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EMS Systems

EMS Systems. Heather Davis, MS, NREMT-P. About the Case Study. Why is the role of ordinary citizens important in this scenario? How many behind the scenes people can be credited with saving Mr... Chlopek’s life? IF E-911 would not have been in place, what delays might have occurred?.

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EMS Systems

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  1. EMS Systems Heather Davis, MS, NREMT-P

  2. About the Case Study • Why is the role of ordinary citizens important in this scenario? • How many behind the scenes people can be credited with saving Mr... Chlopek’s life? • IF E-911 would not have been in place, what delays might have occurred?

  3. EMS System Components • Prehospital component • Hospital Component • Support Personnel

  4. The Prehospital Component • Lay persons trained in CPR • First Responders • EMTs • Paramedics

  5. Hospital Component • Emergency nurses • Emergency physicians • Specialty physicians • Surgery • Rehab

  6. Support Personnel • Emergency Medical Dispatchers • Law enforcement • Firefighters • Public-safety workers • Respiratory therapists • Other allied health technicians

  7. The Systems Approach • System Administration • Medical Control • Public Information and Education • EMS Communications • EMD • Education and Certification • Patient Transportation

  8. The System Continued • Quality Assurance and Improvement • Research • Receiving Facilities • Mutual Aid/MCI Preparation • System Financing

  9. System Administration:The Local EMS Agency • Sets local policies • Hires a medical director • Manages local resources • Assures quality of service

  10. System Administration:The State EMS Agency • Allocates state and federal funding • Works for EMS legislation • Certifies and licenses personnel • Enforces rules and regulations

  11. Medical Control:Medical Director Qualifications • Experienced in emergency medicine • Completed a training program in EMS system • Board certified in emergency medicine • Frequently rides with field crews

  12. Medical Control:Responsibilities • Direct communication with field crews • Intervener physician guidelines • Protocol development: triage, treatment, transport, transfer, special situations • Oversee training and education • Ensure quality assurance through chart review, audit, and evaluation

  13. Public Information/Education • Patient denial of symptoms • Targeting coronary/stroke patients • System access • Bystander BLS in CPR, bleeding control, C-spine stabilization • Future involvement (bystander defib)

  14. EMS Communications • Easy citizen access • Communications center • Operational network • Medical communications • Communications hardware • Communications software

  15. Emergency Medical Dispatch • Interrogation protocols • Response configurations • System status management • Pre-arrival instructions • Dispatcher training • Desired response times

  16. Education & Certification • Original program requirements: 300 didactic, 100 clinical, 300 field • Continuing ed: refresher courses, in-services, seminars • Certification levels: EMT-B,I,P • Additional certification: ACLS, PALS, PHTLS, BTLS

  17. Patient Transportation • Transport to appropriate facility • Ground transportation • Air transportation

  18. Quality Assurance • Monitors quality of clinical care • Evaluation of clinical data • Documents effectiveness of care provided • Identifies weaknesses in system • Often viewed negatively

  19. Quality Improvement • Focuses on customer perceptions of service • Emphasizes customer satisfaction • Recognizes, rewards, and reinforces good performance

  20. Research • What field tx reduces morbidity and mortality? • Are the benefits worth the risks? • What is the cost/benefit ratio of prehospital medicine? • Is field stabilization possible?

  21. Receiving Facilities • Hospital categorization • Specialty centers • Requirements: MD on duty, surgical facility, ICU, lab, x-ray, blood bank, participation in EMS system, reception of all patients, QA procedures, MCI plan participation

  22. MCI & Mutual Aid Requirements • Central coordinating agency • Integration of system components • Frequent drills • Expansion of communications • Standardized regional resources

  23. System Financing • System design: hospital based, fire department, municipal third service, private business, volunteer, combo • Funding options: tax subsidized, contributions, fundraising, corporate sponsorship, subscriber plans, prepaid HMO, Medicare, Medicaid, private medical or auto insurance, user pay, public utility

  24. Any questions about systems approach to EMS?

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