EMS System Communications

1
EMS System Communications

• Marc Muhr, B.A., EMT-P
• Clark County EMS

2
EMS System Communications

• Development of EMS Systems
• Systems Approach to EMS
• System Organization
• Regulatory Authority
• Participants and Standards
• EMS Communications
• Medical Direction
• Research
• Professionalism

3
EMS Systems

• Development of EMS Systems
• Military Medicine
• Late 1800s hospital based ambulance services in
  New York and Cincinnati
• White Paper (1966)
• Published by the National Academy of Sciences
  National Research Council

4
EMS Systems

• Development of EMS Systems (cont.)
• White Paper (cont.)
• Showed low standards for current systems
• No standard for training of personnel
• Lack of prehospital communication
• Poorly equipped hospital emergency facilities.
• Highway Safety Act (1966)
• Created USDOT
• Earmarked 142 million to fund EMS
• Provided legislative authority

5
EMS Systems

• Development of EMS Systems (cont.)
• EMS Systems Act (1973)
• Established regional EMS Systems
• Defined 15 components of an EMS System

6
EMS Systems

• Systems Approach to EMS
• Response Stages
• Preresponse (initial access and CPR)
• Prehospital (1st response, ambulance, dispatch)
• Hospital (ED, inpatient care)
• Critical Care (ICU, Surgery, TICU, etc.)
• Rehab
• Service Areas

7
EMS Systems

• Systems Approach to EMS (cont.)
• Medical Direction and Oversight
• Treatment Protocols
• Triage Protocols (destination hospital)
• Transfer Guidelines
• Record keeping and evaluation

8
EMS Systems

• EMS System Coordination Organization
• State EMS Office (lead agency in each state)
• Responsible for standards, laws and regulations,
  licensure, certification, training approval.
• Regional and local EMS
• Funding of EMS
• Tax revenues, subscription services, Health
  insurance, levies, private pay, and donations

9
EMS Systems

• EMS System Regulatory Authority
• Authority for EMS
• State laws
• Local administrative regulation
• Certification/Licensure
• Personnel are licensed or certified in all states
• NREMT national organization
• Reciprocity
• Revocation due process

10
EMS Systems

• EMS System Regulatory Authority (cont.)
• Delegated Practice
• Medical Program Director
• Appointed by the state
• Recommends certification
• EMS Boards and Committees
• EMS Council
• Regional EMS Council
• Medical Advisory Bored s

11
EMS Systems

• System Planning, Goals, and Objectives
• Tiered Response
• Early patient stabilization
• AED
• Advanced Life Support
• Transport Ground/Air
• Hospital
• Response Times
• Standby locations
• System Status Management

12
EMS Systems

• System Planning, Goals, and Objectives (cont.)
• Advanced Life Support
• Early invasive care
• Direct Indirect Medical Direction
• Load and Go vs Stay and Play
• Early Defibrillation
• Skill expected of any EMS provider
• Mutual Aid and Disaster Medicine
• Assistance with neighboring EMS providers

13
EMS Systems

• System Participants and Standards
• First Responders
• Initial Care and Stabilization
• ALS BLS ILS mixed
• Ambulance
• Staffing
• Accreditation (CAAS)
• Critical Care Transport
• Hospitals
• Staffing/Equipment (ER, Trauma, Surgery, LD,
  Critical care, etc.)

14

• KKK 1822C Standards
• 3 types acceptable
• Minimum standards for operation, lighting and
  patient compartment specs

15
EMS Systems

• System Participants and Standards (cont.)
• Trauma Centers and Systems
• TCs designated as I, II, III, IV based on
  services provided
• Systems based on TCs and EMS resources
• Medical Direction Facilities
• Base - Resource hospital
• Educational Programs
• Initial education
• CAAHEP

16
EMS Systems

• EMS Communications
• Most crucial link in the chain of survival
• System access 911
• Dispatch center PSAP
• Single center linking all resources
• CAD
• Dispatchers
• Call taker
• Dispatcher
• System status management

17
EMS Systems

• EMS Communications (cont.)
• Communications system
• Simplex single channel
• Duplex paired channels
• Multiplex telemetry
• Emergency Medical Dispatch
• Method to prioritize call for help
• Medical Priority Dispatch

