EMS Systems The Realm And a certain Samaritan... going up to him bound up his wounds, pouring in oil and wine; and setting him upon his own beast, brought him to an inn and took care of him." Luke 10:33-34
A System Contains several areas of function! Maybe a complete realm? Where do you fit? Is there an unimportant position? Are you just a first responder? Where to begin young Jedi?
Who are we Medical Fire Ambulance/EMS Rescue First Responder Public Works Utilities Local Government Others as needed
Emergency Medical System Medical Direction Emergency Medical Service Anyone working under the authority of Record keeping Training Legal Hospital Emergency Department & physicians Others
Where do we fit in Medical First Responders Medical direction Local authority EMS
Requirements Level and Scope of training Set by state standards and local medical direction Annual training Renewal of licensure every two years
EMS operations Team effort
Safety and preparation SOP s s and SOG s Personal safety PPE Scene safety Personal training Equipment and supplies Vehicles ready
Incident operations Dispatch and location of incident Proper communications Appropriate response Only necessary resources Safe response On scene Size up and organization Managing patients and resources
Dispatch How are you notified Knowledge of how communications works Proper communication skills Common terminology Effective use of communication system How many others will be using the system Location of incident
Scene operations Size-up What do I have and what do I need to handle it Call for additional resources early Early organization If you don t t control scene it will control you NIMS/ICS Command center if necessary How are resources deployed Assign groups, keep groups intact Scene priorities Life safety Property conversation Life safety Rescuers Bystanders Patients Hazards Existing and potential
Scene size-up Notable hazards Existing and potential Personal protection Level of protection to level of threat Blood borne Infectious diseases Number of patients One critical = one EMS unit Additional resources
Rescue Responsibilities What do you do? Removing patients Homes Vehicular Fires Confined spaces Collapses Others
How to we get them out? Training and experience Get help
Specialized rescue What type of training is needed? Where to get the help
Vehicle crashes Common incident Can be challenging Knowledge for rescuing Access to patients Positions of vehicle Types of collisions Stabilization Extrication and safety zones Scene organization
Hazards Adverse conditions Weather: rains/floods, freezing, hot, storms Electrical Atmosphere: toxic, low O2, hot Haz Mat Violence Collapse Explosive Traffic Fire
Hazardous materials Motor freight, common carrier, rail, facilities Indentify product DOT/ERG Chemtrec Shipping company Shipping papers Placards and labels Product characteristics PPE Training Scene organization Containment Hot zone Warm zone Cold zone Patients needs Decon Patient transportation
Aero medical Need for helicopter Critical patients Golden hour Scene operations LZ night and day LZ description Security Communication In serious cases rapid air transportation may be necessary. Emergency personnel on scene have the authority to call for air medical transport. Keeping in mind the Golden Hour, time of injury to time of definitive treatment at a trauma center and the need for the most efficient means of transport available. Scene prep is important for safety and ground operations. Day time area is a minimum 100 x100, night 125 x125. Watch for overhead obstacles, weather and wind direction. Secure the scene letting no one enter who is not directly involved with handling the patient. Communication to the aircraft should be done by only once designated person on a common radio frequency. Directions to the landing zone and conditions should be given and the site prepared by clearing for all debris that can be moved by the rotor down wash.
Mass casualty How many patients What is needed Triage Staging area Who goes first Types of systems When the amount of patients exceeds the normal operating capacity of the local EMS a mass casualty incident should be called according to local standards. Early on it must be determined how much resources must be called to treat and transport patients. Patients are arranged, or sorted, according to the seriousness of the injury or condition, Triage, and transported in order accounting for who is being sent out and to where. A staging area assembles resources not immediately needed but quickly accessible. Several triage systems are available, use what is according to local protocol. Remember, triage is an ongoing process just as assessment, as patient needs change according to a reassessment the priority of transport will also change.
EMS Operations Local service Medical director Protocols Guidelines Documentation NIMS/ICS A system of operating is necessary for efficient and safe operating. The local ambulance service and its medical director are responsible for establishing the standards of patient care for the local responders, These can be available through protocols and guide lines from the local service. Reporting is just as important and any other part of the system. It provides accountability of the patients condition, use of equipment, personnel activities, and statistical information. Organization during incidents at different locations, command post, as well on the operations scene should be done through an organized incident command system.
Local EMS report Example of a typical patient care report for medical responders. It identifies the patient, what the chief complaint is, vital signs, condition at time of examination, what was done for the patient, and progressive condition. These reports become part of the patient care record and are sent to the local service for filing. These reports are confidential and must be keep in a protected place accessible only to the patient or personnel directly responsible for patient care on request with proper authorization.
Communications Type used by your organization Familiar with its use Effective Terminology Interactive with other departments/agencies Specialized use
Types of Communication Face to face Telephone/Cell Radio Signals Codes Communication is essential for all incidents large or small and it must be properly used and applied. Several types are listed here. Radio usage is the most common at incidents where distant is involved. However it is the most commonly misused. Over use by high volumes of lengthy traffic, unfamiliarity of how the system works, unfamiliar controls, different frequencies among responding agencies, and use of slang or unfamiliar codes. Open plan English is the most preferred form of speech, everyone must know and understand what is said and intended. When a request or command is given it should be repeated back to the one issuing the command.
NIMS/ICS Someone must take charge What does it means to be in charge How to you use it to manage the incident Expandable tool for any incident Common terminology Everyone knows who to work under Maintains accountability and span of control
ICS/NIMS Must have system for managing an incident Can be used for all incidents Grows in size with incident Who is in charge System for managing incidents Maintains accountability Common terminology Communication skills
What does it take to make it work Time Getting it there when it means the most Safety Teamwork Competency Knowledge
Continuing Education When will it ever stop? As long as you do this it won t! Changes Experiences Methods Requirements Renewals
Remember we are all part of a system intended to deliver emergency care to the community that includes all public safety personnel and organizations; the EMS or Emergency Medical System. Each organization has its own responsibility and method of operating. EMS, or Emergency Medical Service, ambulance service is primarily responsible for rendering medical care to patients on the scene and in transport to a hospital. Included in this are medical first responders, formerly first responders. They are part of the local ambulance service, respond to and care for patients under its authority. Standards of local care and protocols are set, determined, and authorized by the EMS medical director. All medical responders work under theses license. All aspects of the system work toward its implementation, operating, reporting, safety, and medical care.