Paramedic Care: Principles & Practice Chapter 2 PDF

Paramedic Care: Principles & Practice Sixth Edition Chapter 2 EMS Systems Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Standard Preparatory (EMS...

Paramedic Care: Principles & Practice Sixth Edition Chapter 2 EMS Systems Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Standard Preparatory (EMS Systems) Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Competency Integrates comprehensive knowledge of EMS systems, the safety and well-being of the paramedic, and medical- legal and ethical issues, which is intended to improve the health of EMS personnel, patients, and the community. Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Introduction (1 of 7) Traditionally, the emergency medical services (EMS) system has been a comprehensive network of personnel, equipment, and resources established to deliver aid and emergency medical care to the community EMS is now reimagining itself to better serve patients in multiple ways, not just in a “reactive” way after an illness or injury occurred Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Introduction (2 of 7) Out-of-Hospital Components – Community members trained in first aid and Cardiopulmonary resuscitation (CPR) – Communications system – EMS providers, including paramedics – Fire/rescue; hazardous-materials services – Law enforcement officers – Public utilities – Resource centers – Divers Alert Network (DAN) Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved 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 Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Introduction (4 of 7) Technological Advances and Health Care Access – EMS systems and health care 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 Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Introduction (5 of 7) Basic Life Support (BLS) versus Advanced Life Support (ALS) – Upon emergency identification, the EMS communicator will initiate an EMS response – Tiered response versus response with paramedic(s) on each unit – Terms of ALS and BLS becoming obsolete Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Introduction (6 of 7) Figure 2-2 Some EMS systems elect to use a tiered response where B LS ambulances handle lower acuity emergencies while a smaller number of A LS ambulances are reserved to provide more advanced care when needed. Other systems send an A LS ambulance to each call. Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Introduction (7 of 7) History of EMS – Emergency medicine traces back to biblical times – Some records 4,000 to 5,000 years old – Many initial medical documents written in “head-to- toe” format still seen in medicine today – Evidence of regulation of medicine and physicians found code of law – EMS has evolved as well Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Table 2-1 An EMS Timeline (1 of 5) 1797 Napoleon’s chief physician implements a prehospital system designed to triage and transport the injured from the field to aid stations. 1860s Civilian ambulance services begin in Cincinnati and New York City. 1891 Dr. Friedrich Maass performs the first equivocally documented chest compression in humans. 1915 First-known air medical transport occurs during the retreat of the Serbian army from Albania. 1920 First volunteer rescue squads organize in Roanoke, Virginia, and along the New Jersey coast. 1947 Claude Beck develops first defibrillator and first human saved with defibrillation. 1958 Dr. Peter Safar demonstrates the efficacy of mouth-to-mouth ventilation. 1960 Cardiopulmonary resuscitation (CPR) is shown to be efficacious. Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Table 2-1 An EMS Timeline (2 of 5) 1965 J. Frank Pantridge converts an ambulance into a mobile coronary care unit with a portable defibrillator and recorded ten prehospital resuscitations with a 50 percent long-term survival rate. 1966 The National Academy of Sciences, National Research Council publishes Accidental Death and Disability: The Neglected Disease of Modern Society. 1966 Highway Safety Act of 1966 establishes the Emergency Medical Services Program in the Department of Transportation. 1967 Star of Life is patented by the American Medical Association. 1968 AT&T designates 911 as its new national emergency number. 1970 National Registry of EMT s is founded. 1970 Television show Emergency! debuts on NBC. 1972 Department of Health, Education, and Welfare allocates $16 million to EMS demonstration programs in five states. Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Table 2-1 An EMS Timeline (3 of 5) 1973 The Emergency Medical Services Systems (EMSS) Act provides additional federal guidelines and funding for the development of regional EMS systems; the law establishes 15 components of EMSsystems. 1975 National Association of EMT s is organized. 1979 First automated external defibrillators (AEDs) become available. 1981 The Omnibus Budget Reconciliation Act consolidates E MS funding into state preventive health and health services block grants, and eliminates funding under the EMSS Act. 1981 Prehospital trauma life support (PHTLS) is developed. 1981 International trauma life support (ITLS), formerly basic trauma life support (BTLS), is developed. 