National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Emergency Care Systems Chapter 2

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Objectives 2.1 List six attributes of an emergency care system. 2.2 List four nationally recognized prehospital emergency care provider levels. 2.3 Compare and contrast direct medical oversight and indirect medical oversight. 2.4 Describe the purpose of quality improvement.

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Topics History EMS Agenda for the Future Emergency Personnel Facilities Continuity of Care The Importance of Commonality Public Health Research continued

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Topics Communication Systems Medical Oversight Protocols Documentation Quality Improvement Continuing Education Chapter Summary

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Presentation You are skiing with some friends when one of your companions falls. As you ski up to her, you find her lying on her side, clutching her ankle. She appears to be in great distress. A quick examination reveals intense pain in the woman’s right lower leg/ankle which is bent at an unnatural angle. She is awake and has no other injuries; however, she is unable to stand, and cannot get down the mountain on her own.

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY History 11 - C Royal flying Doctors of Australia Crusades Napoleonic wars World War I Korean War World War II continued

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY History Copyright Jerry Young / Dorling Kindersley Media Library

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY History Copyright Edward McNamara

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY EMS Agenda for the Future The National Registry of Emergency Medical Technicians (NREMT) founded to establish professional standards Congress passed the National Emergency Medical Service System Act DOT published the first EMT Paramedic Curriculum continued

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY EMS Agenda for the Future National Highway Traffic Safety Administration (1966) ◦ Outlined key goals and 14 attributes of an effective emergency care system ◦ Provided strategies to help fully integrate out-of-hospital activities with the overall health care system. continued

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY EMS Agenda for the Future

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Emergency Personnel Four Nationally Recognized Levels ◦ Emergency Medical Responder (EMR) ◦ Emergency Medical Technician (EMT) ◦ Advanced Emergency Medical Technician (AEMT) ◦ Paramedic continued

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Emergency Personnel Emergency Medical Responder (EMR) ◦ Serves as the first responder of an emergency care system ◦ Often the first formally trained healthcare provider to access the patient. ◦ Trained to provide immediate life-saving treatment and stabilization to critically ill or injured patients while awaiting additional emergency response. continued

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Emergency Personnel Copyright Edward McNamara continued

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Emergency Personnel Emergency Medical Technician (EMT) ◦ Completed a NHTSA-approved EMT National Standard training course or its equivalent ◦ Functions with medical oversight to provide basic life support interventions continued

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Emergency Personnel Advanced Emergency Medical Technician (AEMT) ◦ Completed a NHTSA-approved AEMT National Standard training course or its equivalent. ◦ Functions under medical oversight ◦ May perform all of the skills performed by an EMT continued

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Emergency Personnel Paramedic ◦ Allied healthcare professional who has successfully completed a NHTSA- approved Paramedic course that includes extensive didactic, practical, and clinical training requirements. continued

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Emergency Personnel Copyright Edward McNamara continued

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Emergency Personnel Other EMS Personnel ◦ Physicians (MD, DO) ◦ Physicians Assistants (PA) ◦ Nurse Practitioners (NP) ◦ Registered Nurses (RN) ◦ Licensed Practical Nurses (LPNs) ◦ Allied Health Care Professionals continued

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Emergency Personnel Copyright Edward McNamara continued

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Emergency Personnel Copyright Edward McNamara continued

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Emergency Personnel Tiered approach ◦ Tier 1 - EMR Arrive quickly at the scene Initiate basic emergency care ◦ Tier 2 - EMT Arrive shortly after emergency medical responders Provide basic life support measures continued

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Emergency Personnel Copyright Scott LaPrade continued

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Emergency Personnel Copyright Studio 404 continued

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Emergency Personnel Copyright CORBIS-NY continued

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Emergency Personnel Tiered approach ◦ Tier 3 – AEMT, Paramedics Arrive after EMRs/EMTs Provide advanced life support measurers Transport the patient to a definitive care facility continued

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Emergency Personnel Copyright Studio 404 continued

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Emergency Personnel Tiered approach ◦ Tier 4 – Critical Care Providers Additional life support equipment, therapies, interventions to the scene Transport the patient to specialized hospital continued

