMS

OBJECTIVES

Define the EMS systemDifferentiate the roles & responsibilities of

the EMT vs. other EMS providersDiscuss the roles & responsibilities of the

EMT towards the safety of the crew, patient & bystanders

Define quality improvement & discuss the EMT’s role in the process

OBJECTIVES

State the specific statues & regulations in your state EMS system

Assess areas of personal attitude & conduct the EMTCharacterize various methods used to access the EMS system

VISION OF EMSAs written in the EMS AGENDA OF THE FUTUREEmergency Medical Services (EMS) of the future will be community-based health management that is fully integrated with the overall healthcare system. It will have the ability to identify & modify illness & injury risks, provide acute illness & injury care follow-up, & contribute to treatment of chronic conditions & community health monitoring. This new entity will be developed from the redistribution of existing health care resources & will be integrated with other healthcare providers, public health, & public safety agencies. I will improve community health & result in more appropriate use of acute health care resources. EMS will remain the public’s emergency medical safety net.

EMS AGENDA OF THE FUTURE

14 ComponentsIntegration of health services EMS researchLegislation & regulation System financeHuman resources Clinical careEducation systems Public educationPreventionPublic accessMedical direction EvaluationInformation systemsCommunication systems

THREE EMS SYSTEMS

Hospital BasedFire BasedThird Party Service

CommercialNon-Profit

Service may be different but based upon community needs & resourcesGoals are the same

NATIONAL HIGHWAY TRAFFIC SAFETY ADMINISTRATION

(NHTSA)

Lead coordinating agency for EMSSets national standards for training

ACCESS TO EMS

Calls normally come from Public Safety Access Point (PSAP, 911)

911 Service is universally available in over 95% of United States (Some other countries

have similar services)All 911 phone calls to local PSAP’s are toll free

(including Cell Phones)

EDUCATIONAL STANDARDS

NHTSA has developed a “National Scope of Practice”

Includes Description of the profession5 Pre-hospital personal levels

National EMS Educational Standards

AUTHORTIY TO PRACTICE

State EMS officeDetermines scope of practiceLicenses personal & EMS services

MEDICAL OVERSIGHT

Protocols- to allow EMT’s to practice Quality improvement- Future scope of practice

standardsAdministration- Maintaining the EMS System

LOCAL CREDENTIALING

Many areas require proof of proficiencyUsually administered by “Medical Control

Authorities” (MCA)Has a Physician Medical Director (PMD)May have an administrator

EMPLOYER POLICIES & PROCEDURES

Requirements forUniformsStaffing levelsGroomingEquipment repairMandated operational standards

ROLES, RESPONSIBILITIES,& PROFESSIONALISM

Inspecting & maintaining equipment to operational standardsSafety

PersonalPatientOthers on Scene

ROLES, RESPONSIBILITIES,& PROFESSIONALISM

Provide scene evaluation & summon additional resources as needed

Gain access to patientPerform patient assessmentAdminister EMS care while awaiting arrival of

additional resources (Ambulance, Fire, Law)

ROLES, RESPONSIBILITIES,& PROFESSIONALISM

Provide emotional supportPatientFamilyOther responders

ROLES, RESPONSIBILITIES,& PROFESSIONALISM

Maintain “Continuity of Care”The EMT is a step in the ladder

Maintain medical & legal standards & assure patient privacy

Maintain community relations

PROFESSIONALISM

Characteristics of professional behaviorMaintenance of certification & licensure

PROFESSIONALISM

Characteristics of professional behaviorIntegrityEmpathySelf-motivationAppearance & hygieneSelf-confidenceKnowledge of limitations

PROFESSIONALISM

Characteristics of professional behaviorTime management CommunicationsTeamworkRespectTactPatient advocacyCareful delivery of care

MAINTAIN CERTIFICATION(Licensure)

Personal responsibilityContinuing educationSkill competencyCriminal implicationsFees

QUALITY IMPROVEMENT

Dynamic system for continually evaluating & improving care

Patient safetySignificant – one of the most urgent health

care challengesHow errors happen

Skills-based failureRules-based failureKnowledge-based failure

HOW TO REDUCE ERRORS

Debrief callsConstantly question assumptionsUse decision aidsAsk for help

HISTORY OF EMS

EMS was developed during the war times in the 19th & 20th

centuriesIn the early 1960’s technology & training

EMS lagged behind developments in other areas of medicine

Emergency department staffing was often limited & only in large urban areas

KOREAN WAR

Medical helicopters were introduced causing a decreased rates in battlefield injuries

