Evolution of Healthcare Services and Emergency Medical Training

1. McFatter Technical Center Emergency Medical Technician - Basic Health Science CoreChapter 1, 2, 3, and 4 Revised: February 2008

2. Chapter 1 Introduction to Healthcare Facilitiesand Emergency Medical Care Revised: February 2008

3. History Healthcare Facilities • 200 B.C. Buddhists in India established hospital for crippled, sick, or weary travelers. • 1700 Hospitals were dark, overcrowded, and dirty. • 1800 Hospitals began aseptic techniques and patient outcomes improved. • 1890 x-ray equipment utilized. • 1900 more advancement in equipment Revised: February 2008

4. History of EMS • World War I – Ambulance squads were used to provide care • Prior to 1960s Ambulance service was different: • Hospital based • Funeral homes • Private vehicle • 1966 publication of Accidental Death and Disability: The Neglected Disease of Modern Society Revised: February 2008

5. History of EMS • Congress Mandates: • Highway Safety Act of 1966 • Emergency Medical Act of 1973 • 1970 DOT developed National Standard Curriculum • 1980 Legislation mandated: • Municipality provide prehospital care within their boundaries • Standards for training personnel and required ambulance equipment Revised: February 2008

6. Types of Healthcare Facilities • Acute care facilities – short term healthcare • Extended or long term care facilities – long term or chronic healthcare • Urgent care – non-emergency • Health clinics – free healthcare services or outpatient services • Medical offices – specific type of healthcare • Home health – services provided at home Revised: February 2008

7. Levels of EMS Training • First Responder – Initiate immediate care and assist EMT on arrival • EMT–Basic – Responsible for assessment, care, packaging, and transporting of the patient • EMT-Intermediate – Specifically trained in ALS skills. • EMT-Paramedic – Mastery of basic skills and provides a wide range of ALS skills. Revised: February 2008

8. Components of the EMS SystemDispatch • Enhanced 9-1-1 • Display address of telephone location • Cell phones display location with GPS • Speech or hearing disabilities can communicate with keyboard and printed message • Emergency Medical Dispatch – Dispatcher provides caller with vital instructions to help them deal with medical emergency until EMS arrival Revised: February 2008

9. Components of the EMS SystemMedical Director • Authorizes EMTs to provide medical care in the field • Establish written protocols or standing orders that guide EMTs • Provide medical direction phone, radio, or in person Revised: February 2008

10. EMT Roles and Responsibilities • Ensuring own safety • Locating and safely driving to scene • Perform thorough assessment • Communicate effectively with patient on procedures you will perform • Properly package patient • Give radio report to receiving hospital • Document all findings Revised: February 2008

11. Terms • Contagious – capable of being transferred from one person to another; either directly or indirectly • Asepsis – a condition in which no pathogen, infection, or any form of life is present • Acute – sudden onset • Chronic – slow to develop Revised: February 2008

12. EMT Roles and Responsibilities Question Patient is uncooperative, demanding, unpleasant, ungrateful, and verbally abusive. You should: • (A) Make them sign a release • (B) Call them a cab • (C) Provide compassion, respect, and best care that you can Revised: February 2008

13. Chapter 2The Acute Care Hospital Revised: February 2008

14. Chain of Command • Organizational structure of a facility that indicates the person or department responsible • Large facilities have complex structures • Small facilities have simpler structures • EMS systems uses chain of command and ideal span of control is 5 to 7 Revised: February 2008

15. Emergency Incident Command Structure Revised: February 2008

16. Types of Acute Care Hospitals • General hospitals – most common • Women’s hospitals – offer gynecological services • Pediatric hospital – special care from birth to 18 years old • Cardiac Intervention – special care for cardiac disease • Trauma centers – special care for traumas Revised: February 2008

17. Hospital DepartmentAdministration • Admissions – obtains information • Central purchasing – purchase supplies • Billing and Collections – deals with insurance companies and collecting money for services rendered Revised: February 2008

18. Hospital DepartmentSupport Services • Transporters • Medical records • Security • Maintenance and engineering • Communications • Environmental services • Grounds keeping Revised: February 2008

19. Hospital DepartmentDiagnostic Services • Laboratory • Radiology or imaging • Electrocardiogram • Cardiovascular fitness - Stress test Revised: February 2008

20. Hospital DepartmentTherapeutic Services • Physical therapy • Respiratory therapy • Pharmacy • Speech therapy • Dietary therapy • Cardiac rehabilitation • Occupational therapy Revised: February 2008

21. Hospital DepartmentNursing Services • Ambulatory surgery or same day surgery • Discharge planning and social services • Critical care units (emergency room) • Medical surgical • Pediatrics • Labor and delivery • Post partum unit • Oncology Revised: February 2008

22. Hospital DepartmentNursing Services • Orthopedics • Geriatrics • Operating rooms or surgical suites • Post anesthesia care or recovery room • Transitional care unite • Infection control department • Psychiatric or mental health department • Substance abuse or chemical dependency unit • Education department Revised: February 2008

23. Terms • Myocardial infarction – a heart attack, a condition caused by the blockage of one or more coronary arteries • Sterilization – the complete destruction of all forms of microbial life • EKG or ECG (Electrocardiogram) – visual picture of the heart electrical activity • Critical care – rendering of care to patients with life-threatening conditions Revised: February 2008

24. Chapter 3Hospital Employees and Medical Staff Revised: February 2008

25. Assistant • Nursing assistant - Provide bedside and basic patient care to patients under supervision of licensed nurse • Medical assistant – work in doctor’s offices, clinics, outpatient, and hospitals under supervision of a physician Revised: February 2008

26. Nurses • Largest number of employees • Registered Nurse - Administer medications, prepare patients for diagnostic procedures, admitting, and discharge. • Licensed practical nurse (LPN) – vocational training and performs technical nurse duties • Nurse practitioner or physician’s assistant – able to write prescriptions Revised: February 2008

27. Other Positions • Health Unit Coordinator - Clerical and receptionist duties in the nursing unit. • Doctors – direct patient care, prescribe medication, and diagnose tests. Revised: February 2008

28. Areas of Specialty • Orthopedic • Cardiology • Pulmonary medicine • Emergency medicine • Gastroenterology • Urology • Nephrology • Surgery • Neurology • Oncology • Gerontology • Rheumatology • Gynecology • Neonatology • Pediatrics • Dermatology • Cosmetic Revised: February 2008

29. References • Pollak, Andrew N. Emergency Care and Transportation of the Sick and Injured. 9th ed. Sudbury, Massachusetts: Jones and Bartlett, 2005. • Stevens, Kay, and Garber, Debra. Introduction to Clinical Allied Healthcare. 2nd ed. Clifton Park, New York: Thomson Delmar Learning, 1996. Revised: February 2008