1. 1
Introduction to Emergency Medical Care

2. Multimedia Directory
Slide 9 The Long and Winding Road of Ambulance Service Video

3. Topics
The Emergency Medical Services System Components of the EMS System Research Special Issues
Planning Your Time: Plan 80 minutes for this chapter.
The Emergency Medical Services System (20 minutes)
Components of the EMS System (20 minutes)
Research (20 minutes)
Special Issues (20 minutes)
Note: The total teaching time recommended is only a guideline.
Core Concepts:
The chain of human resources that forms the EMS system
How the public activates the EMS system
Your roles and responsibilities as an EMT
The process of EMS quality improvement

4. The Emergency Medical Services System
Teaching Time: 20 minutes
Teaching Tips: This is an important introductory lesson for a new EMT. It provides context for the EMT's "place in the world" and lays the foundation for future growth within the system. As an instructor, it is your opportunity to lay a strong foundation and teach a positive future outlook. EMS is a relatively new profession. Many of those who built the system are still actively involved at the state level. Contact your local state office and invite such people to class.
Back to Topics

5. How It Began 1790s Civil War World War I Korea/Vietnam Napoleonic Wars
Volunteer ambulance corps
Korea/Vietnam
MASH-type units and helicopter transport from battlefield
Covers Objective 1.2
Discussion Topic: Discuss the history of EMS. Describe the roots of modern EMS systems.
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6. How It Began
Nonmilitary ambulance services began operating in early 1900s in U.S.
Operated by hospitals, fire departments, or funeral homes
No requirements or standards for equipment, crew training, or ambulance design
Covers Objective 1.2

7. EMS Today
1966
Department of Transportation charged with developing EMS standards
1970
Founding of the National Registry of EMTs (NREMT)
Covers Objective 1.2
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8. EMS Today
1973
National Emergency Medical Service Systems Act (NEMSSA) passed by Congress
Covers Objective 1.2

9. The Long and Winding Road of Ambulance Service Video
Covers Objective 1.2
Video Clip
The Long and Winding Road of Ambulance Service
Discuss the progression of EMS throughout history.
What is the purpose of the Emergency Medical Services system?
What agency developed the standard for the assessment and care of prehospital patients?
Discuss possible future advancements in EMS.
Click on the screenshot to view a video on the topic of the history of EMS.
Back to Directory

10. NHTSA Standards for EMS Systems
Regulation and policy
Each state establishes laws, policies, and regulations.
Resource management
Centralized coordination of emergency treatment and transport resources
Covers Objective 1.3
Point to Emphasize: The National Highway Traffic Safety Administration (NHTSA) Technical Assistance Program established an assessment program with a set of standards for EMS systems.
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11. NHTSA Standards for EMS Systems
Human resources and training
Assure EMS personnel are trained and certified to minimum standards
Transportation
Provide safe, reliable transportation
Covers Objective 1.3
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12. NHTSA Standards for EMS Systems
Facilities
Transport to closest appropriate facility
Communications
Universal system access number (911), dispatch-to-ambulance, ambulance-to-ambulance, ambulance-to-hospital, hospital-to-hospital communications
Covers Objective 1.3
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13. NHTSA Standards for EMS Systems
Public information and education
Educate public about role of EMS, access to EMS, participate in injury prevention programs
Medical direction
Medical Director is accountable for EMS personnel within system
Covers Objective 1.3
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14. NHTSA Standards for EMS Systems
Trauma systems
Develop trauma triage, transport, and treatment protocols
Evaluation
Establish program for evaluating and improving effectiveness (QI, QA, TQM)
Covers Objective 1.3

15. Components of the EMS System
Teaching Time: 20 minutes
Teaching Tips: Describe components of the EMS system in local terms. Use specific local examples to demonstrate larger concepts. Use actual EMS providers to discuss the various levels of training. Use a discussion format to review important traits of a good EMT. Allow students to formulate their own ideas of what the important elements are.
Back to Topics

16. Components of the EMS System
Emergency Medical Dispatchers
EMS responders
Emergency Department/Hospital
Doctors, nurses, allied health personnel
Specialty centers
Covers Objective 1.4
Point to Emphasize: It is important to consider the EMS system from the viewpoint of the patient.
Class Activity: Visit a state or regional EMS office. Use this opportunity to discuss the organization of your local system.
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17. Components of the EMS System
Other specialized care facilities
Trauma centers
Burn centers
Pediatric centers
Cardiac centers
Stroke centers
Covers Objective 1.4
Knowledge Application: Have groups of students build a mock EMS system. Discuss the key components and compare these components to existing systems.
Discussion Topic: Describe the components of the EMS system from access to delivery at the hospital. Consider the viewpoint of the patient.

