1. Paramedic Care: Principles & Practice Volume 1: Introduction to Paramedicine CHAPTER Fourth Edition ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Roles and Responsibilities of the Paramedic 3

2. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Standard Preparatory (EMS Systems)

3. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Competency Integrates comprehensive knowledge of EMS systems, the safety and well-being of the paramedic, and medical-legal and ethical issues, which is intended to improve the health of EMS personnel, patients, and the community.

4. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Introduction Strong knowledge of pathophysiology and current medical technology Maintain professional attitude while making medical and ethical decisions. Provide emotional support to patients and their families.

5. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Primary Responsibilities Preparation –Ongoing Training  Aerobics  Exercises  Stretching  Understand biomechanics of lifting  Effects of stress; how to alleviate it

6. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Primary Responsibilities Preparation –Inspection and maintenance of emergency vehicle and equipment –Restocking medications; checking expiration dates –Local EMS protocols, policies, procedures

7. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Primary Responsibilities Preparation –Communications system hardware and software –Local geography –Support agencies

8. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. A paramedic provides emergency care to ill and injured patients—at the scene and in the ambulance. (© Craig Jackson/In the Dark Photography)

9. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Primary Responsibilities Response –Personal safety number one priority –Always follow basic safety precautions en route to incident.  Wear seat belt.  Obey posted speed limits.  Monitor road for potential hazards.

10. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Primary Responsibilities Response –Correct location of incident –Appropriate equipment en route –Request additional personnel or services. –Anticipate high-risk situations based on dispatch information and experience.

11. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Primary Responsibilities Response –Multiple patients –Motor vehicle collisions –Hazardous materials –Rescue situations –Violent individuals –Use of weapon –Knowledge of previous violence

12. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Primary Responsibilities Scene Size-Up –Primary concern safety of crew, patient, and bystanders –Identify all potential hazards. –Never enter unsafe scene until hazards have been dealt with. –Any scene has potential to deteriorate.

13. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Always assess the scene for potential hazards as you approach. (© Kevin Link)

14. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Primary Responsibilities Scene Size-Up –Determine number of patients. –Determine mechanism of injury (MOI) or nature of the illness (NOI).

15. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Primary Responsibilities Patient Assessment—Primary –General impression of appearance –Assess responsiveness. –Assess airway, breathing, circulation. –Treat life threats immediately. –Decide whether to continue assessment on scene or transport.

16. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Primary Responsibilities Patient Assessment—Primary –Take patient's medical history. –Continuously monitor patient. –Provide additional emergency care needed.

17. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. During the primary assessment of your patient, you will look for and immediately treat any life-threatening conditions.

18. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Primary Responsibilities Recognition of Illness or Injury –First aspect of patient prioritization –Patient priority based on urgency for transport.

19. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Primary Responsibilities Patient Management –Follow your system's protocols. –Medical direction:  Instructions on how to proceed with emergency care  Permission to perform certain procedures  Alternatives to standard care

20. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Primary Responsibilities Appropriate Disposition –Patient taken to appropriate facility by appropriate mechanism of transport –Mode of transportation; time and distance key factors –Know resources available. –Follow all local protocols.

21. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Primary Responsibilities Appropriate Disposition –Selecting appropriate receiving facility for patient is your responsibility. –Know which medical facilities in your area offer appropriate services. –Receiving facilities categorized based on level of care they can provide.

22. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Primary Responsibilities Appropriate Disposition –Level I facility: regional resource trauma center; tertiary care facility for trauma care system; university-based teaching hospitals. –Level II trauma center: hospital expected to provide initial definitive trauma care, regardless of severity of injury.

23. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Primary Responsibilities Appropriate Disposition –Level III trauma center: serves communities that do not have immediate access to Level I or II institution. –Level IV trauma facilities: provide advanced trauma life support before patient transfer in remote areas where no higher level of care is available.

24. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Primary Responsibilities Appropriate Disposition –Designated trauma centers that offer unique services: burn, pediatric, psychiatric, perinatal, cardiac, spinal, poison centers. –When in doubt, contact on-line medical direction for advice and support.

25. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Primary Responsibilities Appropriate Disposition –In some areas, paramedics provide primary care and then transport. –Treat and release: paramedics on scene, assess patient, provide emergency care, do not transport.

26. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Primary Responsibilities Patient Transfer –When in doubt about patient's stability for duration of transport, or capabilities of receiving facility, contact medical direction. –Hand-off: prior to removing patient from hospital, request verbal report from primary care provider.

27. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Primary Responsibilities Patient Transfer –First priority during transport is patient. –All documents provided by sending facility turned over to receiving care provider along with copy of run report.

28. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Primary Responsibilities Documentation –Patient care report completed in entirety as soon as emergency care completed. –Notes taken copied into report –Importance of accurate and complete documentation cannot be overemphasized. –Record only observations, not opinions.

29. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Primary Responsibilities Returning to Service –Clean and decontaminate unit. –Properly discard disposable materials. –Restock supplies; replace and stow away equipment. –Refuel unit. –Review call with crew members. –Check for signs of critical incident stress; assist anyone who needs help.

30. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. A paramedic's responsibility does not end with providing patient care. Documentation, restocking, and cleaning of the ambulance and emergency equipment are equally important.

31. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Additional Responsibilities Training civilians in cardiopulmonary resuscitation (CPR) EMS demonstrations and seminars Teaching first aid classes Organizing prevention programs Professional development activities

32. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Additional Responsibilities Administration –Station duties –Recordkeeping and reporting –Special projects –Developing interagency relationships

33. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Additional Responsibilities Community Involvement –Help public learn how to:  Recognize emergency  Provide basic life support (BLS)  Properly access EMS system –Successful effort can save lives. –Illness and injury risk surveys

34. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Additional Responsibilities Support for Primary Care –Promote wellness and prevent illness and injury. –Reduce cost of services by decreasing burden on system.

35. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Additional Responsibilities Citizen Involvement in EMS –Helps give insiders an outside, objective view of quality improvement; problem resolution. –Members of community used in development, evaluation, regulation of EMS system.

36. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Additional Responsibilities Personal and Professional Development –Responsibility to continue personal and professional development –As volume of calls decreases, training correspondingly increases. –Review previously learned materials; receive new information.

37. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Professionalism Paramedic member of health care professions Periodic recertification with specified amount of continuing education time Promote quality patient care. Set and strive for highest standards. Earn respect and confidence of team members and public.

38. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Professionalism Professional Ethics –Ethics: rules or standards that govern conduct of members of a particular group or profession. –Ethics are not laws; they are standards for honorable behavior. –Conformity to ethical standards expected.

39. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Professionalism Professional Ethics –Guiding principles for professional EMT service:  1948: World Medical Association adopted “Oath of Geneva.”  1978: National Association of Emergency Medical Technicians adopted “EMT Code of Ethics.”

40. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Professionalism Professional Attitudes –Establish excellence as goal. –Never be complacent about performance –Practice skills. –Take refresher courses. –Set high standards.

41. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Professionalism Professional Attitudes –Critically review performance; seek ways to improve. –Check all equipment prior to emergency response. –Act in professional manner both on and off duty.

42. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Professionalism Professional Attributes –Leadership –Integrity –Empathy –Self-motivation –Professional appearance and hygiene –Self-confidence

43. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. As leader of the EMS team, the paramedic must interact with patients, bystanders, and other rescue personnel in a professional and efficient manner.

44. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Professionalism Professional Attributes –Communication skills –Time-management skills –Diplomacy in teamwork –Respect –Patient advocacy –Careful delivery of service

45. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Professionalism Continuing Education –Maintaining certification is responsibility of paramedic –Expansion of knowledge and skills –Keep up with emergency health care delivery system.

46. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Summary To become a paramedic, you must be willing to be a leader in prehospital emergency medical care. Responsibilities: on-call emergency duties; off-duty preparation. Be prepared to respond.

47. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Summary Most time as paramedic will be spent preparing yourself to do job properly— not providing emergency care. The best paramedics are those who make a commitment to excellence.