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 1800�s 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, L&D, Critical care, etc.)

15. EMS Systems System Participants and Standards (cont.) Trauma Centers and Systems TC�s designated as I, II, III, IV based on services provided Systems based on TC�s 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

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

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.