TTTTT T EMS 484 EMS management 1 Lecture 1 Dr. Maha Khalid

Contents : Definition of EMS System. Out-of-Hospital Components of an EMS System. In-Hospital Components of an EMS System. BLS. ALS Important milestone in the evolution of EMS The 15 components of EMS System. Continued Development of 14 EMS Attributes. Medical Direction

Definition of EMS System A comprehensive network of personnel, equipment, and resources established to deliver aid and emergency medical care to the community. Bledsoe et al., Essentials of Paramedic Care: Division 1

Out-of-Hospital Components of an EMS System Bledsoe et al., Essentials of Paramedic Care: Division 1 © Members of the Community Communications System EMS Providers Public UtilitiesPoison Control Centers Fire Rescue Hazmat

Bledsoe et al., Essentials of Paramedic Emergency Nurses Emergency and Specialty Physicians Ancillary Services Rehabilitation Services In-Hospital Components of an EMS System

BLS Refers to the basic life-saving procedures such as artificial ventilation and cardiopulmonary resuscitation Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

ALS Refers to advanced life-saving procedures such as intravenous therapy, drug therapy, intubation, and defibrillation Bledsoe et al., Essentials of Paramedic

Some systems are tiered: BLS arrives first and then, if required, ALS arrives later. Bledsoe et al., Essentials of Paramedic Care: Division 1

Important milestone in the evolution of EMS EMS systems have developed from the traditional and scientific beliefs of many cultures. Bledsoe et al., Essentials of Paramedic Care: Division 1

Ancient Times First “protocols” established in Mesopotamia – Evidence of medications, patient assessment techniques, and bandages Bledsoe et al., Essentials of Paramedic Care: Division 1

18th and 19th Centuries Napoleonic Wars – First efforts of field care developed by one of Napoleon’s surgeons. Triage, a method of sorting patients by severity, developed. U.S. Civil War – Triage and transport of wounded soldiers – Improvised hospitals in houses, barns, and churches First civilian ambulance service – Cincinnati, Ohio (1865) – New York City Health Department Ambulance Service (1869) Bledsoe et al., Essentials of Paramedic Care: Division 1

20th Century World War II – Transportation to appropriate facilities – Battlefield ambulances Vietnam and Korean conflicts – Soldiers treated in battlefield – Evacuation by helicopter Bledsoe et al., Essentials of Paramedic

Post-1960s Developments Mortician-operated ambulances withdrew due to costs and demand for additional services. Fire and police departments began providing EMS. Growth of volunteer and independent local EMS provider agencies. Bledsoe et al., Essentials of Paramedic

1966 The National Highway Safety Act established the Department of Transportation, which provided grants for EMS. Publication of Accidental Death and Disability: The Neglected Disease of Modern Society – Highlighted deficiencies in prehospital emergency care – Set guidelines for development of EMS systems, training, ambulances, equipment Bledsoe et al., Essentials of Paramedic

1969 The EMT-Ambulance program was made public. The first paramedic curriculum followed in Bledsoe et al., Essentials of Paramedic

1971 White House issued $9 million in EMS grants for EMS demonstration projects. – Designed to be models for subsequent system development Bledsoe et al., Essentials of Paramedic

1972 The Department of Health, Education, & Welfare funded initiatives to develop regional systems. Bledsoe et al., Essentials of Paramedic

EMS Systems Act of 1973 Provided funding for a series of trauma projects $300 million allocated to study EMS planning, operations, expansion, and research Continued funding for regional systems until 1981 Bledsoe et al., Essentials of Paramedic

ManpowerTraining Communications Transportation Emergency Facilities Critical Care Units Public Safety Agencies Consumer Participation Access to Care Patient Transfer Standardized Recordkeeping Public Information and Education System Review and Evaluation Disaster Management Plans Mutual Aid To be eligible for funding a system must address: (The 15 components of EMS System )

Two Items the Legislation Omitted System finance Medical direction Bledsoe et al., Essentials of Paramedic

1977 First EMT-Paramedic curriculum was developed. Bledsoe et al., Essentials of Paramedic

1981 The passage of the Consolidated Omnibus Budget Reconciliation Act (COBRA) wiped out federal EMS funding. Bledsoe et al., Essentials of Paramedic

1988 Regulation and policy Resources management Human resources/training Transportation Facilities Communications Trauma systems Public information and education Medical direction Evaluation Bledsoe et al., Essentials of Paramedic

EMS Agenda for the Future Published in 1996 as a comprehensive evaluation of the history of EMS Casts a vision for the future for EMS in the United States Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Continued Development of 14 EMS Attributes Integration of health services EMS research Legislation and regulation System finance Human resources Medical direction Education systems Public education Prevention Public access Communication systems Clinical care Information systems Evaluation Bledsoe et al., Essentials of Paramedic

Today’s EMS System Every EMS system must develop a system that best meets its needs. State- and regional-level EMS systems are often responsible for planning, developing protocols, and establishing standards. Bledsoe et al., Essentials of Paramedic

Medical Direction (1 of 2) A medical director is a physician who is legally responsible for all clinical aspects of the system. Bledsoe et al., Essentials of Paramedic Care: Division 1

Medical Direction (2 of 2) The medical director’s role in a system is to: – Educate and train personnel – Participate in personnel and equipment selection – Develop clinical protocols – Participate in quality improvement and problem resolution – Provide direct input into patient care – Interface with the EMS system – Advocate within the medical community – Serve as the “medical conscience” of the EMS system Bledsoe et al., Essentials of Paramedic

The medical director can provide on-line guidance to EMS personnel in the field. This is known as on-line medical direction. Bledsoe et al., Essentials of Paramedic Care: Division 1 © Kenneth Kerr

Off-line medical direction refers to medical policies, procedures, and practices that medical direction has set up in advance of a call, such as standard protocols or standing orders. Bledsoe et al., Essentials of Paramedic Care: Division 1

Protocols are the policies and procedures for all elements of an EMS system.