1984 The EMS for Children program, under the Public Health Act, provides funds for enhancing the EMS system to better serve pediatric patients. Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Table 2-1 An EMS Timeline (4 of 5) 1985 National Research Council publishes Injury in America: A Continuing Public Health Problem, describing deficiencies in the progress of addressing the problem of accidental death and disability. 1988 The National Highway Traffic Safety Administration initiates the Statewide EMS Technical Assessment program based on ten key components of EMS systems 1990 The Trauma Care Systems and Development Act encourages development of inclusive trauma systems and provides funding to states for trauma system planning, implementation, and evaluation. 1993 The Institute of Medicine publishes Emergency Medical Services for Children, which points out deficiencies in our health care system’s ability to address the emergency medical needs of pediatric patients. 1995 Congress does not reauthorize funding under the Trauma Care Systems and Development Act. Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Table 2-1 An EMS Timeline (5 of 5) 1999 President Clinton signs bill designating 911 as national emergency number. 2003 Health Insurance Portability and Accountability Act (H IPAA) becomes effective, strictly regulating the flow of confidential information. 2006 The National Highway Traffic Safety Administration publishes Emergency Medical Services: Agenda for the Future to guide the development of EMS in the United States in the twenty-first century. Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved History of EMS (1 of 22) Early Development – Ancient tablets – Step-by-step instructions for patient care – How to create medications Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved History of EMS (2 of 22) Code of Hammurabi – Governed criminal and civil matters; regulation of medical fees and penalties Out-of-Hospital Care – Treat and then transport Dominique-Jean Larrey (Napoleon's chief surgeon) – First prehospital system using triage and transport First use of aircraft were hot air balloons at Prussian Siege of Paris in 1870 Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved History of EMS (3 of 22) The Nineteenth Century – Nurse Clara Barton organized triage and transport during Civil War – First civilian ambulances founded in Cincinnati, Manhattan, and Chicago (latter 1800s) – AMA president Nicholas Senn stated in 1897, “The fate of the wounded lies with the one who applied the first dressing.” Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved History of EMS (4 of 22) The Twentieth Century – World War I: high mortality rate of soldiers associated with evacuation time – World War II: transport to echelons (levels) of care created – Hospitals experimented with placing physician interns on ambulances Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Figure 2-3 The Roanoke Life Saving Crew was the first reported rescue squad in the United States. Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Figure 2-4 Hindenburg Disaster The ambulance response to the Hindenburg crash in Lakewood, N J was the first reported response to a multiple casualty incident in the United States. (AP Images) Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved History of EMS (5 of 22) The Twentieth Century (cont ) inued – Korean War: helicopters moved injured to mobile army surgical hospitals (MASHs) – Set stage for trauma system in the United States – 1956: mouth-to-mouth resuscitation – 1959: portable defibrillator – 1960: cardiopulmonary resuscitation (CPR) Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Figure 2-5 Medical evacuation helicopters, colloquially called “Dust-off,” saved many lives during the Vietnam War. (Dust off © Joe Kline Aviation Art) Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Figure 2-6 Freedom House began a groundbreaking E MS squad and social initiative by recruiting unemployed black men and women from inner-city Pittsburgh and trained them as E MS practitioners. (Charles ‘Teenie’ Harris/Teenie Harris Archive/Carnegie Museum of Art/Getty Images) Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved History of EMS (6 of 22) The Twentieth Century (cont ) inued – 1966: Accidental Death and Disability: The Neglected Disease of Modern Society (White Paper) – Guidelines for: ▪ Development of EMS systems ▪ Training of prehospital emergency medical providers ▪ Upgrading of ambulances and equipment Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved History of EMS (7 of 22) The Twentieth Century (cont ) inued – 1970: National Registry of Emergency Medical Technicians established – 1972: television show Emergency!; draws public attention to prehospital care – 1973: Emergency Medical Services Systems Act Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Figure 2-8 The television show Emergency! played a major role in bringing the world of E MS into the public spotlight. (Everett Collection) Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved History of EMS (8 of 22) The Twentieth Century (cont ) inued – 1973 Emergency medical Services System Act – Stipulated 15 components of an