1950’s -1960’s

Ambulance service emerged from primarily run by funeral homes to fire departments & ambulance services

HISTORY OF EMS

1966 National Highway Safety ActCharged the US DOT to create training

standards to assist states in upgrading EMS systems1970

National Registry of EMT’s (NREMT) was created to establish

professional standards

HISTORY OF EMS

Research paper “Accidental Death & Disability: The Neglected Disease of Modern Society” was released in 1966It called for

Development of trainingDevelopment of federal guidelines & policies Providing for emergency care & transportEstablish staffed emergency departments

HISTORY OF EMS

1960 CPR developed

1960’s Portable defibrillators introduced

1966Landmark paper “Accidental Death &

Disability: The Neglected Disease of Modern Society” published

HISTORY OF EMS

1972Television show “Emergency”

1973Congress passed the “National Emergency

Medical Services Act” to lead the improvement of EMS Systems in the US

NATIONAL HIGHWAY TRAFFIC SAFETY ADMINISTRATION (NHTSA)

Administers the EMS technical assessment programs based upon 10 components of EMS with standards for EMS

NHTSA10 KEY COMPONENTS

Regulation & policy FacilitiesResource managementCommunicationsHuman resources & training TransportationMedical direction Trauma systemsEvaluationPublic information & education

EVOLUTION OF CURRENT EMS SYSTEMS

From this the current EMS systems were created using Emergency Medical Technician’s & other parts of the system

NHTSA TECHNICAL ASSISTANCE PROGRAMS

Regulation & policyResource managementHuman resources & trainingTransportationFacilities

ACCESS TO EMS

Improvements to 911 (PSAP) dispatch

COMMUNICATIONS SYSTEM

Central 911 dispatch systemEnhanced 911Dispatchers trained in Emergency Medical

Dispatch (EMD)Ambulance to hospital communications

RadioCell phoneLandline

EDUCATION

Created 6 levels of EMS careLay rescuerEMR-Emergency Medical ResponderEMT-Emergency Medical TechnicianAEMT- Advanced Emergency Medical

TechnicianParamedicParamedic Practitioner

LAY RESCUER

Carries little or no equipmentAble to recognize life-threatening injuriesProvides care till EMS arrives

CPR-AEDRelief of airway obstructionBleeding control

EMERGENCY MEDICAL RESPONDER

Equipped with Oxygen Epi-

PenAED

NaloxoneAirway equipment

Provides care till ambulance arrivesPrimarily seen in Fire Departments but can be

seen in business, industry, & schools

EMT-BASIC

Provides basic, non-invasive skillsPatient assessmentAirway adjunctsAEDChildbirthSpinal immobilizationAssists with patient’s medication administrationCan transport patient

EMT-BASIC

Record keepingPatient advocacyCommunicationsExtricationVehicle & equipment maintenance

EMT-INTERMEDIATE

Can provide all functions of EMTProvides more advanced skills

Advanced airwayECG ‘sIV FluidsAdministration of many medications

PARAMEDIC

Provides all functions of EMT & EMT-IProvides advanced techniques including

ECG interpretationDrug therapyInvasive airwaysManual defibrillation

PARAMEDIC PR ACTIONER

Works with patients in the home setting to reduce ER admissionsCan redirect patient to another facilityAssists paramedics on scene with difficult cases

AUTHORIZATION TO PRACTICE

Legislative decisions on scope of practiceState EMS office oversightMedical oversight

Clinical protocolsOfflineOnlineStanding ordersQuality improvementAdministrative

AUTHORIZATION TO PRACTICE

Local credentialingAdministrativeEmployer policies & procedures

ROLES, RESPONSIBILITIES, & PROFESSIONALISM OF EMS PERSONAL

We will reviewRoles & responsibilitiesProfessionalism

ROLES & RESPONSIBILITIES

Maintain vehicle & equipment readinessSafetyPersonalPatientOthers on the scene

Operate emergency vehiclesProvide scene leadershipPerform patient assessment

ROLES & RESPONSIBILITIES

Administer emergency medical care to a variety of patients with varied medical conditions

Provide emotional supportPatientPatient’s familyOther responders

ROLES & RESPONSIBILITIES

Integration with other professionals & continuity of care

Medical personnelLaw enforcementEmergency managementHome healthcare providersOther responders

