EMS Systems Roles and Responsibilities

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EMS Systems Roles and Responsibilities
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EMS System Development

• Pre-20th Century
• Biblical- 4,000-5,000 years ago Mesopotamia
• Edwin Smith papyrus scroll dated 1700 B.C.
• described an instructional system of practice
  with references to the heart and the brain
• Code of Hammurabi
• list of charges for a
• doctors fee distinguished
• between slave free

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• Jean Larrey - one of Napoleons surgeons during
  the Napoleonic Wars credited for the 1st
  ambulance (used covered cart to transport wounded
  soldiers)
• First civilian ambulances established in
  Cincinnati New York City in the 1860s
• American Civil War
• Clara Barton - nurse who coordinated emergency
  care for the wounded brought the Swiss
  organization, Red Cross, to the USA in 1905

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20th Century

• WWI and WWII developments
• Battlefield ambulance corps developed
• Air medical transport established
• Korean and Vietnam Conflicts
• further expansion of immediate care rapid
  evacuation by trained personnel
• efforts started in these conflicts became the
  basis for current prehospital care

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Mortality Comparisons

• WWI to Vietnam
• Advances in field care emerged for trauma
  patients reduction noted in deaths from similar
  trauma
• Battlefield casualties WW I - 8
• WW II -
  4.5
• Korea -
  2.5
• Vietnam -
  lt2

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• 1950s and 1960s
• Most patients received only minimal stabilization
  at the scene and were rushed to the nearest
  hospital
• Urban, hospital-based systems developed into
  municipal services
• Rural funeral homes developed into volunteer fire
  and freestanding services

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1966

• National Academy of Sciences - National Research
  Councils Committee on Trauma Shock published
  report
• Accidental Death and Disability
  The Neglected Disease of Modern
  Society (the White Paper)
• Defined 11 critical points for EMS

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Some Critical Points of White Papers for EMS

• ?Education/training to the lay public
• - Advanced First aid CPR
• ? Standardize training of professionals
• ? Prepare nationally acceptable texts training
• ? Legislation to implement standards for
  ambulance
• design, equipment, qualifications of
  ambulance crews
• ? Adoption of state level policies regulations
• ? Creation of EMS Systems, Fire Protection
  Districts, etc.
• ? Pilot Aeromedical transport programs for rural
  areas
• ? Establish pilot radio communication systems
• ? Designate a single nationwide telephone number
  for EMS emergency calls (911)

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1966

• Highway Safety Act of 1966
• States were directed by this act to develop an
  effective EMS program or lose up to 10 of their
  federal highway construction funds
• Created USDOT as a cabinet-level department
• Provided legislative authority and finance to
  improve EMS
• More than 142 million between
• 1968 and 1979
• Early advanced life support pilot
• programs - 1969 The Emergency
• Medical Technician- Ambulance
• was published

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1970s

• 1973 Emergency Medical Service Systems Act
• Defined 15 required components (next slide)
• Provided funding for Regional approach, trauma
  focus
• Regional system development 1974 1981
• 1977 national educational standards for
  paramedics first developed

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1973 EMSS Act 15 Components Addressed
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• Manpower
• Training
• Communications
• Transportation
• Emergency facilities
• Critical care units
• Public safety agencies
• Consumers

• Access to care
• Patient transfer
• Medical record keeping
• Public information education
• Review evaluation
• Disaster Plans
• Mutual aid

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1980s-90s

• Consolidated Omnibus Budget Reconciliation Act
  (COBRA) of 1981
• Preventive Health and Health Services Block Grant
  consolidation
• NHTSA effort to sustain the DHHS (Dept of Health
  Human Services) effort with reduced funding and
  staff
• NHTSA's 10 system elements (next slide)

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NHTSA's 10 System ElementsEMS System

• Regulation Policy
• EMS Trauma legislation
• Resources management
• Human Resources Training
• Transportation system
• Facilities
• Communications
• Public Access, Fire, Hospital based
• Trauma systems
• Public information and education
• Medical direction
• Evaluation
• Data collection, CQI, Research

