Pre-hospital Care

Question 1

What constitutes pre-hospital care?

Answer 1

1. Basic first aid
   – Bandaging wounds
2. Advanced care
   – IV fluids
   – Intubation
   – CPR
3. Many interventions in between

Question 2

Goals of emergency medical systems?

Answer 2

– Connect patients to appropriate level of care
– Care for patients in a timely manne

Question 3

2 common EMS models?

Answer 3

1. Anglo-American
   * Led by EMS practitioners
   * Patients brought to hospitals
2. Franco-German
   * Led by emergency physicians
   * Physicians treat patients in the field before transport

Question 4

EMS system contruction?

Answer 4

• Access
• Community Response
• EMS Response
• Medical Rescue Services
• Patient Transport Services

Question 5

Access in EMS system?

Answer 5

1. Telecommunications access to a contact center with command and control structure is essential
2. Emergency calls routed to regional dispatch centers
   – Centralized triage
   – Coordinates ambulance response
3. Simple, universal 3-digit number is preferred
   (e.g. 112, 911)
   - Most countries have cellular networks
   - Most emergency requests will come via cellular device

Question 6

Community response in EMS system?

Answer 6

1. Local communities must develop response
   capacity
2. Community education
   – Recognize medical emergencies
   – Communicate emergencies to EMS
   – Provide basic first aid

Question 7

EMS response in EMS system?

Answer 7

• Ambulances take many
  forms
• Require personnel, equipment, medications, communication capabilities

Question 8

Medical rescue services in EMS system?

Answer 8

Help gain access to
patients
– Ex: traffic accidents,
building collapse, wilderness rescue
– Release entrapment
– Provide medical care

Question 9

Ancillary services in EMS system?

Answer 9

Patient Transport Services
– Non-EMS options for patients to reach hospitals
must exist
– Without pathway for non-emergent transport, EMS will be overwhelmed and unavailable for emergencies

Question 10

Principles of pre-hospital care?

Answer 10

• Definitive Care
• Time
• Minimum Standards
• Operating Procedures
• Medical Oversight and Quality Management
• Command and Control

Question 11

Definitive care in pre-hospital care?

Answer 11

• EMS must focus on delivering patient to definitive care
  – Hospital or health center capable of treating patient’s condition
• If definitive treatment cannot be reached, prehospital care is wasted
• Avoid “stay and play”: field stabilisation is senseless if patient never reaches the hospital

Question 12

Time is pre hospital care?

Answer 12

• Many steps in responding and treating
• Each step takes TIME
• Patient outcomes depend upon rapid delivery of
  EMS, emergency facility, and definitive care
• Every step must be as fast as safely possible
• Faster process also increases availability of EMS
  for next emergency response

Question 13

Standards and procedures in prehospital care?

Answer 13

• EMS systems require quality standards for
  – Personnel
  – Equipment
  – Medication– Vehicles– System performance
• Standards allow measurement of performance
  and system capacity, and highlight areas for
  improvement