Chapter 1 Objectives - EMS Systems Flashcards
- List key developments in the history of emergency medical services (EMS). (pp 4-9)
The emergency medical services (EMS) system is always evolving. Originally, its primary role was transportation. As awareness of EMS capabilities grew, the need for improved systems in various (primarily rural) locations became evident.
This awareness, along with research and guidelines from national organizations, has led to the advancement of EMS.
As a paramedic, you will encounter many different situations, so remember:
Your call is a true emergency in the eyes of the callers or patients. Do not judge them if you feel it is not.
In reality, the majority of your calls will not entail true life threats, but they are to your patients.
The public’s perception of you is based on:
- What they have seen on television or read in articles.
- The patient’s previous experiences
- Your treatment of their loved ones
Continued education is a must. What you learn today may not be applicable tomorrow.
Treat all people with respect and dignity.
This applies whenever you are in uniform or representing your profession, whether on duty or off.
EMS System Development
Much of the prehospital emergency medical care you will deliver as a paramedic can be attributed to the visionary advances of pioneers in the field including Drs. Peter Safar and Nancy Caroline.
You may be surprised to learn how long organized systems have been in place.
The history of EMS
1487: The first use of an ambulance occurred during the Siege of Málaga. No documented medical care provided, simply transport
1800s: Baron Dominique-Jean Larrey, chief physician in Napoleon’s army, is credited with establishing the first prehospital system for triaging and transporting patients.
1865: The first civilian ambulance was used in Cincinnati, Ohio.
1869: The first ambulance service started at the Bellevue Hospital in New York City. In the first year alone, ambulances responded to more than 1,800 calls for help throughout the city.
1899: The first operated automobile-type ambulance was used at the Michael Reese Hospital in Chicago, Illinois.
A major shift occurred between World War I and World War II. Many hospital-based ambulance services did not survive.
1926: The Phoenix fire department started service similar to present-day EMS.
1928: Julian Stanley Wise launched the first rescue squad in Roanoke, Virginia. Soon after, numerous other rescue squad organizations were developed along the East Coast, primarily in New Jersey.
1940s: EMS was turned over to fire and police departments due to lack of personnel.
No minimum standard of training was set. Care was not always welcomed.
The 20th century and modern technology
During World War I and World War II, systems for field treatment and transport (battlefield corps) continuously evolved.
EMS made major strides following WWII.
Military medical researchers recognized bringing hospital-type services closer to the field gave patients a better chance of survival.
Helicopters were first used in 1951 during the Korean War. Brought patients to Mobile Army Surgical Hospitals (MASH units). Helped thousands survive
1956: Mouth-to-mouth resuscitation was developed by Drs. Elan and Safar.
The portable defibrillator was developed by Frank Pantridge in 1959.
Late 1950s/early 1960s:
Focus moved back to bringing the hospital to the patient. Mobile intensive care units (MICUs) were developed. Staffed by specially trained physicians. Shortage of physicians led to training of nonphysicians.
1965: The National Academy of Sciences and the National Research Council released “The White Paper.” Also called “Accidental Death and Disability: The Neglected Disease of Modern Society” Findings included: A lack of uniform laws and standards, ambulances and equipment of poor quality or nonexistent, lack of communication between EMS and hospitals, lack of personnel training, hospitals staff only part time, higher number of people died in motor vehicle accidents than the Vietnam War.
Findings outlined 10 critical points to establish a functioning system. Led to the National Highway Safety Act. Enacted in 1966. Act created US Department of Transportation (US DOT). The US DOT provided authority and finances for the development of life support programs.
1968: Task Force of the Committee of EMS created basic training standards and principles of a 9-1-1 system to provide universal access to emergency services. Refer to Table 1-1 for the critical points, required components, and system elements of EMS developed as a result of “The White Paper.”
9. 1969: Dr. Eugene Nagel of Miami, Florida, created the first true paramedic program.
a. Trained firefighters with advanced emergency skills
b. Developed a telemetry system
i. Firefighters transmitted patients’ electrocardiograms (ECGs) to physicians.
ii. Firefighters received medical instructions from physicians.
c. Often called the Father of Paramedicine
d. Standards for ambulance design and equipment were published this year.
10. 1970s:
a. More helicopters became available.
b. The National Registry of Emergency Medical Technicians (NREMT) began.
11. 1971:
a. Emergency Care and Transportation of the Sick and Injured was published.
i. First emergency medical technician (EMT) textbook
ii. Published by the American Academy of Orthopaedic Surgeons (AAOS)
b. AAOS began training EMTs through a national workshop.
c. Emergency!, the first television program focused on EMS, began an 8-year run.
i. The lead characters in the series became household names.
12. 1973: The Emergency Medical Services Systems Act was passed.
a. Defined 15 required components of an EMS system
i. Refer to Table 1-1
b. Emphasis on regional development and trauma care
c. Provided a structure and uniformity to the EMS system that came out of pioneering programs in Miami, Seattle, and Pittsburgh, and the Illinois Trauma System (Dr. David Boyd)
13. 1974:
a. Federal report disclosed fewer than half of ambulance personnel completed training
b. Guidelines published for development and implementation of EMS systems
14. 1975:
a. The American Medical Association recognized emergency medicine as its own branch within medicine.
b. Many cities set up individual advanced EMS training.
15. 1977: The first National Standard Curriculum for paramedics was developed by the US DOT.
a. The first paramedic curriculum was based on Nancy Caroline’s work.
16. 1980s/1990s:
a. The number of trained personnel grew significantly.
b. The National Highway Traffic Safety Administration (NHTSA) developed 10 system elements to help sustain an EMS system.
c. Federal funding and staff for EMS was reduced.
d. Responsibility for EMS was transferred to the states.
e. Funding continues to be a major roadblock for states and local governments.
f. Major legislative initiatives:
i. EMS for Children (EMSC) program implemented in 1985
ii. Amendment to the Public Safety Officers Benefit Act in 1986
(a) Families of firefighters, members of a rescue squad, and members of an ambulance crew are now compensated if a provider is killed in line of duty.
g. Trauma systems started making headway in the 1990s.
i. Some of these secondary programs received federal funding.
ii. Some advances are held back due to lack of funding.
D. The 21st Century
1. Numerous initiatives are appearing.
a. One example is EMS Compass.
i. Measures performance in EMS
ii. Help identify best care practices and establish performance benchmarks throughout the country
b. EMS training is being used in many other areas of health care instead of strictly in an ambulance.
i. Hospital emergency departments
ii. Health care clinics
iii. Physicians’ offices
c. Community paramedicine, the health care model in which experienced paramedics receive advanced training to provide additional services, is making continuing strides.
2. These additional capabilities are not being developed to replace current health care modalities, but rather to utilize the capabilities of paramedics in areas not served previously.
- Discuss the processes of licensure and certification. (pp 9-10)
Test
- Define reciprocity, including its relevance to the practice of emergency medical care. (p 10)
Test
- List the five main types of services that provide emergency medical care. (pp 10-11)
Test
- Discuss the critical points, required components, and system elements of EMS. (pp 11-12)
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- Describe the levels of EMS education in terms of skill sets needed for each of the following: emergency medical responder, emergency medical technician, advanced emergency medical technician, and paramedic. (pp 12-13)
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- Discuss the role of the National Scope of Practice and the National EMS Education Standards as they relate to the levels of EMS education. (pp 13-14)
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- Discuss initial paramedic education and the importance of continuing education. (pp 13-14)
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- Describe various types of transports the paramedic may perform, including transports to specialty centers and interfacility transports. (pp 14-15)
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- Discuss the paramedicʼs role in working with other health care providers and public safety agencies. (pp 15-16)
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- Characterize the EMS systemʼs role in prevention and public education in the community. (pp 16, 18, 20, 26)
Test
- Describe the attributes that a paramedic is expected to possess. (pp 17-18)
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- Describe the roles and responsibilities of the paramedic. (pp 19-21)
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- Discuss issues relating to the appropriate method of transport, as well as non-transport situations. (pp 20, 22)
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- Describe how medical direction of an EMS system works and the paramedicʼs role in the process. (pp 21-22)
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