001. Emergency Medical Services

History

Started in the 1960-1970s. Prior to this, about 1/2 of ambulances were from funeral directors (hearses).

EMS Systems Act of 1973: 15 key elements: Manpower, Training, Communications, Transportation, Facilities, Critical-care units, Public safety agencies, consumer participation, access to care, patient transfer, coordinated patient record keeping, public information and education, review and evaluation, disaster plan, mutual aid.

EMS personnel have 4 categories:

First responders: typically police/firefighters or first aid teams. Can do: CPR, spinal immobilization, hemorrhage control.

EMT-B: Basic. Add in oxygen administration, use of AED (though most laypeople can do AEDs now), extrication, transportation.

EMT-I: Intermediate. IV insertion, basic ECG interpretation, cardiac medication administration.

EMT-P: Paramedic. Highest skill level. Function under physician’s medical license.

Most EMT’s have standing orders and patient care protocols (nitro for any (ANY) chest pain) developed by physicians.

BLS: carry equipment for basically EMT-B, includes oxygen, BVM, immobilization, splinting devices, dressing and hemorrhage control devices. Usually do not carry medications and cannot transport patients requiring IV or cardiac monitor.

ALS: equipped for EMT-Ps, have IV supplies, IV medication, intubation devices, cardiac monitoring and defibrillation.

EMTALA: US Emergency Medical Treatment and Active Labor Act – 1986. Rules for hospitals participating in the US federally financed Medicare program (health care for adults > 65 or <65 with certain chronic illnesses). All patients must have medical screening exam, must be stabilized before transport, explicit acceptance of transfer by receiving hospital.

Utstein template: developed in the 1990s, systematic and standardized format for reporting cardiac arrest data with definitions, time intervals, and descriptors of EMS systems. Helps with EMS/cardiac arrest research data.

Resources

Tintinalli, Seventh Edition, Chapter 1: Emergency Medical Services

 

001. Emergency Medical Services