Chapter 1

EMS (Emergency Medical Services) System: Provide Out-of-Hospital or Prehospital Care.

History of the EMS System:
• 1790s – the French began to transport wounded soldier away from the scene without
medical care.
• American Civil War – Clara Barton provided services for the wounded and help
Establish the American Red Cross.
• World War I – a lot of volunteers joined the Battlefield Ambulance Corps.
• Korean Conflict & Vietnam War – developed more Medical Advances in Field Care,
and also developed Specialized Emergency Medical Centers (ex. Trauma Center)
• Early 1900s – Private Ambulances arise in Major Cities, but still without medical care.
• Late 1940s – Private Ambulances arise in Smaller Communites.
EMS System Today:
• 1960s – the modern EMS system began.
• 1966 – NHSA (Nat’l Highway Safety Act) was Establish to develop EMS Standards and
Upgrade the Quality of Prehospital Care.
• 1970 – NREMT (Nat’l Registry of EMT) was Establish for Professional Standards.
• 1973 – NEMSSA (Nat’l EMS System Act) was Establish to Improve EMS System across
the US.
• Present – NHTSA (Nat’l Highway Traffic Safety Administration) Technical Assistance
Program Sets 10 Standards for EMS System.
1. Regulation and Policy – Enabling Legislation, Must Have: Lead EMS Agency,
Policies, Regulation and Procedures.
2. Resource Management – Must Have a Centralized Coordination of Resources.
This provides Equal Access of Emergency Care and Transport to All Victims.
3. Human Resources and Training – All transporting Prehospital Personels must be
trained to the EMT Level.
4. Transportation – Must be Safe and have a Reliable Ambulance. Ground
Ambulance, Helicopter or Plane (for rapid Transportation).
5. Facilities – Seriously ill/ trauma patient must be delivered in the Closest
Appropriate Facility.
6. Communications – Must Have: 911 system, dispatcher to Ambulance,
Ambulance to Ambulance, Ambulance to Hospital, Hospital to Hospital.
7. Public Information and Education – Educate the public about their role and how
to access the EMS system (911), and how to prevent injuries.
8. Medical Direction – Must Have a Physician as a Medical Director who can give
authority to EMTs, to proceed to medical practices.
9. Trauma Systems – Enabling Legislation. State Must have at least One Trauma
Center, Triage (patient priorities), and Transfer Guidelines for Trauma Patients.
10. Evaluation – Must Have a Program for Evaluating and Improving the EMS
system. Q.I. (Quality Improvement), Q.A. (Quality Assurance), T.Q.M. (Total
Quality Management).
Changed Terms : Victims  Patients
Ambulance Attendant  EMT
Prehospital care  Out-of-Hospital care
 Components of the EMS System:
1. 9-1-1 Call.
2. EMD (Emergency Medical Dispatcher).
3. EMS System Responds and Sends Responders.
4. 1st responders, EMT-B, EMT-I, EMT-P transport Patient to the Hospital.
5. Emergency Department (or E.R.) receives Patient.
6. Allied Health Staff (ex. Nurse) Treat Patient.
*** If Patient is Brought to the Emergency Department with SERIOUS Injuries, Further
Care is given and the O.R. (Operating Room) is Prepared.***
Two Types of Hospitals:
I. Regular Hospital (no Specialty) – treats and handle all routines and Emergency Cases.
II. Specialty Hospital – Treats patients that have Specific Injury or illness.
(Ex. Trauma, Pediatric, Cardiac Catheterization, Stoke and Poison Control Centers)
*** Primary Key of Prehospital EMS team: 1st Responders, EMTs, and Dispatchers.***
Access to the EMS System:
• 9-1-1 System : report Emergencies.
• Enhanced 9-1-1 System: can Automatically identify the Caller’s Number and Location.
• Still NOT all have the 9-1-1 system. Few Communities reach their EMS by dialing the
standard Seven-digit telephone number.
• EMDs (Emergency Medical Dispatchers)
o are Specially Trained Dispatchers who provides Medical Instruction for
Emergency. They instruct callers with CPR, Artificial Ventilation, Bleeding
Control and More.
o Provides Emergency Care at the Earliest Possible Moment.
