1. Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Chapter 1 Emergency Medical Care Systems, Research, and Public Health Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Emergency Medical Care Systems, Research, and Public Health

2. Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Objectives  History of EMS  NHTSA  Levels of training  Roles and Responsibility  Attributes of an EMT  Medical Direction and oversight  CQI – Continuous Quality Improvement  Patient Safety  Research  Public Health

3. Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren History of Emergency Medical Services Emergency care developed during warfare at the beginning of the 20th century. By the 1960s, domestic emergency care lagged behind. Staffed emergency departments were often limited to large urban areas. The local funeral home was the ambulance provider. Now the EMS system allows patient care from the time of injury or illness until rehabilitation or discharge.

4. Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren 1970’s Changes In 1972, mass media brought the concept Paramedicine and ER specialties into our homes

5. Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren  Highway Safety Act and the Emergency Medical Act created funding  DOT developed the first National Standard Curriculum for training EMTs in the early 1970s  EMS established in most of the United States by 1980 Accidental Death and Disability: The Neglected Disease of Modern Society (1996) Recommended: Development of training Development of federal guidelines and policies Provide emergency care and transport Establish staffed emergency departments

6. Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren The Emergency Medical Services System – Technical Assistance Program Assessment Standards (NHTSA)  Standards:  Regulation & Policy  Resource Management  Human Resources and training  Transportation  Facilities  Communications  Public Information and Education  Medical Direction  Trauma Systems  Evaluation

7. Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Figure 1-1 Communications play a vital role in the Emergency Medical Services (EMS) system.

8. Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Figure 1-2 The four levels of EMS practitioners.

9. Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren The Health Care System: EMT’s provide prehospital care. A trauma center can provide rapid surgical intervention and treatment of injuries that generally exceeds hospital emergency department capabilities. (© Edward T. Dickinson)

10. Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren The EMT works closely with other public safety personnel.

11. Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren You will often work as a team with paramedics and others.

12. Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren

13. Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Roles and Responsibilities Personal Safety and the Safety of Others.

14. Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Roles and Responsibilities The EMT is responsible for providing competent patient care.

15. Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Roles and Responsibilities Assessment and emergency care are continued en route to the medical facility.

16. Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Roles and Responsibilities The EMT is responsible for properly transferring the care of the patient to the appropriate medical personnel. Along with patient advocacy.

17. Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Roles and Responsibilities As soon as possible, complete the written or electronic prehospital care report.

18. Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Professional Attributes of an EMT  Puts patient’s needs as a priority without endangering self  Maintains professional appearance and manner  Performs under pressure  Treats patients and families with understanding, respect and compassion  Respects patient confidentiality  Maintains a high level of knowledge and skill.  Meets the physical demands for the EMT position.  Maintenance of Certification and Licensure.

19. Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Professional Appearance The EMT-B should maintain a professional appearance and manner.

20. Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Medical Direction and Oversight  EMT’s are designated agents of the medical direction of the EMS System.  The Medical director (Dr. Marvin Wayne) Provides medical oversight.  Legally responsible for clinical and patient care aspect of the EMS system.  Oversees and provides continuing education.  Facilitates the Quality Improvement system.  Provides medical direction by establishing guidelines, or protocols.

21. Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Quality Improvement or Continuous Quality Improvement In Whatcom County, there is a CQI committee that is overseen by Dr. Wayne. The committee consists of representatives of every Fire District and some agencies within the county EMS system.

22. Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Issues in Patient Safety Safety of care is one of the most important issues High-risk activities Transfer of Care Poor communication Carrying/moving patients in a risky manner. Involvement in an ambulance crash. Lack of spinal immobilization or improper spinal immobilization procedure. Steps to prevent errors during patient care Develop clear protocols Light the scene effectively. Minimize interruptions during assessment and emergency care. Clearly mark all drugs and packages. Reflect on actions. Question all assumptions. Use decision aids if necessary. Ask for help if needed.

23. Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Research and EMS Care Medical Practice has evolved to evidence-based medicine. Evidence-based medicine focuses on clear evidence that procedures, medications, and equipment improve patient’s outcome. Evidence-based decision making;  Formulate a question about emergency care.  Search medical literature for validity and reliability.  Appraise the evidence for validity and reliability.  Change protocol if evidence supports a change in practice. Initiatives are underway to increase the amount of research conducted to support or change delivery of prehospital emergency care.

24. Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Public Health “Healthy people in healthy communities” Identifies problems that affect the health of a particular population. Reduces the incidence of injury and illness through preventive strategies. Enforces laws and regulations. Mission: “Promote physical and mental health and prevent disease, injury and disability.” Greatest 20 th Century public health achievements; Vaccinations Motor-vehicle safety Workplace safety Control of infectious disease Reduction in deaths from coronary heart disease and stroke Safer and more healthful foods Decline in maternal and infant mortality Use of barrier devices during sexual contacts Fluoridation in drinking water Reduction in use of tobacco products.

25. Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Summary  EMS Systems have come a long way, with it’s origins from warfare.  911 became a key component of the EMS system.  Levels of training.  EMT has many roles and responsibilities.  Medical direction and oversight is a key component of the EMS system.  CQI  Professionalism.  Research plays a vital role on how we do things.  Public Health.