18. Components of the EMS System
Covers Objective 1.4
Knowledge Application: Have groups of students build a mock EMS system. Discuss the key components and compare these components to existing systems.
Discussion Topic: Describe the components of the EMS system from access to delivery at the hospital. Consider the viewpoint of the patient.
Emergency department staff Photo: © Edward T. Dickinson, MD

19. Think About It What medical services are available in your community?
How important is it that EMS personnel know the capabilities of community medical facilities?
What are the possible consequences of transporting a patient to a facility not equipped to handle the problem?
Talking Points: Have students list medical services available; add others that are not obvious. Discuss with students their responsibility to know this essential information.

20. Accessing the EMS System
Covers Objective 1.1 and 1.4
Class Activity: Have students work in groups to research examples of EMS systems that pertain to services in their area. Assign various topics including local, regional, state, and federal systems. Have groups present their findings to the class.
The chain of human resources making up the EMS system. Emergency Department staff photo: © Edward T. Dickinson, MD

21. Accessing the EMS System
911 telephone access
Available in most communities
Enhanced 911
Provides caller number and location for landline phones
Covers Objectives 1.1 and 1.4
Point to Emphasize: Discuss how modern technology related to cell phones impact the public's ability to access and utilize the EMS system.

22. Accessing the EMS System
Emergency medical dispatchers
Can provide instructions to callers on how to provide emergency care until EMS personnel arrive
EMD certification required in some jurisdictions
Covers Objective 1.4

23. Accessing the EMS System
Covers Objective 1.4
Emergency medical dispatchers Photo: © Edward T. Dickinson, MD

24. Critical Decision Making
Critical decision making is a very important concept in EMS.
Information must be gathered, patients assessed, and determination made on treatment and transport options.
Decisions often time-critical
Covers Objective 1.3

25. Examples of Critical Decisions
Is it better to take patient to closest hospital or to one farther away but more appropriate for the condition?
Is patient stable enough for further evaluation on scene, or should patient be transported immediately?
Will this treatment make patient better or worse?
Talking Points: Every situation is different, and transport decisions are often based on local protocols. This list should initiate discussion.

26. Levels of EMS Training
Emergency Medical Responder (previously called first responder)
Emergency Medical Technician (previously called EMT-Basic)
Advanced Emergency Medical Technician (previously called EMT-Intermediate)
Paramedic (previously called EMT-Paramedic)
Covers Objective 1.5

27. Roles and Responsibilities of EMTs
Personal safety
Safety of crew, patient, and bystanders
Patient assessment
Patient care
Lifting and moving
Transport
Transfer of care
Patient advocacy
Covers Objective 1.5 and 1.6
Discussion Topic: Discuss the roles and responsibilities of an EMT. What are the most important traits of a good EMT?

28. Think About It
How would it impact an older adult patient if they were transported to the hospital without glasses, hearing aid, or dentures?
On a routine call, would taking the time to gather these items have a negative effect on the patient's care?
How about assuring the home is secure and locked before leaving?
Covers Objective 1.15
Talking Points: Ask the students to think about these questions from the perspective of being a patient. Wouldn't they want the EMS responder to do these things for them? Emphasize how responding to a call is not always about dealing with the emergency, but also providing the emotional support that a patient needs.
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29. Think About It
Could the concept of patient advocacy also extend to the community (fall prevention programs for elderly, poisoning awareness, pool and water safety programs for children)?
Covers Objective 1.15
Talking Points: Patient advocacy is an important role for EMS responders. Ask the students to think of any patient advocacy roles they see EMS responders taking part of in their community.

30. Physical Traits of a Good EMT
Ability to lift and carry equipment and patients up to 125 pounds
Good eyesight (distance and reading)
Awareness of any problems with color vision
Good communication skills (oral and written)
Covers Objective 1.7
Talking Points: Ask the class to give examples of situations where these traits would be vital in performing the duties of an EMT.

31. Personal Traits of a Good EMT
Pleasant
Sincere
Cooperative
Resourceful
Covers Objective 1.7
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32. Personal Traits of a Good EMT
Covers Objective 1.7
A professional appearance inspires confidence.

