Chapter 1 Emergency Medical Care Systems, Research, and Public Health

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Emergency medical care has developed from the days when the local funeral home provided ambulance service to the current, modern emergency medical services (EMS) system. Major improvements in emergency medical care over the years include all of the following EXCEPT:
Use of faster driving speeds during an emergency response to the calls.

WHY: EMS systems have developed to the point where patient care begins at the scene of the emergency by trained professionals. EMS is also recognized as part of the patient care continuum from moment of illness/injury to moment of discharge. Even though EMS systems still utilize emergency responses, the use of fast driving in the ambulance has deemphasize due to a lack of real benefit in arriving earlier and also due to the high number of ambulance crashes.

What was the effect of the publication of “Accidental Death and Disability: The Neglected Disease of Modern Society” on modern-day EMS?
It was the “white paper,” which acted as a catalyst for improving ambulance systems, training, and the provision of care.

WHY: The white paper identified deficiencies in delivery of prehospital care which led the way to changing ambulance systems, training requirements, and the provision of prehospital care.

The National Highway Safety Act charged which government entity with developing an EMS system and upgrading prehospital emergency care?
U.S. Department of Transportation

WHY: The Highway Safety Act of 1966 required each state to establish a highway safety program that met prescribed federal standards and included emergency services. The Department of Transportation, through its National Highway Traffic Safety Administration (NHTSA), took a leadership role in the development of emergency medical services.

The NHTSA technical assistance program assessment standards for EMS systems address the component resource management by stating that each state must:
Have central control of EMS resources so that each locality and all patients have equal access to acceptable emergency care.

WHY: Resource management is the component described regarding equal access of patients to EMS care. The other components include: regulation and policy, human resources and training, transportation, facilities, communications, public information and education, medical direction, trauma systems, and evaluation.

The National Highway Traffic Safety Administration provides a set of recommended standards for EMS systems called the “Technical Assistance Program Assessment Standards.” These ten standards include which one of the following?
Medical direction

WHY: Each EMS system must have a physician as a medical director to provide medical oversight that includes overseeing patient care and delegating appropriate medical practices to EMTs and other EMS personnel.

An enhanced 911 system allows the emergency dispatcher to:
Immediately access the phone number and address from which the call is being made.

WHY: The most common 911 system is enhanced. An enhanced 911 system, called E-911, provides automatic number identification (ANI) and automatic location identification (ALI), which indicate the exact address and phone number from which the call is being made.

If a bystander summons EMS using a mobile phone, and the EMS dispatcher is able to view the caller’s latitude and longitude coordinates, what FCC rules has this wireless provider utilized?
Phase II enhanced 911

WHY: The FCC has adopted rules to improve the accuracy of location information provided to PSAPs by wireless technology companies. With Phase II enhanced 911, the wireless service provider must provide the latitude and longitude of the caller. The information must be accurate within 50 to 300 meters, depending on the type of technology used.

911 calls placed on normal landline phones are routed to:
public service answering point.

WHY: While exact procedures may vary, the basic process is the same for calls coming into a dispatch center. Calls are received by a public service answering point (PSAP) where a call taker collects, verifies, and records the information about the emergency, decides which service must respond, and facilitates alerting the necessary service.

Emergency Medical Responder (EMR) are generally trained to provide the following care:
bleeding control, airway management, and automated external defibrillation.

WHY:The EMR uses basic airway, ventilation, and oxygen therapy devices; takes patient vital signs; and provides stabilization of the spine and suspected extremity injuries, eye irrigation, bleeding control, emergency moves, CPR, automated external defibrillation, and emergency childbirth care.

According to the National EMS Scope of Practice Model, an Advanced EMT should be trained to:
administer medications intravenously.

WHY: The Advanced EMT provides both basic and limited advanced emergency medical care and transportation to patients in the prehospital environment. The AEMT provides all of the skills of the EMT with the addition of the use of advanced airway devices, monitoring of blood glucose levels, initiation of IV and IO infusions, and administration of a select number of medications via IV push. The other skills described are at the Paramedic level.

To receive the highest quality of care, some patients need to be transported to special facilities, such as patients who have:
been critically burned or had a stroke.

Specialty facilities include the following centers: trauma, burn, obstetrical, pediatric, poison, stroke, cardiac, hyperbaric, spine injury, and psychiatric.

What is the MOST common destination facility an EMT will be transporting patients to?
Hospital emergency department

WHY: The EMT may be required to decide on the facility to which the patient must be transported. The most familiar destination is the hospital emergency department, which is staffed by physicians, nurses, and others trained in emergency medical treatment. Here patients are stabilized and prepared for further care. Some patients may need to be transported to special facilities such as a trauma center after the receiving emergency department initially stabilizes them.

Maintaining and recertifying your EMT certification or licensure is:
part of your role as an EMS professional.

