EMS: Overview

Question 1

What is EMS Basic Life Support?

Answer 1

Provision of emergency care without the use of adv Tx:

• airway mgmt (oral/nasal airways, BMV)
• CPR
• hemorrhage control
• spine immobilization
• assistance with childbirth
• Defibrillation with an AED

Question 2

What is EMS ALS?

Answer 2

More comprehensive level of service by highly educated providers.

• advanced airway interventions
• IV placement
• RX
• cardiac monitoring
• manual defibrillation
• certain invasive procedures

Question 3

Single-Tiered System

Answer 3

Every response, regardless of call type, receives the same level of personnel expertise and equipment allocation (ie all BLS or ALS)

Question 4

Multi-tiered Systems

Answer 4

A combination of ALS and BLS response, depending on the nature of the call

Question 5

First-responder System

Answer 5

Usually police officers or firefighters (non-transport ALS or BLS provider)

• provide initial care (basic airway, hemorrhage control, spinal immobilization) before medical care and transportation assets arrive.
• FR assesses & determines whether additional resources are required, initiates patient care, and provides adv info to responding personnel.

Question 6

AHA “Chain of Survival” goal

Answer 6

To ↓ Mortality in out-of-hospital cardiac arrest

Question 7

Chain of Survival Components

Answer 7

1) Early access to care
2) CPR
3) Defibrillation
4) Advanced airway management and medications

Question 8

Basic ambulance equipment

Answer 8

1) Emergency procedures (airway support, hemorrhage control, immobilization, childbirth)
2) Personal protection equipment
3) Patient mobilization
4) Basic rescue procedures

Question 9

EMS Medical director

Answer 9

Physician with specialized interest and knowledge of patient care activities unique to the pre-hospital environment. Typically has administrative authority to implement patient care protocols, interact with all aspects of the system, and remove a provider from practice if medical care/behavior is substandard

Question 10

Off-line (indirect) control

Answer 10

Protocol development, education of personnel, prospective and retrospective review of patient care, and other quality improvement processes directed towards medical accountability for patient care activities

Question 11

Protocols

Answer 11

Pre-established practice guidelines that define the standard of care for most illnesses/injuries encountered in the pre-hospital setting
-Standing orders for particular clinical situations (medications or procedures) before comms with hospital personnel that are performed under the medical license of the medical director

Question 12

Education Quality/Performance Improvement

Answer 12

Review of patient care reports or direct field observation to evaluate individual, system performance and patient outcome.
-Competency, knowledge retention, skill performance, and time standards are measurable parameters

Question 13

On-line (direct) control

Answer 13

Real-time interaction between a physician or designee and the field provider ie radio/telephone comms or direct scene observation

Question 14

Centralized System

Answer 14

Selected hospital designated as the base hospital and is responsible for providing all direct medical control orders and notification regardless of the receiving facility

Question 15

Decentralized System

Answer 15

Each hospital functions as a base station and provides direction to EMTs/paramedics transporting patients to their facility

Question 16

Elements of an EMS System

Answer 16

1) Personnel
2) Training
3) Communications
4) Transportation
5) Facilities
6) Critical Care
7) Public Safety
8) Consumer participation
9) Access to Care
10) Transfer of care
11) Standardization of patients’ records
12) Public information and Education
13) Independent Review and Evaluation
14) Disaster Linkage
15) Mutual aid agreements
16) EMS System Research

Question 17

Priority dispatch

Answer 17

Process by which emergency medical dispatchers collect information to direct the most appropriate EMS response

Question 18

Pre-arrival instruction

Answer 18

Provision of basic instructions to help care for the patient prior to the arrival of EMS personnel

Question 19

Functions of the EMS communication System

Answer 19

1) Public access
2) Prompt dispatch of the appropriate vehicles and personnel
3) Timely hospital notification
4) On-line medical control

Question 20

EMS specific equipment is better adapted to field use vs hospital equipment-

Answer 20

1) Size
2) Weight
3) Durability

Question 21

Four questions for EMS equipment:

Answer 21

1) Does it do the job?
2) Is it safe?
3) Does it do the job and is it safe in the field environment?
4) Does it do the job and is it safe in the field environment in the hands of field personnel?

Question 22

Equipment Necessary for an EMS System

Answer 22

1) Vehicles
2) Communications
3) Electronic Patient Record
4) Universal precautions
5) Personal Protective Equipment (PPE)
6) Resuscitation Equipment (defibrillators, airway/ventilation adjuncts, vascular
access)
7) Spinal Immobilization
8) Extremity Immobilization
9) Pharmaceutical Equipment

Question 23

EMS Vehicles

Answer 23

1) Ground ambulances
a) Type I: standard truck chassis with a separate modular box to carry personnel, patient, and equipment; No access between driver and patient care compartments
b) Type II: enlarged van type vehicle
c) Type III: van chassis with an integrated modular box on the back for medical care and equipment
2) Helicopters
3) Fixed-wing aircraft
4) First-response vehicles (FD, PD)

Question 24

Communications

Answer 24

1) Two way radios- Trunking: in urban centers, communications pathways are managed by a central processor between end users allowing large numbers of users to share a relatively small number of radio frequencies
2) Cellular phones

Question 25

Electronic Patient Record

Answer 25

Standardized data sets and a process for collecting data are essential for research and quality assurance

Question 26

Universal Precautions

Answer 26

Masks, goggles, gloves, occasionally gowns

Question 27

Personal Protective Equipment (PPE)

Answer 27

• For exposure to hazardous material, biologic, or chemical weapons of mass destruction
• Minimum PPE: filtered (N95) mask, goggles, gloves, protective clothing (nonabsorbent & puncture-resistant)

Question 28

Manual Defibrillators/AEDS

Answer 28

-AEDs should have recording capabilities so that the cardiac arrest can be reviewed for medical oversight and QA

Question 29

Airway/Ventilation Adjuncts

Answer 29

• Basic: Oral/Nasal airways, bag
• valve mask, portable suction
• Other adjuncts: LMA, Combitube/King, LMA

Question 30

Advanced airway equipment:

Answer 30

ETTs of varying sizes, laryngoscope blades + handles, stylets, lubricant, Magills, bougies, +/- meds for RSI

Question 31

Vascular access equipment

Answer 31

• Tourniquets, cleaning agent, IV catheters, IV fluid bags, IV tubing
• Medical director must provide guidelines for when/how to institute vascular access to allow appropriate interventions at the appropriate time

Question 32

Spinal Immobilization

Answer 32

-Spinal boards + Cervical collars

Question 33

Extremity Immobilization

Answer 33

-improves patient comfort and increases ease of transport

Question 34

Requirements for Patient Transfers

Answer 34

1) Complete assessment of risks/benefits of transfer
2) Informed consent obtained from patient or family
3) Appropriate transportation (equipment and personnel) arranged
4) Treatment and stabilization performed
5) Acceptance from receiving facility ensured
6) Appropriate patient care data sent (fax or with patient)