PREHOSPITAL EMERGENCY CARE TENTH EDITION 1 Emergency Care

PREHOSPITAL EMERGENCY CARE TENTH EDITION 1 Emergency Care CHAPTER Medical Systems, Research, and Public Health Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Learning Readiness • EMS Education Standards § Preparatory § Public Health Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Learning Readiness Objectives • Please refer to pages 1 and 2 of your text to view the objectives for this chapter. Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Learning Readiness Key Terms • Please refer to page 2 of your text to view the key terms for this chapter. Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Setting the Stage • Overview of Lesson Topics § The emergency medical services (EMS) system § Roles, responsibilities, and attributes of EMTs § State EMS agencies, medical direction, and quality improvement (QI) continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Setting the Stage • Overview of Lesson Topics § Patient safety § Research in EMS § Public health and EMS Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Case Study Introduction Every Saturday Ben Melton has breakfast at Dave’s Diner, a favorite with locals in the small tourist town. Despite having diabetes and carrying an extra 40 pounds around his waist, 51 -year-old Ben finds it hard to pass on Dave’s breakfast platter of eggs, steak, and fried potatoes. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Case Study Introduction This morning, by the time his coffee arrives, Ben isn’t feeling so well. Just as his friend, Arnie, notices that Ben has turned pale and broken into a sweat, Ben collapses, pulling the tablecloth with him to the floor. Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Case Study • What components of a health care system must be in place for Ben to receive immediate help? • What weaknesses in a system could decrease Ben’s chances of getting help? Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Introduction • Sudden loss of life and disability from catastrophic accidents and illnesses is a major public health problem. • Every year thousands of people die or suffer permanent harm because of lack of access to adequate to emergency medical services. • EMTs can make a positive difference. Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

The EMS System: History • What happens to an injured or ill patient before he reaches the hospital can make a critical difference. • Lessons learned from observations in the Korean and Vietnam wars have impacted the development of modern EMS systems. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

The EMS System: History • In the past, care did not begin until the patient reached the hospital. • In 1966, the EMS “white paper” identified deficiencies in prehospital medical care, including lack of EMT training and lack of organized systems. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

The EMS System: History • Modern EMS is part of a continuum of care that begins at the scene of the emergency and continues through hospital discharge and rehabilitation. • Several significant developments helped lead to this EMS system. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

The EMS System: History • The Highway Safety Act of 1966 § Required each state to establish a highway safety program that included emergency services § The National Highway Transportation Safety Administration (NHTSA), part of the Department of Transportation (DOT), led the development of EMS. § An early initiative was the development of national standard curricula for EMS. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

The EMS System: History • The Emergency Medical Services System Act of 1973 provided access to millions of dollars of funding for EMS. • The American Heart Association (AHA) began to teach CPR to the public. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

The EMS System: History • In 1993 the National Registry of EMTs (NREMT) released the National Emergency Medical Services Education and Practice Blueprint, which: § Defined issues related to EMS training and education § Served as a guide to the development of national training curricula continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

The EMS System: History • NHTSA documents § 1996 EMS Agenda for the Future • Focused on making EMS a greater component in the health care system § 2000 EMS Education Agenda for the Future: A Systems Approach • Focused on the need for nationwide consistency in the education, training, certification, and licensure of entry-level EMS personnel continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

The EMS System: History • NHTSA documents § 2005 National EMS Core Content • Defined the domain of knowledge of the National EMS Scope of Practice Model § 2006 National EMS Scope of Practice Model • Defines four levels of EMS licensure § National EMS Education Standards • Outline minimum terminal objectives for EMS education programs continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

The EMS System: History • The 2006 Institute of Medicine (IOM) report The Future of EMS Care: EMS at the Crossroads recommends: § Common scopes of practice to allow reciprocity between states § National accreditation for all paramedic programs § National certification as a prerequisite for state licensure and local credentialing Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

The EMS System: Standards • NHTSA provides a set of recommended state standards, the Technical Assistance Program Assessment Standards. • There are ten components. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

