Introduction to Introduction to Emergency Medical CareEmergency Medical Care

History of EMSHistory of EMS

Developed during warfare in the 20Developed during warfare in the 20thth centurycentury

By 1960, domestic emergency care lagged By 1960, domestic emergency care lagged behindbehind

Staffed emergency departments were Staffed emergency departments were often linked to large urban areasoften linked to large urban areas

Funeral homes provided most emergency Funeral homes provided most emergency transport with no trainingtransport with no training

History of EMSHistory of EMS

1966 publication of 1966 publication of Accidental death and Accidental death and Disability: The Neglected Disease of Disability: The Neglected Disease of Modern SocietyModern Society recommended: recommended:– Development of trainingDevelopment of training– Federal guidelines and policiesFederal guidelines and policies– Provide emergency care and transportProvide emergency care and transport– Established staffed emergency roomsEstablished staffed emergency rooms

History of EMSHistory of EMS

Highway safety Act and the Emergency Highway safety Act and the Emergency Medical Act created federal fundingMedical Act created federal funding

DOT developed first National Standard DOT developed first National Standard Curriculum for EMT training (early 70’s)Curriculum for EMT training (early 70’s)

By 1980 EMS is established in most of the By 1980 EMS is established in most of the United StatesUnited States

Layers of TrainingLayers of Training

Lay ResponderLay Responder

First ResponderFirst Responder

EMT-BasicEMT-Basic

EMT-IntermediateEMT-Intermediate

EMT-ParamedicEMT-Paramedic

King County EMS King County EMS SystemSystem

King CountyKing County

King County coverage area

map.

King CountyKing CountyDispatch Centers follow Criteria-Based Guidelines.• Seattle• Eastside

Communications• Port of Seattle• Valley

Communications• Enumclaw

King CountyKing County

Fire/EMS Agencies.

• 38 Fire Departments

• 4000 EMTs

King CountyKing County

Medic One.

• 5 agencies• 250 paramedics

King CountyKing County

Hospitals

• Medical control hospitals

• Other hospitals

Layers of CareLayers of Care

• Citizens

• Emergency dispatchers

• EMTs

• Paramedics

• Emergency Departments

Chain of AccountabilityChain of Accountability

• Washington State RCW and WAC

• County Medical Program Director

• Program Medical Directors

• Emergency physicians at medical control hospitals

• EMTs and paramedics

Roles & ResponsibilitiesRoles & Responsibilities

Personal SafetyPersonal Safety– Safety of self, crew, patient, and bystandersSafety of self, crew, patient, and bystanders

Patient AssessmentPatient Assessment– Patient car based on assessment findingsPatient car based on assessment findings

Lifting and moving patients safelyLifting and moving patients safely

Transport and transfer of careTransport and transfer of care

Record keeping/data collectionRecord keeping/data collection

Patient AdvocacyPatient Advocacy

EMT Top 10 ListEMT Top 10 List

10. Be Professional10. Be Professional

Act the partAct the part

Focus on the patient’s problemFocus on the patient’s problem

Listen to the patient!Listen to the patient!

Keep family informedKeep family informed

Bedside mannerBedside manner

Respect privacy of patientRespect privacy of patient– ConfidentialityConfidentiality

9. Always Be a Student9. Always Be a Student

Certification every 3 years, on-going Certification every 3 years, on-going through CBTthrough CBT

EMS Online resource websiteEMS Online resource website

Remember every patient can teach you Remember every patient can teach you somethingsomething

Don’t forget to talk with the doctorDon’t forget to talk with the doctor

The day you stop learning is the day you The day you stop learning is the day you retire from this professionretire from this profession

8. Document Everything8. Document Everything

Documentation is your friend and will Documentation is your friend and will protect you when you memory failsprotect you when you memory fails

Vital signsVital signs

Patient informationPatient information

Descriptive narrativesDescriptive narratives

Always document unusual situationsAlways document unusual situations

If you did not document it, it did not If you did not document it, it did not happen!happen!

7. Embrace Change7. Embrace Change

New protocols and guidelines for CPR, New protocols and guidelines for CPR, FBAO, and resuscitationFBAO, and resuscitation

ROCROC

SPHERESPHERE

Alert CardsAlert Cards

New protocols and procedures!New protocols and procedures!

6. Follow Established Guidelines6. Follow Established Guidelines

US Department of Transportation US Department of Transportation curriculumcurriculum

Washington State certificationWashington State certification

King County guidelines (blue book King County guidelines (blue book protocols)protocols)

Local policies as outlined by agencyLocal policies as outlined by agency

5. Seek Help5. Seek Help

Stay humbleStay humble

Help from your partnersHelp from your partners

Help from your paramedicsHelp from your paramedics

Help from hospital controlHelp from hospital control

4. Be Safe4. Be Safe

Above all else, your safety is tantamount Above all else, your safety is tantamount to all that we do.to all that we do.

Take care of yourselfTake care of yourself

Remember to be proactive in the use of Remember to be proactive in the use of PPE/BSIPPE/BSI

Drive safely…it’s not your emergencyDrive safely…it’s not your emergency

Everyone goes home at the end of the Everyone goes home at the end of the shiftshift

3. Stick to the Basics3. Stick to the Basics

SICK or NOT SICK!SICK or NOT SICK!

Vital signs, MOI, NOI, IOSVital signs, MOI, NOI, IOS

Common sense and good judgmentCommon sense and good judgment

Remember, it’s okay if you cannot Remember, it’s okay if you cannot diagnose what is wrong with the patient, diagnose what is wrong with the patient, it’s not okay if you fail to take care of what it’s not okay if you fail to take care of what you know how to take care.you know how to take care.

