Chapter 1 EMS Systems

Question 1

Define emergency medical services EMS pg. 3

Answer 1

Is a multidisciplinary system of professionals and agencies working together to provide prehospital emergency care to sick and injured people

Question 2

What are the four levels of EMS training and licensers pg. 4

Answer 2

Emergency medical responder EMR
emergency medical technician EMT
Advanced emergency medical technician AEMT
Paramedic

Question 3

Describe licensure criteria for advanced emergency medical technicians (AEMTs) (pp 6-7)

Answer 3

High school diploma or equivalent
* Proof of immunization against certain communicable diseases
Successful completion of a background check and drug screening
* Valid driver’s license
* Successful completion of a recognized health
care provider’s basic life support (BLS)/cardio-
pulmonary resuscitation (CPR) course
* Successful completion of a state-recognized
AEMT course
* Successful completion of a state-recognized
written certification examination
* Successful completion of a state-recognized
practical certification examination
* Demonstration that you can meet the psychological and physical criteria necessary to perform safely and properly all the tasks and functions described in the defined role of an
AEMT
* Compliance with other state, local, and employer provisions

Question 4

Describe how the Americans with Disabilities Act (ADA) applies to employment as an AEMT. (p 7)

Answer 4

Employers with 15 or more employees are required to adjust processes so a candidate with a disability can be considered for the position and, when possible, to modify the work environment or how the job is normally performed.1 This allows many people who can perform the functional job skills the opportunity to pursue a career in EMS.

Question 5

Discuss the history of the development of the EMS system. (pp 7-8)

Answer 5

Early efforts to systematize prehospital care include the field treatments and transport innovated during the Civil War. Civilian ambulatory services soon followed. In World War II, the military trained special corpsmen to provide care in the field and bring the casualties to aid stations staffed by nurses and physicians. Congress mandated that two federal agencies address these issues. The NHTSA of the Department of Transportation (DOT), through the Highway Safety Act of 1966, and the Department of Health, Education, and Welfare (now known as the Department of Health and Human Services), through the Emergency Medical Services Development Act of 1973, created funding sources and pro- grams to develop improved systems of prehospital emergency care. The DOT developed and published the first National Standard Curriculum to serve as the guideline for the training of EMTs.3 To support the EMT course, the American Academy of Orthopedic Surgeons prepared and published the first EMT textbook—Emergency Care and Transportation of the Sick and Injured—in 1971.

Question 6

Describe the levels of EMS training in terms of skill sets needed for each of the following: emergency medical responder (EMR), emergency medical technician (EMT), AEMT, and paramedic. (pp 8-11)

Answer 6

An EMT also provides the skills listed in the EMR level.

An AEMT also provides the skills listed in the EMR and EMT levels.

A paramedic also provides the skills listed in the EMR, EMT, and AEMT levels.

Question 7

Discuss the possible presence of other responders at a scene with EMR training, some knowledge of first aid, or merely good intentions, and their need for direction. (pp 12-13)

Answer 7

the presence of other responders would mean they are seen as BLS providers and try to keep the patient alive till the ambulance can get there

Question 8

Describe the components of the EMS system. (pp 13-16)

Answer 8

Inherently safe and effective, so the entire system from start to finish is designed to minimize exposure to injury, infections, illness, or stress
* Integrated and seamless, where EMS is fully integrated with all other aspects of health care and is engaged with other emergency services and within the communities in which they
operate
* Reliable and prepared, ensuring EMS care is
delivered consistently and compassionately and is guided by sound research at all times, by all EMS providers, at all levels, or from all agencies
* Socially equitable, so that access to care and the quality of care are not determined by a patient’s age, socioeconomic status, gender, ethnicity, or where they live
* Sustainable and efficient, meaning systems must be fiscally responsible, providing value to the community with a minimum of waste and a maximum of accountability
* Adaptable and innovative, evolving to meet the changing needs of the people whom they serve by continuously evaluating new tools and techniques, education programs, and system designs

Question 9

Describe how medical direction of an EMS system works and your role in the process. (pp 16-17)

Answer 9

the way the system works is the agency has a medical director and they allow you to work with in certain parameters of what license you have. your role in that process is to work with in the guide lines you are expected to be in.

Question 10

Describe the goals of Mobile Integrated Healthcare (MIH) and community paramedicine. (p 18)

Answer 10

with the goal to facilitate improved access to health care at an affordable price. In the MIH model, health care is provided within the community, rather than at a physician’s office or hospital.