The EMS System: Standards • Regulation and policy § Laws, regulations, policies, and procedures that govern the EMS system § A state-level EMS agency to provide leadership to local jurisdictions • Resource management § Central control of EMS resources so that there is equal access to acceptable emergency care continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

The EMS System: Standards • Human resources and training § All personnel who staff ambulances and transport patients must be trained to at least the EMT level • Transportation § Safe, reliable transportation by ground or air ambulance continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

The EMS System: Standards • Facilities § Patients must be delivered to appropriate medical facilities • Communications § Public access to the system § Communication among dispatcher, EMS personnel, and hospital continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

The EMS System: Standards • Public information and education § EMS personnel should participate in programs to educate the public in injury prevention and how to access the EMS system. • Medical direction § A physician medical director to provide medical oversight continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

The EMS System: Standards • Trauma systems § A system of specialized care for trauma patients • Evaluation § A quality improvement system Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

EMS System Access • The most common way of accessing EMS is dialing 911. • Enhanced 911 (E-911) allows: § Automatic number identification § Automatic location information continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Communications play a vital role in the Emergency Medical Services (EMS) system. Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

EMS System Access • Benefits of 911 § Public safety answering point (PSAP) is staffed by specially trained dispatchers. § The number is easy to remember and use. § All emergency services—police, fire, and EMS—are accessible by dialing one number. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

EMS System Access • Cell phones pose some challenges to 911 systems. § They are not identified with a fixed site, so the location is identified as the closest cell tower. § Calls near geographic boundaries can go to a different PSAP. § FCC rules are being implemented to improve cellular access to 911. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

EMS System Access • Voice over Internet Protocol (Vo. IP) also poses potential challenges that are addressed by FCC rules. § 911 service must be a standard feature to all customers. § The subscriber must give the physical location of where the service will be used. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

EMS System Access • Voice over Internet Protocol (Vo. IP) also poses potential challenges that are addressed by FCC rules. § The provider must transmit all 911 calls and associated information to the appropriate PSAP. Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Case Study Charlene, one of the waitresses in the restaurant, pulls a cell phone from her pocket and dials 911. The dispatcher immediately transfers the call to a specially trained emergency medical dispatcher. The EMD asks Charlene a series of questions to get help on the way, and gives her instructions for checking and monitoring Ben’s condition until help arrives. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Case Study • What components of the EMS system have been used in this case so far? Click each item you select. Regulations & Policy Resource Management Human Resources & Training Transportation Facilities Communication Public Information & Education Medical Direction Trauma Systems Evaluation Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Case Study EMTs Juliana Smock and Peter Saylor, who had just finished their check of the ambulance, respond to the dispatch, heading down Highway 129 toward Dave’s. An anxious customer holds open the front door as Juliana and Peter pull to a stop in front of the restaurant. Taking a look around at the scene, the EMTs grab their equipment and head for the door. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Case Study • What EMT responsibilities have Juliana and Peter demonstrated so far? • What EMT responsibilities do you predict they will perform next? • How will the EMTs’ appearance and actions determine how they are perceived by others? Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Levels of Providers • The National EMS Scope of Practice Model identifies four levels of EMS practitioners. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

The four levels of EMS practitioners. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Levels of Providers • Emergency Medical Responder § Provides immediate lifesaving care to patients while awaiting response from a higher-level EMS practitioner continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Levels of Providers • Emergency Medical Technician § Provides basic emergency medical care and transportation using the basic equipment found on an ambulance continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Levels of Providers • Advanced Emergency Medical Technician § Provides basic and limited advanced emergency medical care and transportation to patients in the prehospital environment continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Levels of Providers • Paramedic § Performs advanced assessments, forms field impressions, and provides invasive and drug interventions as well as transport Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

The Health Care System • A health care system is a network of medical care that begins in the field and extends to hospitals and other treatment centers. • EMS providers are part of a community’s health care system. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

The Health Care System • The different health care facilities to which EMTs may transport patients have different capabilities. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

