Phil ems system

THE PHILIPPINE EMS SYSTEM

Teodoro Javier Herbosa MD FACS FPCS FPSECPProfessor

Department of Emergency MedicineUniversiti Kebangsaan Malaysia Medical Center, KL

College of Medicine University of the Philippines, Manila

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Department of Emergency MedicineDepartment of Emergency Medicine

Objectives

� Present EMS its evolution� Define selected terms used in Emergency

Medical Systems.� State the principles of the organization and management of an Emergency Medical

Systems� Present Philippines EMS System

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Department of Emergency MedicineDepartment of Emergency Medicine

DefinitionsEmergency any situation that requires immediate action.

WHO

Situation wherein– Proposed intervention is deemed necessary– Delay in treatment may jeopardize life or

result in disfigurement or impaired faculties

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Department of Emergency MedicineDepartment of Emergency Medicine

Emergency MedicineInternational Federation for Emergency Medicine, 1991

� knowledge & skills required for the prevention, diagnosis and management of acute & urgent aspects of illness & injury

� all age groups � spectrum of episodic undifferentiated physical &

behavioral disorders� encompasses pre-hospital & in-hospital

emergency medical systems

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Department of Emergency MedicineDepartment of Emergency MedicineTel Aviv, Israel 1991

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Department of Emergency MedicineDepartment of Emergency Medicine

911 Cook County EMS

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Department of Emergency MedicineDepartment of Emergency Medicine

Stuuggard DRF

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Department of Emergency MedicineDepartment of Emergency Medicine

Formula 1 EMS 2008, 2009, 2010Formula 1 EMS 2008, 2009, 2010

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Department of Emergency MedicineDepartment of Emergency Medicine

Emergency Medicine in the Philippines

� 70’s-80’s ERC – Under DFM� 1991 –Departmentalization of Emergency Services,

UP-PGH� 1992 – Trauma Surgery Fellowship Program� April 1994 – Chairman of DEMS� 1996 – Setting up of PGH Emergency Medical

Services System� 1997 – Establishment of Residency Program at

DEMS, PGH� 2001 – Department of EM established as

Academic unit of UP College of Medicine

EEMERGENCYCY

1997

UP-PGH

MEDICINE

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Department of Emergency MedicineDepartment of Emergency Medicine

EMS System The total system intended to

care for a casualty from the site of incident to definitive care.

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Department of Emergency MedicineDepartment of Emergency Medicine

EMS System includes

� Triage� On-site care� Initial resuscitation and treatment� Medical transport� Definitive care or Trauma Center

““Scoop and run”Scoop and run”

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Department of Emergency MedicineDepartment of Emergency Medicine

EMS System Components� Transport� Personnel� Communications System� Medical Control� Equipment and Supplies� Legislation and advocacy

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Department of Emergency MedicineDepartment of Emergency Medicine

EMS System COMPONENTS� Transport - system of ambulances which may vary

from (BLS) to (MICU) or (ALS) vehicles. Also connotes air transport either through fixed wing aircraft or rotary wing type air transports.

� Personnel - Medical First Responders (MFR),

Emergency Medical Technicians (EMT's),

Paramedics, Ambulance Nurses, & Flight Paramedics.

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Department of Emergency MedicineDepartment of Emergency Medicine

EMS Transport

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Department of Emergency MedicineDepartment of Emergency Medicine

EMS System COMPONENTS

Communications System

connotes the ability to relay information about an emergency response and to receive information or instruction as to what further actions should be taken.

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Department of Emergency MedicineDepartment of Emergency Medicine

The BystanderThe Bystander

The DispatcherThe Dispatcher

The EMS RespondersThe EMS Responders

By calling first, you By calling first, you join a team of join a team of Emergency Service Emergency Service dispatchers and dispatchers and responders. responders.

Each member has Each member has a vital role.a vital role.

Early Access

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Department of Emergency MedicineDepartment of Emergency Medicine

EMS System COMPONENTSMedical Control - use of on-line communications

with a specialized physician or through off-line protocols of care for emergency situations. Off-line (indirect) medical control is the responsibility of the service medical director.

Three components of off-line medical director are: (1) development of protocols, (2) development of medical accountability (QA)(3) development of ongoing education.

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Department of Emergency MedicineDepartment of Emergency Medicine

EMS System COMPONENTS

Equipment and Supplies - all the necessary tools which EMT's need

Legislation and Advocacy - stipulates the regulation of the practice of pre-hospital and emergency medicine in a locality. Secures the high standards of care needed. The financial aspects of the EMS System may also be included.

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Department of Emergency MedicineDepartment of Emergency Medicine

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Department of Emergency MedicineDepartment of Emergency Medicine

Regional Trauma Care System

An organized approach in the management of acute injury utilizing the components of an EMSS and trauma centers or definitive care centers, trauma specialists and other aspects of trauma care in a locality, province, region or country.