Question 11

Discuss the purpose of the EMS continuous quality improvement (CQI) process. (p 18)

Answer 11

is a dynamic, circular system of continuous internal and external reviews and audits of all aspects of an EMS call. To provide CQI, periodic run review meet- ings are held in which all staff involved in patient care review the run reports and discuss any areas of care that seem to need change or improvement.

Question 12

Describe ways to limit or eliminate human error and improve patient safety. (pp 18-19)

Answer 12

Another way to help limit medical errors is to use checklists, reference material, and “cheat sheets.” Have a copy of your protocol book with you.

Question 13

Describe situations in which transport to a specialty center is warranted. (pp 24-25)

Answer 13

You must know the location of the centers in your area and when, according to your protocol, you must transport the patient dir- ectly to one. Sometimes, air medical transport will be necessary. Local, regional, and state protocols will guide your decision in these instances.

Question 13

Characterize the EMS system’s role in prevention and public education in the community. (pp 21-22)

Answer 13

Once that information is stored electronically, it can be used to improve care. For example, how many times has a department seen patients with chest pain? What is the average on-scene time for major trauma patients? How many AED runs has the de- partment had? These questions and many more can be answered using the information gathered from computerized medical records. This information is used for a variety of pur- poses. It is used to construct educational sessions for the department. Data from ambulance activity logs are used to justify hiring more personnel. Ex- amining the types of patients and their frequency can provide the foundation for the purchase of new equipment and guide continuing education ses- sions.

Question 14

Discuss the signs of human trafficking that you may encounter during an emergency response. (p 23)

Answer 14

• The patient shows signs of physical abuse or injury.
• The patient is accompanied everywhere by a person
  who speaks for the patient or will not allow the
  patient to speak when addressed directly.
• The patient appears fearful or under the control of
  another person.
• The patient has ongoing health issues that have not
  been addressed.
• The patient is unfamiliar with the neighborhood in
  which the scene is located.
• The patient appears to be traveling with a minimal
  or inappropriate amount of luggage or belongings.
• The patient has a lack of identification documents
  or does not have control over personal identification
  documents.
• The patient is a juvenile engaged in a commercial
  sex act.

Question 15

Describe your roles and responsibilities as an AEMT. (pp 25-26)

Answer 15

• Keep vehicles and equipment ready for an emergency.
• Ensure the safety of yourself, your partner, the patient, and bystanders.
• Properly and safely operate the emergency vehicle.
• Be an on-scene leader.
• Perform an evaluation of the scene.
• Call for additional resources as needed.
• Gain patient access.
• Perform a patient assessment.
• Give emergency medical care to the patient.
• Properly and safely move patients.
• Communicate effectively with the patient and
  advise the patient of any procedures you will
  perform.
• Give emotional support to the patient, the patient’s
  family, and other responders.
• Maintain continuity of care by working with other
  health care professionals.
• Resolve emergency incidents.
• Uphold medical and legal standards.
• Ensure and protect patient privacy.
• Give administrative support.
• Constantly continue your professional development.
• Cultivate and sustain community relations.
• Give back to the profession.

Question 16

Describe the attributes you are expected to possess. (p 26)

Answer 16

Integrity - Consistent actions, adheres firmly to a code of honest behavior

Empathy - Shows awareness and considera- tion about the needs of others

Self-motivation - Discovers problems and solves them without direction

Appearance and hygiene - Uses persona to project a sense of trust, professionalism, knowledge, and compassion

Self-confidence - Knows what you know and what you do not know; asks for help when needed

Time management - Performs or delegates multiple tasks while ensuring efficiency and safety

Communication - Understands others and ensures they understand you

Teamwork and diplomacy - Works with others; knows your place within a team; communi- cates while giving respect to the listener

Respect - Places others in high regard or importance; understands others are more important than you

Patient advocacy - Constantly keeps the needs of the patient at the center of care; sup- ports patients’ rights

Careful delivery of care - Pays attention to detail; ensures what is being done for the patient is done as safely as possible

Question 17

Discuss the impact of the Health Insurance Portability and Accountability Act (HIPAA) on patient privacy. (p 27)

Answer 17

hich was enacted in 1996 to limit the availability of patients’ health care information and penalize violations of patient privacy.

Question 18

You were just hired as an AEMT and report to your first day on the job with the local ambulance service. As you begin your orientation, the EMS director asks you two initial questions:
1. What is emergency medical services (EMS)?
2. Why was the National Registry of Emergency Medical Technicians (NREMT) established?

Question 19

The director continues to explain that the service uses the National EMS Scope of Practice Model as the framework for what its providers can do in the field. He also mentions that the local 9-1-1 center hires only dispatchers who have completed the Emergency Medical Dispatch (EMD) course.
3. What is the National EMS Scope of Practice Model?
4. How does the EMD system work?

