Transcript Paramedic Care: Principles & Practice Volume 1

Paramedic Care:
Principles & Practice
Volume 1
Introduction to Advanced
Prehospital Care
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Chapter 3
EMS Systems
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Topics
History of EMS
Today’s EMS Systems
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Introduction
An EMS system is a comprehensive
network of personnel, equipment, and
resources established to deliver aid and
emergency medical care to the community.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Components of an
EMS System
Out-of-Hospital Elements
Members of the
community
EMS providers
Communication
system
Public utilities
Fire, rescue,
hazmat
Poison control
centers
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Components of an
EMS System
In-Hospital Elements
Emergency nurses
Emergency and specialty physicians
Ancillary services
Rehabilitative services
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Types of EMS Response
Basic Life Support
Advanced Life
Support
Tiered Response
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
History of EMS
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
History of EMS
Ancient times
– A “good Samaritan” provided care to a wounded
traveler by the side of a road
– Ancient tablets provided healers with step-bystep instructions for patient care
– Code of Hammurabi
One particular section of the code was devoted to the
regulation of medical fees and penalties
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
History of EMS
18th and 19th Century
– Napoleonic Wars
First efforts of field care developed. Triage, a method
of sorting patients by severity, developed.
– U.S. Civil War
Triage and transport of wounded soldiers
Improvised hospitals in houses, barns, and churches
– First civilian ambulance service
Cincinnati, Ohio (1865)
New York City Health Department Ambulance Service
(1869)
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
History of EMS
20th Century
– World War II
Transportation to appropriate facilities
Battlefield ambulances
– Vietnam and Korean conflicts
Soldiers treated in battlefield
Evacuation by helicopter
Until the late 1960s, few areas of the United
States provided adequate civilian
prehospital emergency care.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
History of EMS
Post-1960s Developments
– Mortician-operated ambulances withdrew due to
costs and demand for additional services.
– Fire and police departments began providing
EMS.
– There was growth of volunteer and independent
local EMS provider agencies.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
History of EMS
In 1966, the publication of “Accidental Death
and Disability: The Neglected Disease of
Modern Society” addressed EMS
– Highlighted deficiencies in prehospital
emergency care
– Set guidelines for development of EMS systems,
training, ambulances, equipment
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Federal and Private Initiatives
1966-National Highway Safety Act
– Established the U.S. Department of
Transportation (DOT)
– Provided matching grants to states for
emergency medical services
– Funds were also provided for the development
of educational programs
In 1969 the EMT–A program developed
First paramedic curriculum followed in 1977
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Federal and Private Initiatives
1971
– White House issued $9 million in EMS grants for
EMS demonstration projects
– Designed to be models for subsequent system
development
1972
– The Department of Health, Education, and
Welfare funded a $16 million five-state initiative
for the development of regional EMS systems
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Federal and Private Initiatives
EMS Systems Act of 1973
– Provided funding for a series of trauma projects
– $300 million allocated to study EMS planning,
operations, expansion, and research
– Amended in 1976 and 1979 to continue funding
for regional EMS systems
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Federal and Private Initiatives
Two Items the Legislation Omitted:
– System finance
Federal funding was significantly reduced in the early
1980s
– Medical direction
Many services were operating without medical
direction
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Federal and Private Initiatives
1981
– The Consolidated Omnibus Budget
Reconciliation Act (COBRA) wiped out federal
EMS funding
Funding that remained was placed into state
preventive-health and health-services block grants
– The National Highway Traffic Safety
Administration (NHTSA) attempted to sustain
the efforts
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Federal and Private Initiatives
1988
– Statewide EMS Technical Assessment Program
was established
Defines elements necessary to all EMS systems
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Statewide EMS Technical
Assessment Program
Elements necessary for an EMS System
Regulation
Resources
management
Human
resources/training
Transportation
Facilities
Communications
Trauma systems
Public information
Medical direction
Evaluation
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Federal and Private Initiatives
EMS Agenda for the Future
– Published in 1996 as a comprehensive
evaluation of the history of EMS
– Focuses on aspects of EMS related to
emergency care outside of traditional health
care facilities
– Casts a vision for the future of EMS in the
United States
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Federal and Private Initiatives
2005
– The National EMS Scope of Practice Model
Supports a system of EMS personnel licensure
A guide for States in developing their Scope of
Practice legislation, rules, and regulation
Will increase the consistency of the nomenclature and
competencies of EMS personnel nationwide
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
History of EMS
21st Century EMS
– The terrorist
attacks on the
World Trade Center
in New York City
and the Pentagon
on September 11,
2001 forever
changed EMS and
the world
© Reuters/Corbis
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
History of EMS
21st Century EMS (cont.)
– Attacks pointed out the problems and
inefficiencies with the United States emergency
response system
Fragmented and uncoordinated oversight of
emergency response
2006
– National Academies of Science
Emergency Medical Services: At the Crossroads
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Emergency Medical Services:
At the Crossroads
Study found that there were significant
problems at the federal, state, and local
level
– Government leadership in emergency care is
fragmented and inconsistent
Hospital-based emergency and trauma care
is scattered across multiple agencies and
departments
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Other Identified Problems
Insufficient
coordination
Coordination of
transport within
regions is limited
Disparities in
response times
Uncertain quality of
care
Lack of readiness
for disasters
Divided
professional
identity
Limited evidence
base
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Today’s EMS Systems
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Today’s EMS Systems
Every EMS system must develop a system
that best meets its needs.