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Department of Emergency MedicineDepartment of Emergency Medicine

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Department of Emergency MedicineDepartment of Emergency Medicine

COMPARATIVE DESIGNS OF EMERGENCY RESPONSE SERVICES

USA PhilippinesFunding Well Funded Scarce FundingInfrastructure Uniform federal Not Uniform

SupportNational Safety stats. Vehicles, Exists Does not Existequipment'sMinimum standard Recognition Requirescare provided present recognitionMinimum guidelines Existing Not existingfor education &training

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Department of Emergency MedicineDepartment of Emergency Medicine

COMPARATIVE DESIGNS OF EMERGENCY RESPONSE SERVICES

USA PhilippinesSupport Professional Minimal VoluntaryImprovements in Organizations OrganizationsSystem DesignCost of Med. & Heightened Lack of Trauma Care awareness awarenessPublic Health Continued Non existentPrevention Prog. AwarenessNetwork for Disaster Structured PartiallyResponse structuredSystem Flexibility Existent No System

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Department of Emergency MedicineDepartment of Emergency Medicine

Human Resources in the Emergency Medical Services System

Medical First ResponderEmergency Medical TechniciansEMT - BasicEMT - IntermediateEMT – ParamedicEMS Physician/Medical DirectorEmergency NursesEmergency PhysicianGeneral Surgeon/Trauma Surgeon/Orthopedic

Surgeon/PhysiciansEmergency Manager/Emergency Department Coordinator

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EP's and EMSS

Emergency Physicians (EP's)� great help in improving the health care during MCI’s. � help triage and institute initial management of injured patients while the surgeons deliver definitive care. � this specialist may be those certified in other

fields of specialization like general surgery, orthopedics, internal medicine, or family medicine.

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Airway Devicesoxygen tanksnon-rebreather masksnasal cannulaoropharyngeal airway devices of different sizesnasopharyngeal airway devices Intubation equipment like laryngoscopesendotracheal tubesLMA's (laryngeal mask airway)tracheostomy instrumentstracheostomy tubes and suction machinesCervical immobilization devices

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Department of Emergency MedicineDepartment of Emergency Medicine

Management of Hypovolemic Shock

Devices for hemorrhage control Surgical gauze packs Elastic and rolled bandagesIV access, IV cannulas of different sizes, central lines, cutdown sets, intra-osseous infusion needles Crystalloids & colloids for fluid replacementAccess to blood bank facilities or blood retrieval Traction splints for long bone fractures

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Department of Emergency MedicineDepartment of Emergency Medicine

Defibrillation

� Automated external defibrillators (AED's)– Manual defibrillators

� Personnel trained in ACLS � Biphasic defibrillators � Cardiac monitors w/ AED's incorporated

into one machine

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Department of Emergency MedicineDepartment of Emergency Medicine

Critical Care Monitoring Critical monitoring devices should include � pulse oximetry� non-invasive blood pressure readings, heart rate and cardiac rhythm� Point of care testing devices like arterial blood gas determinations (ABG) and electrolytes are useful. � End Tidal carbon dioxide tension (ETCO2)

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Department of Emergency MedicineDepartment of Emergency Medicine

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Department of Emergency MedicineDepartment of Emergency Medicine

Characteristics of the EMSS� Triage, Stabilize, Prioritize, Refer,

Observe� ABCs� Limited resources

– Time– Information– Space

� Technology dependent� Cutting-edge medicine

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Unique Characteristics of Prehospital Care

� Not necessary to arrive at diagnosis� Does not follow sequence of SOAP

– Assess Action Reassess Action� Always thinks of worst-case scenario

– Chest pain is MI!� SAMPLE history� Don’t believe everything you hear!

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Patient Transport� Star of Life

� Type I – cab & chassis

� Type II – van-type, modified height

� Type III – larger with walk-through passage

� BLS or ALS/ICU

1902 American EraUsed blueprint of Johns Hopkins University

(JHU)—the best US medical school Philippine Medical School 1905 Philippine General Hospital 1907University of the Philippines College of

Medicine 1908 Sept 1, 1910, state-of-the-art public teaching

hospital, the Philippine General Hospital

Philippine General Hospital 1910

PGH Horse drawn ambulance

CIRCA 1992

Capiz 2009

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Department of Emergency MedicineDepartment of Emergency Medicine

Philippine EMS System Components

� Transport (family van conversions)� Personnel (EMT-B)� Communications System (117)� Medical Control (EP's)� Equipment and Supplies� Legislation and advocacy (EMT law

SB3458)

Modern EMS units in the Philippines

PNRCSubic Naval BaseERUFAAPPCSODOH STOPDEATHUPPGHMakati Rescue

Lifeline ArrowsBFPFC Fire brigadePAGCOR EMSBacolod Amity EMSDavao 911Marikina RescueMany others

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SAREX NAIA

Philippine Society of EMT'sPSEMTAffiliate of the Philippine Society of Emergency Care Physicians PSECP Australasian Registry of EMT'sAREMT

Life Support Training International

is a Philippine Training Industry leader in all levels of instructions in pre-hospital emergency care. It carries the standard of the Philippines Society of Emergency Medical Technicians,

member expanded council of resuscitation of the Philippine Heart Association, the International Liaison committee on

resuscitation and the country regional affiliate of Australasia Registry of Emergency Medical

Technicians.

http://apcaregivers.com/trainings.htm

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Department of Emergency MedicineDepartment of Emergency Medicine

Directions in EMS

� EMT Law� Research & Documentation� SimulationTraining

– BLS, ACLS, ATLS/BEST– Emergency Nursing– Emergency Medical

Technicians

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Department of Emergency MedicineDepartment of Emergency Medicine

Directions in EMSS

� Pre-Hospital & ED reimbursement � Emergency Public Health Information

Dissemination� EMS Systems Design� Patient Safety � Quality Assurance� Decreasing Errors in EM� Technology

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Department of Emergency MedicineDepartment of Emergency Medicine

The Future is Uncertain“Everything that can be invented have been

invented.” Charles Duell Commissioner US Office of Patents 1899

“Who the hell wants to hear actors talk?”Harry M. Warner Warner Brothers 1921

“There is no reason for any individual to have a computer in their home.”

Kieth Olsen, President, Chairman and Founder Digital Equipment Corp. 1977 (filed for bankcruptcy 1991)

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Questions ?Questions ?