It is the overall operation of the EMS service that saves lives. Within that service are a multitude of procedural guidelines that contribute to life-saving efforts and each one has its role in delivering exceptional results. Be sure you know all of the guidelines and understand how they function in a well-run EMS service. You need to consult your textbook for complete details on all of the following concepts.
Emergency medical services are a system of response for the care of the sick and injured. An EMS system includes many components including personnel, training, and equipment to report and respond to emergencies. The system includes ambulances and other first responders, emergency dispatching and medical oversight. The Americans with Disabilities Act provides provisions for EMTs with disabilities to perform EMS when possible.
Terms/Concepts to Know: Emergency Medical Services, certification, licensure, Americans with Disabilities Act of 1970, National EMS Scope of Practice
States typically follow national guidelines developed by NHTSA in the National EMS Scope of Practice Model. The latest model went into effect in 2016 and made changes to the levels of certification and skills practiced.
EMRs are trained to provide immediate lifesaving care prior to the arrival of EMTs. Training includes familiarity with some EMT procedures and equipment, but not competency in those procedures or in ambulance operations.
EMTs are trained to provide basic emergency care to ill and injured patients. EMT training is the foundation for the next levels of certification and EMTs are often considered the backbone of EMS systems. Training is typically 150 hours. This is what you are training for.
AEMT builds on the EMT training to include limited advanced life support care such as IV therapy, advanced airways, and some medications. Training is typically an additional 200-400 hours.
Paramedic is the highest level of pre-hospital training. It includes comprehensive training in basic and advanced life support knowledge and skills. Training ranges from 1,000 to 1,3000 hours and it is becoming common for it to be included as part of a college degree.
Terms/Concepts to Know: Advanced Life Support (ALS), Automated External Defibrillator (AED), Emergency Medical Responder (EMR), Emergency Medical Technician (EMT), Advanced EMT (AEMT), and Paramedic
In the past, civilian EMS was not organized and varied widely by location. It was commonly provided by funeral homes, with minimal care beyond the ability to transport someone on a stretcher. A few urban areas had better equipped ambulance services, but the focus was still on transport. Modern EMS systems are considered to have had their start with the passage of federal legislation in the 1960s and 70s that provided guidance and funding for development.
Terms/Concepts to Know: The White Paper, National Highway Transportation Safety Administration (NHTSA), Highway Safety Act of 1966, and EMS Agenda for the Future
The EMS Agenda for the Future defines 14 components of an EMS system that interact with each other. An EMS system cannot function without all of them and it is important to understand and know each of them.
A system to request help is is vital. In most areas this is provided by dialing 9-1-1 and being connected to an emergency communication center. Dispatchers can assess information and send ambulances and other responders. Dispatchers may also be use emergency medical dispatch to provide first aid and CPR instructions.
Radio and other communication links are essential for sending resources. GPS can be used to track the locations of responders. Wireless communications can be used to transmit important information such as response maps and updated information to computers in the ambulance.
EMTs are trained to use a variety of emergency equipment. How and when to use that equipment is called scope of practice. Also, familiarity with the usual service area, checking equipment, and being able to operate all the features in the ambulance are important.
How people are recruited, compensated, and retained are important functions of human resources. The goal is to create systems that attract and retain talented people. Interstate mobility, career ladders, and protection of employee well-being are vital to achieving these goals.
Each EMS system has a set of protocols written by a physician who authorizes the care provided by EMTs. These protocols constitute the EMT’s scope of practice. Modifications or further treatments may be directed by online medical control. Training and education requirements are also determined by the medical director.
EMS systems are governed by individual state laws and regulations. State EMS offices administer these laws and provide oversight, often with input from an advisory committee. Locally, EMS systems have individual policies and procedures regarding daily operations.
EMS care is only the start of the patient’s medical journey. The care started must be integrated with the receiving hospitals to assure proper coordination. Many EMS systems have developed special alert procedures for certain time-sensitive conditions, such as stroke and heart attacks.
Continuous quality improvement is a circular process of reviewing and improving the processes of patient care and reducing error. Errors can be rule, knowledge, or skill-based and are inevitable in systems run by humans. EMTs have an obligation to recognize and reduce errors.
Computer technology has become an integral part of EMS systems. Data can be used for a wide variety of purposes, including staffing, equipment justification and identifying training needs. Federal data reporting provides a snapshot of EMS that can be used to improve planning.
Regardless of the type of EMS system, funding is needed for continued operations. Funding may come from many sources, including patient fees, taxes, donations, and grants. EMTs play a critical role by properly documenting care and obtaining patient billing signatures.
Education systems are critical for producing EMS providers and offering continuing education. Accreditation is common and some states require special certification for EMS educators. EMTs have a professional duty to maintain knowledge and obtain needed education hours.
EMS can be considered part of the public health system. The goal of public health is to prevent health problems, which can then reduce the costs of healthcare. EMTs’ knowledge about the causes of injury and illness in their community can be used for prevention efforts.
EMTs can play important roles in educating the public about healthy behaviors and injury prevention. CPR and first aid education of the public can minimize the effects of events when they occur. Public education efforts also increase the standing of EMTs in the community.
EMS treatments were often adopted from other healthcare providers. Evidence-based medicine is now being used to guide EMS treatment. Good documentation may be vital to gathering research information. Research must be read carefully to understand the results.
Terms/Concepts to Know: EMS Agenda for the Future, public safety access point, emergency medical dispatch (EMD), primary service area (PSA), medical director, medical control, mobile integrated healthcare (MIH), continuous quality improvement (CQI), National EMS Information System (NEMSIS), public health, primary prevention, secondary prevention.
EMTs have many roles and responsibilities from knowing their equipment to protecting patient privacy under HIPAA. EMTs must also display professional attributes including appearance, integrity, empathy, and respect.
Terms/Concepts to Know: Health Insurance and Portability and Accountability Act (HIPAA).