EMS:
IntroductionEMS:
Introduction
History of EMS
1797 - Baron Dominique-Jean Larrey, "the father of EMS", was appointed by Napoleon to develop a plan for the French army to care for wounded soldiers on the battlefield. He developed a carriage known as a "ambulance volante" or flying ambulance. He developed the precepts of EMS used today:
1. rapid access to patients by trained personnel.
2. field treatment and stabilization.
3. rapid transport back to the medical facility.
4. provide medical care en route.
1950's - J. D. "Deke" Farrington MD, FACS, "the father of modern EMS", was instrumental in bringing the EMS process used by the military to civilians.
1975 - The National Registry of Emergency Medical Technicians (NREMT) and the National Association of EMT's (NAEMT) were created.
What's an EMT?
The EMT is at the heart of the EMS system. They are usually the first contact the patient has with the healthcare system. The EMT plays a crucial role in determining how and where the patient will go in the first few minutes or hours of their healthcare encounter.
Emergency medical care involves:
1. rapid response
2. assessment
3. stabilization
4. transportation
5. definitive care
Levels of EMT Training:
First Responder: This level of training is designed for persons who are first on the scene. They activate the EMS system, provide immediate care for life-threatening injuries, control the scene, and prepare for the arrival of the ambulance.
EMT-Basic (EMT-B): provides assessment and basic emergency medical care for the ill or injured patient.
EMT-Intermediate (EMT-I): provides basic care and may use intravenous therapy, advanced airway management, and administration of medications beyond that of the EMT-B. This level also includes those trained as Shock Trauma Technician or Critical Care Technician.
EMT-Paramedic (EMT-P): provides basic and intermediate care plus uses a wider variety of medications, IV solutions, inserts endotracheal tubes, ECG interpretation, and other advanced techniques.
Primary Functions
The EMT has a number of roles and responsibilities which include:
Preparedness - the EMT must be prepared at all times to perform their job. This includes knowing how all equipment functions and understanding policies and procedures of the EMS system.
Response - the EMT must respond to all calls in a safe manner. This includes knowledge of general geographics, traffic patterns, and all traffic laws.
Safety - personal safety is the most important responsibility of the EMT followed closely by the safety of other members of the rescue team, patient, and bystanders.
Assessment - before treatment can begin, the EMT must identify what is wrong with the patient. This includes obtaining historical information as well as information relating to the current illness or injury. This information can be obtained through observation, evaluation, assessment, examination, and intervention.
Prompt & Effective Care - this may include airway control, control of bleeding, cardiopulmonary resuscitation, or treatment of shock.
Lifting & Moving - most cases will involve shifting the patient from the site of illness or injury to the ambulance cot and then transportation of the patient to the hospital.
Safe & Efficient Transport - the patient must be treated at the scene and during transportation to increase the likelihood of survival.
Transfer - the EMT must select the most appropriate medical facility and is responsible for communicating verbally with the receiving hospital prior to arrival and at the time of transfer. A written prehospital care report is also an essential tool for communicating information to the receiving hospital.
Record keeping/data collection - some type of record is developed and data are collected on every patient seen in the EMS system. The record includes details about the circumstances of the call, results of the assessment, and description of any care provided by the EMTs.
Patient advocacy - the EMT must represent the patient and act in the patient's best interest until that responsibility can be passed on to another EMS provider.
Related functions - the EMT may perform other duties at times which may include restocking supplies in the ambulance, extrication, community education, and other duties.
Situations
EMTs will respond to calls involving a number of different situations which may include:
1. Violence - if the EMT is is in danger, they must get away as soon as possible. Do not attempt to disarm a patient. Additional police help is essential in situations involving violent behavior.
2. Media intervention - the EMT should not release information about a patient to the media. This type of intervention is handled by the officer in charge.
3. Special needs - some patients need wheelchairs, seeing eye dogs, or various other assistive devices. Maintain eye contact and explain procedures before you do them to avoid unnecessary stress to the patient and possible harm to the EMT.
Attitude & Conduct
The EMT must dress professionally and present themselves as skilled and caring. An EMT should be compassionate, physically and emotionally stable, and exhibit leadership qualities. A good EMT should exhibit the following personality traits:
Pleasant
Sincere
Cooperative
Resourceful
Self-starter
Emotionally stable
Leadership
Neat & clean
Good moral character
Respectful
Good self-control
Good communication skills
Good listener
Ethics & Patient Confidentiality
Ethics are moral principles or standards the govern your conduct. All information an EMT receives about a patient is confidential. The patient's privacy should be protected from third parties without the patient's permission. Information given to other EMS personnel about the patient's condition for the purpose of continuing patient care is not a violation of confidentiality.
An EMT must be familiar with the EMT Oath, the National Association of Emergency Technicians Code of Ethics, and the Oath of Geneva.
Communication
The EMT communicates with the patient verbally and nonverbally. The type of actions exhibited by the EMT and verbal communication should be to provide reassurance and calming, NOT in a manner that increases anxiety of the patient. Running around and yelling between EMTs will increase patient anxiety and make treatment more difficult. Developing a good rapport with the patient will make assessment and treatment much easier, decrease risk to the EMT, and increase chances of survival for the patient.
Proficiency in radio communication is of utmost importance. The EMT should know how to operate the radio and how to communicate properly over the radio. The EMS personnel must work as a team.
Legal Considerations
EMT's are responsible for knowing the laws and regulations that govern their practice within their state. They must continually renew and update their skills and broaden their knowledge. States either provide licenses or certification of EMTs. Laws and regulations change frequently so, the EMT must always keep up with changes in the laws and regulations that affect their practice.
Quality Improvement
Quality improvement consists of continuous self-review with the purpose of identifying aspects of the system that require improvement. Anytime EMS is activated, if a problem is identified, a plan of action must be implemented to avoid such problems in future such cases and improve upon the system.
Medical Direction
Every EMS system has a medical director who is a physician that assumes the ultimate responsibility. The medical director oversees training and develops protocols. An EMT operates as a designated agent of the physician. Since the physician cannot be physically present at every call, standing orders are developed. These are policies or protocols that authorize the EMT to perform particular skills in certain situations. When such medical care is performed without the medical director or attending physician present, the EMT is following off-line medical direction. Whenever an EMT radios or telephones in directly to the medical director or attending physician and is instructed to provide medical care, this is termed on-line medical direction.
Organizations
The National Association of Emergency Medical Technicians (NAEMT) was formed in 1975. The NAEMT goals are to promote the professional status of the EMT. It can be contacted at 102 West Leake, Clinton MS 39056.
The National Registry of Emergency Medical Technicians (NREMT) is a national, non-profit organization that tests EMT's and documents their level of competence according to standards. It can be reached at 6610 Busch Boulevard, P.O. Box 29233, Columbus, OH 43229.
Review Questions:
1. Define each of the four EMT precepts listed above in detail and give an example of why each is important.
2. Compare how your parents received emergency medical services with how the EMS is today. What changes have taken place?
3. How would you handle a call to a residence that when you arrived you found a women, who was a victim of domestic violence, lie bleeding profusely on the living room floor. It appears that she has been cut severely by shards of glass which you can see broken all around her on the floor. As you enter the front door which is wide open, the husband is standing over her. In one hand, he holds their newborn baby by the hair of the head and, with his other hand, he holds a pistol to the baby's head. The husband threatens to shoot the baby if you come any closer.
4. What are some dangers and problems you are likely to encounter if you answer the following call as follows? Then describe the best way to approach this situation. [Frantz and Shelly arrive at a scene where a blind woman, who was walking with her seeing eye dog, was struck by a car which swerved onto the curb striking her. you can see, as you arrive at the scene from the ambulance, that she has received an open fracture to her femur and is bleeding profusely. She is screaming hysterically while she clutches her dog's collar. Frantz screeches to a halt and jumps out of the ambulance. As he runs around the ambulance towards the screaming patient, he shouts for Shelly to get several items from the back of the ambulance and yells out what he plans to do with the patient to her.]
5. Suppose Eric is trying to control bleeding on a patient when he notices that Jenni has been grabbed by a bystander and is being choked. What should he do? Why?
6. Suppose you have to transport the lead singer from Korn to the hospital after he collapses in the middle of a concert at Thomas & Mack. A reporter from one of the local TV stations insists on riding along with him to the hospital. Can you allow the reporter and/or the camera person in the ambulance? Are you able to tell the reporter what your assessment is of the singer? What if the reporter says they want to interview the singer directly? How about if the reporter says they will not show any video or report any news until they get the singers permission?
7. Identify and describe the primary functions of an EMT.
8. What is the difference between on-line and off-line medical direction?
9. Are EMT's allowed to provide medical care to patients on their own? What allows an EMT to provide medical care to patients?
10. What is the difference between the NAEMT and the NREMT?