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Current EMS System

• Network of coordinated services that provide aid
  and medical care to the community
• Work as a unified whole, to meet emergency care
  needs of a community

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Health Care Reform

• Managed care
• Health Maintenance Organizations (HMOs)
• Preferred Provider Organizations (PPOs)
• Expanded scope of practice for EMS
• Health screenings
• Physical examinations
• Triage of care
• Follow-up examinations
• Providing immunizations

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EMS System Operation

• Citizen activation
• Dispatch
• Prehospital care
• Hospital care
• Rehabilitation

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EMS Provider Levels

• Emergency Medical Dispatchers
• First Responder
• EMT-Basic
• EMT-Intermediate
• Paramedic
• PHRN
• (pre-hospital RN)

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Paramedic Education

• Initial education
• National standard curriculum
• Competencies (math, reading, writing skills)
• Pre- or co-requisites (anatomy physiology
  courses)
• Provides minimum content for a standardized
  program of study
• Includes cognitive,
  psychomotor, affective
  objectives
• Clinical requirements in
• variety of settings
• Length - minimum 950
• hours (avge 1000-1200)

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Continuing Education

• Benefits
• Maintenance of core or minimal levels of
  knowledge
• Maintenance of fundamental technical/
  professional skills
• Expansion of skills
  and knowledge
• Awareness of advances
  in profession

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Continuing Education Requirements in Illinois

• 30 Hours CE per year
• 120 hours total over 4 years of licensure period
• Limitation-30 hours per 1 subject area/4 years

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Professionalism

• Education should help produce a professional
  paramedic
• Profession
• The existence of a specialized
• body of knowledge or expertise
• Generally, self regulating through
  licensure or certification verifying
  competence
• Maintains standards including initial and
  continuing educational requirements

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Professionalism

• Professionals follow standards of conduct and
  performance for the
  profession
• Adherence to a code
  of ethics approved
  by the
  profession

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Health Care Professional

• Conforms to the standards of
• health care professions
• Provides quality patient care
• Instills pride in the profession
• Strives for high standards
• Earns respect of others
• Recognizes high societal
• expectations of professionals while
• on and off duty

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Health Care Professional

• EMS personnel occupy positions of public trust
• Unprofessional conduct hurts the image of the
  profession
• Commitment to excellence is a daily activity

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Health Care Professional

• Image and behavior
• How you appear to others and to yourself is
  important
• Vital to establishing credibility and instilling
  confidence
• Highly visible role model
• Paramedics represent a variety
• of persons/organizations
• Self
• EMS agency
• State/ county/ city/ district EMS office
• Peers

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Attributes of Professionalism

• Time Management
• Teamwork and Diplomacy
• Respect
• Patient Advocacy
• Careful Delivery of Service

• Integrity
• Empathy
• Self-Motivation
• Appearance Personal Hygiene
• Self-Confidence
• Communications

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Primary Responsibilities

• Preparation
• Response
• Scene assessment
• Patient assessment
• Management
• Appropriate disposition
• Patient transfer
• Documentation
• Returning to service

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Additional Responsibilities

• Community involvement
• Supporting primary care efforts
• Advocating citizen involvement in the EMS system
• Participating in leadership activities
• Personal and professional development

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1 Rule
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• People will seldom remember what you did or what
  you said. But they will almost always remember
  how you made them feel.
• - Cab Driver, Boston

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Definition of Caring

• To have or show regard,interest, or concern as
  respecting some person
• To protect or provide for guard watch over
• Patients are highly aware of a caregivers
  attitude - positive or negative.
• If you show honest concern the patient will sense
  it!

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What We Do...

• Fix problems (technical stuff)
• splinting
• bandaging
• IVs
• Medications
• Fix People
• family concerns
• emotions
• comfort
• being a friend / advocate

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Be Effective in Your Role

• See the patient as more than the problem they
  present
• Appreciate that patients are customers that reach
  out to you in the worst moment of their lives
• Explain every phase of treatment
• Let the patient know what to expect ask
  permission before a procedure whenever possible
• Give them an opportunity to report changes

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Show You Care

• Introduce yourself to the patient
• Connect with the person - not the problem
• Smile
• Maintain eye contact
• Interact on eye level with the patient
• These actions put you in touch with the emotional
  state and mental status of the patient

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Caring...