ROLES & RESPONSIBILITIES

Resolve emergency incidentMaintain medical & legal standardsProvide administrative supportEnhance professional developmentDevelop & maintain community relations

CHARACTERISTICS OF PROFESSIONAL BEHAVIOR

IntegrityEmpathySelf-motivationAppearance & hygieneSelf-confidenceTime management

CHARACTERISTICS OF PROFESSIONAL BEHAVIOR

CommunicationVerbalWritten

Teamwork & diplomacyRespect for patients, co-workers & other healthcare professionalsPatient advocacyCareful delivery of service

LIAISON WITH OTHER PROFESSIONALS

Conflicts may occur when responsibilities overlap with other professionals

Police take charge at crime scenesFire takes charge fire & HAZMAT ScenesEMS provides for patient care & transportOther medical professionals care for patient at a

fixed facility (hospital, nursing home, clinic, patient’s home)

Cooperation is essentialIncident Command System needs to be practiced

MAINTENANCE OF CERTIFICATION & LICENSURE

Personal responsibilityContinuing educationSkill competency verificationCriminal implicationsFees

QUALITY IMPROVEMENT

System for continually evaluating & improving care

Continuous Quality Improvement (CQI)Dynamic process

EMT’s ROLE

DocumentationRun review & auditsFeedback from patients & hospital staffMaintaining equipmentContinuing educationSkills maintenance

PATIENT SAFETY

Significant – One of the most urgent health care challenges

High-risk activitiesHand-offCommunication issuesDropping patientsAmbulance crashesSpinal immobilization

PATIENT SAFETY

How Errors HappenSkills-based failureRules-based failureKnowledge-based failure

PREVENTING ERRORS

EnvironmentalClear protocolsLightMinimal interruptionsOrganization & packaging of drugs

PREVENTING ERRORS

IndividualReflection in actionConstantly question assumptionsReflection biasUse decision aidsAsk for help

REASERCH IN EMS

Impact of research on EMS CareResearch findings are important to identify what

should be changed in EMSAssessment & management and to improve

patient care & outcome (i.e. CPR guidelines change based on current research )

Quality assurance research for an EMS system can improve service deliveryData collection

EVIDENCE BASED DECISION MAKING

Traditional medical practice Is based onMedical knowledgeIntuitionJudgment

High-quality patient care should focus on procedures proven useful in improving patient outcomesThe challenge for EMS is the relative lack of pre-hospital research

EVIDENCE BASED DECISION MAKING

Evidence-based decision-making techniqueFormulate a question about appropriate

treatments Search medical literature for related research Appraise evidence for validity & reliabilityIf evidence supports a change in practice,

adopt the new therapy allowing for unique patient needs

PAPERWORK

LocalSchoolMunicipal

StateVaries from state to state

Federal Can be sent via commercial software

COURSE DESCRIPTION

This course meets the requirements of NHTSA EMS Training

NREMT State Local facility

COURSE EXPECTATIONS

Upon successful completion of this training program the student may be take the NREMT exams A practical & computer based exam will need to be passed to state certification (licensure)Student will be required to complete all sections of this training program & pass all exams to be recommended to take the NREMT exam

PHYSICAL EXAM

EXAMStudent must pass physical exam as

specified by this institutionIMMUNIZATIONS

Influenza (Flu)Hep BMMRTDaP

CRIMINAL BACKGROUND CHECK

Most states require medical personnel to have a criminal background check prior to

certification (licensure)Requirements vary by stateSome clinical sites require students to have a

clear record

CRITERIA FOR CERTIFICATION

Successful course completionBe physically & mentally able to met the

safe & effective practices of the EMT-BWritten & practical examsState & local requirements

AMERICANS WITHDISABILITIES ACT

Federal, state, & local requirements will be meet

HARASSMENT

Class policy on harassment

PROGRAM POLICIES

Uniforms (grooming) ConfidentialityDrugs (alcohol) WeaponsAttendance SmokingSafetyGradesDismissal from the program

INCIDENT MANAGEMENT SYSTEM HOME WORK

Complete FEMA independent Study CoursesICS-100-b Introduction to Incident

Command SystemICS-700.a National Incident Management

System (NIMS) An IntroductionTurn copies of Online Certificates of Completion

to instructorhttp://www.training.fema.gov/is/crslist.aspx

?? QUESTIONS ??

NEXT ASSIGNMENT

THE END