Unit 1

Introduction to Emergency Medical Services

Overview

• Introduction and mission of EMS

• History and evolution of EMS

• Network of EMS professionals

• Components of EMS system

• Future challenges

Introduction

• Emergency Medical Services (EMS)– A coordinated network of professionals – Provides a variety of emergency medical

care services

• Mission of EMS– Provide patient care prior to hospitalization– Involvement in public health– Identify and resolve public health concerns

History of Medical Services

• Military contribution to EMS− Roman Wars (1500 B.C.)

• Chariots used to transport wounded

− Napoleonic Wars (1797)• Horse-drawn ambulance volante is constructed

– U.S. Civil War (1860s)• The First Ambulance Service and American

Red Cross are created

History of Medical Services (cont’d.)

The First Ambulance Service in the United States is developed by U.S. Army Surgeon Jonathan Letterman.

A horse-drawn carriage called the ambulance volante in Napolean’s time.

History of Medical Services (cont’d.)

• Military contribution to EMS (cont’d.)− The World Wars (1910-1940)

• Air medic transport, combat medic, field hospitals, first aid stations, and mechanized ambulances arrive

− Korean and Vietnam Wars (1950-1970)• Mobile Army Surgical Hospitals (MASH) are

developed

History of Medical Services (cont’d.)

• Military contribution to EMS (cont’d.)– Iraq War (1970s–Present)

• 68W health care specialist (Army medic) introduced

• Development of specialized medical techniques to treat combat-specific injuries: special blood-stopping dressings, one-handed tourniquets, surgical procedures for extremity injuries and burns

History of Medical Services (cont’d.)

• Civilian contribution to EMS− U.S. ambulances (1865-1960)

• First civilian ambulance service in Cincinnati

• Horse-drawn carriage ambulance with interns in New York City

• Hospital staff accompany the “Invalid’s Car” in Des Moines

• First volunteer rescue squad formed in Roanoke

Figure 1.2 Modern civilian EMS

History of Medical Services (cont’d.)

• Civilian contribution to EMS (cont’d.)− Out-of-hospital medical advances (1950s)

•American Red Cross provides basic medical training to rescue squad members

•Mouth-to-mouth ventilation•Civilian cardiopulmonary resuscitation

(CPR) course•Prototypical EMT-Ambulance course

History of Medical Services (cont’d.)

• Civilian contribution to EMS (cont’d.)− Development of an EMS system (1960s)

• In 1966 a white paper was produced on “Accidental Death and Disability: The Neglected Disease of Modern Society

• The National Highway Safety Act • First coronary care units • First paramedic telemetry units • Medic One paramedic program

History of Medical Services (cont’d.)

• Civilian contribution to EMS (cont’d.)− The Star of Life & Voices of EMS (1970s)

• National Registry of EMTs (NREMT)• “Emergency!” debuts on television• Emergency Medical Services System Act • National Association of EMTs (NAEMT)

American Ambulance Association (AAA)

History of Medical Services (cont’d.)

• Civilian contribution to EMS (cont’d.)– Star of Life adopted as

national EMS symbol (1973)

• Six points: integrated components of EMS

• Central staff symbolic of medicine and healing

Star of Life, the national EMS symbol

History of Medical Services (cont’d.)

• Civilian contribution to EMS (cont’d.)– Agenda for the future – funding (1980 –

2006)• Omnibus Budget Reconciliation Act• EMS for Children (EMS-C) program• The Trauma Care Systems and Development

Act

History of Medical Services (cont’d.)

• Civilian contribution to EMS (cont’d.)– Agenda for the future – education (1980 –

2006)• National Research Council• National Highway Traffic Safety Administration• Institute of Medicine• “The EMS Agenda for the Future”

Modern EMS

• Universal access– 9-1-1 allows universal

access to emergency services

– Computer-aided dispatch (CAD) system

– PASP (Public Safety Access Point) Medical Priority Dispatching

Modern EMS (cont’d.)

• Universal access (cont’d.)– Emergency Medical

Dispatch• Emergency dispatcher

takes caller info, alerts emergency services and prioritizes calls

• Provides medical care instructions

Figure 1.4 Emergency MedicalDispatcher

Modern EMS (cont’d.)

• Universal access (cont’d.)– Emergency Medical

Responders• First responder (FR)• Emergency Medical

Responder (EMR)

Figure 1.5 Emergency MedicalResponder

Modern EMS (cont’d.)

• Universal access (cont’d.)– Emergency Medical Technician (EMT)

• Basic entry level training• Found aboard ambulance or field• Knowledge covers basics of many illnesses

and management of a patient during transport to hospital

Modern EMS (cont’d.)

• Universal access (cont’d.)– Advanced Emergency Medical Technician

(AEMT)• Intermediate level EMS provider• Skills of an AEMT are of high benefit and low

risk to the patient• Trained in specialized or advanced techniques

Modern EMS (cont’d.)

• Universal access (cont’d.)– Paramedic

• Highest level of EMS pre-hospitalization education

• 1,000 to 1,500 hours of training• Expanded training and education in the

management of the ill or injured patient• Advanced skill set

Modern EMS (cont’d.)

• Origins and practice of emergency medicine– Emergency medicine

• American College of Emergency Physicians (ACEP) formed in 1968

• Emergency medicine recognized as a specialty in medicine in 1979

Figure 1.8 The EmergencyPhysician is the leader of the EMSteam

Modern EMS (cont’d.)

• Specialty care centers– Trauma centers

• Provide expert surgical care within the first hour of traumatic injury

• Aeromedical transportation− Provides mix of pre-hospital emergency

response and interfacility transport− Composed of nurses and an Emergency

Medical Technician-Paramedic (EMT-P)

Modern EMS (cont’d.)

• The future of EMS– Aging Americans

• Baby boomer generation is aging• EMS calls to elderly patients are increasing

– Homelessness• Results in greater use of EMS system and

emergency departments

– Infectious disease• Increasing resistance to antibiotics

Modern EMS (cont’d.)

• Operational challenges– Human resources

• Decreasing membership because many EMS workers are volunteers

– Financial restrictions• Cost of equipment, training, and insurance• Many EMS organizations are under-funded

Conclusion

• Rich past of EMS has many examples of heroism and leadership

• Future of EMS depends on attention to trends in emergency medicine and the challenges they may present

• Research-based practices should be used to refine daily practices to provide the best quality of care