1. ems & disaster response
TRANSCRIPT
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Paleerat Jariyakanjana, MD
Faculty of Medicine
Naresuan University
Emergency Medical Services & Disaster ResponseEmergency Medical Services & Disaster Response
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EMERGENCY MEDICAL SERVICES
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EMS is the extension of emergency medical care into the prehospital setting.
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History
ช่�วงเวลาที่ 1 สภาอุ�ณาโลมแดงแห่�งช่าติ�สยาม ม�ลนิ�ธิ�ป่�อุเติ�กติ� ง & ม�ลนิ�ธิ�ร่�วมกติ"ญญู�
ช่�วงเวลาที่ 2 ติ%าร่วจจร่าจร่ช่�วยเห่ล'อุผู้�)ป่�วยฉุ�กเฉุ�นิ ศู�นิย,ก�)ช่พนิเร่นิที่ร่
ช่�วงเวลาที่ 3 พ"ฒนิาร่ะบบบร่�การ่การ่แพที่ย,ฉุ�กเฉุ�นิ ให่)ลงไป่ส��ร่ะด"บ
ช่�มช่นิ และมความคร่อุบคล�มพ'4นิที่ที่" วป่ร่ะเที่ศู Tsunami
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Key elements
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Manpower
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Training
initial provider trainingcontinuing education
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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
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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
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BLS ambulances
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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
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ALS ambulances
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Transportation
http://www.manafeth.com/index.php/en/products/view/Ambulance-Type-I#
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Air transport
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Facilities and Critical-Care Units
closest appropriate hospital or to the hospital of the patient's choice
divert patients to other hospitals ED overcrowding
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Public Safety Agencies
strong ties with police and fire departments
1. providing scene security
2. provide first responder services
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Consumer Participation
encourage representation of the general public on the membership of regional EMS councils
public can participate by volunteering for local EMS agencies
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Access to Care
no barriers or disincentives preventing timely access to the system
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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
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Coordinated Patient Record Keeping
Standardization of EMS medical records
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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
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Review and Evaluation
radio communications, response times, scene times, and patient care records
Outcome: cardiac arrest, stroke, and traumaEMS research
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Disaster Plan
written policies and proceduresstockpiling suppliesparticipating in regional disaster drills with
other emergency response agencies and hospitals
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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
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Phases of EMS response
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DISASTER RESPONSE
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Definition
Major Incidents: any incident where the number, severity, type or location of live casualties requires extraordinary resources
Disaster: need > resourceMass casualty incident: Healthcare need >
resource
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Disaster Management Cycle
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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
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Management and Support Principles
CommandSafetyCommunicationAssessmentTriageTreatmentTransport
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Command
CSCATTT
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Safety
The 1-2-3 of Safety
1. Staff
2. Situation
3. Survivors
CSCATTT
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Communication
CSCATTT
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Assessment
My call sign/Major incident declaredExact location: Grid ref.Type of incidentHazards: Present/PotentialAccess: Roads, Landing areaNumber of casualties: Type, SeverityEmergency services: Present and Required
CSCATTT
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Triage
CSCATTT
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Triage sieve
CSCATTT
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Triage sort
CSCATTT
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Triage sort
CSCATTT
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Treatment
Aim: “do the most for the most”
CSCATTT
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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 injuryInjury found or suspectedSigns (vital signs)Treatment given
CSCATTT
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Take home message
EMS is the extension of emergency medical care into the prehospital setting.
Disaster response: CSCATTT
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Reference
Tintinalli's Emergency Medicine, 7th editionhttp://www.emsworld.com/article/10319356/th
e-star-of-lifehttps://sites.google.com/site/dimersarred/disa
ster-management-cyclehttps://sites.google.com/site/sarbook1/excerp
t-incident-command
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ANY QUESTIONS?