Chapter 1: Introduction to the EMS System

Cognitive Objectives

1-1.1 Define the components of Emergency Medical Services (EMS) systems.

1-1.2 Differentiate the roles and responsibilities of the First Responder from other out-of-hospital care providers.

1-1.3 Define medical oversight and discuss the First Responder’s role in the process.

1-1.4 Discuss the types of medical oversight that may affect the medical care of a First Responder.

Affective Objectives

1-1.6 Accept and uphold the responsibilities of a First Responder in accordance with the standards of an EMS professional.

1-1.7 Explain the rationale for maintaining a professional appearance when on duty or when responding to calls.

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Affective Objectives

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1-1.8 Describe why it is inappropriate to judge a patient based on a cultural, gender, age, or socioeconomic model, and to vary the standard of care rendered as a result of that judgment.

There are no psychomotor objectives.

Knowledge and Attitude Objectives

1. Understand and describe the four general goals of your first responder training.

2. Define the components of an emergency medical services (EMS) system.

3. Describe how the seriousness of the patient’s condition is used to determine the urgency of transportation to an appropriate medical facility.

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Knowledge and Attitude Objectives

4. Define the roles and responsibilities of a first responder.

5. Describe the importance of documentation.

6. Describe the relationship between your attitude and conduct and acceptable patient care.

7. Define medical oversight and discuss the first responder’s role in the process.

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The First Responder

• First medically trained person to arrive on the scene

• Initial care is essential.

– Available sooner than more advanced medical care

– Usually followed by more sophisticated care

First Responder Trauma Skills

• Control airway, breathing, and circulation.

• Control external bleeding (hemorrhage).

• Treat shock.

• Treat wounds.

• Splint injuries to stabilize extremities.

First Responder Medical Treatment

• Heart attacks

• Seizures

• Heat and cold exposure

• Substance abuse

• Poisonings

• Bites and stings

• Altered mental status

• Behavioral or psychological crises

• Emergency childbirth

Goals of First Responder Training

• Know what you should not do.

• Know how to use available resources.

• Know how to improvise.

• Know how to assist other EMS providers.

What Not to Do

• Examples:

– It may be better to treat a patient in the position found than move without proper equipment.

– Never judge a patient; you are there to treat.

Life Support Kit

• Should be small enough to fit in the trunk of an automobile

• Limited supplies, but adequate to provide immediate care for most patients

First Responder Life Support Kit

Improvise

• You will often be in situations with little or no emergency medical equipment.

• Important to know how to improvise

– Use clothing or handkerchiefs to stop bleeding.

– Use wooden boards, magazines, or newspapers to immobilize injured extremities.

Assist Other Providers

• Many EMS procedures require three or more people.

• Be prepared to assist EMTs or paramedics with some procedures.

Additional Skills

• First responders operate in a variety of settings.

• Different skills are required in different settings.

• Your local EMS system may require supple-mental skills and equipment.

The Emergency MedicalServices System

• Reporting: Dispatch center is contacted.

• Dispatch: Appropriate equipment and personnel are dispatched to scene.

• First response: Fire fighters or law enforcement personnel are often first on scene.

• EMS response: EMT-Bs, EMT-Is, or paramedics arrive shortly thereafter.

• Hospital care: Patient is taken to hospital if necessary.

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The Emergency Medical Services System

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Reporting

• Reporting of an incident activates the system.

• Dispatch center usually receives the call.

• Enhanced 9-1-1 centers can determine location of caller.

Dispatch

• Appropriate equipment and personnel are dispatched to the scene.

• How notification occurs varies by community.

First Response

• Fire fighters and law enforcement personnel are likely to be first on scene.

• Most communities have more first responders than EMTs or paramedics.

• First responders are a key element!

EMS Response

• BLS unit stabilizes patient and prepares for transport.

• BLS personnel can administer IV fluids, certain medications, and monitor and treat heart conditions.

• All skill levels are based on first responder skills.

Hospital Care

• Special facilities include burn centers, pediatric centers, poison control centers, perinatal centers, and trauma centers.

• Follow your local patient transportation protocols.

History of EMS

• Advances in civilian EMS have followed progress in the military medical system.

• 1966: Accidental Death and Disability published.

– Led to development of national standard curriculum

Components of EMS System

• Regulation/policy

• Resource management

• Human resources/training

• Transportation

• Medical/support facilities

• Communications

• Public information/ education

• Medical direction

• Trauma system and development

• Evaluation

Transportation

• Transport: Patient requires medical care, but speed is not important.

• Prompt transport: Patient requires medical care in a fairly short period of time, or patient may get worse or die.

• Rapid transport: Patient cannot be stabilized by EMS personnel and may die if not immediately transported to appropriate medical facility.

Roles and Responsibilities

• Respond promptly.

• Protect yourself.

• Protect scene and patients from further harm.

• Summon appropriate resources.

• Gain access to patient.

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Roles and Responsibilities

• Perform patient assessment.

• Administer emergency medical care and reassurance.

• Move patients only when necessary.

• Seek and then direct help from bystanders, if necessary.

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Roles and Responsibilities

• Control activities of bystanders.

• Assist EMTs and paramedics, as necessary.

• Document your care.

• Keep your knowledge and skills up-to-date.

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Documentation

• Should be clear, concise, accurate, and in accordance with accepted policies

• Serves as a legal record of treatment

• Provides basis to evaluate quality of care given

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Documentation

• Initial condition of patient

• Patient’s description of injury or illness

• Initial and later vital signs

• Treatment given

• Personnel who took over care

• Any other pertinent information

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Attitude and Conduct

• Professional behavior has a positive impact on patients.

• Be calm, caring, and considerate of patients’ privacy.

• Medical information about a patient is confidential.

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Attitude and Conduct

• A professional attitude and appearance provide reassurance to the patient.

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Medical Oversight

• Direct: Physician is in contact with prehospital EMS providers, usually by two-way radio or wireless telephone.

• Indirect: Physician directs training courses, helps set medical policies, and ensures quality management of the EMS system.