2National EMS Education Standard Competencies Preparatory Integrates comprehensive knowledge of the EMS system, safety/well-being of the paramedic, and medical/legal and ethical issues, which is intended to improve the health of EMS personnel, patients, and the community.
3National EMS Education Standard Competencies Emergency Medical Services (EMS) SystemsEMS systemsHistory of EMSRoles/responsibilities/professionalism of EMS personnelQuality improvementPatient safety
4National EMS Education Standard Competencies ResearchImpact of research on emergency medical responder (EMR) careData collectionEvidence-based decision makingResearch principles to interpret literature and advocate evidence-based practice
6Introduction The public’s perception of you is based on: TV and articlesYour treatment of their loved onesContinued education is a must.Treat everyone with respect and dignity.
7The History of EMS 1485 1800s 1926 1940s First use of an ambulance Transport only1800sFirst use of ambulance/ attendant to care for injuries on site1926Service started similar to present day1940sEMS turned over to fire and police departmentsNo standards set
9The 20th Century and Modern Technology 1956Mouth-to-mouth resuscitation developedLate 1950s/early 1960sFocus shifted to bringing hospital to patientsMICUs developed
10The 20th Century and Modern Technology 1965: “The White Paper” releasedFindings included:Lack of uniform laws and standardsPoor-quality equipmentLack of communicationLack of training
11The 20th Century and Modern Technology “The White Paper” findings outlined 10 critical points for EMS systemLed to National Highway Safety ActCreated US Department of Transportation1968Training standards implemented9-1-1 created
12The 20th Century and Modern Technology 1969First true paramedic programStandards for ambulance design and equipment1970sNREMT beganCourtesy of Eugene L. Nagel and the Miami Fire Department
13The 20th Century and Modern Technology 1970s (cont’d)1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS1973: Emergency Medical Services System Act1977: First National Standard Curriculum for Paramedics developed by US DOT
14The 20th Century and Modern Technology 1980s/1990sNumber of trained personnel grewNHTSA developed 10 system elements to help sustain EMS systemResponsibility for EMS transferred to the statesMajor legislative initiatives
15Licensure, Certification, and Registration Certiﬁcation examination:Ensures all health care providers have the same basic level of knowledge and skillOnce you pass certification you can apply for state licensure.
16Licensure, Certification, and Registration How states control who practicesAlso known as certification or credentialingUnlawful to practice without licensureHolding a license shows you:Completed initial educationMet the requirements to achieve the licenseParamedics are required to receive medical direction.
17Licensure, Certification, and Registration You may be required to be registered and licensed.Board of registration holds your:Education recordsState or local licensureRecertification
18Licensure, Certification, and Registration ReciprocityCertification granted from another state/agencyRequirements:Hold a current state certification.Be in good standing.National Registry certification.
19The EMS SystemA complex network of coordinated services that provides care to the communityThe public needs to be taught how to:Recognize emergencies.Activate the EMS system.Provide basic care.
20The EMS System Patient outcomes determined by: Bystander care TransportationDispatchEmergency department careResponseDefinitive carePrehospital careRehabilitation
21The EMS System Dispatchers Usually the public’s first contactTraining level varies by stateScene may differ from what dispatcher relays
22The EMS System As a paramedic, you must: Develop care plan Decide on transport methodDetermine receiving facilityBe active in your community.
23Levels of Education EMS system functions from a federal to local level Federal: National EMS Scope of Practice ModelState: LicensureLocal: Medical director decides day-to-day limits
24Levels of EducationThe national guidelines designed to create more consistent delivery of EMS nationallyMedical director can only limit scope of practice2009: National EMS Education StandardsNREMT provides a national standard for testing and certification
28Advanced EMT (AEMT) Formerly EMT-I Initially developed in 1985 Major revision in 1999Trained in:More advanced pathophysiologySome advanced procedures
29Paramedic Highest level to be nationally certified 1999: Major revisions to curriculum greatly increased level of training and skillsEven if independently licensed, you must:Function under guidance of physicians.Be affiliated with a paramedic-level service.
30Paramedic Education Initial education Most states base education programs on the National EMS Education Standards.Outline minimum knowledge needed for practiceStates require varying hours of education.National average: 1,000-1,500 hours
31Paramedic Education Continuing education Most states require proof of hours.Attend conferences and seminars.Read EMS journals.Get everyone involved in postrun critiques.The responsibility for continuing education rests with you.
