Prehospital emergency care 10th edition chapter 1

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What is one of the most critical health problems in the united states?
Sudden loss of life and disability caused by catastrophic accidents and illnesses.

Why do thousands of people die and suffer permanent harm every year?
Lack of adequate and available emergency medical services.

EMS system (Emergency medical services system)
Permits patient care to begin at the scene of the injury or illness, and EMS is part of continuum of patient care that extends from the time of injury or illness until rehabilitation or discharge.

When did the modern EMS system evolve?
The 1960’s.

What was the “Accidental Death and Disability: The Neglected Disease of Modern Society” or the “White Paper”.
A report detailing the number of deaths and injuries related to traffic crashes in the United States, it also identified severe deficiencies in the delivery of prehospital care in the United States and made recommendations intended to change ambulance systems, training requirements, and the provision of prehospital care.

Highway Safety act of 1966
Required each state to establish a highway safety program that met prescribed federal standards and included emergency medical services

Who took a leadership role in the development of emergency medical services? What was one early focus and one initiative taken?
The National Highway Traffic Safety Administration (NHTSA)
An early focus was improving education of prehospital personnel. An initiative taken was the development of national standard curricula.

Emergency medical services act of 1973
Provided access to millions of dollars of funding geared to EMS system planning and implementation, personnel availability and training.

What is now a prerequisite to the EMT course due to the American Heart Association?
CPR Course.

What was the National Emergency Medial Services Education and Practice Blueprint released by the National Registry of EMT’s in 1993 ?
It defined issues related to EMS training and education and was meant to guide the development of national training curricula .

What did the national Highway traffic safety administration published in 1966?
The EMS agenda for the future document which with the intent to make you more as a greater component in the healthcare system United States

Quality improvement:
is a system internal and external reviews and audits of all aspects of an emergency medical system
Goals of quality improvement
Document carefully
Perform reviews and audits
Obtain feedback
Maintain equipment
Participate in continuing education
Maintain skills

Evidence based medicine:
Focuses on research to provide clear evidence that certain procedures, medications, and equipment improve patient outcome.
Steps in evidence based decision making:
Formulate a question about emergency care that needs to be answered
Search medical literature for research data that is related and applicable to the question
If evidence supports the change in practice change protocols and implement change in prehospital emergency care

What was that your Ems education agenda for the future of system approach?
Release to address the issues of consistency in the education and training and certification of entry level EMS personnel

What is the national EMS core content and who published it?
It defined the domain of knowledge found in the national EMS scope of practice model and the national Highway traffic safety administration and health resources and services administration published it

What is the national EMS scope of practice model and who published it?
Defines the four levels of EMS licensure and the corresponding knowledge and skills necessary at each level. National highway traffic safety administration.

The Institute of medicine report the future of your EMS care: EMS at crossroads in 2006
Recommended that all state governments adopt a common scope of practice that allows for reciprocity between the states ,national accreditation for all paramedic programs and ,national certification as a prerequisite for state licensure and local credentialing

National EMS education standards
Outline the minimum terminal objectives for entry level EMS personnel based on the national EMS scope of practice model. The content of this textbook are based on the national EMS education standards

Technical assistance program assessment standards
Regulation and policy
Resource Management
Human Resources and Training
Public Information and education
Medical direction
Trauma systems

Regulation and policy
Each state must have laws and regulation, policies and procedures that govern the EMS system . State level EMS agency are also required to provide leadership to local jurisdiction.

Resource Managment
Each state must have central control of EMS resources so that each locality and all patients have equal access to acceptable emergency care.

Human resources and training
All personnel that staff ambulances and transport patients must be trained to at least an EMT level.

Patients must be provided with safe reliable transportation by ground or air ambulance.

Each seriously ill or injured patient must be delivered in a timely manner to an appropriate medical facility.

A system of communications must be in place to provide public access to the system and communication among dispatcher, EMS personnel and hospital.

Public information and education
EMS personnel should participate in programs designed to educate the public in the prevention of injuries and how to properly and appropriately access the ems system.

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

Trauma systems
Each state must develop a system of specialized care for trauma patients, including one or more trauma centers and rehabilitation programs, plus systems for assigning and transporting patients to those facilities.

Each state must have a quality improvement system for the continuing evaluation and upgrading of the system.

the nationwide number used to access emergency services including police, fire, and EMS.

Provide (ANI) and (ALI) Displays on dispatchers screen even if caller hangs up. Immediate response can be dispatched with E-911

public service answering point , where call takers collect verify and record the information about the emergency, then decides which service must respond , and facilitates alerting the necessary service.

Takes psap calls and facilitate instructions for lifesaving emergency care, such as bleeding control, CPR, that can be administrated by the caller or another Pearson on the scene.

Federal communications commission: adopts rules to improve the accuracy of location information provided to PSAPs by wireless technology companies.

Basic 911
The wireless service provider to transmits all calls to PSAP regardless or whether or not the caller subscribes to the providers service.

