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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Specialty facilities include the following centers: trauma, burn, obstetrical, pediatric, poison, stroke, cardiac, hyperbaric, spine injury, and psychiatric.
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.
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.
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.
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.
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.
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.
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.
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.
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”.
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.
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.
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.
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.
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: 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.
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.
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.
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.
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.
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.
WHY: EMS providers and their medical directors need to increase the amount of research being conducted about prehospital care and procedures.
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.
WHY: Examples of the roles of state and/or local health departments would include: injury prevention, disease surveillance, health prevention and promotion.
WHY: Primary health promotion would include education and vaccination programs.
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.
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.
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.
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.