32Additional Types of Transports Specialty centerRequire in-house staffs of specialistsTransport time can be slightly longer.Know:Location of centersProtocol for direct transportInterfacilityUse for:Nonambulatory patientsPatients who require medical monitoringOther medical professionals may accompany patient.
33Working With Other Professionals Hospital staffBecome familiar with the hospital.You may consult with staff by using the radio through established procedures.The best patient care occurs when emergency care providers have close rapport.
35Working With Other Professionals Continuity of careThe community has expectations of EMSFocus on preventionYou will interact with many professional groupsUnderstand your role, as well as theirs.
36National EMS Group Involvement Many national and state organizations exist and invite paramedic membership.Impact EMS futureProvide access to resourcesPromote uniformity
37ProfessionalismYou have responsibilities as a health care professional.You will be measured by:Standards, competencies, and education requirementsPerformance parametersCode of ethics
38Professionalism You are in a highly visible role in your community. You must:Instill confidence.Establish and maintain credibility.Show concern for your patients.
39Professionalism Your appearance is of utmost importance. Has more impact than you may thinkPresent a professional image and treat colleagues with respect.Arguing with colleagues is inappropriate.Raise issues at the appropriate time and place.
40Professionalism Attributes of professionalism: Integrity CommunicationsEmpathyExpress and exchange ideas, thoughts, findingsSelf-motivationHave an internal drive for excellenceListen well.Documentation is important.ConfidenceStrive to be the best paramedic you can.
41Professionalism Attributes of professionalism (cont’d): Teamwork and respectCareful delivery of serviceWork togetherDeliver the highest-quality carePatient advocacyTime managementAct in the patient’s best interestPrioritize your patient’s needsInjury preventionAdministration
42ProfessionalismMore health care locations are using paramedic services, including:Administering vaccinationsServing as home health nursesPerforming special transports
44Roles and Responsibilities Teach the community about prevention of injury and illness.Appropriate use of EMSCPR trainingInfluenza and pandemic issuesCampaign for EMS systemCourtesy of Captain David Jackson, Saginaw Township Fire Department
45Medical Direction Paramedics carry out advanced skills Must take direction from medical directorsMedical directors may perform many roles:Educate and trainRecommend new personnel or equipmentDevelop protocols, guidelines, and quality improvement programs
46Medical Direction Roles of the medical director (cont’d): Provide input for patient careInterface between EMS and other agenciesAdvocate for EMSServe as “medical conscience”
47Medical DirectionMedical directors also provide online and off-line medical control.OnlineAllows for the development of:Provides immediate and specific patient care resourcesProtocols or guidelinesStanding ordersAllows for continuous quality improvementProceduresTrainingCan render on-scene assistanceOffline
48Improving System Quality Continuous quality improvement (CQI)Tool to continually evaluate careQuality controlProcess of assessing current practices, looking for ways to improveDynamic process
49Improving System Quality Review ambulance runs when possible.Focus of CQI is improving careCQI can be a peer review.Be professionalShould be a constructive process
50Improving System Quality CQI programs help prevent problems by:Evaluating day-to-day operationsIdentifying possible stress pointsLook for ways to eliminate human error.Ensure adequate lightingLimit interruptionsStore medications properly
51Improving System Quality Ways to eliminate human error (cont’d)Be careful when handing patients off.Three main sources of errors:Rules-based failureKnowledge-based failureSkills-based failure
52Improving System Quality Ways to eliminate human error (cont’d)Agencies need clear protocols.Be aware of your environment.Ask yourself “Why am I doing this?”Use cheat sheets.Be conscientious of protocols.
53EMS Research EMS has been drawn toward evidence-based practice. Protocols should be based on scientific findings.Research should be performed by properly educated researchers.More education centers now offer an EMS track.
54The Research Process Identify problem, procedure, or question. Develop research agenda by specifying:Questions to be answeredMethods to gather dataStick to the research agenda.
55The Research Process Determine the research domain. Area of researchDomains: clinical, systems, or educationResearch may be performed within a research consortium.
56Funding Researchers should use an IRB when a project begins. All research requires funding.Any type of support is considered funding.Researchers must:Disclose sources of funding.Maintain transparency of research methods.
