Emergency Medical Services History Quiz

Paramedic Care: Principles & Practice

• Textbook Title: Bledsoe's Paramedic Care: Principles & Practice
• Edition: Sixth
• Volume: Volume 1
• Chapter: 2 - EMS Systems
• Copyright: © 2023, 2017, 2013 Pearson Education, Inc.

Standard

• Preparatory: (EMS Systems)

Competency

• Integrates comprehensive knowledge of EMS systems, the safety and well-being of the paramedic, and medical-legal/ethical issues, intended to improve the health of EMS personnel, patients, and the community.

Introduction (1 of 7)

• Traditionally, EMS is a comprehensive network of personnel, equipment, and resources to deliver aid and emergency medical care to the community.
• EMS is reimagining itself to better serve patients in multiple ways beyond just a reactive response after an illness or injury.

Introduction (2 of 7)

• Out-of-Hospital Components:
  • Community members trained in first aid and CPR
  • Communications systems
  • EMS providers (including paramedics)
  • Fire/rescue; hazardous-materials services
  • Law enforcement officers
  • Public utilities
  • Resource centers
  • Divers Alert Network (DAN)

Introduction (3 of 7)

• In-Hospital Components:
  • EMS practitioners
  • Emergency nurses
  • Advanced-practice providers
  • Emergency and specialty physicians
  • Ancillary services
  • Social workers
  • Mental health providers
  • Rehabilitation services

Introduction (4 of 7)

• Technological Advances and Health Care Access:
  • EMS systems and health care are constantly evolving.
  • Telemedicine consults
  • Health services phone hotlines
  • Virtual physician visits via the Internet
  • Smartphone apps for emergency announcements
  • EMS transmission of vital patient information

Introduction (5 of 7)

• Basic Life Support (BLS) versus Advanced Life Support (ALS):
  • Upon emergency identification, the EMS communicator initiates an EMS response.
  • Tiered response versus response with paramedic(s) on each unit.
  • Terms of ALS and BLS are becoming obsolete.

Introduction (6 of 7)

• Tiered Response:
  • BLS ambulances handle lower acuity emergencies.
  • ALS ambulances are reserved for more advanced care when needed.
  • Other systems send an ALS ambulance to each call.

Introduction (7 of 7)

• History of EMS:
  • Emergency medicine traces back to biblical times.
  • Records date back 4,000 to 5,000 years.
  • Many initial medical documents were written in a "head-to-toe" format.
  • Evidence of the regulation of medicine and physicians found in codes of law.
  • EMS has evolved.

Table 2-1 An EMS Timeline (1 of 5)

• 1797: Napoleon's chief physician implements a prehospital system.
• 1860s: Civilian ambulance services begin in major cities.
• 1891: Dr. Friedrich Maass documents chest compressions in humans.
• 1915: First-known air medical transport during the retreat of the Serbian army.
• 1920: First volunteer rescue squads organized.
• 1947: Claude Beck develops the first defibrillator and saves a life using it.
• 1958: Dr. Peter Safar demonstrates the efficacy of mouth-to-mouth ventilation.
• 1960: CPR is shown to be efficacious.

Table 2-1 An EMS Timeline (2 of 5)

• 1965: J. Frank Pantridge adapts an ambulance into a mobile coronary care unit.
• 1966: National Academy of Sciences publishes a report on accidental death and disability.
• 1966: Highway Safety Act establishes the Emergency Medical Services Program.
• 1967: Star of Life is patented.
• 1968: AT&T designates 911 as the national emergency number.
• 1970: National Registry of EMTs is founded.
• 1970: Television show Emergency! debuts to introduce prehospital care and raise awareness.
• 1972: Budget allocation to support EMS demonstration programs.

Table 2-1 An EMS Timeline (3 of 5)

• 1973: The Emergency Medical Services Systems Act is passed.
• 1975: The National Association of EMT-s is organized.
• 1979: Automated External Defibrillators (AEDs) become available.
• 1981: Omnibus Budget Reconciliation Act modifies EMS funding.
• 1981: Prehospital trauma life support (PHTLS) and International trauma life support (ITLS) are introduced.
• 1984: The EMS for Children program is introduced.

Table 2-1 An EMS Timeline (4 of 5)

• 1985: National Research Council publishes a study on injury in America.
• 1988: The National Highway Traffic Safety Administration initiates the Statewide EMS Technical Assessment program.
• 1990: Trauma Care Systems and Development Act is passed.
• 1993: A report on Emergency Medical Services for Children is published.
• 1995: Funding for Trauma Care Systems and Development Act is not reauthorized.

Table 2-1 An EMS Timeline (5 of 5)

• 1999: President Clinton signs a bill designating 911 as the national emergency number.
• 2003: The Health Insurance Portability and Accountability Act (HIPAA) is implemented.
• 2006: The National Highway Traffic Safety Administration publishes a report on an agenda for the future of EMS.

History of EMS (1 of 22)

• Early Development: Ancient tablets provide step-by-step instructions for patient care and medication creation.

History of EMS (2 of 22)

• Code of Hammurabi: Governed criminal and civil matters; regulated medical fees and penalties.
• Out-of-Hospital Care: Emphasized treatment followed by transport.
• Dominique-Jean Larrey: Napoleon's chief surgeon; established the first prehospital system using triage and transport.
• Hot air balloons: First use of aircraft for transportation in the Prussian Siege of Paris 1870.

History of EMS (3 of 22)

• Nineteenth Century: Nurse Clara Barton organized triage and transport during the Civil War; first civilian ambulances.
• AMA statements: Dr. Nicholas Senn made a notable statement about the importance of the first dressing in wound care.

### History of EMS (4 of 22)

• Twentieth Century: High mortality rate of soldiers during World War I was associated with evacuation time.
• World War II: Development of transport to echelons (levels) of care was also developed.
• Hospitals: Hospitals began placing physician interns on ambulances.

Figure 2-3

• The Roanoke Life Saving Crew was the first reported rescue squad in the United States.

Figure 2-4

• The Hindenburg crash in Lakewood, NJ marked the first reported response to a multiple-casualty incident in the United States.

History of EMS (5 of 22)

• Korean War helicopters for transporting injured to mobile army surgical hospitals.
• Setting the stage: Marked a key stage in developing the trauma system in the United States.
• 1956 - 1960: Introduction of mouth-to-mouth resuscitation and portable defibrillators to help cardiac emergencies.

Figure 2-5

• Medical evacuation helicopters were colloquially called "Dust-off" in Vietnam War.

Figure 2-6

• Freedom House in Pittsburgh recruited unemployed black men and women to train them in EMS work.

History of EMS (6 of 22)

• 1966 Accident Report: Published an influential report on accidental death and disability highlighting the need for improvement in emergency medical services. This report laid the foundation for policy guidelines.
• Developing systems: Development of emergency medical services systems.
• Training: Providing enhanced training to prehospital medical providers.
• Equipment/Ambulances: Upgrading ambulances and equipment to match the rising needs for better patient care.

History of EMS (7 of 22)

• 1970: Establishment of National Registry of Emergency Medical Technicians and TV series Emergency drew public attention to prehospital care.
• 1973: Emergency Medical Services Systems Act was enacted.

History of EMS (8 of 22)

• Specific Component Examples: The EMS system act of 1973 set out 15 critical components for a functioning system. Components included: Manpower; Training; Communications; Transportation; Emergency Facilities, etc.

History of EMS (9 of 22)

• 1970s and Beyond: Act provided components for a better emergency medical system. Further components included critical care units; public safety agencies; consumer participation; access to care; transfer of patient.

History of EMS (10 of 22)

• 1970s and Beyond: Continued expansion on the components included; standardized record keeping; public information and education; system review and evaluation; Disaster management plans; Mutual Aid.

History of EMS (11 of 22)

• 1980s: Introduction of helicopter air ambulances (HAAs).
• 1988 NHTSA: National Highway Traffic Safety Administration outlines ten core elements of a good EMS system: Regulation & Policy, Resource Management, Human Resources & Training, Transportation, Facilities, Communications, Trauma Systems, Public Information & Education, Medical Direction, and Evaluation.

History of EMS (12 of 22)

• 1980s and beyond: Additional components listed for the 1988 NHTSA study include Communication Systems; Trauma Systems; Public Information and education; Medical direction; Evaluation.

History of EMS (13 of 22)

• 1990s: Introduction of Trauma Care Systems and Development Act; publication on Emergency Medical Services for Children to raise awareness for better care for children.
• Funding lost: Act not reauthorized by Congress in funding.
• Ontario study: Ontario Prehospital Advanced Life Support study

History of EMS (14 of 22)

• 1996 NHTSA EMS Agenda: Outlines 14 key attributes of a good EMS system, including: Integration of health services; EMS research; Legislation & regulation; System finance; Human resources; Medical direction; Education systems.

History of EMS (15 of 22)

• 1996 EMS Agenda: further attributes for the EMS system including; Public education; Prevention; Public access; Communication Systems; Clinical care; Information systems; Evaluation.

History of EMS (16 of 22)

• September 11, 2001 (9/11): Homeland Security department was created among other agencies to coordinate protective measures for the country.
• National Incident Management System: (NIMS): Helped the nation prepare for terrorism and other threats.

Figure 2-9

• The September 11, 2001 attacks in New York and Washington changed the face of EMS across the nation, and globally.

History of EMS (17 of 22)

• 2000 EMS Education agenda: The NHTSA published an EMS education agenda for the future, highlighting a systems approach.
• National EMS Core content: National standards for the core content of EMS training programs were developed.
• Scope of Practice Model: A model for the scope of EMS practice.
• Educational standards/Accreditation: National standards and accreditation processes for EMS training programs were improved in these years.

History of EMS (18 of 22)

• 2006 report card: National Academies Institute of Medicine published a report card on the state of emergency medicine focusing on EMS in the U.S.

History of EMS (19 of 22)

• 2006 ACEP Study: American College of Emergency Physicians published a study highlighting the stress on the EMS system and emergency rooms, leading to compromised quality of patient care.

History of EMS (20 of 22)

• Helicopter Air Ambulance: Improved ambulance programs, increased helicopter air ambulance services due to reimbursement improvements.
• 2008 Accident Records: A record number of accidents occurred in 2008.
• 2009 NTSB Hearings: The National Transportation Safety Board (NTSB) held hearings in 2009 that recommended significant changes to the EMS industry, specifically regarding helicopter ambulance safety.

History of EMS (21 of 22)

• 2014 EMS Compass: National Highway Traffic Safety Administration (NHTSA) and National Association of State EMS Officials engaged stakeholders to develop standards based on a shared vision for a new EMS compass.
• Performance Standards: Performance standards for the EMS were released in 2016 and benchmarks developed.

History of EMS (22 of 22)

• 2018 EMS Agenda 2050: Twenty-year update to the original EMS agenda in a document called the EMS Agenda 2050.
• Six core values: The updated 2018 agenda includes six core values: Adaptable and innovative; Sustainable and efficient; Socially equitable; Inherently safe and effective; Integrated and seamless; Reliable and prepared.

Today's EMS Systems (1 of 2)

• Different Types of EMS Configurations:
  • Fire-based systems
  • Third service
  • Private (profit or nonprofit)
  • Hospital-based systems
  • Volunteer
  • Hybrid (combination)

Today's EMS Systems (2 of 2)

• American Heart Association Chain of Survival: Factors Affecting Survival and Recovery of Cardiac Arrest Patients.
  • Activation of emergency response
  • High-quality CPR
  • Defibrillation
  • Advanced resuscitation
  • Post-cardiac arrest care
  • Recovery

Essential Components for Continuum of Care (1 of 23)

• Health Care System Integration:
  • Public service access points (PSAPs)
  • 911 call centers
  • Identifying acute coronary syndrome and ST-segment elevation myocardial infarction (STEMI)
  • Primary percutaneous coronary intervention (PPCI)

Essential Components for Continuum of Care (2 of 23)

• Levels of Licensure/Certification:
  • Emergency Medical Responder (EMR)
  • Emergency Medical Technician (EMT)
  • Advanced EMT (AEMT)
  • Paramedic

Essential Components for Continuum of Care (3 of 23)

• Local- and State-Level Agencies:
  • Administrative oversight agency
  • Planning board
  • Define who may function within system
  • Policies consistent with state requirements
  • State EMS agencies: allocate funds; enact legislation

Essential Components for Continuum of Care (4 of 23)

• Medical Oversight:
  • Medical director: physician legally responsible for all clinical and patient care aspects of system
  • Prehospital care providers are medical director's designated agents.
  • Both online and offline medical oversight.

Figure 2-11

• The EMS physician provides on-line guidance to EMS personnel in the field, as needed.

Essential Components for Continuum of Care (5 of 23)

• Public Information and Education:
  • Recognizing emergencies
  • Ways to access the system
  • Providing basic life support assistance
  • Educating the public

Figure 2-13

• EMS also has a role in preventing disease and injury.

Essential Components for Continuum of Care (6 of 23)

• Effective Communications:
  • Regional EMS system coordination in urgent medical situations
  • Citizen access to the system (911)
  • Use of a single control center
  • Operational and medical communications capability
  • Necessary software and hardware requirements for communication.

Essential Components for Continuum of Care (7 of 23)

• Effective Communications:
  • Roles of emergency medical dispatchers
  • Emergency medical dispatchers assigning appropriate medical care to patients.
  • Processes and procedures of EMS dispatch.

Figure 2-15

• The EMS communications center is the heart of modern EMS systems.

Essential Components for Continuum of Care (8 of 23)

• Education and Certification:
  • Completing a paramedic program following the most current National EMS Education Standards.
  • Three types of learning components: Cognitive , Affective, and Psychomotor.
• Accreditation is required for all paramedic programs.

Essential Components for Continuum of Care (9 of 23)

• Continuing Education:
  • Refreshers for recertification and periodic in-service training sessions are mandatory.
  • The Continuing Education Coordinating Board for Emergency Medical Services (CECBEMS).

Essential Components for Continuum of Care (10 of 23)

• Licensure, Certification, Registration, and Reciprocity:
  • Licensure: occupational regulations
  • Certification: recognition for meeting qualifications
  • Reciprocity: automatic certification or licensure for comparable certifications from another agency.

Essential Components for Continuum of Care (11 of 23)

• National Registry of EMTs (NREMT):
  • A nonprofit entity that develops standards for testing and registration of EMS provider levels.
  • Establishes qualifications for registration.
  • Establishes national minimum standards of competence for EMS provider qualifications and registration.

Essential Components for Continuum of Care (12 of 23)

• Professional Organizations: A list of key professional organizations in the EMS field.
• National Association of EMTs (NAEMT)
• National Association of Search and Rescue (NASAR)
• National Association of EMS Educators (NAEMSE)
• National Association of EMS Physicians (NAEMSP)
• International Flight Paramedics Association (IFPA)
• National EMS Management Association (NEMSMA)
• National Council of State EMS Training Coordinators
• American Paramedic Association (APA)

Essential Components for Continuum of Care (13 of 23)

• Professional Journals and Magazines: A range of professional publications for the EMS field.
• Academic Emergency Medicine
• American Journal of Emergency Medicine
• Annals of Emergency Medicine
• Emergency Medical Services
• EMS World Magazine
• Journal of Emergency Medical Services
• Journal of Pediatric Emergency Medicine
• Journal of Trauma: Injury, Infection, and Critical Care
• Prehospital Emergency Care

Essential Components for Continuum of Care (14 of 23)

• The Internet: Resources available on the Internet for EMS providers.
• Updated content and news
• Accredited continuing education programs
• International EMS discussions; networking

Essential Components for Continuum of Care (15 of 23)

• Effective Patient Transportation:
  • Air transport (fixed-wing or rotor wing)
  • Ground transport -- Vehicles meeting local/state requirements. Ambulance Types (I,II, and III).

Figure 2-19

• Transport of patients by ground and air; helicopter transport (1950s)

Figure 2-20

• Fixed-wing aircraft and helicopters have become an important part of patient transport in modern EMS systems.

Figures 2-21, 2-22, 2-23 and Figure 2-25

• Images of ambulances of different types

Figure 2-26

• The diesel, unibody ambulance is becoming more widespread due to cost, fuel economy, and safety.

Essential Components for Continuum of Care (16 of 23)

• Appropriate Receiving Facilities:
  • EMS commonly transports patients to Emergency Departments (EDs)
• EMS systems often categorize hospitals to guide patient transfers appropriately.
• Specialty facilities (like cardiac, stroke, trauma, and burn centers) play a crucial role in managing patients with specialized needs.

Figure 2-27

• Specialized trauma centers significantly improved patient care in terms of morbidity and mortality rates.

Essential Components for Continuum of Care (17 of 23)

• Mutual Aid and Mass-Casualty Preparation:
  -Ensuring help is available when needed.
  • Disaster planning for catastrophes
  • Incident command processes.
  • Establishing mutual aid agreement (MA).

Essential Components for Continuum of Care (18 of 23)

• Quality Assurance and Improvement:
  • Quality improvement guidelines
  • Leadership (needed) for quality improvement programs.
  • Information and analysis in quality assurance systems
  • Strategic quality planning and human resource development.
  • EMS process management; satisfaction and quality assurance (QA) versus continuous quality improvement (CQI) programs.

Essential Components for Continuum of Care (19 of 23)

• Customer satisfaction, service quality and medical errors:
  • Customer satisfaction is connected to service quality
  • Medical errors include skill based failures, rule based failures, and knowledge-based failures.

Essential Components for Continuum of Care (20 of 23)

• High-Risk Areas of EMS Practice:
  • Hand-offs between EMS responders.
  • Issues in communication.
  • Medication issues.
  • Airway issues
  • Dropping patients in transport
  • Ambulance crashes.
  • Death pronouncements.

Essential Components for Continuum of Care (21 of 23)

• Research:
  • Components that are important in justifying the EMS system.
  • Importance of outcome studies.
  • Role of paramedics in data collection, evaluation, and research interpretation

Essential Components for Continuum of Care (22 of 23)

• Evidence-Based Medicine (EBM):
  • Emphasizing the proper use of the latest scientific evidence
  • Combining clinical expertise with the best evidence
• EMS personnel are trained in prehospital care using sound clinical judgement.

Essential Components for Continuum of Care (23 of 23)

• System Financing:
  • EMS systems can be hospital based, fire or police department based, municipal service, private commercial business, volunteer, or a combination of those.

Summary

• Evolution of EMS over thousands of years
• Innovations learned from military conflicts.
• Dynamic changes to EMS, occurring as health care evolves and realigns.
• Technology playing a more significant role in patient care.
• Solid quality assurance programs and ongoing research in the field.

Test your knowledge on the significant milestones in the evolution of Emergency Medical Services (EMS). This quiz covers key acts, organizations, and technological advancements that shaped EMS from the 1960s to the 1980s. Perfect for students and professionals interested in the history of emergency response.