1. Current EMS System

2. Define and enumerate the general principles of the current EMS system, its various component and various rule of each and every component.

3. Lecture Topics 1.Definition. 2.Introduction. 3.Component of the EMS. 4.Medical Direction. 5.EMS System Operation.

4. EMS system  Definition :  Definition : A comprehensive network of personnel, equipment, and resources, established to deliver aid and emergency medical care to the community.

5. EMS agenda for the future In 1996 NHTSA and Health Resources and Services administration published Emergency Medical Services Agenda for the Future The function of this Agenda is : 1.It is used to build common vision for future of EMS. 2.Help guide planning, decision making and policy for EMS.

6.  The agenda has 14 suggestion for the EMS: 1.Integration of health services. 2.EMS research. 3.Legislation and regulation. 4.System finance. 5.Human resources. 6.Medical direction. 7.Education systems. 8. Public education. 9. Prevention. 10. Public access. 11. Communication systems. 12. Clinical care. 13. Information systems. 14. Evaluation.

7. Criteria of an efficient EMS Systems 1. Network of coordinated services. 2.Defined by NHTSA Technical Assistance program Standards. 3.Ensures quick treatment. 4.Resources used efficiently. 5.Reduces health care costs.

8. NHTSA Technical Assistance program Standards 1.Regulation and Policy : Each state establishes laws, policies, and regulations. 2.Resource Management : Centralized coordination of emergency treatment and transport resources. 3.Human Resources and Training :Assure that all EMS personnel are trained and certified to minimum standard by qualified instructors

9. NHTSA Technical Assistance program Standards 4.Transportation : ability to provide safe, reliable transportation (ground, air, or other means). 5.Facilities : The patient must be transported to closest appropriate facility. 6.Communications : Universal access number (911), dispatch to ambulance, ambulance to ambulance, ambulance to hospital, hospital to hospital number.

10. NHTSA Technical Assistance program Standards 7.Trauma Systems : able to develop trauma triage, transport, and treatment protocols 8.Evaluation : establish program for assessing and improving quality of care provided. 9.Public Information and Education : Educate public about role of EMS, increase public awareness, participate in injury prevention programs

11. NHTSA Technical Assistance program Standards 10.Medical Direction : Medical director oversees, is accountable for EMS personnel within system.

12. Components of the EMS system 1.Out of the hospital component : responsible for first phase of medical care. 2.In the hospital component: responsible for the second phase of the medical care. 3.Other specialized care facilities: responsible for definitive phase of the medical care.

13. Out-Of-Hospital Components 1.Members of the community 2.Communications system 3.EMS providers 4.Public utilities 5.Poison control centres 6.Fire rescue, hazmat

14. In-Hospital Components 1.Emergency nurses 2.Emergency and specialty physicians 3.Ancillary services 4.Rehabilitation services

15. Other specialized care facilities 1.Trauma centers. 2.Burn centers. 3.Stroke centers. 4.Cardiac centers. 5.Labor and delivery/ pediatrics. 6.Poison control.

16. Chain of Human Resources in EMS System

17. Medical Direction  Definition : A medical director is a physician who is legally responsible for all clinical aspects of the system.  EMS systems Must retain a medical director  Medical care provided by paramedics is considered an extension of the medical director’s license.  Types of medical direction is either online medical control and offline medical control.

18. On line medical direction  Definition : Its when the medical director provide direct on line guidance to personnel on the field.

19. Role of the medical director 1.Educate and train personnel. 2.Participate in personnel and equipment selection. 3.Develop clinical protocols in cooperation with expert EMS personnel. 4.Participate in quality improvement and problem resolution 5.Provide direct input into patient care.

20. Role of the medical director 6.Advocate within the community. 7.Serve as the medical conscience of the EMS system including advocating for patient care. 8.Interface between the EMS system and other health care agencies.

21. Offline Medical Direction  Refers to medical policies, procedures, and practices that the medical director has set up in advance of the call.  Protocols are designed around the four “T’s” of emergency care (Triage, Treatment,Transport and Transfer.

22. Offline Medical Direction Protocols are the policies and procedures for all elements of an EMS system.

23. Communications  A coordinated, flexible communications plan should present in any good EMS system : 1. Citizen Access 2. Single Control Centre 3. Operation Communication Capabilities 4. Medical Communication Capabilities 5. Communications Hardware 6. Communications Software

24. Emergency Medical Dispatcher (EMD)  The activities of an EMD are crucial to the efficient operation of EMS.  EMDS do not only response only to the call, they also make sure that the system resources are always ready.  EMDs must be medically and technically trained.

25. Mutual Aid and Mass-Casualty Preparation  A formalized mutual aid agreement that ensures that help is available when needed.  Agreements should be between neighboring departments, systems, or territories  Each system should also put a disaster plan in place for catastrophes that can overwhelm available resources.

26. EMS System Operation 1.Citizen activation. 2.Prehospital care. 3.Hospital care. 4.Rehabilitation.

27. Citizen Activation The EMS system begins with citizen involvement or citizen activation. That is why the public needs to be taught on how to: 1.Recognize what is an emergency and what is not. 2.Activate the EMS system. 3.Provide basic care before EMS arrives (BLS).

28. Prehospital Care  Level and extent of the prehospital care given to patient depends on : 1.Patient condition. 2.Resources available. 3.Level of paramedic training.  The range of prehospital care may include : comfort and reassurance, BLS, ALS, I.V fluid and medication administration.

29. Hospital Care  In the hospital setting the available resources, diagnostic tests are performed and more advanced intervention are usually done.  the resources may even extend beyond the emergency department to include surgery, cardiac catheterization and intensive care admissions.

30. Rehabilitation  Carried out after hospital delivery either before or after hospital discharge  It may be in the form of education, physical or occupational therapy  It Helps the patient maintain maximum independence after incident.

31. So what are the factors that determine the patient survival in prehospital setting?? 1.Bystander care. 2.Dispatch (including prearrival directions). 3.Response (both mode and distance). 4.Prehospital care provided (level of EMS-trained personnel) 5. Transportation. 6. Emergency department care. 7.Definitive care. 8.Rehabilitation.

33. An EMS system must be designed to meet the needs of the patient. Therefore, the only acceptable quality of an EMS system is EXCELLENCE!

34. Quality Assurance and Improvement  Quality Assurance: is designed to maintain continuous monitoring and measurement of the quality of clinical care.  Continuous Quality Improvement (CQI) is designed to refine and improve an EMS system, emphasizing customer satisfaction.

35. Continuous Quality Improvement (CQI)  CQI – A Dynamic Process that aim at : 1. Identify Problems 2. Elaborate on the cause 3. Develop remedies 4. Lay out plan to correct problems 5. Enforce the plan 6. Reexamine the problem

36. Rules and Responsibilities of Paramedic Within EMS System 1.Preparation 2. Response 3. Scene size-up 4. Patient assessment 5.Treatment and management. 6. Moving and lifting. 7. Disposition and transfer 8. Documentation. 9. Clean-up, maintenance and review.

37. Rules and Responsibilities of Paramedic Within EMS System

38. Home work Define EMS system ? Enumerate the rules of medical director ? Any questions ?