1. Oregon’s EMS System

2. Objectives
Describe the environment in which the first ‘ambulances’ responded
Identify the first volunteer ambulance
Identify the agency that was tasked, through Legislation, with developing the Emergency Medical Services

3. Objectives
State when Legislation was passed to develop Oregon’s Trauma System
List the Oregon Revised Statutes and Oregon Administrative Rules that outline the responsibilities of Oregon’s EMS Office
List three things an EMT can do to assist the EMS Office in providing service to him/her

4. Objectives
State the difference between Level 1, Level 2, Level 3 and Level 4 Trauma Hospitals in Oregon
List three reportable actions defined in OAR
Identify three functions of the Medical Director

5. Way Back Napoleonic War Civil War NYC 1869
Horse drawn wagons
Civil War
NYC 1869
1899 – The first motorized ambulance
Chicago

6. In the beginning…
1913 – Ben C. Buck started the nation’s first private ambulance service in Portland, Oregon
1918 – Mr. Buck donated one of the few motorized ambulances used in WW-I
1920 – First volunteer ambulance service, Roanoke, Virginia
1942 – Buck Ambulance became the first to carry oxygen as standard equipment

7. More Recent CPR, 1960s 8% WWI, 4.5% Korea, 2% Vietnam 1966 – DOT – EMS
Dr. Leonard Rose, Cardiac Tech
8% WWI, 4.5% Korea, 2% Vietnam
Accidental Death & Disability, The Neglected Disease of American Society, 1966
1966 – DOT – EMS

8. America’s deaths from influenza were greater than the number of U. S
America’s deaths from influenza were greater than the number of U.S. servicemen killed in any war
Thousands
Civil WWI WWII Korean Vietnam
War Influenza War War

9. Historical Perspective Civilian Evolution
Civilian evolution varied from region to region in U.S.
Rural areas – Undertakers
Fire departments and volunteer ambulance replaced funeral directors
Urban areas
Hospital-based
Fire departments
Police departments
Independent ambulance companies

11. More Modern Times OHD 1973-82 Title 12 Grants June 30, 1981
$12 million to Oregon
June 30, 1981
1987 Trauma System
1989 BME
OHD
- Now DHS-EMS

12. State EMS Office (DHS, Emergency Medical Services and Trauma Systems)
Statutory responsibility
Oregon Revised Statutes Chap. 682, 431
Oregon Administrative Rules Chap , 250, 255, 260, 265, Chap. 847
State EMS office
State EMS Committee
Subcomm. EMT Cert. and Discipline
STAB, ATAB

13. State EMS Office Charge – minimum standards Certification, CMEFR
EMTs
Ambulance vehicles
Ambulance services
Trauma hospitals
Certification, CME
Accreditation process

14. State EMS Office Be nice to them Do your research Start locally
Read, then follow directions
Know your responsibilities
Document, conduct business in writing
Don’t shop for answers

15. Things in the works! “Certification” of First Responders
Revision of Oregon EMT-Intermediate Curriculum (rethinking)
ACEP/OHD-EMS Supervising Physician Course
40 Hour Oregon Version DOT National Standard EMS Instructor Course
National Registry Exam
Manage Grant Programs

16. Total of All Certification Levels as of March 17, 2006
EMT-B %
EMT-I %
EMT-P %
TOTAL EMTS ALL LEVELS 8160

17. Oregon’s EMTs All Levels by ZIP code

18. Oregon’s EMT-Basics by ZIP code
4075
51.23%
of total EMTs

19. Oregon’s EMT-Intermediates by ZIP code
1472
18.51%
of total EMTs

20. Oregon’s Paramedics by ZIP code
2407
30.16%
of total EMTs

21. Statewide ALL EMS Agencies

22. Statewide Transport Agencies

23. Statewide Non-transport Agencies

25. Trauma Section State wide trauma system Hospital designation 1-4
Data gathering
Triage criteria
911 System

26. Revised 3/20/02

27. TRIAGE CRITERIA AND DECISION SCHEMETO
TRAUMA
HOSPITAL
VITAL SIGNS & LEVEL OF CONSCIOUSNESS:
Systolic blood pressure <90 mmHg; or
Respiratory distress with rate<10 or >29; or
Airway management required; or
Glasgow Coma Scale <12
ANATOMY OF INJURY:
Penetrating injury of the head, neck, torso, or groin; or
Amputation above the wrist or ankle; or
Spinal cord injury with limb paralysis; or
Flail chest; or
Two or more obvious long-bone (humerus/femur) fractures.
YES →
MANDATORY
TRAUMA SYSTEM ENTRY
MECHANISM OF INJURY:
Death of a same car occupant; or
Ejection of patient from an enclosed vehicle; or
Heavy extrication time >20 minutes.

28. NO↓ YES → HIGH ENERGY TRANSFER SITUATIONS: Falls >20 feet; or
NO↓
HIGH ENERGY TRANSFER SITUATIONS:
Falls >20 feet; or
Pedestrian hit at 20 mph or thrown 15 feet; or
Rollover; or
Motorcycle, ATV or bicycle crash; or
Significant impact or intrusion into occupant space of vehicle.
YES →
DISCRETIONARY
TRAUMA SYSTEM ENTRY
These criteria shall cause a high index of suspicion that a patient may have sustained a severe injury. Trauma system entry for patients meeting two or more of these criteria is strongly encouraged.
CO-MORBID FACTORS:
Extremes of age <5 or >55 years; or
Patient with bleeding disorder or patient on anticoagulants; or
Medical illness: cardiac or respiratory disease, insulin-dependent
diabetes, cirrhosis, or morbid obesity; or
Pregnancy; or
Immunosuppressed patients; or
Presence of intoxicants.

29. Prehospital Standards
Reporting criteria (ORS (4))
Applications and recertification.
Backgrounds
E-4
The nasty stuff
Sexual assault elderly
Walking around in sox
Diverting drugs to owner
Convicted double homicide

30. Medical Directors Under BME Standing orders (protocols)
Advocate, training
Scope of Practice
Don’t violate
Only under an agency's protocols
Teamwork

31. Questions??