2. Take Pride in our System2. Take Pride in our System

International reputationInternational reputation

Highest cardiac arrest survival rate in the Highest cardiac arrest survival rate in the worldworld

Highest rates of bystander CPRHighest rates of bystander CPR

Highest taxpayer support (Medic 1 Levy)Highest taxpayer support (Medic 1 Levy)

Highest trained paramedics in the worldHighest trained paramedics in the world

Best EMT trainingBest EMT training

1. Take Pride in Yourself1. Take Pride in Yourself

Helping others is a proud and noble Helping others is a proud and noble professionprofession

Provide care, comfort, and compassion to Provide care, comfort, and compassion to all patients…equallyall patients…equally

Exceed expectations, strive to be your Exceed expectations, strive to be your best in every situationbest in every situation

Approach each day with courage and Approach each day with courage and convictionconviction

EMT Well-BeingEMT Well-Being

The Well- Being of the EMTThe Well- Being of the EMT

Personal health, safety, and well-being are Personal health, safety, and well-being are vital to any EMS operationvital to any EMS operation

Intrinsic dangers and hazards of our Intrinsic dangers and hazards of our occupation vary greatly from call to calloccupation vary greatly from call to call

You will be constantly faced with mental You will be constantly faced with mental and physical stresses on the joband physical stresses on the job

Even the most experienced provides have Even the most experienced provides have difficulty overcoming personal reactions difficulty overcoming personal reactions

Understand the causes of stress Understand the causes of stress to prevent it from negatively to prevent it from negatively

affecting you!affecting you!

Remember, if you cannot take Remember, if you cannot take care of yourself, how will you care of yourself, how will you

take care of others?take care of others?

Stressful SituationsStressful Situations

Death and dyingDeath and dyingMass-casualty incidentsMass-casualty incidentsSevere traumaSevere traumaAbuseAbuseCo-worker death or injuryCo-worker death or injuryVehicle accident caused by EMS Vehicle accident caused by EMS personnelpersonnelViolent scenesViolent scenes

Warning SignsWarning Signs

PhysicalPhysical

– FatigueFatigue

– Changes in Changes in appetiteappetite

– HeadachesHeadaches

– InsomniaInsomnia

– IrritabilityIrritability

Warning SignsWarning Signs

Psychological:Psychological:

– FearFear

– DepressionDepression

– AngerAnger

– FrustrationFrustration

– Inability to copeInability to cope

Stress ManagementStress Management

Understand the effects of stressUnderstand the effects of stress

Find balance in your lifeFind balance in your life

Change or eliminate stressorsChange or eliminate stressors

Avoid complaining or worrying about Avoid complaining or worrying about things you cannot changethings you cannot change

Expand your social support systemExpand your social support system

Take care of yourself: diet, exercise, sleepTake care of yourself: diet, exercise, sleep

Stress Management ResourcesStress Management Resources

Partners and co-workersPartners and co-workers– Be open with and aware of each otherBe open with and aware of each other

Family membersFamily members

ChaplainsChaplains

Wellness Counseling and EAPWellness Counseling and EAP

CISMCISM

Critical Incident Stress DebriefingCritical Incident Stress Debriefing

Held within 48-72 hours of a major incidentHeld within 48-72 hours of a major incident

All information is confidentialAll information is confidential

CISD leaders and mental health CISD leaders and mental health professionals offer suggestions for professionals offer suggestions for overcoming stressovercoming stress

Can be initiated by anyoneCan be initiated by anyone

CISM SystemCISM System

Pre-incident stress Pre-incident stress educationeducation

Peer supportPeer support

CISDCISD

Follow-up servicesFollow-up services

Spouse and family Spouse and family support systemsupport system

Scene SafetyScene Safety

Hazardous materialsHazardous materials– Identification and isolationIdentification and isolation

ElectricityElectricity– Live electricity is difficult to seeLive electricity is difficult to see– Power off at sourcePower off at source

FireFire– Protective gearProtective gear– Do only what you have been trained to do!Do only what you have been trained to do!

Scene SafetyScene Safety

Violent ScenesViolent Scenes– Civil disturbances, domestic disputes, crime Civil disturbances, domestic disputes, crime

scenes, large gatherings (mobs)scenes, large gatherings (mobs)

Motor vehicle accidentsMotor vehicle accidents– Safety at sceneSafety at scene

Highways, streets, and roadsHighways, streets, and roads– Moving traffic is a major hazard!Moving traffic is a major hazard!

Body Substance IsolationBody Substance Isolation

Minimum protection Minimum protection on all calls: gloves on all calls: gloves and eye protectionand eye protection

Mask and gowns per Mask and gowns per RGT policyRGT policy

Hand washing and Hand washing and sanitizer usesanitizer use

Sharps disposalSharps disposal

Body Substance IsolationBody Substance Isolation

Always use Body Substance isolation Always use Body Substance isolation precautionsprecautions

Always us a barrier between yourself and Always us a barrier between yourself and the patientthe patient

Always wash/sanitize your hands after Always wash/sanitize your hands after each patient contacteach patient contact

Make certain immunizations are up to dateMake certain immunizations are up to date

Be careful handling sharpsBe careful handling sharps

Remember, to always take Remember, to always take care of yourself first…care of yourself first…

...BSI and Scene Safety...BSI and Scene Safety