Research, Profession and Practice

EMS SYSTEMS

Components of an EMS System

Research, Profession and Practice

Today’s EMS System

• Every EMS system must develop an EMS system that best meets its needs.

• Provincial and regional-level EMS systems are often responsible for planning, developing protocols, and establishing standards.

Research, Profession and Practice

What Constitutes an EMS System

• By accepted definition, an EMS System is:– A comprehensive network of personnel,

equipment, and resources established to deliver aid and emergency medical care to the community.

Research, Profession and Practice

OUT-OF-HOSPITAL COMPONENTS OUT-OF-HOSPITAL COMPONENTS OF AN EMS SYSTEMOF AN EMS SYSTEM

MEMBERS OF THE

COMMUNITY

COMMUNICATIONS SYSTEM

EMS PROVIDERS

PUBLIC UTILITIES

POISON CONTROL CENTERS

FIRERESCUEHAZMAT

Research, Profession and Practice

IN-HOSPITAL COMPONENTS OF IN-HOSPITAL COMPONENTS OF AN EMS SYSTEMAN EMS SYSTEM

EMERGENCYNURSES

EMERGENCY AND SPECIALTYPHYSICIANS

ANCILLARY SERVICES

REHABILITATION SERVICES

Research, Profession and Practice

Some Systems are tiered in which BLS arrives first and then, if required, ALS arrives later.

Research, Profession and Practice

Medical Direction

• A medical director is a physician who is legally

responsible for all clinical aspects of the system.

• Ontario Base Hospital Group.

Research, Profession and Practice

Medical Direction• The medical director’s role in a

system is to:– educate and train personnel– participate in equipment and personnel selection– develop clinical protocols– participate in problem resolution and QA/QI– provide direct input into patient care– interface with the EMS system– advocate within the medical community– serve as the “medical conscience” of the EMS system– Certify and License personnel to practice

Research, Profession and Practice

The Medical Director can

provide on-line guidance to

EMS personnel in the field.

This is known as

on-line medical direction.

Research, Profession and Practice

Off-line medical direction refers to medical policies, procedures, and

practices that medical direction has set up in

advance of a call, such as standard

protocols or standing orders.

Research, Profession and Practice

Protocols are the policies and

procedures for all elements of an EMS

system.

Research, Profession and Practice

Protocols are designed around the four “T’s” of emergency care.

• Triage

• Treatment

• Transport

• Transfer

Research, Profession and Practice

Patient Transportation

• Patients should be taken to the nearest facility whenever possible.

• Medical direction should designate the facility.

• Patients may be transported by ground or air.

Research, Profession and Practice

The helicopter has become an integral part of prehospital

care.

Research, Profession and Practice

Military helicopters frequently assist civilian

EMS systems.

Research, Profession and Practice

A Type-I Ambulance

Research, Profession and PracticeA Type II

Ambulance

Research, Profession and Practice

A Type III Ambulance

Research, Profession and Practice

An Emergency Response Unit

Research, Profession and Practice

Air Ambulance

Research, Profession and Practice

Not all receiving facilities are equal in emergency and support service

capabilities.

Local systems and regions categorize hospitals based on capabilities.

Research, Profession and PracticeAmerican Trauma Center

Levels• Level I – provides the highest level of

trauma care

• Level II – may not have specialty paediatrics or a neurosurgeon on site

• Level III – generally does not have immediate surgical facilities available

Research, Profession and Practice

Canadian Trauma Centre Levels

• Tertiary Trauma Centre (TTC)

• District Trauma Centre (DTC)

• Primary Trauma Centre (PTC)

Research, Profession and Practice

Mutual Aid and Mass-Casualty Preparation

• A formalized mutual aid agreementensures that help is available when needed.

• Agreements should be betweenneighbouring departments, municipalities, systems, or provinces.

• Each system should also put a disaster plan in place for catastrophes that can overwhelm available resources.

Research, Profession and Practice

KEY POINT

An EMS system should have a

disaster plan in place that is practiced

frequently.

Research, Profession and Practice

Quality Assurance and Improvement

• Quality Assurance is designed tomaintain continuous monitoring andmeasurement of the quality ofclinical care.

• Continuous Quality Improvement (CQI) is designed to refine and improve an EMS system, emphasizing customer satisfaction.

Research, Profession and Practice

An EMS system must be designed to meet the needs of the patient. Therefore,

the only acceptable quality of an EMS system is

EXCELLENCE!

Research, Profession and Practice

Customer satisfaction can be created or

destroyed with a simple word or deed.

Service Quality

Research, Profession and Practice

Public Education

• An essential and often overlooked component of EMS is the public.

• EMS systems should develop plans to educate the public on recognizing an emergency. … accessing the system. … initiating BLS procedures.

Research, Profession and Practice

CommunicationsA coordinated, flexible communications plan should include:• Citizen Access• Single Control Centre• Operation Communication Capabilities• Medical Communication Capabilities• Communications Hardware• Communications Software

Research, Profession and Practice

Education and Certification

• Two kinds of EMS education are initial and continuing education. Initial education is the original training

course for pre-hospital providers. Continuing medical education programs

include refresher courses for recertification and periodic in-service training sessions.

Research, Profession and Practice

Initial Education

• Ideally based on the PAC NOCP’s establishes the minimum competencies for

the course CMA accredits education courses http://www.paramedic.ca under ‘initiatives’ Not all programs follow NOCP guidelines

tightly

Research, Profession and Practice

Once the initial education is

completed, the paramedic will become either

certified or licensed.

Research, Profession and Practice

Certification vs. Licensure

• Certification is the process by which an agency grants recognition to an individual who has met its qualifications.

• Licensure is the process of occupational regulation.

Research, Profession and Practice

4 Certification Levels

• Emergency Medical Responder• Primary Care Paramedic• Advanced Care Paramedic• Critical Care Paramedic

Make sure you know the scope of practice and CME requirements for these

Research, Profession and Practice

The First Responder is usually the first EMS-trained provider to

arrive on the scene.

Research, Profession and Practice

The PCP is trained to do all that a first responder can do, plus

other complex skills.

Research, Profession and Practice

The ACP Should Possess All the Skills of a PCP and Be

Competent in Advanced Airway, IV Therapy, and Other Skills.

Research, Profession and Practice

The CCP is the most advanced EMS provider.

Research, Profession and Practice

Paramedic Association of

Canada• Canada’s only national organization

• ‘May’ Regulate Practice

• ‘May’ Approve Training Programs

Research, Profession and Practice

For next WeekFor next Week

National Groups and Associations