maine ems on-line medical control training program

Module :

Maine EMS On-Line Medical Control

Training Program

Module 1: EMS systems

© EMRCI 2008 Module : 1

Module 1: EMS Systems

• Objectives– By the end of this module, you will be able

to:• Identify at least 6 components of an EMS system• Differentiate between a Basic Life Support and

Advanced Life Support EMS Service• Describe protocols• Define scope of practice• Describe the structure of Maine EMS


Overview of EMS

• EMS– Provision of care outside of hospital by

personnel with varying levels of training– Personnel are physician extenders

• Not delegated practice• Individually licensed• Require physician endorsement


16 Components• Manpower

• Training

• Communication

• Transportation

• Emergency Facilities

• Critical Care Units

• Public Safety Agencies

• Disaster Planning

• Medical Direction

• Consumer Participation• Access to Care• Patient Transfers• Standardized Record

Keeping• Public Information and

Education • System Review and

Evaluation • Mutual Aid


Level of Practice

• Basic Life Support– Staffing by EMT-Basics

• Defined by level of training• Based on NHTSA / DOT National Standard

Curriculum

– Limited equipment• Limited medications• AED• +/- Advanced Airway


Level of Practice

• Advanced Life Support– Either EMT-Intermediate, Critical Care

Technician or Paramedic– Staffing by EMT-Paramedics

• Much more training (1000+ hours)

– Full complement of medications– Cardiac monitor / defibrillation /

pacemaker / cardioversion– Advanced airway (intubation)


Protocols

• Written documents that guide the EMT’s care

• Series of instructions

• Based on chief complaint or clinical impression

• Define what interventions may / must be done


Protocols

• Protocols divided into 2 parts– Standing orders

• Authorized by protocol• EMT may perform these items if indicated

without contacting medical control• Defined by service medical director

– Orders requiring on-line medical control• EMT must contact and consult with medical

control before initiating these protocols


Protocols

• Define care for majority of patients

• Some patients fall outside protocols– Medical control may authorize EMT to

utilize any protocol– Medical control may make orders

outside protocols if the orders fall in EMT’s Scope of Practice


Scope of Practice

• The breadth of practice of a provider defined by licensure, education, and medical director authorization


Scope of Practice


Scope of Practice

State License


Scope of Practice

Education


Scope of Practice

Medical Director (System)


Scope of Practice

State License

Medical Director (System)

Education


Overview of Maine EMS

• Maine is relatively unique– No requirement for ALS services to

have a medical director

• Medical direction carried out at regional and state level

• Statewide protocols

• State QI


State Level Organization

R e g io na l E M S O ffices S te ve n E . D ia z , M DE M S M e d ica l D ire c to r

B o a rd o f E M S (1 7)

Ja y B ra d sh awD ire c to r

A n ne H . Jo rd anC o m m iss io n er

D e p artm en t o f P u b lic S a fe ty

G o vern o r Jo h n E lia s B a ld a cci


Board of EMS Members

• Regional Councils (6)• Ambulance Services (2)• Non Transporting Services• Public (2)• Emergency Physician• Emergency Nurse (RN)• Emergency Medical Dispatch• Hospitals• Fire Services (2)


Maine EMS Office (MEMS)

• Director– Jay Bradshaw

• Staff– Training and Education: Jan Brinkman, RN EMT-P– Licensing Agent: Alan Leo, EMT– Licensing Agent: Dawn Kinney, EMT-P– Licensing Assistant: Karen Cutler– Data & Preparedness Coordinator: Jon Powers,

NREMT-P– EMD Coordinator: Drexell White, EMT-P


Contact Information

• Maine Emergency Medical Services

• 45 Commerce Drive

• 152 State House Station

• Augusta, ME 04333

• (207) 626-3860

• [email protected]

• www.maine.gov/dps/ems


Regional Offices

E d u ca tion C oo rd ina to r Q u a lity Im p ro ve m en t C oo rd in a to r A d m in is tra tive S u pp o rt

R e g ion a l C o o rd in a to r M e d ica l D ire c to r

B o a rd o f D ire c to rs


Medical Directions and Practice Board

• State Medical Director– Steve Diaz MD

• Medical Direction and Practice Board– State Medical Director– 6 regional medical directors– Maine ACEP representative


Medical Directions and Practices Board

• Reviews and establishes Protocols

• Reviews/approves certain medical devices

• Establishes Quality Assurance benchmarks


Quality Improvement

• Centralized function

• Services send data to region– Goes to state– Entered in statewide database– QI committees– Hospital QI nurse / coordinator


MEMS

• Other Committees


York, Cumberland, & Sagadahoc

• Southern Maine EMS

• 496 Ocean St.

• So. Portland, ME 04106

• (207) 741-2790


• Donnell Carroll, Regional Coordinator

• Tony Bock, MD, Medical Director


Androscoggin, Franklin, & Oxford

• Tri County EMS

• 300 Main St.

• Lewiston, ME 04240

• (207) 795-2880


• Joanne LeBrun, Regional Coordinator

• Kevin Kendall MD, Medical Director


Kennebec & Somerset

• Kennebec Valley EMS

• 71 Halifax St

• Winslow, ME 04901

• (207) 877-0936


• Rick Petrie, Regional Coordinator

• Timothy Pieh MD, Medical Director


Hancock, Penobscot, Piscataquis, &

Washington• Northeast EMS

• 354 Hogan Rd

• Bangor, ME 04401

• (207) 974-4880


• Rick Petrie, Regional Coordinator

• Jonnathan Busko MD, Medical Director


Aroostook

• Aroostook EMS

• 111 High St.

• Caribou, ME 04736

• (207) 492-1624


• Steve Corbin, Regional Coordinator

• Peter Goth MD, Medical Director


Lincoln, Waldo, & Knox

• Mid Coast EMS

• P O Box 610

• Union, ME 04862

• (207) 785-5000


• Bill Zito, Regional Coordinator

• Colin Coor MD, Medical Director


Local EMS Services in Maine

• 285 licensed agencies• Transporting (Ambulance)

– Ground– Fixed wing (Airplane)– Rotor wing (Helicopter)

• Non-transporting• Unregulated industrial / private first

response agencies (e.g. ski patrols)


Maine EMS Service License Levels

• Basic Life Support

• Advanced Life Support


Service Levels of Performance

• First Responder

• Emergency Medical Technician (EMT)

• EMT-Intermediate

• Paramedic permit

• Paramedic service


State Levels of Certification / Practice

• First responder (282)

• Licensed ambulance attendant (15)

• EMT (3,952)

• EMT Intermediate (841)

• EMT-Critical Care (27)

• EMT- Paramedic (1,016)

• PIFT


Basic Life Support

• First responder

• Ambulance Attendant*

• Emergency Medical Technician (EMT)


Advanced Life Support

• EMT-Intermediate

• EMT-Critical Care*

• EMT-Paramedic

• Paramedic Interfacility Transfer


Federal Grants / Projects

• Rural Access to Emergency Devices: $1m (4 years)– Free AEDs to rural responders and

community centers– Discounted AEDs available statewide– ~ 10,000 people trained in CPR/AED– Ended 8/31/06


Trauma / EMS

• Maine EMS Trauma Plan– 1990: Federal Trauma System Grant– Trauma Advisory Committee established– October 1996: Trauma Plan Implemented– 2004: Technical Assistance Teams– Formerly supported by federal grant

($40,000/yr)


Emergency Medical Service for Children

• DHHS/MCHB funded $115,000/year– Injury prevention projects

• Playground safety• CPS• Health & Safety Fairs

– EMS for SHCN patients– Data collection (NEMSIS)– Pediatric Equipment, training, and

medical control


Statewide Protocols

• Universal protocols statewide• All paramedics practice under the

same protocols• Regional variants

– Research / Pilot projects by region• CPAP in several Regions• Mid Coast EMS: Stroke protocol• Regions 1 & 4: New PIFT• IO: now ubiquitous


Summary

• EMS is not ED Care

• All EMS agencies are not the same

• Maine EMS– Oversees– Monitors– Supports

• Statewide protocols


End of Module 1

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maine ems on-line medical control training program

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