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Emergency Medical Services &

Disaster ResponsePaleerat Jariyakanjana, MD, FTCEP

Faculty of medicine

Naresaun university

Emergency Medical

Services

EMS: extension of emergency medical care into

the prehospital setting

History

ชวงเวลาท 1สภาอณาโลมแดงแหงชาตสยาม มลนธปอเตกตง & มลนธรวมกตญญชวงเวลาท 2ต ารวจจราจรชวยเหลอผปวยฉกเฉน ศนยกชพนเรนทรชวงเวลาท 3พฒนาระบบบรการการแพทยฉกเฉน ใหลงไปสระดบชมชน และมความ

ครอบคลมพนททวประเทศ

Tsunami

Key elements

Manpower

Personnel Comment Duration

First responder First professional or trained

layperson to arrive at a medical

emergency

16 hr

EMT-B (Basic) Oxygen, CPR, AED, extrication,

immobilization, hemorrhage

control

110 hr

EMT-I (Intermediate) EMT-B plus IV insertion, some

medication administration, ECG

interpretation

2 yr

EMT-P (Paramedic) Advanced resuscitation

techniques such as intubation

4 yr

Training

initial provider training

continuing 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#

Transportation

Ground transportation is appropriate for the

majority of patients, especially in urban and

suburban areas.

air transport

helicopter

considered for critically ill patients when the

ground transport time would be dangerously long

or if the terrain is difficult to navigate

Air transport

Boat ambulance

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 trauma

EMS research

Disaster Plan

written policies and procedures

stockpiling supplies

participating 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

Response

Disaster Response

Definition

Major Incidents: any incident where the number,

severity, type or location of live casualties

requires extraordinary resources

Disaster: need > resource

Mass 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

Command

Safety

Communication

Assessment

Triage

Treatment

Transport

DISASTER Paradigm

Detection

Incident command

Scene security and safety

Assess hazards

Support

Triage and Treatment

Evacuation

Recovery

Management and Support Principles

DISASTER Paradigm

Detection

Incident command

Scene security and

safety

Assess hazards

Support

Triage and Treatment

Evacuation

Recovery

MIMMS

Command

Safety

Communication

Assessment

Triage

Treatment

Transport

CommandCSCATTT

Safety

The 1-2-3 of Safety

1. Staff

2. Situation

3. Survivors

CSCATTT

CommunicationCSCATTT

Assessment

My call sign/Major incident declared

Exact location: Grid ref.

Type of incident

Hazards: Present/Potential

Access: Roads, Landing area

Number of casualties: Type, Severity

Emergency services: Present and Required

CSCATTT

TriageCSCATTT

Triage sieveCSCATTT

Triage sortCSCATTT

Triage sortCSCATTT

START (Simple triage and rapid

treatment)

SALT (Sort, Assess, Life-Saving Interventions,

Treatment and/or Transport)

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 injury

Injury found or suspected

Signs (vital signs)

Treatment given

CSCATTT

Take home message

EMS

extension of emergency medical care into the

prehospital setting

15 key elements of EMS systems

6 phases of EMS response

Disaster response

MIMMS: CSCATTT

DISASTER Paradigm

Triage: Sieve & Sort, START, SALT

Reference

Tintinalli's Emergency Medicine, 7th edition

http://www.emsworld.com/article/10319356/the-

star-of-life

https://sites.google.com/site/dimersarred/disaste

r-management-cycle

https://sites.google.com/site/sarbook1/excerpt-

incident-command

Any questions?