Levels of EMS Training:
1. 1st Responder – Many Police, Firefighters, and Industrial Health Personnel are Certified.
2. EMT-BASIC – Minimum Level of Certification for Ambulance Personnel. Should
Complete the U.S. DOT’s EMT National Standard Training Program.
3. EMT-INTERMEDIATE – a.k.a “Shock-Trauma Technician” or “Critical Care
Technician”
Provides Advance Life Support:
o Giving IV (intravenous) lines
o Advance Airway Technique
o Giving Some Medications
4. EMT-PARAMEDIC – Should complete U.S. DOT’s National Standard Paramedic
Curriculum.
Performs Invasive Field Care (can perform Surgeries)
o Insertion of Endotracheal Tubes
o Giving IV lines
o Giving Medications
o Interpretation of Electrocardiogram and Cardiac
Defibrillation.
 8 Responsibilities of an EMT:
1. Personal Safety – help self first before others.
2. Safety of the Crew/Patient/Bystanders (audience) – should be concerned with their
safety.
3. Patient Assessment – rule of thumb in Emergency Care. Finding out what’s wrong with
the patient.
4. Patient Care – simple emotional support to Life-saving CPR and Defibrillation.
5. Lifting and Moving – lifting and moving Patients without injuring yourself or the
patient.
6. Transport – secure patient while transporting them in a ambulance.
7. Transfer of Care – Must NEVER abandon care for the Patient until transfer to a hospital
personnel.
8. Patient Advocacy (support for the Patient) – EMTs are the ones who patients rely on.
They speak up for the patient. **** EMT – Patient Connection ****
Physical Traits on an EMT:
• Fit and healthy
• Can carry up to 125 pounds
• Needs Dexterity, Coordination and Strength
• Good eyesight is very important
13 Personal Traits on an EMT:
• Pleasant – have confidence and helps calm patient
• Sincere – convey (expresses) understanding
• Cooperative – has better coordination with other EMS members
• Resourceful – can easily adapt a technique in unusual situations
• Self-Starter – start procedure without depending on others
• Emotionally Stable – Overcome uneasy feelings
• Able to Lead – can take Charge of the situations
• Neat and Clean – gives patient confidence and trust
• Good Moral Character and Respectful – provides trust to the patient
• Control of Personal Habits – never consumes alcohol and smokes during duty
• Controlled in Conversation and Able to Communicate Properly
• Good Listener – Accurate interviews and inspire confidence
• Non-Judgmental and Fair – Treating All Patients equally
EMT Education:
o Maintain up-to-date knowledge and skills
o Refresher training
o Continuing Education
EMT Provider:
• In public or private settings, like fire departments, ambulance services and rural or
urban settings.
• Can be a volunteer in a community
National Registry of Emergency Medical Technicians (NREMT):
• Establish and Maintain national standards for EMTs.
• Provides Registration to 1st Responders, EMTs, EMT-I, and EMT-P
• After passing the exam, EMTs will be entitled to wear the REMT Patch
 Quality of Improvement:
• Continuous Self-Review with the Purpose of Identifying and Correcting Aspects of the
System.***
• 5 Quality of Improvement
1. Keeping Carefully written Documents
2. Involve in Quality Process – volunteer for assignment to the Q.I. committee.
Have another EMT look over your report before completion.
3. Obtaining Feedback From Patient or Hospital Staff – can be done
informally or formally.
4. Maintaining Equipment – Checking and Maintaining equipment Regularly
5. Continuing Education – Procedures change over time.
Medical Direction:
• Medical Director – physician responsibility for patient-care aspects in EMS system
• Medical Direction – Oversight (watchful) of the Patient-Care Aspects of the EMS
system
• Protocols – list of steps for assessment and interventions (counseling)
• Designated Agent – EMT-B to EMT-P are assigned and authorized by Physician to do
what he or she commands
• Standing Orders – Policy or Protocols that Authorizes EMTS to perform particular
skills in certain situations.
• Off-line Medical Direction – allows EMTs to give certain medication or perform certain
procedures without speaking to a Medical Director
• On-line Medical Direction – Orders from the on-duty physician given by radio or phone