Question 20

Midway through your first day of orientation, you are introduced to the medical director. He explains to you his roles and responsibilities as medical director of the service. He further tells you specific rules and regulations that you, as an AEMT, must follow on every call to maintain your certification.
5. What dictates the skills that you, as an AEMT, may perform in the course of your duties?
6. What are the two types of medical control?

Question 21

The final speaker for your first day of orientation is the service’s QA/CQI officer. He explains to you the required format for documenting your calls, as well as what can be expected of him.
7. What is the purpose of a QA/CQI meeting?
8. How can a QA/CQI review make you a better provider?

Question 22

What is emergency medical services (EMS)?

Answer 22

EMS consists of a team of health care profession- als who are responsible for and provide prehospital emergency care and transportation for sick and in- jured people. Each EMS agency is part of a local or regional EMS system that provides the prehospital components required to delivery proper emergency medical care.

Question 23

Why was the National Registry of Emergency Medical Technicians (NREMT) established?

Answer 23

The NREMT was established to certify and regis- ter EMS professionals through a valid and uniform process that assesses their knowledge and skills to ensure competent practice. The NREMT requires a reregistration process every 2 years to ensure con- tinued competence.

Question 24

What is the National EMS Scope of Practice Model?

Answer 24

At the federal level, NHTSA brought in experts from around the country to create the National EMS Scope of Practice Model. This document provides overar- ching guidelines for the minimum skills each level of EMS provider should be able to accomplish. Be- cause licensure is a state function, at the state level laws are enacted to regulate how EMS providers will operate and are then executed by the state-level EMS administrative offices that control licensure. Finally, the local medical director decides the day- to-day limits of EMS personnel. For example, the medications that will be carried on an ambulance or where patients are transported are both day-to-day operational concerns in which the medical director will have direct input.
The national guidelines are intended to create more consistent delivery of EMS across the country. The only way a medical director can allow an AEMT to perform a skill is if the state has already approved performance of that skill. The medical director can limit the scope of practice but cannot expand it be- yond state law. Expanding the scope of practice re- quires state approval.

Question 25

How does the EMD system work?

Answer 25

Emergency medical dispatch was developed to assist dispatchers in providing callers with vital in- structions to help them deal with an emergency until the arrival of EMS crews. Dispatchers are trained and provided with scripts to help them relay rel- evant instructions to the callers. The system helps the dispatchers select appropriately resourced units to respond to a request for assistance. It is the dispatcher’s duty to relay all relevant and availableinformation to the responding crews in a timely man- ner. Keep in mind, however, that current technology does not allow the dispatcher to see what is actually going on at the scene and that it is not uncommon for you to find the reality of the call quite different from the dispatch information. A dispatcher can only relay the information provided by the caller.

Question 26

What dictates the skills that you, as an AEMT, may perform in the course of your duties?

Answer 26

Each EMS system has a physician medical director who authorizes the providers in the service to provide emergency medical care in the field. The appropriate care for each injury, condition, or illness that you will encounter in the field is determined by the medical director and is described in a set of written standing orders and protocols. Protocols are described in a comprehensive guide delineating the scope of prac- tice of AEMTs. Standing orders are part of protocols and designate what AEMTs are required to do for a specific complaint or condition.

Question 27

What are the two types of medical control?

Answer 27

Medical control is off-line (indirect) or online (direct), as authorized by the medical director. Online medical control consists of direction given over the phone or radio directly from the medical director or desig- nated physician. Off-line medical control consists of standing orders, training, and supervision authorized by the medical director.

Question 28

What is the purpose of a QA/CQI meeting?

Answer 28

A QA/CQI meeting is part of a circular system of con- tinuous internal and external reviews and audits of all aspects of an EMS call. Periodic run review meet- ings are held in which all involved in patient care re- view the run reports and discuss any areas of care that seem to need change or improvement.

Question 29

How can a QA/CQI review make you a better provider?

Answer 29

A QA/CQI review can identify overall problems within a service or EMS system and individual or team per- formance problems. The review helps to identify the source of the problem and possible solutions. The potential solutions can be evaluated by discussing their potential benefits and risks and by trying the most likely beneficial solutions in a safe setting, such as role playing, and/or in practice, depending on the nature of the problem and solution. You can learn about how to clearly identify problems and to propose and evaluate solutions by participating in QA/CQI meetings. You can also learn new informa- tion and techniques by participating in the meetings and by receiving feedback from the meetings.