57Types of Research Qualitative Quantitative Focuses on questions within surrounding events and concurrent processesOften used when quantitative research does not provide answersMajority of researchQuantitativeBased on numeric dataThree types:ExperimentalScientific approachNonexperimentalDescriptiveSurvey
58Types of Research Retrospective Examines available data May be used to:Develop educational sessions for EMS personnelPlan public education and prevention strategiesIn large studies, data often collected from widespread databasesTechniques can be used at the local level
59Types of Research Other types of research: Prospective Cohort Case studyCross-sectional designLongitudinal designLiterature review
60Research Methods Identify the group(s) necessary for research. Ways to select subjects for research:Systematic samplingAlternative time frame samplingConvenience samplingParameters should be identified.
61Research Methods Studies can be: Research statistics can be: Blinded Subjects not told project specificsSingle-, double-, or triple-blindedUnblindedParticipants advised of all aspectsResearch statistics can be:DescriptiveObservations madeNo attempts made to alter eventInferentialHypothesis used to prove one finding
62Ethical Considerations The IRB monitors whether a study is conducted ethically and ensures:Protection of participantsAppropriate conductBenefits must outweigh risks.Conflicts of interest must be identified.
63Ethical Considerations All subjects must:Give consent.Know their rights will be protected.Participate voluntarily.Be informed of all potential risks.Be free to withdraw at any time.
64Evaluating Medical Research When evaluating research, look for certain criteria to determine the research quality.Know what questions to answer.Read every part of the research.Consider the type of journal.
65Evaluating Medical Research Peer review helps ensure quality.Subject-matter experts review material prior to publicationInternet sites can be valid tools.Studies must follow a structured process.There will always be limitations.
66Evidence-Based Practice Care should focus on procedures that have proven useful in improving patient outcomes.Evidence-based practice will have a growing role in EMS.Stay up to date on health care advances.Make sure you understand new research results.
67Evidence-Based Practice Level IHighest-quality evidenceMultiple studiesLarge sample sizeRandomizationUses multiple techniquesSignificant positive effect outcomeLevel IISingle, randomly controlled trial, orMultiple trials with small sample sizes, orLarge, randomly controlled studiesModerate effect on patient outcome
68Evidence-Based Practice Level IIILevel IIIA: Well-designed trial without randomizationLevel IIIB: Evidence from causal comparison and case or cohort studiesLevel IIIC: Evidence gathered from single experiments
69Evidence-Based Practice Level IVLowest levelReviews of:Descriptive studiesExpert opinionUncontrolled studies
70Evidence-Based Practice Research determines the effectiveness of treatment.Can help identify which procedures, medications, and treatments do and do not workWhen following a new study, measure the results with your CQI program.
71SummaryAmbulance corps were developed during World Wars I and II to transport and rapidly care for soldiers.Helicopters were used to rapidly remove soldiers from the battlefield during the Korean and Vietnam Wars.
72SummaryIn 1966 the National Academy of Science and the National Research Council released “The White Paper” outlining 10 points.The National Highway Safety Act and the US Department of Transportation were created as a result.Paramedics must be licensed (also known as certification or credentialing) before performing any functions.
73SummaryStandards for prehospital emergency care, and the people who provide it, are regulated under state law by a state office of EMS.There are four levels of training: emergency medical responder, emergency medical technician, advanced emergency medical technician, and paramedic.Paramedics may be involved in interfacility transports and transports to specialty centers.
74SummaryParamedics should be familiar with the roles and responsibilities of other health care providers and public safety agencies.Continuing education programs expose paramedics to new research findings and refresh their skills and knowledge.A physician medical director authorizes EMS providers to provide care in the field through off-line or online medical direction.
75SummaryThere are expected standards and a code of ethics for all paramedics.There are many professional attributes that a paramedic is expected to have, including but not limited to integrity, empathy, teamwork, patient advocacy, and time management skills.
76SummarySome of the primary paramedic responsibilities include preparation, response, scene management, patient assessment and care, management and disposition, patient transfer and report, documentation, and return to service.Paramedics evaluate their care through quality control and continuous quality improvement.
77SummaryResearch establishes a consensus of what EMS personnel should or should not do. Research may be quantitative or qualitative.There are many ethical considerations when conducting research. Researchers must always obtain consent from subjects, inform them of the research parameters, and protect their rights and welfare.
78SummaryParamedics should know how to evaluate the quality of research, including how to recognize peer-reviewed literature and how to find quality research on the Internet.Review medical literature as it becomes available, and stay up to date on changing guidelines.