18
EMS Systems

• Medical Priority Dispatch
• Response to call is prioritized based on c/c
• Initial Assessment (case entry)
• Secondary Assessment (key questions)
• Response (determine code and send)
• Post Dispatch Instructions
• CPR, Childbirth, Choking
• Pre-arrival Instructions

19
EMS Systems

• Medical Priority Dispatch

20
EMS Systems

• Medical Priority Dispatch

21
(No Transcript)
22
(No Transcript)
23
(No Transcript)
24
EMS Systems

• Medical Direction
• Medical Program Director
• Allow Medic to function as physician surrogate
• Responsibilities
• Est. Pt. care protocols
• Certification/Recertification duties
• Discipline
• QA/QI
• Research
• Procedures for controlled medications
• Patient care procedures

25
EMS Systems

• Medical Direction
• On-line
• Surgical procedures
• Refusals
• Controlled Meds
• If in doubt

26
EMS Systems

• Medical Direction
• Off-line
• Standing orders
• Protocol
• Guidelines
• Scope of Practice

27
EMS Systems

• Medical Direction
• Prospective
• Education
• Initial training
• Operational Policy
• Administrative Rules
• Ordinance
• Medical Protocols
• System-wide standard development
• Hospital Designation
• Disaster Management
• Mutual Aid

28
EMS Systems

• Medical Direction
• System Direction
• Interagency cooperation
• Consistent guidelines

29
EMS Systems

• Medical Direction
• System Direction, Allied Agencies

30
EMS Systems

• Medical Direction
• Quality Assurance/Improvement
• QA
• Retrospective review of care
• Peer review
• Performance evaluation
• QI
• System methodology
• Management creates workable environment
• Focus is on tools and environments

31
EMS Systems

• Medical Direction
• Documentation
• Medical Incident Report
• Billing information
• Refusal for patient care
• Operational Incident Report
• Inventory
• Other forms
• CME attendance
• Research tracking

32
(No Transcript)
33
EMS Systems

• Research
• Prehospital vs clinical
• Validates treatment techniques
• New equipment
• Medications
• Impact system structure
• Alternative transport
• OMEGA response

34
Primary Responsibilities of the Paramedic

• Preparation
• Response
• Scene size-up
• Patient assessment
• Treatment and management

• Disposition and transfer
• Documentation
• Clean-up, maintenance, and review

35
Preparation

• The paramedic must be physically, mentally, and
  emotionally able to meet job demands.

36
Response

• Safety is the number one priority!
• Wear seatbelts.
• Obey posted speed limits.
• Monitor roadway for potential hazards.

37
Patient Assessment

• Initial assessment.
• Physical examination.
• Patient history.
• Ongoing assessment.

38
Patient Management

• Protocols ensure consistentpatient care.
• Communication with medicaldirection.
• Movement of the patient fromone location to
  another.

39
Appropriate Disposition

• Transportation type.
• Receiving facility.
• Treat and release.

40
Patient Transfer

• While moving the patient from one facility to
  another the first priorityis patient care.
• Request a verbal report fromprimary-care
  provider.
• At destination provide a report toreceiving care
  provider.

41
Documentation

• Complete a patient care report as soon as
  possible after emergency care has been provided.
• Necessary to ensure continuity of care.
• Be complete, neat, and legible.

42
Returning to Service

• Prepare the unit to return to service
• Clean and decontaminate.
• Restock.
• Refuel.
• Review the call with crew members.
• Be aware of signs of critical incident stress.

43
Additional Responsibilities

• Community involvement.
• Cost containment.
• Citizen involvement in EMS.
• Personal and professional development.

44
Community Involvement

• Help the public
• Recognize an emergency
• Know how to provide BLS
• Know how to properly access the EMS system.

45
Citizen Involvement in EMS

• Gives outsiders an insiders view
• The community is the customer involve
  them as much as possible

46
EMS Systems

• Professionalism
• Represent
• Yourself
• Agency
• EMS system
• Medical Director

47
Continuing Education

• The paramedic must always strive to stay abreast
  of changes in EMS.

48
Personal and Professional Development

• Personal and professional development is your
  responsibility.
• Keep updated with journals, seminars, computer
  newsgroups, and other learning experiences.
• Explore alternative or non-traditional career
  paths.