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Advanced EMT A Clinical-Reasoning Approach

CHAPTER

Introduction to Advanced Emergency Medical Technician Practice

1

Advanced EMT: A Clinical-Based Approach Melissa Alexander • Richard Belle • Medical Editor: Steven Weiss

Advanced EMT Education Standard

• Applies fundamental knowledge of the EMS system, safety/well-being of the AEMT, and medical/legal and ethical issues to the provision of emergency care.


Objectives

1. Define key terms introduced in this chapter.

2. Describe the competencies, roles, responsibilities, and professional characteristics of the Advanced Emergency Medical Technician (AEMT). 16-17, 31-37

3. Describe the scope of practice of the AEMT. 5-9


Objectives

4. Place the roles and responsibilities of the AEMT in the larger contexts of emergency medical services (EMS), health care, and public health. 21-29

5. Discuss key issues in the contemporary practice of the AEMT, including professionalism, the focus on patient safety, research, and evidence-based practice. 10, 20, 30, 38


Introduction

• AEMTs are a critical part of the emergency medical services (EMS).

• They provide comfort, emergency medical care, and transportation.

• AEMTs provide a link between patients and the health care and public health systems.


EMS and EMS Providers

• EMS systems developed to provide life-saving care and emergency transportation to critically ill and injured patients.

• EMS providers engage in community health education and promotion efforts and work in a variety of settings.


The Contemporary EMS Profession

• EMS knowledge defined in documents published by NHTSA.

–National EMS Core Content

–National EMS Scope of Practice

–National EMS Education Standards


EMS and EMS Providers

Figure 1–1 AEMTs work in a variety of settings. (© Craig Jackson/In the Dark Photography)


The Contemporary EMS Profession

• EMT Oath and EMT Code of Ethics describe the professional conduct expected of EMS personnel.

• EMS providers must be aware of activities and agendas of major EMS state and national professional agencies and organizations.


Think About It

• While on a call you see a coworker photograph a patient. Later, when you ask them about it, they tell you they are going to post the photo online because it was unusual.

• What role do rules of professional conduct play in this situation?


EMS Provider Levels

• Four nationally recognized levels of EMS providers

–Emergency medical responder (EMR)

–Emergency medical technician (EMT)

–Advanced emergency medical technician (AEMT)

–Paramedic


EMS Provider Levels

• Emergency Medical Responders (EMRs)

–Trained in very basic skills.

–Use minimal equipment.

–Provide basic first-aid measures to less critically ill and injured patients.

–Can perform simple assessments to identify and manage life threats.


EMS Provider Levels

• Emergency Medical Responders (EMRs)

–Use basic airway management and ventilation skills, CPR, AED, simple methods to control bleeding.

–Trained to recognize injuries that require immobilization.

–Training completed in 48 to 60 hours.


EMS Provider Levels

• Emergency Medical Technicians (EMTs)

–Provide emergency medical care and transportation.

–Use basic equipment supplied on an ambulance.

–Play a variety of roles in EMS systems.

–Act in a first-response capacity.

–Provide immediately life-saving care.


EMS Provider Levels

• Emergency Medical Technicians (EMTs)

–May provide primary transporting EMS service in a community or work for ambulance services.

–May work with partner at same level or may work with an AEMT or paramedic partner.

–Trained to assess patients.

–Training completed in 150 to 190 hours.


EMS Provider Levels

• Advanced EMT

–Training includes all knowledge and skills of EMRs and EMTs.

–Able to provide limited number of advanced life support (ALS) interventions.

–Must practice within the Scope of Practice approved by state and EMS service physician medical director.


EMS Provider Levels

• Advanced EMT

–Must either have completed EMT training or it must be incorporated into program.

–Training requires 150 to 250 hours beyond time required to complete EMT training.


EMS Provider Levels

• Paramedics

–Allied health care professionals who provide complex assessments and interventions for critical and emergent patients.

–Complex understanding of anatomy, physiology, pathophysiology, and treatment modalities.


EMS Provider Levels

• Paramedics

–Education programs are often based in institutions of higher education.

–The Commission on Accreditation of EMS programs (CoAEMSP) accredits paramedic education programs.

–Programs range from 1000 to 1500 hours beyond—EMT level.


Think About It

• A tour bus MVC has occurred in your jurisdiction, resulting in multiple injuries and possible fatalities.

• What levels of EMS responders are likely to be on-scene?

• Responders must work together.


Advanced EMT Roles and Responsibilities

Figure 1–5 AEMT responsibilities include making sure equipment and the emergency vehicle are prepared to respond to emergency calls.



• Each state has legislation that defines the Scope of Practice of licensed EMS personnel.

• Emergency vehicle readiness and operations

–Emergency vehicle must be in good mechanical repair and driven safely.

–Vehicle must have adequate amount of required equipment and supplies.



• Safety

–Responsibility for own safety, and safety of coworkers, patients, and others.

– Important to adhere to the AEMT’s safe medication administration practices.

–Awareness of safety of public while operating emergency vehicle and safety of others at scene of emergency.



Figure 1–6 Teamwork is required to integrate the tasks of patient care and patient transportation.



• Scene leadership, management, teamwork

–Be confident and in control.

–Be empathetic to medical and emotional needs of patients and family members.

–Patient assessment, care, and transportation must be integrated into a smooth process.



• Patient assessment and management

–Ability to assess and manage patients who have variety of illnesses and injuries from minor to critical.

–Be aware of the most current trends and practices in EMS.

–Be willing to discard outdated knowledge and practice to add new ones.



• Maintaining certification or licensure

–An individual professional obligation of each health care provider, not a responsibility of employers or educational institutions.

–Requirements include documentation of mandatory continuing education activities, medical director verification of skills, submission of CPR card, payment of a fee.



Figure 1–7 AEMTs work closely with other health care and public safety providers.



• Working with other public safety and health-care personnel

–Emergency medical services are cross-disciplinary; both public safety and health care personnel.

–Strive to maintain cooperative relationships with other professionals.


Think About It

• You arrive at the emergency department with a 9-year-old drowning victim.

• What is the most important information to share in the handoff?

• What could result from an incomplete handoff?


Advanced EMT Professional Characteristics

• Professional characteristics defined by

–Expectations of public

–Professional group itself

–Other related professional groups

–Most visible way patients and families can judge—professionalism is through interactions with them



• Define each term listed below

– Integrity

–Empathy

–Self-motivation



Figure 1–8 Appearance and demeanor are critical elements of professionalism.



• Why do EMS personnel wear uniforms?

• Define the each term listed below

–Self-confident

–Self-confidence



• Who do AEMTs communicate with?

• Why is good communication required?

• What does good time management mean?



• Define each of the following terms

–Teamwork

–Diplomacy (tact)

–Respect



• Define each of the following terms

–Patient advocacy

–Careful delivery of service


Think About It

• You and your partner respond to a domestic violence call at a familiar address. You arrive shortly after law enforcement.

• How do you proceed?


Chapter Summary

• AEMTs are an essential part of EMS and of the health care and public health systems.

• AEMTs are health care professionals of whom the public has high expectations.

Advanced EMT - PFFNHpffnh.org/AEMT/Chap 1 Intro to Advanced EMT Practice.pdfAdvanced EMT: A...

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