• Remember people have families/significant others
• families are important to us (supportive network,
  can add information to the history)
• try not to dismiss family members just so we can
  do our job - this may be the last time the
  patient is seen in a comfortable setting
• the situation may be stressful for us as well as
  the patient and their families
• What we do will be permanently imprinted
  including everything said, heard, and seen

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Caring...

• Two roads to take
• the high road
• compassionate, conveys caring, explains
  procedures/actions, gives permission to grieve,
  offers continuous support (clergy, CISD,
  counselors, friends)
• the low road
• callused, avoids interacting with others, cold,
  distant
• Tough is not equivalent to professional

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Improving System Quality

• Major goal for any EMS system is to continually
  evaluate and improve care
• Continuous Quality Improvement (CQI)
• Focus is on a process, system or
  organization, and not an individual,
• such as in evaluating
• Scene times
• Documentation
• Skill competencies

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Guidelines for Successful CQI

• Leadership to support guide process
• Information obtained and data analysis
• Strategic quality planning
• Human resources development management
• EMS process management
• EMS system results
• Satisfaction of patients
  and other stakeholders

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EMS Research - Benefits

• Quality EMS research is beneficial to future of
  EMS
• sheds light on efficiency, effects
  cost-effectiveness of EMS activity
• EMS funding dependent on scientifically proving
  the value of EMS services
• Enhances recognition and respect for EMS
  professionals

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Basic Principles of Research

• Finding research
• Peer review and publication of research
• Examples of research
• Conclusions based on scientifically sound
  procedures, techniques,
  and equipment
• Answering a clinically
  important question
• Results leading to system
  improvement

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Changes in Practice as a Result of Research
Data Collection

• Divided highways have cut down on the number of
  head on collisions
• Combination lap and shoulder restraint systems in
  vehicles decreases injuries
• Air bags deploying at less force create less
  complications
• Infants facing backwards in restrained car seats
  until 20 pounds are more protected

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Conducting Research

• Prepare a question
• Write a hypothesis
• Decide what to measure and the best method for
  measuring it
• Define the population
• Identify study limitations
• Seek study approval
• Obtain informed
  consent

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Conducting Research

• Data gathered
• Data analyzed
• Determine what to do
  with the research product
• Publish
• Present
• Follow-up studies

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Data Collection

• EMS providers role in data collection
• every EMS provider must be willing to participate
  in the collection of research data for continued
  development of EMS care

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Evaluating Interpreting Research
?

• Was the research peer reviewed?
• What was the research hypothesis?
• Was the study approved by an institutional review
  board and conducted ethically?
• What was the population being studied?
• What were the entry/exclusion criteria for the
  study?

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Evaluating Interpreting Research

• What method was used to draw a sample of
  patients?
• How many groups were the patients divided into?
• How were patients assigned into the groups?
• What type of data was gathered?
• Does it appear that the study had enough patients
  enrolled?
• Do there appear to be any potential confounding
  variables that are not
  accounted for?
• Was the data properly analyzed?

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Evaluating Interpreting Research

• Is the authors conclusion logical based on the
  data?
• Does it apply to local EMS systems?
• Are patients in the study similar to
  those in the local EMS system?

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Caring

• Consider how and what
• you are doing
• ...and what you say!
• Remember, an emergency is defined by its owner -
  not by us
• dont underestimate the patient
• people can easily become overwhelmed
• it does not make them stupid
• and it is not a waste of our time

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Rules to Work By...

• ?Always be nice
• ? Treat everyone with
• respect
• kindness
• patience
• consideration
• ?Regard everyone as a customer
• ?Count your blessings

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EMS System Roles Responsibilities

• Packet preparation input
• Brian Sobeck, BA, NREMT-P (NIEMSCA)
• Sharon Hopkins, RN, BSN, EMT-P
• Jeff Steingart, EMT-P, Deputy chief, Countryside
  Fire Department (presentation EMS Caring)

Questions ??