emt/emr introduction to ems & research powerpoint training module
TRANSCRIPT
Brave Training SolutionsCopyright 2017
www.bravetraining.comEMT-1 V2
INTRODUCTION TOEMERGENCY MEDICAL CARE
&RESERACH IN EMS
OBJECTIVES
Define the EMS systemDifferentiate the roles & responsibilities of
the EMT vs. other EMS providersDiscuss the roles & responsibilities of the
EMT towards the safety of the crew, patient & bystanders
Define quality improvement & discuss the EMT’s role in the process
OBJECTIVES
State the specific statues & regulations in your state EMS system
Assess areas of personal attitude & conduct the EMTCharacterize various methods used to access the EMS system
VISION OF EMSAs written in the EMS AGENDA OF THE FUTUREEmergency Medical Services (EMS) of the future will be community-based health management that is fully integrated with the overall healthcare system. It will have the ability to identify & modify illness & injury risks, provide acute illness & injury care follow-up, & contribute to treatment of chronic conditions & community health monitoring. This new entity will be developed from the redistribution of existing health care resources & will be integrated with other healthcare providers, public health, & public safety agencies. I will improve community health & result in more appropriate use of acute health care resources. EMS will remain the public’s emergency medical safety net.
EMS AGENDA OF THE FUTURE
14 ComponentsIntegration of health services EMS researchLegislation & regulation System financeHuman resources Clinical careEducation systems Public educationPreventionPublic accessMedical direction EvaluationInformation systemsCommunication systems
THREE EMS SYSTEMS
Hospital BasedFire BasedThird Party Service
CommercialNon-Profit
Service may be different but based upon community needs & resourcesGoals are the same
NATIONAL HIGHWAY TRAFFIC SAFETY ADMINISTRATION
(NHTSA)
Lead coordinating agency for EMSSets national standards for training
ACCESS TO EMS
Calls normally come from Public Safety Access Point (PSAP, 911)
911 Service is universally available in over 95% of United States (Some other countries
have similar services)All 911 phone calls to local PSAP’s are toll free
(including Cell Phones)
EDUCATIONAL STANDARDS
NHTSA has developed a “National Scope of Practice”
Includes Description of the profession5 Pre-hospital personal levels
National EMS Educational Standards
AUTHORTIY TO PRACTICE
State EMS officeDetermines scope of practiceLicenses personal & EMS services
MEDICAL OVERSIGHT
Protocols- to allow EMT’s to practice Quality improvement- Future scope of practice
standardsAdministration- Maintaining the EMS System
LOCAL CREDENTIALING
Many areas require proof of proficiencyUsually administered by “Medical Control
Authorities” (MCA)Has a Physician Medical Director (PMD)May have an administrator
EMPLOYER POLICIES & PROCEDURES
Requirements forUniformsStaffing levelsGroomingEquipment repairMandated operational standards
ROLES, RESPONSIBILITIES,& PROFESSIONALISM
Inspecting & maintaining equipment to operational standardsSafety
PersonalPatientOthers on Scene
ROLES, RESPONSIBILITIES,& PROFESSIONALISM
Provide scene evaluation & summon additional resources as needed
Gain access to patientPerform patient assessmentAdminister EMS care while awaiting arrival of
additional resources (Ambulance, Fire, Law)
ROLES, RESPONSIBILITIES,& PROFESSIONALISM
Provide emotional supportPatientFamilyOther responders
ROLES, RESPONSIBILITIES,& PROFESSIONALISM
Maintain “Continuity of Care”The EMT is a step in the ladder
Maintain medical & legal standards & assure patient privacy
Maintain community relations
PROFESSIONALISM
Characteristics of professional behaviorMaintenance of certification & licensure
PROFESSIONALISM
Characteristics of professional behaviorIntegrityEmpathySelf-motivationAppearance & hygieneSelf-confidenceKnowledge of limitations
PROFESSIONALISM
Characteristics of professional behaviorTime management CommunicationsTeamworkRespectTactPatient advocacyCareful delivery of care
MAINTAIN CERTIFICATION(Licensure)
Personal responsibilityContinuing educationSkill competencyCriminal implicationsFees
QUALITY IMPROVEMENT
Dynamic system for continually evaluating & improving care
Patient safetySignificant – one of the most urgent health
care challengesHow errors happen
Skills-based failureRules-based failureKnowledge-based failure
HOW TO REDUCE ERRORS
Debrief callsConstantly question assumptionsUse decision aidsAsk for help
HISTORY OF EMS
EMS was developed during the war times in the 19th & 20th
centuriesIn the early 1960’s technology & training
EMS lagged behind developments in other areas of medicine
Emergency department staffing was often limited & only in large urban areas
KOREAN WAR
Medical helicopters were introduced causing a decreased rates in battlefield injuries
1950’s -1960’s
Ambulance service emerged from primarily run by funeral homes to fire departments & ambulance services
HISTORY OF EMS
1966 National Highway Safety ActCharged the US DOT to create training
standards to assist states in upgrading EMS systems1970
National Registry of EMT’s (NREMT) was created to establish
professional standards
HISTORY OF EMS
Research paper “Accidental Death & Disability: The Neglected Disease of Modern Society” was released in 1966It called for
Development of trainingDevelopment of federal guidelines & policies Providing for emergency care & transportEstablish staffed emergency departments
HISTORY OF EMS
1960 CPR developed
1960’s Portable defibrillators introduced
1966Landmark paper “Accidental Death &
Disability: The Neglected Disease of Modern Society” published
HISTORY OF EMS
1972Television show “Emergency”
1973Congress passed the “National Emergency
Medical Services Act” to lead the improvement of EMS Systems in the US
NATIONAL HIGHWAY TRAFFIC SAFETY ADMINISTRATION (NHTSA)
Administers the EMS technical assessment programs based upon 10 components of EMS with standards for EMS
NHTSA10 KEY COMPONENTS
Regulation & policy FacilitiesResource managementCommunicationsHuman resources & training TransportationMedical direction Trauma systemsEvaluationPublic information & education
EVOLUTION OF CURRENT EMS SYSTEMS
From this the current EMS systems were created using Emergency Medical Technician’s & other parts of the system
NHTSA TECHNICAL ASSISTANCE PROGRAMS
Regulation & policyResource managementHuman resources & trainingTransportationFacilities
ACCESS TO EMS
Improvements to 911 (PSAP) dispatch
COMMUNICATIONS SYSTEM
Central 911 dispatch systemEnhanced 911Dispatchers trained in Emergency Medical
Dispatch (EMD)Ambulance to hospital communications
RadioCell phoneLandline
EDUCATION
Created 6 levels of EMS careLay rescuerEMR-Emergency Medical ResponderEMT-Emergency Medical TechnicianAEMT- Advanced Emergency Medical
TechnicianParamedicParamedic Practitioner
LAY RESCUER
Carries little or no equipmentAble to recognize life-threatening injuriesProvides care till EMS arrives
CPR-AEDRelief of airway obstructionBleeding control
EMERGENCY MEDICAL RESPONDER
Equipped with Oxygen Epi-
PenAED
NaloxoneAirway equipment
Provides care till ambulance arrivesPrimarily seen in Fire Departments but can be
seen in business, industry, & schools
EMT-BASIC
Provides basic, non-invasive skillsPatient assessmentAirway adjunctsAEDChildbirthSpinal immobilizationAssists with patient’s medication administrationCan transport patient
EMT-BASIC
Record keepingPatient advocacyCommunicationsExtricationVehicle & equipment maintenance
EMT-INTERMEDIATE
Can provide all functions of EMTProvides more advanced skills
Advanced airwayECG ‘sIV FluidsAdministration of many medications
PARAMEDIC
Provides all functions of EMT & EMT-IProvides advanced techniques including
ECG interpretationDrug therapyInvasive airwaysManual defibrillation
PARAMEDIC PR ACTIONER
Works with patients in the home setting to reduce ER admissionsCan redirect patient to another facilityAssists paramedics on scene with difficult cases
AUTHORIZATION TO PRACTICE
Legislative decisions on scope of practiceState EMS office oversightMedical oversight
Clinical protocolsOfflineOnlineStanding ordersQuality improvementAdministrative
AUTHORIZATION TO PRACTICE
Local credentialingAdministrativeEmployer policies & procedures
ROLES, RESPONSIBILITIES, & PROFESSIONALISM OF EMS PERSONAL
We will reviewRoles & responsibilitiesProfessionalism
ROLES & RESPONSIBILITIES
Maintain vehicle & equipment readinessSafetyPersonalPatientOthers on the scene
Operate emergency vehiclesProvide scene leadershipPerform patient assessment
ROLES & RESPONSIBILITIES
Administer emergency medical care to a variety of patients with varied medical conditions
Provide emotional supportPatientPatient’s familyOther responders
ROLES & RESPONSIBILITIES
Integration with other professionals & continuity of care
Medical personnelLaw enforcementEmergency managementHome healthcare providersOther responders
ROLES & RESPONSIBILITIES
Resolve emergency incidentMaintain medical & legal standardsProvide administrative supportEnhance professional developmentDevelop & maintain community relations
CHARACTERISTICS OF PROFESSIONAL BEHAVIOR
IntegrityEmpathySelf-motivationAppearance & hygieneSelf-confidenceTime management
CHARACTERISTICS OF PROFESSIONAL BEHAVIOR
CommunicationVerbalWritten
Teamwork & diplomacyRespect for patients, co-workers & other healthcare professionalsPatient advocacyCareful delivery of service
LIAISON WITH OTHER PROFESSIONALS
Conflicts may occur when responsibilities overlap with other professionals
Police take charge at crime scenesFire takes charge fire & HAZMAT ScenesEMS provides for patient care & transportOther medical professionals care for patient at a
fixed facility (hospital, nursing home, clinic, patient’s home)
Cooperation is essentialIncident Command System needs to be practiced
MAINTENANCE OF CERTIFICATION & LICENSURE
Personal responsibilityContinuing educationSkill competency verificationCriminal implicationsFees
QUALITY IMPROVEMENT
System for continually evaluating & improving care
Continuous Quality Improvement (CQI)Dynamic process
EMT’s ROLE
DocumentationRun review & auditsFeedback from patients & hospital staffMaintaining equipmentContinuing educationSkills maintenance
PATIENT SAFETY
Significant – One of the most urgent health care challenges
High-risk activitiesHand-offCommunication issuesDropping patientsAmbulance crashesSpinal immobilization
PATIENT SAFETY
How Errors HappenSkills-based failureRules-based failureKnowledge-based failure
PREVENTING ERRORS
EnvironmentalClear protocolsLightMinimal interruptionsOrganization & packaging of drugs
PREVENTING ERRORS
IndividualReflection in actionConstantly question assumptionsReflection biasUse decision aidsAsk for help
REASERCH IN EMS
Impact of research on EMS CareResearch findings are important to identify what
should be changed in EMSAssessment & management and to improve
patient care & outcome (i.e. CPR guidelines change based on current research )
Quality assurance research for an EMS system can improve service deliveryData collection
EVIDENCE BASED DECISION MAKING
Traditional medical practice Is based onMedical knowledgeIntuitionJudgment
High-quality patient care should focus on procedures proven useful in improving patient outcomesThe challenge for EMS is the relative lack of pre-hospital research
EVIDENCE BASED DECISION MAKING
Evidence-based decision-making techniqueFormulate a question about appropriate
treatments Search medical literature for related research Appraise evidence for validity & reliabilityIf evidence supports a change in practice,
adopt the new therapy allowing for unique patient needs
PAPERWORK
LocalSchoolMunicipal
StateVaries from state to state
Federal Can be sent via commercial software
COURSE DESCRIPTION
This course meets the requirements of NHTSA EMS Training
NREMT State Local facility
COURSE EXPECTATIONS
Upon successful completion of this training program the student may be take the NREMT exams A practical & computer based exam will need to be passed to state certification (licensure)Student will be required to complete all sections of this training program & pass all exams to be recommended to take the NREMT exam
PHYSICAL EXAM
EXAMStudent must pass physical exam as
specified by this institutionIMMUNIZATIONS
Influenza (Flu)Hep BMMRTDaP
CRIMINAL BACKGROUND CHECK
Most states require medical personnel to have a criminal background check prior to
certification (licensure)Requirements vary by stateSome clinical sites require students to have a
clear record
CRITERIA FOR CERTIFICATION
Successful course completionBe physically & mentally able to met the
safe & effective practices of the EMT-BWritten & practical examsState & local requirements
AMERICANS WITHDISABILITIES ACT
Federal, state, & local requirements will be meet
HARASSMENT
Class policy on harassment
PROGRAM POLICIES
Uniforms (grooming) ConfidentialityDrugs (alcohol) WeaponsAttendance SmokingSafetyGradesDismissal from the program
INCIDENT MANAGEMENT SYSTEM HOME WORK
Complete FEMA independent Study CoursesICS-100-b Introduction to Incident
Command SystemICS-700.a National Incident Management
System (NIMS) An IntroductionTurn copies of Online Certificates of Completion
to instructorhttp://www.training.fema.gov/is/crslist.aspx
?? QUESTIONS ??
NEXT ASSIGNMENT
THE END