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Emergency Personnel continued

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Facilities Medical facilities are an important part of the emergency care system Hospitals Acute care clinics ◦ Acute pediatric care facility ◦ Burn center ◦ Stroke center ◦ Toxicology center

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Continuity of Care Complex continuum involving each attribute of emergency care ◦ Delivery of high quality emergency medical care ◦ Patient transitions from his initial contact with a first responder through definitive treatment

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Continuity of Care Copyright Studio 404

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY The Importance of Commonality A Team Approach ◦ Common goals ◦ Common language Medical terms Rescue terms ◦ Common practices and procedures

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY The Importance of Commonality Copyright Craig Brown

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Update Activate the emergency care system: send someone for ski patrol assistance; keep the patient calm and warm. Try not to move the person; stabilize the ankle and leg. Assist ski patrollers upon their arrival: provide information about the incident and the patient. continued

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Update Patrollers assess the patient and initiate treatment: they splint the leg to prevent further injury and transport the patient to an awaiting ambulance crew who administer pain medication and take the patient to a definitive care facility. What is your responsibility? continued

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Update

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Public Health Designed to promote healthier living: ◦ Epidemiology ◦ Injury prevention ◦ Policy and program development

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Research Research plays an essential role in health care ◦ Identify epidemiological and pathological trends ◦ Report clinically relevant findings ◦ Introduce new technologies, practices and techniques.

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Research Copyright Snowbird

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY continued Communication Systems EMS communication system ◦ Hardware ◦ Software ◦ Specialized professionals

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Communication Systems continued

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Communication Systems OEC technicians use various communication tools: ◦ Radio Radio etiquette Radio terminology Factors that can adversely affect communications NATO Alphabet Military time

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Communication Systems continued

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Communication Systems continued

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Communication Systems continued

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Communication Systems OEC technicians use various communication tools: ◦ Hard wired telephones ◦ Cellular telephones

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Medical Oversight A licensed physician must assume legal responsibility for a patient’s care during an emergency. ◦ Direct oversight Real-time voice contact Licensed physician ◦ Indirect oversight Out of hospital providers not authorized to contact a physician before specific treatments Pre-authorizing

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Medical Oversight Copyright Edward McNamara

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Protocols Developed on a local level by emergency professionals who are familiar with area’s medical needs, available resources, system capabilities and local standard of care. continued

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Protocols Written instructions ◦ Guidelines that identify the assessment and treatment considerations for commonly encountered emergencies ◦ Reviewed annually and revised as needed

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Documentation Good documentation Hallmark of true medical professional Serves many purposes ◦ Pertinent clinical details ◦ Can be used as a research source continued

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Documentation Serves many purposes ◦ Provide legal protection for: Care provider Patrol Ski area ◦ Quality improvement purposes

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Quality Improvement Providing the best patient care possible ◦ On-going process that is designed to ensure products and services meet or exceed customer expectations ◦ Quality improvement Prospective Concurrent Retrospective

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Continuing Education Essential requirement of any professional license or certification ◦ On-going training ◦ OEC refresher coursework

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Continuing Education Copyright Edward McNamara

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Disposition The patient makes a full recovery due to your quick response in activating the local emergency care system.

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY continued Chapter Summary OEC technicians are an essential part of an emergency care system. OEC technicians provide emergency assistance and transportation to patients not served by traditional

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary An emergency care system is a network of specially trained personnel, equipment, facilities, and other resources that respond to emergencies. Ski patrols and ski patrollers are part of the emergency care system. continued

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary An effective emergency care system has 14 distinct attributes. In the United States, there are four types of out-of-hospital emergency care providers: emergency medical responder, EMT, Advanced EMT, and Paramedic. continued

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary Emergency care system resources are deployed using a tiered approach that is based on specific needs. Common goals, language, and practice allow the components of an emergency care system to function as a team. continued

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary Effective communications permits the emergency care system to operate in a coordinated manner. Time is measured using military or universal time. continued

National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary Medical oversight and quality improvement ensure that the care the patient receives is in accordance with area medical guidelines. By using prospective, concurrent and retrospective quality improvement methods, an OEC technician can improve his care.