Phase 1 enhanced 911
The wireless service provider must provide the PSAP with the telephone number of the device placing the call and location of the cell site or base station transmitting the call.

Phase 2 Enhanced 911
The wireless service provider must provide the latitude and longitude of the caller. The information must be accurate with 50 to 300 meters depending on the type of tech used.

EMR (emergency medical responder)
First responder level, provides immediate life saving care to patients who have accessed the ems system and is awaiting the response from a higher level EMS practitioner.

EMT (emergency medical technician)
Provides basic emergency care and transportation to patients who have accessed the EMS system. Interventions like the ones used by the EMR but with basic equipment found on the ambulance.

AEMT (advanced emergency medical technician)
provides both basic and advanced emergency medical care and transportation to patients in the prehospital environment.

scope of practice includes the skills performed by the EMT and AEMT with the addition of more advanced assessment and patient management skills and provision of the highest level of prehospital care.

Prehospital care
Emergency medical treatment given to patients before they are transported to the hospital or other facility

Out of hospital care
providing care on the scene without subsequent transport to a hospital, also includes treatment given during inter-facility transport.

special facilities that patients may need to be transported to:
trauma center
burn center
obstetrical center
pediatric center
poison center
stroke center
cardiac center
hyperbaric center (toxic exposures)
spine injury center
psychiatric center

Maintain vehicle and equipment readiness
Ensure safety of the crew, the patient, and bystanders at scene
Operate emergency vehicle
Assess the patient
Provide emergency care
Safely lift and move patient
Prepare oral and written reports
Safely transport the patient
Transfer patient care
Perform record keeping and data collection
Serve as the patients advocate
Provide emotional support to patient, relatives and others on scene
Integrate the EMS service with other emergency and non Emergency services
Resolve the emergency incident
Maintain medical and legal standards
Provide administrative support
Enhance professional development
Develop and maintain community relations

Americans with disabilities act of 1990
protects individuals who have a documented disability from being denied initial or continued employment based in their disability.

Professional attributes of an EMT
Appearance, Knowledge, Skills, the ability to meet physical demands, general interests and temperament, and maintenance of certification and licensure

Knowledge and skills
use and maintenance of common emergency equipment
assistance with the administration of medications
cleaning, disinfection and sterilization of non-disposable equipment
safety and security measures
territory and terrain
state and local traffic laws and ordinances

Physical demands
must be able to lift 125 pounds
good eyesight
good communication orally and written
good hearing

personal traits as a emt
a calm and reassuring personality
leadership ability
good judgement
stability and adaptability
ability to listen
resourcefulness and ability to improvise

State EMS agency roles
Overall planning of the statewide EMS system
Coordination of statewide EMS system
Regulation of the statewide EMS system
Licensing local EMS agencies and personnel
: The state EMS agency is actively involved in ensuring that a high quality of emergency medical services is provided in order to protect the health and safety of the public.

medical director
A physician who is legally responsible for the clinical and patient care aspects of the EMS system.
Also involved in the EMS education programs and refresher courses, overseeing and providing continuing education, and facilitating the quality improvement system.

Medical direction
The medical director is responsible for providing medical direction. A primary charge of medical direction is developing and establishing the guidelines under which emergency medical service personnel function.

Protocols compromise a full set of guidelines that define the entire scope of medical care. ( triage, treatment, transport, destination). Consists of both offline and online medical direction .

Offline medical direcetion
is provided through a set of predetermined written guidelines that allow EMT’s to use their judgement to administer emergency medical care according to the written guidelines without having to contact a physician.

online direction
requires that the EMT acquire permission from a physician via cell phone telephone or radio communication prior to administering specific emergency care.

Standing orders
a sunset of protocols that do not require real-time physician input.

Medical oversight
describes the ems system medical director’s responsibilities , including all of the clinical and administrative functions and activities performed by the medical director as necessary to excise ultimate responsibility for the emergency care provided by individual personnel and the entire EMS system.

Activities that are considered high risk and put patients at greater risk for medical mistake.
Transfer of care or hand-off at the scene between emergency responders or at the medical facility.
Poor communications that leads to misunderstanding and medical errors.
Carrying and moving patients in a manner that puts them at risk for being dropped.
Lack of spinal immobilization or improper spinal immobilization procedures that increase the risk of converting a stable spinal column injury into an unstable spinal column injury, or improper immobilization that exacerbates the existing injury.

Steps to prevent errors that may jeopardize patient safety
Develop clear protocols
Light up the scene effectively
Try to minimize interruptions during assessment and emergency care
clearly mark all drugs and packages so each is very clear and distinct
reflect of all actions
questions all assumptions
use decision aids if necessary
ask for assistance if needed

The ten greatest public health achievements in the united states in the 20th century were:
Motor vehicle safety
Workplace safety
Control of infectious disease
Reduction in deaths from coronary heart disease and stroke
Safer and more healthful foods
Decline in maternal and infant mortality
Use of barrier devices during sexual contacts
Fluoridation of drinking water
Reduction in the use of tobacco products

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