EMS System 1. Manpower 2. Training 3. Communications 4. Transportation 5. Emergency facilities Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved History of EMS (9 of 22) The Twentieth Century (cont ) inued – 1973 Emergency medical Services System Act – Stipulated 15 components of and EMS System 6. Critical care units 7. Public safety agencies 8. Consumer participation 9. Access to care 10.Patient transfer Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved History of EMS (10 of 22) The Twentieth Century (cont ) inued – 1973 Emergency medical Services System Act – Stipulated 15 components of and EMS System 11.Standardized record keeping 12.Public information and education 13.System review and evaluation 14.Disaster management plans 15.Mutual aid Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved History of EMS (11 of 22) The Twentieth Century (cont ) inued – 1980s: Helicopter air ambulances (HAA) developed – 1988 NHTSA: Ten System Elements 1. Regulation and policy 2. Resources management 3. Human resources and training 4. Transportation 5. Facilities Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved History of EMS (12 of 22) The Twentieth Century (cont ) inued – 1988 NHTSA: Ten System Elements 6. Communications 7. Trauma systems 8. Public information and education 9. Medical direction 10.Evaluation Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved History of EMS (13 of 22) The Twentieth Century (cont ) inued – The 1990s ▪ Trauma Care Systems and Development Act ▪ Emergency Medical Services for Children publication ▪ Trauma Care Systems and Development Act not reauthorized by Congress (funding lost) ▪ Ontario Prehospital Advanced Life Support study Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved History of EMS (14 of 22) The Twentieth Century (cont ) inued – The 1996 NHTSA published EMS Agenda for the Future (14 core attributes of EMS) 1. Integration of health services 2. EMS research 3. Legislation and regulation 4. System finance 5. Human resources 6. Medical direction 7. Education systems Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved History of EMS (15 of 22) The Twentieth Century (cont ) inued – The 1996 NHTSA published EMS Agenda for the Future (14 core attributes of EMS) 8. Public education 9. Prevention 10.Public access 11.Communication systems 12.Clinical care 13.Information systems 14.Evaluation Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved History of EMS (16 of 22) The Twentieth Century (cont ) inued – Result of September 11, 2001 (9/11): ▪ Department of Homeland Security: coordinates agencies responsible for protecting country ▪ National Incident Management System (NIMS): prepares country for terrorist attacks and other threats Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Figure 2-9 The attacks on New York City and Washington on September 11, 2001, forever changed the face of EMS and the nation. (Miguel Juarez/Reuters) Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved History of EMS (17 of 22) The Twenty-First Century – 2000: NHTSA EMS Education Agenda for the Future: A Systems Approach 1. National EMS Core Content 2. National EMS Scope of Practice Model – Revised in 2019 3. National EMS Educational Standards – Revised in 2021 4. National EMS Education Program Accreditation 5. National EMS Certification Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved History of EMS (18 of 22) The Twenty-First Century (cont ) inued – 2006: National Academies Institute of Medicine ▪ Report Card on the State of Emergency Medicine – Published “Emergency Medical Services: At the Crossroads” ▪ Evaluating the Environment of Emergency Care Systems State by State ▪ Found EMS systems overstressed to point of quality of care suffering Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved History of EMS (19 of 22) The Twenty-First Century (cont ) inued – 2006: American College of Emergency Physicians (ACEP) published study – National report card on the state of emergency medicine ▪ Determined that emergency services (Emergency Department (ED) and EMS) in the United States are overstressed to the point of quality care being compromised Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved History of EMS (20 of 22) The Twenty-First Century (cont ) inued – Helicopter Air Ambulance ▪ 300 to 900 programs after reimbursement improved ▪ Record number of accidents in 2008 ▪ National Transportation Safety Board (NTSB) hearings in 2009 recommended sweeping changes to profession Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved History of EMS (21 of 22) The Twenty-First Century (cont ) inued – EMS Compass ▪ 2014, National Highway Traffic Safety Administration (NHTSA) and National Association of State EMS Officials (NASEMSO) engaged stakeholders – Develop performance standards – 2016 released first set of performance benchmarks Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved History of EMS (22 of 22) The Twenty-First Century (cont ) inued – EMS Agenda 2050 (2018) ▪ Twenty years after original document ▪ Six core values 1. Adaptable and innovative 2. Sustainable and efficient 3. Socially equitable 4. Inherently safe and effective 5. Integrated and seamless 6. Reliable and