33. Personal Traits of a Good EMT
Self-starter
Emotionally stable
Able to lead
Neat and clean
Of good moral character and respectful of others
Covers Objective 1.7
Knowledge Application: Have students play the role of EMTs. Assign negative traits and have students demonstrate the serious impact of poor behavior. Discuss.
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34. Personal Traits of a Good EMT
In control of personal habits
Controlled in conversation and able to communicate properly
Able to listen to others
Nonjudgmental and fair
Covers Objective 1.7

35. Education Maintain up-to-date knowledge and skills Refresher courses
Continuing education courses
Conferences, seminars, and lectures
Covers Objective 1.7
Talking Points: Emphasize to students that being an EMT involves career long learning in order to stay abreast of current standards of care. Provide examples of how research has led to changes in standard of care in the past. For example, hyperventilation of cardiac arrest patients.

36. Education
Covers Objective 1.7
Talking Points: Emphasize to students that being an EMT involves career long learning in order to stay abreast of current standards of care. Provide examples of how research has led to changes in standard of care in the past. For example, hyperventilation of cardiac arrest patients.
Many EMS/rescue operations adopt new procedures and equipment on the basis of research providing evidence that they are effective.

37. Think About It
How will you refresh your knowledge and stay current once you are out of the classroom?
What qualities would you like to see in an EMT who is caring for you? How can you come closer to being this kind of EMT?
Covers Objective 1.15
Talking Points: Being an EMT involves career long learning. Just because your class ends does not mean you should stop learning. The students may list qualities such as: emphatic, caring, respectful, of good moral standing, able to lead, and nonjudgmental.

38. Where Will You Become a Provider?
Ambulance services
Fire departments
Rural/wilderness teams
Urban/industrial settings
Volunteering
Covers Objective 1.8
Talking Points: Many fire and EMS agencies are volunteers, especially in rural communities. In addition, many fire department personnel are cross-trained as firefighters and EMTs.

39. Where Will You Become a Provider?
Covers Objective 1.8
Talking Points: Many fire and EMS agencies are volunteers, especially in rural communities. In addition, many fire department personnel are cross-trained as firefighters and EMTs.
There is a wide variety of career opportunities for EMTs, including work in rural/wilderness settings. Photo © Edward T. Dickinson, MD

40. National Registry of Emergency Medical Technicians
Registration for EMRs, EMTs, AEMTs, and paramedics who successfully complete NREMT examinations
May help in reciprocity (transferring to another state or region)
Beneficial when applying for employment
Covers Objective 1.9
Talking Points: NREMT exams are often used as state certification exams. If your state or region does not use the registry exam, ask your instructor how you can sit for the examination. Upon passing the exam and obtaining registry, you will be entitled to wear the NREMT patch.

41. Quality Improvement
Continuous self-review with the purpose of identifying aspects of the system that require improvement
Develop plans to correct deficiencies and improve performance
Covers Objective 1.10
Point to Emphasize: Quality assurance, research, and education ensure constant improvement for both individual providers and the EMS system in general.
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42. Quality Improvement Everyone in organization has a role.
Preparing carefully written documentation
Becoming involved in the quality process
Obtaining feedback from patients and hospital staff
Maintaining your equipment
Continuing your education
Covers Objective 1.11

43. Medical Direction
All patient care performed under direction of Medical Director
Ultimate responsibility for patient care
Oversees training
Develops treatment protocols
Issues off-line medical direction (standing orders)
Provides on-line medical direction
Covers Objective 1.12

44. EMS Role in Public Health
Injury prevention for geriatric patients
Injury prevention for youth
Public vaccination programs
Disease surveillance
Covers Objective 1.14

45. Research Back to Topics Teaching Time: 20 minutes
Teaching Tips: Describe components of the EMS system in local terms. Use specific local examples to demonstrate larger concepts. Use actual EMS providers to discuss the various levels of training. Use a discussion format to review important traits of a good EMT. Allow students to formulate their own ideas of what the important elements are.
Back to Topics

46. Research
Focus on improving patient outcomes and through evidence-based techniques
Evidence-based process
Forming a hypothesis
Reviewing literature
Evaluating the evidence
Adopting the practice if evidence supports it
Covers Objective 1.13
Talking Points: EMTs should stay abreast of ongoing EMS-related research, and should participate in the research process when possible to assure the quality of care for the patient.
Critical Thinking: Once you have completed class, how will you continue to improve as an EMT? Use specific examples.
Knowledge Application: Have students work in groups. Assign meaningful EMS research articles. Have the groups discuss how these articles impacted national and local EMS systems.