WHY: You and only you are responsible for maintaining your certification and knowing all the requirements. This is one of the attributes of a professional. Remember that the EMT’s certification or licensure to practice is between that individual and the state they work in, not that individual and the EMS system they work in. Neither your EMS employer nor your medical director has the responsibility to ensure you meet your CE needs and recertify as appropriate.

The EMT’s FIRST and MOST important priority is:
personal safety.

WHY: Your first and most important priority is to protect your own safety. Remember this rule: You cannot help the patient, other rescuers, or yourself if you are injured. You also do not want to endanger other rescuers by forcing them to rescue you—instead of the patient. Once scene safety is ensured for you and your peers, the patient’s needs become your next priority.

During the transport of a patient to the hospital, you should always:
notify the receiving facility of the nature and extent of injuries.

WHY: Use the communications equipment available to you to notify the receiving facility of the number of patients, the destination(s), and the nature and extent of injuries. Alert the emergency department or receiving facility about high-priority patients and what will be needed immediately upon arrival, such as a trauma team or a stroke team. Report changes in the patient’s condition, and consult medical direction during transport as appropriate and as required.

When applying for a new job as an EMT with a local EMS provider you had to take a quick test which involved watching a videotaped scenario and then completing a prehospital care report and giving an oral patient hand-off report. This interview activity was designed to assess:
the expected ability to maintain good verbal and written communication skills.

WHY: Personal traits the effective EMT should have include: calm and reassuring personality, leadership ability, good judgment, good moral character, stability and adaptability, ability to listen, resourcefulness and ability to improvise, and cooperation.

Integrity, empathy, and effective time management are examples of an EMT’s:
Integrity, empathy, and effective time management are examples of an EMT’s:

WHY: The characteristics of professional behaviors for EMTs include: integrity, empathy, self-motivation, professional appearance and hygiene, self-confidence, effective time management, good verbal and written communication skills, teamwork and diplomacy, and respect for patients, coworkers, and other health care professionals, patient advocate, and careful delivery of service.

What is the official name for the physician who assumes responsibility for all patient care aspects within a specific EMS system?
Medical director

WHY: The medical director is a physician who is legally responsible for the clinical and patient care aspects of the EMS system. An EMS medical director is also involved in EMS education programs and refresher courses, overseeing and providing continuing education, and facilitating the quality improvement system.

The EMT gains the authority to render care from the:
Medical Director

WHY: As an EMT, you are the designated agent of the physician medical director of your EMS system. The care you render to patients is considered an extension of the medical director’s authority.

Off-line medical control for an EMT is provided by a physician through:
Standing Orders

WHY: Off-line medical direction is provided through a set of predetermined, written guidelines that allow EMTs to use their judgment to administer emergency medical care according to the written guidelines without having to contact a physician. These are also referred to as “standing orders”.

One aspect of quality improvement that every EMT can participate in is?
Continuing education

WHY: Participate in refresher courses and continuing education to reinforce, update, and expand your knowledge and skills. This will help ensure your knowledge base and make the CQI process for patients you care for more effective.

Which of the choices is the MOST important reason why documentation is an important part of any CQI program?
It allows for better interpretation of the care rendered.

WHY: The better the quality of the written patient care report, the easier it will be for the CQI team to interpret the care rendered to ensure proper things were done and that protocol was adhered to. If documentation is poor, it will be difficult to determine if the right care was provided.

As an EMT, your role in quality improvement includes all of the following EXCEPT:
withholding important information from your CQI officer because it pertains to your partner.

WHY: Any CQI program is only as good as the information it can gather. To this end, if you witness something that would be important to the CQI process, for example your partner failing to properly immobilize an injury but then documenting he did, you have a professional and personal obligation to report this finding.

Your CQI officer sends you a request for additional information regarding a patient you had six months ago that subsequently died. How should you respond to this request?
You should respond to this request to the best of your ability given your memory of the call.

WHY: Just because a CQI officer requests information from you that does not mean that it is because you are in trouble. Remember that CQI is to be a non-disciplinary process to improve care, not punish EMS providers. I could be simply a case where the CQI officer is missing some important data, or feels that a part of the report was written in a confusing matter.

Safe patient lifting and moving techniques include:
using the easiest recommended moves and equipment.

WHY: The safest way to lift and move patients is to do so using the appropriate number of EMTs needed and to use the equipment designed for such movement. This minimizes the risk to the patient and the providers.

Why would the failure of a CQI program to advise EMTs within the system about the system’s overall performance be a risk to future patients?
It may lead to patient care errors from lack of knowledge about treatment protocols.

WHY: If the CQI program does not provide individual or system performance evaluations to the EMS providers, any one of them may make medical mistakes repeatedly because they do not know they are violating the EMS protocols to begin with.

