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8/2/2019 Pre Hospital Care Introduction Teaching
1/23
It provides the first professional medical aids to the
victims..
Ambulance service is very challenging and
rewarding service provided by hospital through outthe country.
INTRODUCTIONINTRODUCTION
Through quick assessment, treatment, management,
communications and transportation countless life can
be saved.
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Occasionally, they get called to exciting and
dangerous emergencies that would make a good
TV shows, but that doesnt happen every day.
In real life, paramedics try to comfort little
old ladies with broken hips, and they sometimeshelp derelicts who are dirty and smell bad.
Other times they take abuse from people who
are under influence of alcohol and drugs.
INTRODUCTIONINTRODUCTION
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The purpose:
- is to get trained personnel to the patient
quickly as possible, and
- to provide emergency care on the scene,
- en route to the hospital, and
- at the hospital.
Modern EMS system developed to provide what
is known as prehospital or out of hospital care.
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No actual records are available.
HISTORYHISTORY
Ambulance was said to be introduced in the fifties.
Ambulance services were more of scoop and run.
Ambulance team consist of a driver and anattendant.
Later a medical assistant role was inevitable
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In 1790s, French transported wounded soldiers so
that they can be cared by physicians away fromthe scene.
HOW DID PARAMEDICS COME TO BE?HOW DID PARAMEDICS COME TO BE?
During WWI &WWII, many volunteers joined
battlefield non military ambulance corps
- transport service only. During conflict in Korea (1950s) andVietnams
War (1960s & 1970s), medical teams
produces advances in field care for trauma
MAST suit.
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Importance of extending hospital-quality
care to sick and injured at emergencyscene were recognized
- of beginning care at the scene and continuing
it, uninterrupted, during transport to hospital.
HOW DID PARAMEDICS COME TO BE?HOW DID PARAMEDICS COME TO BE?
Need to organize systems for such
Emergency Pre Hospital Care and to train
personnel to provide it.
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30 years ago, no such things as EMT,
paramedic.
Today more than 50,000 EMT-paramedic in
USA, Australia, Germany, Canada & U.K.
HOW DID PARAMEDICS COME TO BE?HOW DID PARAMEDICS COME TO BE?
Story begins in Belfast, Northern Ireland,Germany, Eastern Europe, where mobile ICU
introduced in 1950s and 1960s to enable early
care of critically ill and injured.
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Idea was simple Bring the emergency room
to the patient before bringing the patient to theemergency room & therefore saves precious
minutes that could mean life and death.
HOW DID PARAMEDICS COME TO BE?HOW DID PARAMEDICS COME TO BE?
The idea worked and MICUs proliferate in
various European countries.
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In USA, not feasible to staff ambulances
around the clock with physicians speciallytrained in Emergency Care. In 1960s, no
physicians specially trained in Emergency Care.
Early MICUs in USA staffed with cardiologist.
HOW DID PARAMEDICS COME TO BE?HOW DID PARAMEDICS COME TO BE?
Very few interested in riding the ambulances.Become necessary to look for alternatives to
physician staffing in MICUs.
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The question were asked:
Can a non physician be taught thesophisticated skills of Advance Life
Support!
HOW DID PARAMEDICS COME TO BE?HOW DID PARAMEDICS COME TO BE?
1st Doctor to provide affirmative answer to the
question was Dr. EugeneN
agel and he wasconsidered the Father of Paramedics, trained
Miami fireman in Advance Emergency skills to
supplement the basic first Aid the learned as
part of their fire training.
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In addition, Dr. Nagel developed the telemetry
system that enables firemen to transmit apatients ECG to doctors and receive instructions
from the doctor regarding measures to take.
HOW DID PARAMEDICS COME TO BE?HOW DID PARAMEDICS COME TO BE?
With the introduction of radio / telemetry
communication, the rescuer working in thestreet became an extension of the doctor
working in the emergency room.
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This idea of operating under radio command
by physicians spread quickly. By 1976, US Department of Transportation
issued 1st set ofNational Standards and
Guidelines for paramedic training.
HOW DID PARAMEDICS COME TO BE?HOW DID PARAMEDICS COME TO BE?
By end of 1980, there were >50,000
paramedics certified in USA.
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In 196
0s, development of modern EMSsystem begin.
In 1966, USDOT set up and upgrade quality
Prehospital Emergency Care
EMS TODAYEMS TODAY
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The categories and standards set summarized
below:
EMS TODAYEMS TODAY
Regulation and policy
- must have legislation, regulations,
policies and procedures.
Resource management- centralised coordination of resources
so that all victims of trauma or medical
emergencies have equal access to
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Resource management
- basic emergency care and transport bycertified personnel, in a licensed and
equipped ambulance, to an appropriate
facility.
EMS TODAYEMS TODAY
Human Resources and Training- at the minimum, all transporting
prehospital personnel should be trained
using standardized curriculum taught
by qualified professional
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Transportation
- Safe, reliable ambulance transportation isa critical component.
- Ground ambulances / Helicopter or
airplane rapid transportation
EMS TODAYEMS TODAY
Facilities -
Seriously ill or injured patient must be
delivered in a timely manner to the
closest appropriate facility
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Communications
- must have effective communicationsystem:
* beginning with Universal Number,
* dispatched -to-ambulance,
* ambulance-to-ambulance,* ambulance-to-hospital, and
* hospital-to-hospital communications
EMS TODAYEMS TODAY
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Public Information and Education Center
- EMS personnel may participate in efforts
to educate the public about:
* their role in the system,
* their ability to access the system,
* and prevention of injuries.
EMS TODAYEMS TODAY
Medical Direction
- EMS physician delegate medical practice
to non-physician providers (Medical
Delegate Act) and must be involved in all
aspects of the patient care system
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Trauma systems
- Enabling legislation must exist to developa trauma system including :
* one or more trauma center, triage, and
transfer guidelines for trauma patients,
* rehabilitation programs, data collection,
mandatory autopsies, and
* means of managing and assuring the
quality of the system
EMS TODAYEMS TODAY
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Evaluation
- Must have a program for evaluating andimproving the effectiveness of the EMS
system, known as Quality Improvement
Program (QIP), a Quality Assurance
Program (QAP), or a Total QualityManagement (TQM).
EMS TODAYEMS TODAY
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Dial 999 via Telecoms
AMBULANCE SERVICE FLOWCHARTAMBULANCE SERVICE FLOWCHART
AED Medical Asistants
Alarm / Ambulance
Staff Equipment Communications
Ambulance Team Departs
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VICTIMS
AMBULANCE SERVICE FLOWCHARTAMBULANCE SERVICE FLOWCHART
Scoop & Run
Enroute to Hospital
AED
CPR
/ BLS1ST
AID
Discharge Admission to Ward
Specialist Clinic Mortuary
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Privatisation- Foundation Level (3 months)
- Paramedic Level I (6 months)
- Paramedic Level II (2 years)
- Paramedic Level III - Post Diploma(Advance Diploma Paramedical Science (Pre
Hospital Care - Australia[ LevelV - 6 months])
Whatarethe future directions oftheWhatarethe future directions ofthe
Ambulance ServiceAmbulance Service
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