Chapter 1: Introduction to Emergency Medical Care Flashcards
What was the earliest documented Emergency Medical Service?
In the 1790s the French transported wounded soldiers away from battle to be seen by physicians.
When did nonmilitary ambulance services begin?
Early 1900s
When/who developed the modern EMS system?
1966 by the DOT
When was the NREMT founded?
1970, they established professional standards
Who established an assessment program with a set of standards for EMS systems?
The National Highway Traffic Safety Administration (NHTSA)
What are the standards set forth by the NHTSA? (10)
- Regulation and policy
- Resource management
- Human Resources and training
- Transportation
- Facilities
- Communications
- Public information and education
- Medical direction
- Trauma systems
- evaluation
Regulation and policy
enable legislation, a lead EMS agency, funding, regulations, policies/procedures
Resource management
centralized coordination of resources, equal access to basic emergency care and transport to an appropriate facility
Human resources and training
all transporting personnel should be trained to the EMT level using national standards
Transportation
safe, reliable transport. most effectively transported by ground, some may need air travel.
Facilities
seriously ill/injured patients must be taken to the closest appropriate facility
Communications
effective communication systems throughout all processes
Public information and education
EMS personnel may educate the publtic about their role, access, and prevention of injuries
Medical direction
Each EMS system must have a physician as a medical director who is accountable for activities of EMS personnel. Involved in all aspects.
Trauma systems
Each state must enable legislation to develop one or more trauma centers, rehabilitation programs, data collection, mandatory autopsies, means to manage/ensure quality of the system
Components of the EMS system
dispatcher, EMR/EMT/AEMT/Medic, ED
Trauma Center
surgery teams capable of the comprehensive treatment of trauma patients are available 24/7. Every specialty.
Who are key members of the prehospital EMS team?
Dispatchers and EMTs
Enhanced 911
identifies the caller’s phone number and location
Emergency Medical Dispatcher (EMD)
Dispatcher that is not only trained to take 911 calls, but trained to provide medical instructions for emergency care such as CPR, artificial ventilation, bleeding control, etc.
Levels of EMS Training (4)
- EMR
- EMT
- AEMT
- Paramedic
Roles and Responsibilities of the EMT (8)
- personal safety
- safety of the crew, patient, and bystanders
- patient assessment
- patient care
- lifting and moving
- transport
- transfer of care
- patient advocacy
Personal Safety
Roles and Responsibilities of the EMT #1 responsibility; you cannot help others if you're injured/dead
Safety of the crew, patient, and bystanders
Roles and Responsibilities of the EMT #2 responsibility; they are facing the same scene dangers as you
Patient Assessment
Roles and Responsibilities of the EMT
Finding out enough about what is wrong with your patient be able to provide appropriate treatment
Patient Care
Roles and Responsibilities of the EMT
An action or series of actions that your training will prepare you to take to help the patient deal with and survive their illness or injury
Lifting and Moving
Roles and Responsibilities of the EMT
Must perform movement without injuring yourself or further injuring the patient
Transport
Roles and Responsibilities of the EMT
safe operation of the ambulance, as well as caring for the patient during the ride
Transfer of Care
Roles and Responsibilities of the EMT
providing accurate and descriptive verbal reports to nurses/physician. Never abandon pt until transfer of care is complete
Patient Advocacy
Roles and Responsibilities of the EMT
speak up for the pt and plead their cause; bring any of their concerns up to the hospital staff
Physical Traits of an EMT
- be able to lift and carry up to 125 lbs; coordination, dexterity, strength
- clear eyesight
- be able to give and receive oral and written instructions and communicate with the patient
Personal Traits of an EMT
- pleasant
- sincere
- cooperative
- resourceful
- a self-starter
- emotionally stable
- able to lead
- neat and clean
- of good moral character and respectful of others
- in control of personal habits
- controlled in conversation and able to communicate properly
- able to listen to others
- nonjudgemental and fair
Refresher courses
present material to the EMT who has already been through a full course but needs to receive updated info.
Continuing Education
supplements the EMT’s original course. Does not take the place of original training.
Where are EMTs employed?
- Fire departments
- ambulance services
- urban/industrial
- rural/wilderness
Quality Improvement
a process of continuous self-review with the purpose of identifying and correcting aspects of the system that require improvement
What are several ways an EMT can work toward quality care?
- Preparing carefully written documentation
- Becoming involved in the quality process
- Obtaining feedback from patients and the hospital staff
- Maintaining your equipment
- Continuing your education
Medical Director
a physician who assumes ultimate responsibility for the patient-care aspects of the EMS system
Medical Direction
oversight of the patient-care aspects of an EMS system by the Medical Director.
Off-line medical direction
standing orders issued by medical direction that allow EMTs to give certain procedures without speaking to the Medical Director
On-line medical direction
orders from the on-duty physician given directly to an EMT in the field by radio or telephone
Protocols
list of steps (assessments and interventions) to be taken in different situations; developed by the Medical Director of the EMS system
Designated Agent
an EMT or other person authorized by a Medical Director to give medications and provide emergency care; transfer of such authorization to a designated agent is an extension of the Medical Director’s license to practice medicine
Standing Order
a policy or protocol issued by a Medical Director that authorizes EMTs and others to perform particular skills in certain situations
EMS role in public health
- injury prevention for geriatric pts
- injury prevention for youth
- public vaccination programs
- disease surveillance
What must play a role in EMS for it to continue to evolve as a respected profession?
Research
Patient Outcomes
the long-term survival of patients
Evidence-based
description of medical techniques or practices that are supported by scientific evidence of their safety and efficacy, rather than merely on supposition and tradition
General procedures needed to make research decisions
- form a hypothesis
- review literature
- evaluate the evidence
- adopt the practice if evidence supports it
Types of Medical Research
- case studies/case reports
- cohort/concurrent control/cas-control studies
- randomized controlled trials (RCTs)
- Systematic review
- Meta-analysis
How many levels of evidence are there?
5