The Health Care System • • • Trauma center Burn center Obstetrical center Pediatric center Poison center • • • Stroke center Cardiac center Hyperbaric center Spine injury center Psychiatric center continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

The Health Care System • Trauma centers continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

A trauma center can provide rapid surgical intervention and treatment of injuries that generally exceeds hospital emergency department capabilities. (© Edward T. Dickinson) Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

The Health Care System • EMTs work as team members with other public safety personnel. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

The EMT works closely with other public safety personnel. Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

You will often work as a team with paramedics and others. Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Case Study After quickly determining the nature of Ben’s problem, the EMTs head toward the closest hospital, a 35 -minute trip, with Juliana behind the wheel and Peter in the back of the ambulance, caring for Ben. Having arranged for a paramedic unit to meet them en route, Peter gives the paramedics a quick radio report. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Case Study Peter continues patient care, following protocols until they meet with the paramedic unit. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Case Study • How can requesting a paramedic intercept benefit the patient? • What are some of the potential pitfalls in patient safety at this phase of the call? Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

EMT Responsibilities • All EMTs share a common set of responsibilities. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Table 1 -1 Roles and Responsibilities of the Emergency Medical Technician continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

EMT Responsibilities • Personal safety and the safety of others continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

The EMT must ensure personal safety at all times. (© Pat Songer) continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

EMT Responsibilities • You cannot help the patient, other rescuers, or yourself if you are injured. § Use safe driving habits. § Do not enter or stay on an unsafe scene. § Be alert to situations with a risk for violence. § Wear reflective clothing and protective clothing as indicated. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

EMT Responsibilities • Patient assessment and emergency care continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

The EMT is responsible for providing competent patient care. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

EMT Responsibilities • Gain access to patients, recognize and evaluate problems, and provide emergency care. § Primary assessment • Identify and manage immediate threats to life. § Secondary assessment • Identify other problems. § Treat the conditions you find. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

EMT Responsibilities • Safe lifting and moving § Prevent further harm to the patient. § Prevent yourself from being injured through good body mechanics and having an adequate amount of help. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

EMT Responsibilities • Transport and transfer of care § Make a destination decision according to protocols. § Notify the receiving facility of the patient’s condition. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

The EMT can get on-line medical direction by telephone, cell phone, or radio. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

EMT Responsibilities • Transport and transfer of care § Continue care en route. § Drive safely. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Assessment and emergency care continued en route to the medical facility. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

EMT Responsibilities • Transport and transfer of care § Give verbal and written reports. § Provide additional assistance as needed. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

The EMT is responsible for properly transferring the care of the patient to the appropriate medical personnel. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

EMT Responsibilities • Record-keeping and data collection § Log the call. § Complete patient care reports. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

As soon as possible, complete the written or electronic prehospital care report. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

EMT Responsibilities • Patient advocacy § EMTs are responsible for protecting the patient’s rights. • Secure and transport personal belongings if needed. • Protect the patient’s privacy. • Make sure that the patient’s family knows how to get to the hospital. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

EMT Responsibilities • Patient advocacy § EMTs are responsible for protecting the patient’s rights • Provide necessary information to hospital personnel. • Honor any patient requests you reasonably can. • Maintain patient confidentiality. Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Case Study At the designated point, the EMTs meet the paramedic unit and give an update on Ben’s status. The paramedic, Alexis Brady, further assesses Ben and implements advanced life support (ALS) treatment. Following the treatment, which was administered to increase Ben’s abnormally slow heart rate, Ben regains consciousness and is confused about what is happening. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Case Study • Now that Ben is conscious, what do you think are his expectations for how Peter and Alexis interact with him? • How could the nature of those interactions affect the quality of patient care? Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

EMT Professional Attributes • Certain professional attributes are important to maximize effectiveness as an EMT. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Table 1 -2 for EMTs Characteristics of Professional Behavior Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

EMT Professional Attributes • Appearance § Excellent personal grooming and a neat, clean appearance help instill confidence in patients and help protect them from contamination that caused by dirty hands, fingernails, or clothing. § Proper appearance can send the message that you are competent and can be trusted to make the right decisions. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