prepared Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Today’s EMS Systems (1 of 2) Differing types of EMS configuration – Fire-based systems – Third service – Private (profit or nonprofit) – Hospital-based systems – Volunteer – Hybrid (combination of any of these) Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Today’s EMS Systems (2 of 2) American Heart Association Chain of Survival – Factors affecting survival and recovery of cardiac arrest patients 1. Activation of emergency response 2. High quality CPR 3. Defibrillation 4. Advanced resuscitation 5. Post-cardiac arrest care 6. Recovery Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Essential Components for Continuum of Care (1 of 23) Health Care System Integration – Public service access points (PSAPs) ▪ 911 call centers; interface between EMS system and communities it serves ▪ Identification of acute coronary syndrome and ST-segment elevation myocardial infarction (STEMI) ▪ Primary percutaneous coronary intervention (PPCI) Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved 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 Each level: unique role, set of skills, knowledge base Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved 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 Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved 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 – On-line and off-line medical oversight Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Figure 2-11 The EMS physician can provide on-line guidance, if needed, to E MS personnel in the field. (© Dr. Bryan E. Bledsoe) Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Essential Components for Continuum of Care (5 of 23) Public Information and Education – Recognize emergency – How to access system – Provide basic life support assistance – EMS practitioners have a role in health education with “teachable moments,” and public education Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Figure 2-13 Providing disease and injury prevention education to the public has become an important role of EMS in the twenty-first century. (© Dr. Bryan E. Bledsoe) Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Essential Components for Continuum of Care (6 of 23) Effective Communications – Heart of regional EMS system – Coordinates components into organized response to urgent medical situations – Citizen access (911) – Single control center – Operational and medical communications ability – Communication software and hardware Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Essential Components for Continuum of Care (7 of 23) Effective Communications – Emergency Medical Dispatcher ▪ Assigns and directs appropriate medical care to patients – EMS dispatch processes and procedures Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Figure 2-15 The EMS communications center is truly the heart of the modern E MS system. Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Essential Components for Continuum of Care (8 of 23) Education and Certification – Initial education: completion of a paramedic program following the most current National EMS Education Standards published by the U.S. DOT ▪ Cognitive ▪ Affective ▪ Psychomotor – All paramedic programs must be accredited ▪ By CoAEMSP (or state accreditation processes) Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Essential Components for Continuum of Care (9 of 23) Continuing Education: – Refresher courses for recertification and periodic in- service training sessions; mandatory – Continuing Education Coordinating Board for Emergency Medical Services (CECBEMS) Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Essential Components for Continuum of Care (10 of 23) Licensure, Certification, Registration, and Reciprocity – Licensure: occupational regulation – Certification: agency or association grants recognition to individual who has met its qualifications – Reciprocity: agency grants automatic certification or licensure to individual who has comparable certification or licensure from another agency Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Essential Components for Continuum of Care (11 of 23) National Registry of EMTs (NREMT) – Nonprofit entity – Prepares and administers standardized tests for EMS provider levels – Establishes qualifications for registration and biennial reregistration – Establishes national minimum standard of competency Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Essential Components for Continuum of Care (12 of 23) Professional Organizations – 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) Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Essential Components for Continuum of Care (13 of 23) Professional Journals and Magazines – 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 Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Essential Components for Continuum of Care (14 of 23) The Internet – Websites designed for EMS providers – Updated content and news – Accredited continuing education programs – International EMS discussions; networking Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Essential Components for Continuum of Care (15 of 23) Effective Patient Transportation – Air transport ▪ Fixed wing or rotor wing – Ground transport ▪ Vehicles must meet local and state requirements – Type I ambulance – Type II ambulance – Type III ambulance Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Figure 2-19 Patients may be transported by ground or air. Medical helicopter transport was introduced in the 1950s during the Vietnam War. (© Ed Effron) Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Figure 2-20 Fixed-wing aircraft, as well as helicopters, have become an important part of patient transport in the modern EMS system. (© Reach Air Medical Services) Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Figures 2-21, 2-22, 2-23 Three different styles of ambulances Type I, Type II, Type III . Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Figure 2-25 Some EMS systems have elected to use medium-duty ambulances that are built on a commercial truck chassis. (© Pat Songer) Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Figure 2-26 The diesel, unibody ambulance is becoming increasingly popular because of cost, fuel economy, and safety. (© Acadian Ambulance Services) Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Essential Components for Continuum of Care (16 of 23) Appropriate Receiving Facilities – EMS most commonly transports to an ED – EMS systems organize hospitals into categories – Specialty facilities ▪ Cardiac centers ▪ Stroke centers ▪ Trauma centers ▪ Burn centers ▪ Pediatric centers ▪ Other exist (psych, VA, etc.) Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Figure 2-27 The development of specialized trauma centers has resulted in significant improvements in trauma morbidity and mortality. (© Dr. Bryan E. Bledsoe) Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Essential Components for Continuum of Care (17 of 23) Mutual Aid and Mass-Casualty Preparation – Ensures help available when needed – Transcends geographical, political, historical boundaries – Disaster plan for catastrophes – Incident command system – Mutual-aid agreement Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Essential Components for Continuum of Care (18 of 23) Quality Assurance and Improvement – Guidelines for Quality Improvement ▪ Leadership ▪ Information and analysis ▪ Strategic quality planning ▪ Human resources development and management ▪ EMS process management ▪ EMS system results ▪ Satisfaction of patients and other stakeholders – QA versus continuous quality improvement (C QI) programs Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Essential Components for Continuum of Care (19 of 23) – Customer satisfaction: service quality – Medical errors: ▪ Skills-based failures ▪ Rules-based failures ▪ Knowledge-based failures Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Essential Components for Continuum of Care (20 of 23) High-Risk Areas of EMS Practice: – Hand-off – Communications issues – Medication issues – Airway issues – Dropping patients – Ambulance crashes – Death pronouncements Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Essential Components for Continuum of Care (21 of 23) Research – Component of EMS system for moral, educational, medical, financial, and practical reasons – Outcome studies required to justify funding and ensure future of EMS – Paramedics play valuable role in data collection, evaluation, interpretation of research Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Essential Components for Continuum of Care (22 of 23) Evidence-Based Medicine (EBM) – Conscientious, explicit, judicious use of current best scientific evidence in making decisions about care of individual patients ▪ It requires combining clinical expertise with the best available clinical evidence from systematic research – EMS personnel proficient in prehospital care; exercise sound clinical judgment Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Essential Components for Continuum of Care (23 of 23) System Financing – EMS can be: ▪ Hospital-based ▪ Fire or police department-based ▪ Municipal service ▪ Private commercial business ▪ Volunteer service ▪ Some combination of the above configurations Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Summary Evolution of EMS over thousands of years Many innovations result of lessons learned from military conflicts Dynamic changes to EMS occurring as health care in general has been evolving and realigning Technology is playing a larger role than ever in patient care Solid quality assurance programs and ongoing research will continue to chart the way Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Copyright This work is protected by United States copyright laws and is provided solely for the use of instructors in teaching their courses and assessing student learning. Dissemination or sale of any part of this work (including on the World Wide Web) will destroy the integrity of the work and is not permitted. The work and materials from it should never be made available to students except by instructors using the accompanying text in their classes. All recipients of this work are expected to abide by these restrictions and to honor the intended pedagogical purposes and the needs of other instructors who rely on these materials. Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved