Chapter 1 Introduction to EMS Systems

Emergency Medical Services (EMS) Systems

• EMS systems originated in the 1790s with the French military transporting wounded soldiers.
• Clara Barton's Civil War service and later founding of the American Red Cross also contributed.
• World War I saw volunteer-staffed ambulances, and later, specialized field hospitals influenced post-conflict civilian medicine (e.g., Trauma Centers).
• Military medicine consistently influences civilian trauma treatment, demonstrating the lasting impact of conflicts.
• Tourniquets, initially seen as a last resort, gained renewed acceptance due to effectiveness in modern warfare.
• Civilian ambulance services developed gradually in the early 20th century, initially focused on transport, evolving into vital medical services.
• Local mortuaries and fire departments often provided EMS services during the 1940s-1980s, as ambulance services matured.
• 1965/66 research highlighted significant highway fatalities, leading the Department of Transportation to establish EMS standards in 1966.
• 1970 marked the founding of the National Registry of EMTs, affecting uniformity in EMT certification.
• California's 1970 "Wedworth-Townsend Act" established paramedics, a landmark, legislative achievement.
• The 1973 National Emergency Medical Services systems act focused on funding and standards for local EMS systems.
• Early EMS relied on transport, shifting to medical care roles over time.

Components of an EMS System

• Regulation and Policy: Established by the National Highway Traffic Safety Administration, including funding models and foundational policies.
• Resource Management: Coordinating emergency treatment and transport.
• Human Resources and Training: Ensures EMTs meet minimum national standards; uniformity across jurisdictions.
• Transportation: Facilitating safe and reliable patient transport using proper equipment.
• Facilities: Providing access to appropriate definitive care facilities and specialist centers.
• Communications: Utilizing 9-1-1, radio systems, and cell phones facilitating communication and coordination between hospitals and emergency responders.
• Public Information and Education: Reducing the need for EMS with public campaigns for CPR/First Aid and awareness programs.
• Medical Direction: Ensuring physician oversight of EMT practices; includes county-level medical directors.
• Trauma Systems: Triaging, transporting, and treating trauma patients efficiently.
• Evaluation: Analyzing patient outcomes to improve treatments and effectiveness.
• Local systems may adapt national standards based on their needs and resources.

EMS System Personnel and Levels

• Dispatchers: Initial contact point for 9-1-1 calls, providing first aid steps or guidance to callers. Dispatchers may also have EMT training.
• Emergency Medical Responders (EMRs): Basic level, usually with 80 hours of training; provide immediate on-scene assistance until more advanced responders arrive.
• Emergency Medical Technicians (EMTs): Intermediate level, 170-200 hours of training, providing pre-hospital care and transport.
• Advanced EMTs: Mid-level providers; 600+ hours of training; specific scope of practice involving certain medications or procedures.
• Paramedics: Highest level of training, typically 1400-1600 hours including hospital time, using advanced knowledge and experience.
• Responsibilities include personal, patient (and bystander) safety; collaboration with other public safety entities.

EMT Roles and Responsibilities

• Patient Assessment: High-priority skill for determining all patient care. Comprehensive assessments are crucial.
• Lifting and Moving Patients: Safe patient handling and transport including gurneys and equipment.
• Transport: Securely transporting patients in ambulances, focusing on patient and crew safety.
• Transfer of Care: Effectively conveying patient information to hospitals. Thorough documentation is essential.
• Advocate: Advocating for patients' needs in pre-hospital care; referral to appropriate support services. This includes safety and welfare for the vulnerable patient.
• Physical and Visual Requirements: Physical strength, appropriate vision, and excellent communication skills. Adequate physical abilities are required for the job.
• Personal Traits: Pleasant, cooperative, resourceful, emotionally stable, neat, respectful, with well-managed personal habits. Professionalism and reliability are vital.
• Maintenance of Certifications: Compliance with continuing education (CE) requirements (CPR/BLS) and other training requirements
• EMTs need to prioritize personal, crew, and patient safety in all situations.

EMS System Models

• Los Angeles City Fire Department Model: Fire departments with integrated ambulance services.
• Los Angeles County Model: Fire departments and private ambulance services partner in shared response roles.
• Third Service Model: Separate government-run EMS providers (often more specialized and expensive), commonly seen in rural areas.

EMS Certification and Licensure

• National Registry of EMTs: A national standard for testing, not a license to operate. Computer adaptive with varying question numbers and durations.
• California Certification: County-issued certification cards required for practice in California.
• Recertification: Two-year recertification cycle requiring continuing education (CE) and skills validation. Continuing education (CE) is required for recertification.
• Responsibilities of the EMT: Maintaining and renewing certifications is the responsibility of the EMTs themselves.
• National Registry certifications are not licenses.

Quality Improvement

• Self-Review: Regularly reviewing patient care and service delivery, identifying areas needing improvement.
• Developing improvement plans: Implementing corrective actions or improving efficiency to enhance performance and care.
• Feedback Mechanisms: Obtaining feedback from patients and hospital staff for further improvement.
• Maintenance & Quality Audits: Ensuring equipment and educational resources are up-to-date. Regular audits ensure effectiveness and safety.

Medical Direction

• Medical Directors: Overseeing EMT practices via standing orders, field protocols, or online direction, differing by provider level and county protocols.
• Standing Orders/Field Protocols: Written guidelines for treatment decisions and procedures.
• Online Medical Direction: Direct consultation with medical professionals for specific guidance.
• LA County utilizes both online and offline medical direction.

EMS Role in Public Health and Research

• Injury Prevention: Participating in preventive programs and raising awareness.
• Public Health Programs: Involvement in vaccination programs or disease surveillance initiatives.
• Research: Focusing on improving patient outcomes and evidence-based treatments through review and analysis. Continued research is vital to improving treatment protocols.
• EMS plays a growing role in public health programs and injury prevention.