All of the following are examples of steps to prevent errors that may jeopardize the patient’s safety, EXCEPT:
use intuition and judgment rather than protocols.

WHY: Steps to prevent errors include: develop clear protocols, light the scene effectively, minimize interruptions in assessment, clearly mark all drugs, reflect on all actions, question all assumptions, use decision aids as needed, and ask for assistance if you need it.

High-risk activities of the EMT with regard to patient safety would include:
carrying and moving patients.

WHY: Some of the “high-risk” activities include: transfer of care, poor communications, carrying and moving patients, ambulance crashes, and improper or lack of spinal immobilization.

A term for treatments backed by research that proves interventions have positive effects in patient care is:
evidence-based medicine.

WHY: As medical practice has evolved, the science component has become more emphasized through the concept of evidence-based medicine. Evidence-based medicine focuses on research to provide clear evidence that certain procedures, medications, and equipment improve the patient’s outcome.

Which step in the evidence-based medicine process deals with the concept of determining what we already know about a particular intervention or situation?
Searching medical literature

WHY: After the question for the research has been decided, the researcher will then perform an extensive review of the existing medical literature to determine all that is currently known about the research question. This helps to better define the question and to determine if the question has been already answered previously.

What is the BEST characterization about the availability of evidence-based research on interventions done in the prehospital environment?
There is minimal evidence-based medicine for prehospital care.

WHY: Very little research has so far been done regarding prehospital care. EMS has typically relied on research done in the emergency department. Although hospital and prehospital emergency care are somewhat related, there are variables in the prehospital environment that are not encountered in the hospital setting; thus, it is often difficult to extrapolate and apply the results to prehospital practice.

Although the evidence-based approach is very desirable for EMS, what is its biggest obstacle?
There is a limited amount of prehospital research available.

WHY: EMS providers and their medical directors need to increase the amount of research being conducted about prehospital care and procedures.

Why cannot evidence-based medicine that was conducted in the emergency department be applied to the prehospital environment?
Because there are variables in the prehospital setting that are absent in the emergency department.

WHY: Although hospital and prehospital emergency care are somewhat related, there are variables in the prehospital environment that are not encountered in the hospital setting; thus, it is often difficult to extrapolate and apply the results to prehospital practice.

Of the following roles, which would NOT be considered a function of the local or state health department?
Vehicle rescue training

WHY: Examples of the roles of state and/or local health departments would include: injury prevention, disease surveillance, health prevention and promotion.

Health promotion and prevention is accomplished by health department personnel through:
vaccination programs.

WHY: Primary health promotion would include education and vaccination programs.

An example of a population or group at risk for injuries from falls would be:
the elderly.

WHY: At risk groups are those who are more prone to sustain specific injuries or medical conditions. The elderly are considered at risk for falls and there are strategies to help decrease falls in their homes.

Over the past few weeks you have noticed a trend where an elderly woman has been calling EMS for basic wound care. What should you do besides continue to respond to the calls promptly?
Discuss the trend with your medical director for potential referral.

WHY: When trends are noticed and you may have identified the need for county public health nurse services, this should be discussed with your service medical director.

What public health initiative has shown beneficial in the reduction of HIV and other sexually transmitted diseases?
Use of barrier devices during sexual contacts.

WHY: The use of barrier devices during sexual contacts has been determined to be one of the ten greatest public health achievements in the United States in the 20th century.

Which of the following is NOT one of the ten greatest public health initiatives in the 20th century?
Safety gear for sporting events

WHY: Sports safety, although important, is not one of the ten greatest public health achievements. However, vaccination programs, control of infectious diseases, and reduction in the use of tobacco products have all been shown to be benefits from public health education.

We use cookies to give you the best experience possible. By continuing we’ll assume you’re on board with our cookie policy authorized by a medical director to give medications and provide emergency care. The transfer of such authorization is an …

We use cookies to give you the best experience possible. By continuing we’ll assume you’re on board with our cookie policy Paramedic’s takes hard work and patience, people say it’s not easy becoming a paramedic you need the right education …

We use cookies to give you the best experience possible. By continuing we’ll assume you’re on board with our cookie policy Aggregate Population group with common characteristics Competencies Unique capabilities required for the practice of public health nursing WE WILL …

We use cookies to give you the best experience possible. By continuing we’ll assume you’re on board with our cookie policy Privat Health Care Facilities Hospitals, clinics, long term care facilities (Mostly Medical facilities) Government Agencies WHO, USDHHS, NIH, CDC, …

We use cookies to give you the best experience possible. By continuing we’ll assume you’re on board with our cookie policy American Public Health Association 1872 – to facilitate Interprofessional efforts and promote “practical application of public hygiene” American Red …

We use cookies to give you the best experience possible. By continuing we’ll assume you’re on board with our cookie policy As mentioned before, EMS mainly comprises of different people who are skilled and specially trained for medical emergency situations. …

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