EMT Professional Attributes • Knowledge and skills § § § Required coursework Use and maintenance of equipment Safety and security procedures Geography and travel routes Traffic laws Continuing education continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

EMT Professional Attributes • Physical demands § Ability to lift and carry up to 125 pounds § Good (or correctable) eyesight and color vision § Ability to communicate effectively orally and in writing § Good hearing continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

EMT Professional Attributes • Personal traits § Patients look toward someone to reestablish order in a suddenly chaotic world. § That requires the characteristics listed on the following slides. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

EMT Professional Attributes • Leadership ability § Assess a situation quickly. § Step forward to take control when appropriate. § Set action priorities. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

EMT Professional Attributes • Leadership ability § Give clear and concise directions. § Be confident and persuasive enough to be obeyed. § Carry through with what needs to be done. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

EMT Professional Attributes • Calm, reassuring personality § Be able to calm anxious and agitated patients. • Good judgment § EMTs must make decisions in stressful situations. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

EMT Professional Attributes • Good moral character § EMTs are in a position of public trust that cannot be defined by laws alone. • Stability and adaptability § EMTs are exposed to stressful situations and must delay expression of emotions until an appropriate time. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

EMT Professional Attributes • Ability to listen § EMTs must accurately gather information from patients and bystanders. § EMTs must be accurate when receiving orders from medical direction. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

EMT Professional Attributes • Resourcefulness and ability to improvise § Each call, situation, and patient is different, requiring that EMTs be resourceful to provide efficient, effective care. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

EMT Professional Attributes • Cooperativeness § The care of a patient requires the cooperative interactions of many personnel. • Maintenance of certification and licensure § This is a personal responsibility that involves obtaining continuing education and submitting required forms and fees. Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

State EMS Agency Role • There is overlap between the EMS, public safety, and public health. • State EMS agencies act in ensuring that high-quality EMS is provided in order to protect the health and safety of the public. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

State EMS Agency Role • Primary responsibilities include: § Overall planning, coordination, and regulation of the statewide EMS system § Licensing EMS agencies and personnel Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Case Study En route to the hospital, Alexis and Peter continue their treatment and Alexis calls in a report to the receiving hospital. As Peter continues to reassure Ben and monitor his condition, Alexis begins some preliminary paperwork. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Case Study • What is the legal basis for EMTs providing medical treatment to patients? • What mechanisms must be in place to ensure that the care provided is of the highest quality and conforms to the standards of the medical community? Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Medical Direction • Every EMS system must have a physician medical director. • EMTs are designated agents of the medical director. • The medical director is legally responsible for the patient care aspects of the EMS system. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Medical Direction • Medical directors participate in EMS provider education and EMS system quality assurance. • A primary charge of medical direction is developing and establishing the guidelines under which the emergency medical service personnel function. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Medical Direction • Protocols are a complete set of guidelines that define the scope of medical care provided by EMS personnel. • Protocols may be used off-line or may require on-line medical direction. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Medical Direction • Off-line medical direction consists of a set of written guidelines that allow EMTs to use their judgment to provide care without having to contact a physician. • Sometimes called standing orders continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Medical Direction • On-line medical direction requires that the EMT contact a physician for consultation and authorization prior to administering specific emergency care. Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Quality Improvement • Quality improvement (QI), or continuous quality improvement (CQI), is a system of internal and external reviews and audits of all aspects of an emergency medical system. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Quality Improvement • The purpose of QI is to ensure that the public receives the highest quality of prehospital care. • The goals of quality improvement are to: § Identify aspects of the system that can be improved. § Implement plans and programs to remedy shortcomings. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Quality Improvement • QI is focused on how effective the system is and to identify what improvements can be made to deliver a better service. • QI can assist individuals with poor performance, but is should be used an evaluation of system effectiveness, not as a punitive mechanism. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

The EMT takes an active role in quality improvement. Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Issues in Patient Safety • Certain aspects of prehospital care high-risk in terms of patient safety. • High-risk activities include: § Transfer of care from one provider to another § Communications with other providers § Carrying and moving patients § Ambulance transportation § Spinal immobilization decisions continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Issues in Patient Safety • Errors during patient care can cause harm, and usually result from: § Improper skill performance § Not following the rules § Lack of knowledge continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Issues in Patient Safety • Steps to reduce errors include: § Clear protocols § Providing enough light to work effectively § Minimizing interruptions during assessment and care § Clearly marking drugs and packaging continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Issues in Patient Safety • Steps to reduce errors include: § § Reflecting on all actions Questioning assumptions Using decision aids Asking for assistance when needed Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Research in EMS • Evidence-based medicine (EBM) uses research to provide evidence that certain procedures, medications, and equipment improve the patient’s outcome. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Research in EMS • There are four steps in evidence-based decision-making: 1. Formulate a question that needs to be answered. 2. Search medical literature for applicable data. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Research in EMS • There are four steps in evidence-based decision-making: 3. Appraise the data for validity and reliability. 4. If the evidence supports a change in practice, change protocols and implement the change in prehospital emergency care. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Research in EMS • Research does not exist to support many practices in EMS. • Research in hospital settings does not always transfer well to EMS settings. • If the opportunity arises, every EMT has an obligation to participate in research that contributes to the profession. Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Case Study Ben was seen in the emergency department, and then admitted to the cardiac care unit of the hospital. Ben’s cardiologist told Ben that he has several risk factors for heart problems, but that some of the risk factors can be changed. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Case Study • What are some public health efforts that can help decrease the rate of illnesses like Ben’s? • What role could EMS providers take in such public health efforts? Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Public Health • EMTs are part of the public health team. • Public health deals with protecting the health of an entire population. • EMTs can play a role in identifying public health problems and in attempts to reduce injury and illness and promote health. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Public Health • The ten greatest public health achievements in the United States in the 20 th century were: § Vaccinations § Motor vehicle safety § Workplace safety continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Public Health • The ten greatest public health achievements in the United States in the 20 th century were: § Control of infectious disease through clean water and sanitation § Reduction in death from coronary heart disease and stroke continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Public Health • The ten greatest public health achievements in the United States in the 20 th century were: § Safer, healthier foods § Decreased maternal and infant mortality § Use of barrier devices during sexual contact § Fluoridation of drinking water § Reduction of tobacco use continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Public Health • Roles of EMS in public health include: § Health prevention and promotion through primary prevention (vaccinations, education), secondary prevention of complications of disease, and health screening § Disease surveillance through identifying and reporting certain diseases or conditions that are identified as public health issues continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

The roles of the EMS in public health include participation in public education programs (CPR). continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Public Health • Roles of EMS in public health include: § Injury prevention through education, promotion of the use of safety equipment (seat belt use, helmet use, falls prevention, fire prevention), and injury surveillance continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

The roles of the EMS in public health include participation in health screenings. Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Case Study After giving a report to the emergency department (ED) about Ben’s condition and prehospital treatment, Alexis compliments Peter and Juliana on their assessment and care. Peter takes the opportunity to ask Alexis a few questions about patients who present as Ben did. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Case Study Ben was discharged from the hospital with a cardiac pacemaker to keep his heart beating at the right rate. He participates in a cardiac rehabilitation program and is working with a nutritionist on his diet. He still frequents Dave’s, but more often than not, opts for a bowl of oatmeal with fruit. Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Lesson Summary • The shape of the modern EMS system has been influenced by many events throughout history. • EMS systems must address 10 specific areas as defined by NHTSA. • 911 is the access number for EMS in the United States. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Lesson Summary • There are four nationally recognized levels of EMS providers in the United States. • EMTs have several specific responsibilities. • Medical direction and QI are essential components of all EMS systems. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Lesson Summary • EMS practices change over time, based on research findings. • EMS is part of the public health system and can make an impact on the health of the community. Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved