Presentation on theme: "Chapter 1 EMS Systems. Preparatory Integrates comprehensive knowledge of the EMS system, safety/well-being of the paramedic, and medical/legal and ethical."— Presentation transcript:
Chapter 1 EMS Systems
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. National EMS Education Standard Competencies
Emergency Medical Services (EMS) Systems –EMS systems –History of EMS –Roles/responsibilities/professionalism of EMS personnel –Quality improvement –Patient safety National EMS Education Standard Competencies
Research –Impact of research on emergency medical responder (EMR) care –Data collection –Evidence-based decision making –Research principles to interpret literature and advocate evidence-based practice National EMS Education Standard Competencies
Introduction The public’s perception of you is based on: –TV and articles –Your treatment of their loved ones Continued education is a must. Treat everyone with respect and dignity.
The History of EMS 1485 –First use of an ambulance –Transport only 1800s –First use of ambulance/ attendant to care for injuries on site 1926 –Service started similar to present day 1940s –EMS turned over to fire and police departments –No standards set
The 20th Century and Modern Technology 1956 –Mouth-to-mouth resuscitation developed Late 1950s/early 1960s –Focus shifted to bringing hospital to patients –MICUs developed
The 20th Century and Modern Technology 1965: “The White Paper” released –Findings included: Lack of uniform laws and standards Poor-quality equipment Lack of communication Lack of training
The 20th Century and Modern Technology “The White Paper” findings outlined 10 critical points for EMS system –Led to National Highway Safety Act –Created US Department of Transportation 1968 –Training standards implemented –9-1-1 created
The 20th Century and Modern Technology 1969 –First true paramedic program –Standards for ambulance design and equipment 1970s –NREMT began Courtesy of Eugene L. Nagel and the Miami Fire Department
The 20th Century and Modern Technology 1970s (cont’d) –1971: Emergency Care and Transportation of the Sick and Injured published by the AAOS –1973: Emergency Medical Services System Act –1977: First National Standard Curriculum for Paramedics developed by US DOT
The 20th Century and Modern Technology 1980s/1990s –Number of trained personnel grew –NHTSA developed 10 system elements to help sustain EMS system –Responsibility for EMS transferred to the states –Major legislative initiatives
Licensure, Certification, and Registration Certiﬁcation examination: –Ensures all health care providers have the same basic level of knowledge and skill –Once you pass certification you can apply for state licensure.
Licensure, Certification, and Registration Licensure: –How states control who practices –Also known as certification or credentialing –Unlawful to practice without licensure Holding a license shows you: –Completed initial education –Met the requirements to achieve the license Paramedics are required to receive medical direction.
Licensure, Certification, and Registration You may be required to be registered and licensed. –Board of registration holds your: Education records State or local licensure Recertification
Licensure, Certification, and Registration Reciprocity –Certification granted from another state/agency –Requirements: Hold a current state certification. Be in good standing. National Registry certification.
The EMS System A complex network of coordinated services that provides care to the community The public needs to be taught how to: Recognize emergencies. Activate the EMS system. Provide basic care.
The EMS System –Bystander care –Dispatch –Response –Prehospital care –Transportation –Emergency department care –Definitive care –Rehabilitation Patient outcomes determined by:
The EMS System Dispatchers –Usually the public’s first contact –Training level varies by state Scene may differ from what dispatcher relays
The EMS System As a paramedic, you must: –Develop care plan –Decide on transport method –Determine receiving facility –Be active in your community.
Levels of Education EMS system functions from a federal to local level –Federal: National EMS Scope of Practice Model –State: Licensure –Local: Medical director decides day-to-day limits
Levels of Education The national guidelines designed to create more consistent delivery of EMS nationally –Medical director can only limit scope of practice 2009: National EMS Education Standards –NREMT provides a national standard for testing and certification
Advanced EMT (AEMT) Formerly EMT-I Initially developed in 1985 –Major revision in 1999 Trained in: More advanced pathophysiology Some advanced procedures
Paramedic Highest level to be nationally certified –1999: Major revisions to curriculum greatly increased level of training and skills Even if independently licensed, you must: –Function under guidance of physicians. –Be affiliated with a paramedic-level service.
Paramedic Education Initial education –Most states base education programs on the National EMS Education Standards. Outline minimum knowledge needed for practice –States require varying hours of education. National average: 1,000-1,500 hours
Paramedic 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.
Additional Types of Transports Specialty center –Require in-house staffs of specialists –Transport time can be slightly longer. –Know: Location of centers Protocol for direct transport Interfacility –Use for: Nonambulatory patients Patients who require medical monitoring –Other medical professionals may accompany patient.
Working With Other Professionals Hospital staff –Become 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.
Working With Other Professionals Continuity of care –The community has expectations of EMS –Focus on prevention –You will interact with many professional groups Understand your role, as well as theirs.
National EMS Group Involvement Many national and state organizations exist and invite paramedic membership. –Impact EMS future –Provide access to resources –Promote uniformity
Professionalism You have responsibilities as a health care professional. You will be measured by: –Standards, competencies, and education requirements –Performance parameters –Code of ethics
Professionalism You are in a highly visible role in your community. You must: –Instill confidence. –Establish and maintain credibility. –Show concern for your patients.
Professionalism Your appearance is of utmost importance. –Has more impact than you may think Present a professional image and treat colleagues with respect. –Arguing with colleagues is inappropriate. –Raise issues at the appropriate time and place.
Professionalism –Integrity –Empathy –Self-motivation Have an internal drive for excellence –Confidence Strive to be the best paramedic you can. –Communications Express and exchange ideas, thoughts, findings Listen well. Documentation is important. Attributes of professionalism:
Professionalism –Teamwork and respect Work together –Patient advocacy Act in the patient’s best interest –Injury prevention –Careful delivery of service Deliver the highest- quality care –Time management Prioritize your patient’s needs –Administration Attributes of professionalism (cont’d):
Professionalism More health care locations are using paramedic services, including: –Administering vaccinations –Serving as home health nurses –Performing special transports
Roles and Responsibilities Teach the community about prevention of injury and illness. –Appropriate use of EMS –CPR training –Influenza and pandemic issues –Campaign for EMS system Courtesy of Captain David Jackson, Saginaw Township Fire Department
Medical Direction Paramedics carry out advanced skills –Must take direction from medical directors Medical directors may perform many roles: –Educate and train –Recommend new personnel or equipment –Develop protocols, guidelines, and quality improvement programs
Medical Direction Roles of the medical director (cont’d): –Provide input for patient care –Interface between EMS and other agencies –Advocate for EMS –Serve as “medical conscience”
Medical Direction Medical directors also provide online and off-line medical control. Online –Provides immediate and specific patient care resources –Allows for continuous quality improvement –Can render on-scene assistance Offline –Allows for the development of: Protocols or guidelines Standing orders Procedures Training
Improving System Quality Continuous quality improvement (CQI) –Tool to continually evaluate care –Quality control –Process of assessing current practices, looking for ways to improve –Dynamic process
Improving System Quality Review ambulance runs when possible. Focus of CQI is improving care CQI can be a peer review. –Be professional –Should be a constructive process
Improving System Quality CQI programs help prevent problems by: –Evaluating day-to- day operations –Identifying possible stress points Look for ways to eliminate human error. –Ensure adequate lighting –Limit interruptions –Store medications properly
Improving System Quality Ways to eliminate human error (cont’d) –Be careful when handing patients off. –Three main sources of errors: Rules-based failure Knowledge-based failure Skills-based failure
Improving 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.
EMS 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.
The Research Process Identify problem, procedure, or question. Develop research agenda by specifying: –Questions to be answered –Methods to gather data Stick to the research agenda.
The Research Process Determine the research domain. –Area of research –Domains: clinical, systems, or education Research may be performed within a research consortium.
Funding 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.
Types of Research Qualitative –Focuses on questions within surrounding events and concurrent processes –Often used when quantitative research does not provide answers –Majority of research Quantitative –Based on numeric data –Three types: Experimental –Scientific approach Nonexperimental –Descriptive Survey
Types of Research Retrospective –Examines available data –May be used to: Develop educational sessions for EMS personnel Plan public education and prevention strategies –In large studies, data often collected from widespread databases Techniques can be used at the local level
Types of Research Other types of research: –Prospective –Cohort –Case study –Cross-sectional design –Longitudinal design –Literature review
Research Methods Identify the group(s) necessary for research. Ways to select subjects for research: –Systematic sampling –Alternative time frame sampling –Convenience sampling Parameters should be identified.
Research Methods Studies can be: –Blinded Subjects not told project specifics Single-, double-, or triple-blinded –Unblinded Participants advised of all aspects Research statistics can be: –Descriptive Observations made No attempts made to alter event –Inferential Hypothesis used to prove one finding
Ethical Considerations The IRB monitors whether a study is conducted ethically and ensures: –Protection of participants –Appropriate conduct Benefits must outweigh risks. Conflicts of interest must be identified.
Ethical 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.
Evaluating 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.
Evaluating Medical Research Peer review helps ensure quality. –Subject-matter experts review material prior to publication Internet sites can be valid tools. Studies must follow a structured process. There will always be limitations.
Evidence-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.
Evidence-Based Practice Level I –Highest-quality evidence –Multiple studies –Large sample size –Randomization –Uses multiple techniques –Significant positive effect outcome Level II –Single, randomly controlled trial, or –Multiple trials with small sample sizes, or –Large, randomly controlled studies –Moderate effect on patient outcome
Evidence-Based Practice Level III –Level IIIA: Well-designed trial without randomization –Level IIIB: Evidence from causal comparison and case or cohort studies –Level IIIC: Evidence gathered from single experiments
Evidence-Based Practice Level IV –Lowest level –Reviews of: Descriptive studies Expert opinion Uncontrolled studies
Evidence-Based Practice Research determines the effectiveness of treatment. –Can help identify which procedures, medications, and treatments do and do not work When following a new study, measure the results with your CQI program.
Ambulance 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. Summary
In 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. Summary
Standards 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. Summary
Paramedics 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. Summary
There 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. Summary
Some 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. Summary
Research 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. Summary
Paramedics 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. Summary