Documente Academic
Documente Profesional
Documente Cultură
CHAPTER 1 Introduction to Emergency Medical Care KEY TERMS Direct medical direction:
Medical direction in which physician speaks directly with EMTs in the field; also referred to as online medical direction.
2 3
EMT-Basic:
A basic prehospital life support provider trained to the NHTSA guidelines for EMT-Basic.
EMT-Intermediate:
An EMT with additional education in one or more advanced techniques such as vascular access and intubation.
EMT-Paramedic:
An EMT with additional education to the level of full advanced life support.
First Responder:
An individual employed in a position that includes providing initial medical assistance in an emergency.
Page 1 of 22
Mosby's EMT-Basic Textbook - Revised Reprint, 2nd Edition Indirect medical direction:
Any direction provided by physicians that is not direct, including system design, protocol development, education, and quality improvement; also referred to as offline medical direction.
Medical direction:
The process (usually by a physician) of ensuring that the care EMTs provide is medically appropriate; also called medical oversight.
Quality improvement:
A system for continually evaluating and improving the care provided within an EMS system.
Page 2 of 22
Page 3 of 22
3 4
IN THE FIELD
Marco and Brittany had just completed the morning truck check. As they were sitting down to a glass of orange juice and the review of the outgoing shifts calls, the EMS supervisor, Walt, arrived at their station. Along with him was Juan, a local high-school student. Juan was interested in taking an EMT-Basic course and working as an EMS provider. Marco explained the training requirements. He told Juan that it was challenging, but rewarding. He told him without the knowledge and skills he learned in the EMT course, he could not function as well as he did in this environment. Brittany talked about the personal satisfaction she gained from helping others. She described the camaraderie of her co-workers and displayed her pride in the profession. She encouraged Juan to enroll in the course and offered him the opportunity to complete ride-along shifts with her and Marco while he attended class. As Walt and Juan left the station, Marco and Brittany returned to their chart review, confident that they had helped guide Juan's career and proud of their service and the EMS system. Welcome to the rewarding and exciting field of Emergency Medical Services! This chapter marks the beginning of your educational process for becoming an Emergency Medical Technician (EMT). EMTBasics who care for ill or injured patients before they reach the hospital require a solid foundationa road map for
Page 4 of 22
Page 5 of 22
Mosby's EMT-Basic Textbook - Revised Reprint, 2nd Edition Fig. 1-1 The EMS system encompasses emergency recognition, system access, EMS personnel dispatch and response, care provided to the patient as the scene, medical direction when necessary, and patient stabilization, transportation, and delivery to the hospital.
4 5
Page 6 of 22
These aspects of the system are described below to help you better understand the overall system in which you will be working as an EMTBasic. Regulation and policy standards ensure that all states have a lead EMS agency, funding, regulations, and operational policies and procedures. State legislatures must pass laws that promote quality EMS care and provide adequate funding. States finance their EMS systems in various ways, but all need to have funds to provide high-quality, effective EMS care. As you train for your profession and begin working as an EMT Basic, you will become familiar with state and local rules and regulations, policies, and procedures.
5 6
Fig. 1-2 The National Highway Traffic Safety Administration's 10 standards for EMS systems.
Page 7 of 22
Page 8 of 22
Mosby's EMT-Basic Textbook - Revised Reprint, 2nd Edition Fig. 1-3 In many areas of the United States, 911 is the universal number for access to police, fire, and EMS.
Regardless of the phone number used, EMTs should educate the public on proper access to the system. Public information campaigns, such as Make the Right Call, teach the public the proper local access number and when to call for an ambulance. EMTs at all levels should be active in these and other public service campaigns.
LEVELS OF EDUCATION
The National EMS Education and Practice Blueprint sets the standards for the education of prehospital emergency care providers. As mentioned earlier, the four established levels are: First Responder EMTBasic EMTIntermediate
Page 9 of 22
Page 10 of 22
Some patients require the attention of a specialty care center. EMTs transport these patients to centers such as trauma facilities, burn centers, pediatric or children's hospitals. Additionally, with the advances in healthcare, many areas now have access to chest pain and stroke centers. These specialty centers vary in different regions. Knowledge of the specialty centers in your area is important, including the local protocol for transporting patients to one of these facilities. Your service area may have additional specialty centers.
Fig. 1-4 EMTs often interact with other public safety workers, including law enforcement officials.
Page 11 of 22
Mosby's EMT-Basic Textbook - Revised Reprint, 2nd Edition REVIEW QUESTIONS THE EMERGENCY MEDICAL SERVICES SYSTEM
1. What federal agency has developed standards for training and development of the EMS system? a. The National Highway Traffic Safety Administration b. The Department of Homeland Security c. The Department of Public Health d. The National Institutes of Health 2. Currently, the National EMS Education and Practice Blueprint and the National Registry of EMTs recognize how many levels of EMS providers? 3. List the levels of recognition/certification.
Page 12 of 22
Fig. 1-5 EMTs assess patients to determine the need for care.
Page 13 of 22
Mosby's EMT-Basic Textbook - Revised Reprint, 2nd Edition Transport and Transfer of Care
When en route to the receiving facility, or when awaiting a transport unit, EMTs continue to provide care based on ongoing patient assessment. An orderly transfer of patient care should be maintained, whether transporting to the receiving facility or another unit. This involves medical/legal issues such as preserving patient confidentiality and preventing abandonment (see Chapter 3). Chapter 15 and Chapter 16 describe important issues involved in the transfer of care and information such as record keeping and data collection. Both are important roles of EMTBasics (Fig. 1-6).
Patient Advocacy
Another role of EMTs is that of the patient advocate. You must support the patient's legal rights, privacy, and human dignity as an individual. Chapter 3 describes the patient's legal rights. All patients should be treated with respect and dignity, regardless of their social and economic backgrounds. Always treat patients as you wish to be treated yourself.
PROFESSIONAL ATTRIBUTES Fig. 1-6 One of the many responsibilities of EMTs is record keeping and data collection.
Page 14 of 22
Fig. 1-7 Continuing education provides opportunities for EMTs to expand their knowledge and practice skills that are not often used.
Page 15 of 22
10 11
Page 16 of 22
MEDICAL DIRECTION
Medical direction, sometimes called medical control, is the process by which physicians monitor the care given by EMTBasics to ill or injured patients. In the past, some states required medical direction only at an advanced level and not for EMTBasics. The nationwide curriculum change in 1994 recommended that physicians be involved in all levels of prehospital care. Additionally, several skills performed by the EMT-Basic require medical direction authorization. These skills can be monitored through the two components of medical direction called direct medical direction and indirect medical direction. Direct medical direction, also referred to as online medical control, means direct communication between the physician and the provider in the field (Fig. 1-8). This communication may occur via a cellular telephone, radio, or telephone (land-line). In some cases, the physician may be present at the scene of the illness or injury, allowing prehospital providers to speak directly with the physician. The role of a physician at the emergency scene may vary. Local protocol dictates the proper procedure for following the orders and advice of a physician at the emergency scene. Indirect medical direction, or offline medical control, consists of other ways physicians influence care, such as EMS system design, developing protocols and standing orders, providing initial and continuing
Page 17 of 22
Fig. 1-8 A, Direct medical direction allows the EMT on the scene to consult with physicians or other medical staff at the medical treatment facility (B) by radio or telephone to determine proper care for the patient.
Page 18 of 22
Fig. 1-9 Indirect medical direction, such as routine physician review of prehospital care reports, contributes to quality improvement and influences care to all patients.
EMTBasics have a responsibility to interact with the medical director in a professional manner and to abide by his or her decisions. The medical director is a resource for problem solving before, during, and after patient interactions. Try to become acquainted with your EMS system of medical direction. A strong working relationship with the medical director will enhance the quality and appropriateness of the medical care you provide.
Page 19 of 22
Mosby's EMT-Basic Textbook - Revised Reprint, 2nd Edition REVIEW QUESTIONS QUALITY CARE
1. Indicate whether the following activities are direct or indirect medical direction. a. The medical director meets with a crew to perform case reviews. b. The medical director rewrites the Chest Pain Protocol. c. The medical director advises the EMTBasic over the radio to administer sublingual nitroglycerin. d. The medical director advises the EMTBasic to complete a trauma education program. e. The medical director orders the patient to be transported to a burn center. 2. Quality improvement is best described as? a. Sorting out the bad apples b. System audits c. A continuous cycle of evaluation d. Improving the patient care delivery system
12 13
Page 20 of 22
Mosby's EMT-Basic Textbook - Revised Reprint, 2nd Edition THE EMERGENCY MEDICAL TECHNICIANBASIC
The EMTBasic has many roles and responsibilities, including personal safety; the safety of crew, patient, and bystanders; patient assessment; patient care based on assessment findings; lifting and moving patients safely; transportation of patients and transfer of care; record keeping and data collection; and patient advocacy. The individual ambulance service provides the EMTBasic with a job description outlining specific roles and responsibilities. The EMTBasic is a healthcare professional with certain professional attributes: attending continuing education programs; projecting a professional appearance; maintaining knowledge and skills at a competent level; participating in issues that affect EMS on a local, state, and national level; and serving as a patient advocate.
QUALITY CARE
Quality improvement and medical direction go hand in hand. They are important aspects of quality prehospital care. Quality improvement includes comprehensive planning, reviews of patient care delivery, and development of methods to improve the delivery system. Medical direction establishes that all care given to a patient is medically appropriate. Direct medical direction involves direct contact between the physician and providers in the field. Indirect medical direction includes other activities such as system planning, protocol development, education, and quality management.
13 14
United Statis Department of Transportation National Highway Traffic Safety Administration EMT-Basic Objectives
Check your knowledge. The National Registry of EMTs and many state EMS agencies use the objectives below to develop EMT-Basic certification examinations. Can you meet them?
Cognitive
1. Define Emergency Medical Services (EMS) systems. 2. Differentiate the roles and responsibilities of the EMT-Basic from other prehospital care providers. 3. Describe the roles and responsibilities related to personal safety. 4. Discuss the roles and responsibilities of the EMT-Basic for the safety of the crew, the patient, and bystanders. 5. Define quality improvement and discuss the EMT-Basic's role in the process. 6. Define medical direction and discuss the EMT-Basic's role in the process.
Page 21 of 22
Affective
1. Assess areas of personal attitude and conduct of the EMT-Basic. 2. Characterize the various methods used to access the EMS system in your community.
Psychomotor
No psychomotor objectives identified.
14 15
QUALITY CARE
1. a. indirect b. indirect c. direct d. indirect e. direct 2. c
Page 22 of 22