module : maine ems on-line medical control training program module 1: ems systems
TRANSCRIPT
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
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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
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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
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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
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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)
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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
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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
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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
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Scope of Practice
• The breadth of practice of a provider defined by licensure, education, and medical director authorization
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Scope of Practice
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Scope of Practice
State License
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Scope of Practice
Education
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Scope of Practice
Medical Director (System)
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Scope of Practice
State License
Medical Director (System)
Education
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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
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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
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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)
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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
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Contact Information
• Maine Emergency Medical Services
• 45 Commerce Drive
• 152 State House Station
• Augusta, ME 04333
• (207) 626-3860
• www.maine.gov/dps/ems
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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
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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
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Medical Directions and Practices Board
• Reviews and establishes Protocols
• Reviews/approves certain medical devices
• Establishes Quality Assurance benchmarks
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Quality Improvement
• Centralized function
• Services send data to region– Goes to state– Entered in statewide database– QI committees– Hospital QI nurse / coordinator
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MEMS
• Other Committees
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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
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Androscoggin, Franklin, & Oxford
• Tri County EMS
• 300 Main St.
• Lewiston, ME 04240
• (207) 795-2880
• Joanne LeBrun, Regional Coordinator
• Kevin Kendall MD, Medical Director
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Kennebec & Somerset
• Kennebec Valley EMS
• 71 Halifax St
• Winslow, ME 04901
• (207) 877-0936
• Rick Petrie, Regional Coordinator
• Timothy Pieh MD, Medical Director
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Hancock, Penobscot, Piscataquis, &
Washington• Northeast EMS
• 354 Hogan Rd
• Bangor, ME 04401
• (207) 974-4880
• Rick Petrie, Regional Coordinator
• Jonnathan Busko MD, Medical Director
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Aroostook
• Aroostook EMS
• 111 High St.
• Caribou, ME 04736
• (207) 492-1624
• Steve Corbin, Regional Coordinator
• Peter Goth MD, Medical Director
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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
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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)
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Maine EMS Service License Levels
• Basic Life Support
• Advanced Life Support
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Service Levels of Performance
• First Responder
• Emergency Medical Technician (EMT)
• EMT-Intermediate
• Paramedic permit
• Paramedic service
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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
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Basic Life Support
• First responder
• Ambulance Attendant*
• Emergency Medical Technician (EMT)
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Advanced Life Support
• EMT-Intermediate
• EMT-Critical Care*
• EMT-Paramedic
• Paramedic Interfacility Transfer
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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
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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)
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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
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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
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Summary
• EMS is not ED Care
• All EMS agencies are not the same
• Maine EMS– Oversees– Monitors– Supports
• Statewide protocols
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End of Module 1
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