Paleerat Jariyakanjana, MD

Faculty of Medicine

Naresuan University

Emergency Medical Services & Disaster ResponseEmergency Medical Services & Disaster Response

EMERGENCY MEDICAL SERVICES

EMS is the extension of emergency medical care into the prehospital setting.

History

ช่�วงเวลาที่ 1 สภาอุ�ณาโลมแดงแห่�งช่าติ�สยาม ม�ลนิ�ธิ�ป่�อุเติ�กติ� ง & ม�ลนิ�ธิ�ร่�วมกติ"ญญู�

ช่�วงเวลาที่ 2 ติ%าร่วจจร่าจร่ช่�วยเห่ล'อุผู้�)ป่�วยฉุ�กเฉุ�นิ ศู�นิย,ก�)ช่พนิเร่นิที่ร่

ช่�วงเวลาที่ 3 พ"ฒนิาร่ะบบบร่�การ่การ่แพที่ย,ฉุ�กเฉุ�นิ ให่)ลงไป่ส��ร่ะด"บ

ช่�มช่นิ และมความคร่อุบคล�มพ'4นิที่ที่" วป่ร่ะเที่ศู Tsunami

Key elements

Manpower

Training

initial provider trainingcontinuing education

Communications

1. collect the necessary information from the caller, dispatch appropriate medical resources, and offer first aid information or prearrival instructions

2. Ambulance personnel should also be able to communicate with the destination hospital

3. online medical control

Transportation

BLS ambulances carry equipment appropriate for personnel

trained at the EMT-B level oxygen, bag-mask ventilation devices,

immobilization and splinting devices, and dressings for wound care and hemorrhage control

do not carry medication and cannot transport patients requiring IVs or cardiac monitoring, although some may carry AEDs

BLS ambulances

Transportation

ALS ambulances equipped for EMT-Ps or other advanced

health care personnel IV supplies, IV medication, intubation devices,

cardiac monitoring and defibrillation, and equipment for other specialized techniques unique to specific areas, such as hypothermia application after cardiac resuscitation

ALS ambulances

Transportation

http://www.manafeth.com/index.php/en/products/view/Ambulance-Type-I#

Air transport

Facilities and Critical-Care Units

closest appropriate hospital or to the hospital of the patient's choice

divert patients to other hospitals ED overcrowding

Public Safety Agencies

strong ties with police and fire departments

1. providing scene security

2. provide first responder services

Consumer Participation

encourage representation of the general public on the membership of regional EMS councils

public can participate by volunteering for local EMS agencies

Access to Care

no barriers or disincentives preventing timely access to the system

Patient Transfer

all patients must receive a medical screening exam and be stabilized before transfer to another facility

explicit acceptance of the transfer by the receiving hospital

Coordinated Patient Record Keeping

Standardization of EMS medical records

Public Information and Education

train the public how to access them when needed and how to use them appropriately

convey to the public is the importance of learning CPR, first aid, and basic disaster preparedness principles

Review and Evaluation

radio communications, response times, scene times, and patient care records

Outcome: cardiac arrest, stroke, and traumaEMS research

Disaster Plan

written policies and proceduresstockpiling suppliesparticipating in regional disaster drills with

other emergency response agencies and hospitals

Mutual Aid

mutual aid agreements with neighboring jurisdictions so that uninterrupted emergency care is available when local agencies are overwhelmed or unable to provide services

Phases of EMS response

DISASTER RESPONSE

Definition

Major Incidents: any incident where the number, severity, type or location of live casualties requires extraordinary resources

Disaster: need > resourceMass casualty incident: Healthcare need >

resource

Disaster Management Cycle

Major Incident Medical Management and Support (MIMMS)

major incident training course

systematic, 'all hazards' approach to the principles of pre-hospital, multiple-casualty incident medical management

Management and Support Principles

CommandSafetyCommunicationAssessmentTriageTreatmentTransport

Command

CSCATTT

Safety

The 1-2-3 of Safety

1. Staff

2. Situation

3. Survivors

CSCATTT

Communication

CSCATTT

Assessment

My call sign/Major incident declaredExact location: Grid ref.Type of incidentHazards: Present/PotentialAccess: Roads, Landing areaNumber of casualties: Type, SeverityEmergency services: Present and Required

CSCATTT

Triage

CSCATTT

Triage sieve

CSCATTT

Triage sort

CSCATTT

Triage sort

CSCATTT

Treatment

Aim: “do the most for the most”

CSCATTT

Transport

Aim: get the right casualty to the right place in the right time

Casualties should be dispersed to different hospitals, most appropriate to their need.

Mechanism of injuryInjury found or suspectedSigns (vital signs)Treatment given

CSCATTT

Take home message

EMS is the extension of emergency medical care into the prehospital setting.

Disaster response: CSCATTT

Reference

Tintinalli's Emergency Medicine, 7th editionhttp://www.emsworld.com/article/10319356/th

e-star-of-lifehttps://sites.google.com/site/dimersarred/disa

ster-management-cyclehttps://sites.google.com/site/sarbook1/excerp

t-incident-command

ANY QUESTIONS?