47. The Basics of EMS Research
Not all research is created equal.
Rely on the scientific method.
Exacting and comprehensive studies are both difficult and time consuming.
Obtain an objective opinion.
Covers Objective 1.13
Knowledge Application: Provide a sample of a research article and ask the students to determine what method was used.
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48. The Basics of EMS Research
Methods of reducing bias
Prospective versus retrospective
Randomization
Control groups
Study group similarity
Covers Objective 1.13
Knowledge Application: Provide a sample of a research article and ask the students to determine what method was used.
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49. The Basics of EMS Research
Types of medical research
Case studies/case reports
Cohort/concurrent control/case-control studies
Randomized controlled trials (RCTs)
Systematic review
Meta-analysis
Covers Objective 1.13
Knowledge Application: Using the same research article and ask the students to identify the type of research.
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50. The Basics of EMS Research
"Level of Evidence" designation by American Heart Association
Level of Evidence 1
Level of Evidence 2
Level of Evidence 3
Level of Evidence 4
Level of Evidence 5
Covers Objective 1.13
Knowledge Application: Using the same research article and ask the students what questions they would ask in preparation for participating in the research.

51. The Basics of EMS Research
Questions to ask when evaluating a study
Assists in identifying bias of flaws in methodology
Questions to ask before participating in a study
Assists in understanding the study and providing needed information
Covers Objective 1.13
Knowledge Application: Using the same research article and ask the students what questions they would ask in preparation for participating in the research.

52. Questions to Ask Before Participating in EMS Research
What is the title of the study?
Who are the principal investigator and primary contact?
What is the research question or hypothesis?
What are the study's inclusion criteria?
What are the study's exclusion criteria?
Covers Objective 1.13
Knowledge Application: Using the same research article and ask the students what questions they would ask in preparation for participating in the research.
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53. Questions to Ask Before Participating in EMS Research
What EMS data is needed?
How will informed consent be handled?
If a treatment is going to be randomized, how will that happen?
What samples will need to be collected?
What are the potential benefits to the patient?
Covers Objective 1.13
Knowledge Application: Using the same research article and ask the students what questions they would ask in preparation for participating in the research.
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54. Questions to Ask Before Participating in EMS Research
What are the potential risks to the patient?
What institutional review board has approved the study?
Has the EMS agency's Medical Director approved the study?
Has the EMS agency's administration approved the study?
Covers Objective 1.13
Knowledge Application: Using the same research article and ask the students what questions they would ask in preparation for participating in the research.

55. Special Issues Back to Topics Teaching Time: 20 minutes
Teaching Tips: Describe components of the EMS system in local terms. Use specific local examples to demonstrate larger concepts. Use actual EMS providers to discuss the various levels of training. Use a discussion format to review important traits of a good EMT. Allow students to formulate their own ideas of what the important elements are.
Back to Topics

56. Special Issues Throughout the course we will discuss: Local issues
Administrative matters
Course description
Class meeting times
Requirements for certification as an EMT
Talking Points: At this time you should explain the above topics with your students if you have not already done so.
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57. Special Issues
The Americans with Disabilities Act (ADA) has set strict guidelines preserving the rights of Americans with disabilities.
Talking Points: At this time you should explain the above topics with your students if you have not already done so.

58. Chapter Review

59. Chapter Review
The EMS system has been developed to provide prehospital as well as hospital emergency care.
The EMS system includes 911 or another emergency access system, dispatchers, EMTs, hospital emergency department, physicians, nurses, physician's assistants, and other health professionals.
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60. Chapter Review
The EMT's responsibilities include safety; patient assessment and care; lifting, moving, and transporting patients; transfer of care; and patient advocacy.
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61. Chapter Review
An EMT must have certain personal and physical traits to ensure the ability to do the job.
Education (including refresher training and continuing education), quality improvement procedures, and medical direction are all essential to maintaining high standards of EMS care.

62. Remember EMS dates back to Napoleonic times.
Modern EMS standards come from 1960s–1970s and National Emergency Medical Service Systems Act (NEMSSA).
There is a chain of human resources involved in EMS.
Critical decisions are made by each member of the chain.
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63. Remember
There are certain personal and physical traits that help you to be a successful EMS provider.
An EMS provider should actively pursue opportunities to improve personal knowledge and abilities as well as the unit's overall quality.

64. Questions to Consider
What innovation was introduced in the Korean and Vietnam wars that is now common in many EMS systems?
What are the four levels of EMS providers?
Requesting orders from a physician by radio is an example of what kind of medical control?
Talking Points: Helicopter transport
EMR, EMT, AEMT, paramedic
On-line medical control

65. Critical Thinking
Your patient is hesitant to go to the hospital because she is worried about her dog. What can you do to assist in this situation? What part of your role as an EMT is this an example of?
Talking Points: Help to contact a neighbor or relative that can come by and check on the dog; Patient advocate.