Certain elements are essential to ensure the
best possible patient care.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Today’s EMS Systems
Local and State-Level Agencies
– The first step in developing a comprehensive
EMS system is to establish an administrative
agency.
Manages the local system’s resources, develops
operational protocols, and establishes standards and
guidelines
– The agency designates who may function within
the system and develops policies consistent with
existing state requirements.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Today’s EMS Systems
Medical Direction
– The Medical
Director is a
physician who is
legally responsible
for all clinical and
patient-care
aspects of the
system.
© Ken Kerr
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Medical Direction
Role of the Medical Director
–
–
–
–
–
–
–
–
Educate and train personnel
Participate in equipment and personnel selection
Develop clinical protocols
Participate in problem resolution and quality
improvement
Provide direct input into patient care
Interface with the EMS system
Advocate within the medical community
Serve as the “medical conscience” of the EMS
system
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Medical Direction
On-line Medical Direction
– A qualified physician gives direct orders to a
prehospital care provider
– May be delegated to qualified personnel
Mobile intensive care nurse (MICN), a physician
assistant (PA), or a paramedic
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Medical Direction
Off-Line Medical
Direction
– Policies,
procedures, and
practices that a
system physician
has set up in
advance
Prospective
Retrospective
– Use of Protocols
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Public Education
An essential and often overlooked
component of EMS is the public.
Educate the public
– Recognizing an emergency
– Accessing the system
– Initiating BLS procedures
Public involvement may include bystander
defibrillation.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Communications
A coordinated, flexible communications plan
should include:
– Citizen access
–
–
–
–
–
Single control center
Operation communication capabilities
Medical communication capabilities
Communications hardware
Communications software
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Emergency Medical
Dispatcher (EMD)
The activities of an
EMD are crucial to the
efficient operation of
EMS.
EMDs must be
medically and
technically trained.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
EMS Dispatch
The means of assigning and directing
appropriate medical care to patients
– Includes interrogation protocols, response
configurations, system status management, and
prearrival caller instructions
An effective EMS dispatching system places
the first responding units on scene within 4
minutes.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Education and Certification
Two kinds of EMS education are initial and
continuing education.
– Initial education is the original training course for
prehospital providers.
– Continuing education programs include
refresher courses for recertification and periodic
in-service training sessions.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Initial Education
Based on the EMT-Paramedic: National
Standard Curriculum published by the U.S.
DOT
– Establishes the minimum content for the course
– Divided into 3 specific learning domains
Cognitive
Affective
Psychomotor
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Education and Certification
Certification
– The process by which an agency grants recognition to an
individual who has met its qualifications
Licensure
– The process of occupational regulation
Registration
– Is entering your name and essential information within a
particular record
Reciprocity
– An agency grants automatic certification or licensure to an
individual who has comparable certification or licensure from
another agency
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Certification Levels
First Responder
Emergency Medical Technician-Basic
Emergency Medical Technician-Intermediate
Emergency Medical Technician-Paramedic
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
First Responder
The First
Responder is
usually the first
EMS-trained
provider to arrive
on the scene.
Emergency Medical
Responder (EMR)
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Emergency Medical
Technician-Basic
The EMT-Basic is
trained to do all that
a First Responder
can do, plus other
complex skills.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Emergency Medical
Technician- Intermediate
The EMT-I should
possess all the
skills of an EMT-B
and be competent
in advanced airway,
IV therapy, and
other skills.
Advanced EMT
(AEMT)
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Emergency Medical
Technician- Paramedic
The EMT-P is the
most advanced
EMS provider.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Expanding Roles
Critical care transport
– Paramedics manage complicated interhospital
transports
Industrial or occupational EMS
– Used to staff construction sites, oil rigs, and
other facilities
Tactical EMS
– Accompany specially trained law enforcement
officers on tactical operations
Primary care
– Triaging and directing patients to the proper
nonhospital facilities
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
National Registry of
EMTs (NREMT)
Prepares and administers standardized tests
for EMS responders
Establishes the qualifications for registration
and re-registration, and establishing a minimal
standard of competency
Serves as a major tool for reciprocity by
providing a process for EMTs
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Professional Organizations
Belonging to a professional organization is a
good way to keep informed about the latest
technology.
Organizations assist in the development of
educational programs, operational policies
and procedures, and the implementation of
EMS.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Professional Organizations
Include:
National Association of EMTs
National Association of Search and Rescue
National Association of State EMS Directors
National Association of EMS Physicians
National Flight Paramedics Association
National Council of State EMS Training
Coordinators
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Professional Journals
A variety of journals are available
Journals provide an abundant source of
continuing-education material
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
These Professional Journals
Include:
Annals of Emergency Medicine
Emergency Medical Services
Prehospital Emergency Care
Journal of Emergency Medical Services
Journal of Emergency Medicine
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Patient Transportation
In general, patients should be taken to the
nearest facility whenever possible.
Medical direction should designate the
facility
– Based on patient need and availability of
resources
Patients may be transported by ground or
air.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Patient Transportation
All transport vehicles must be licensed and
meet local and state EMS requirements.
Regional standardization of equipment and
supplies is most effective in facilitating
interagency efforts during disaster
operations.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Patient Transportation
The helicopter has
become an integral
part of prehospital
care.
Trauma care
systems use law
enforcement,
municipal, hospitalbased, private, and
military helicopter
transport services.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Patient Transportation
KKK-A-1822 Federal Specifications for
Ambulances were developed in 1974.
It identified 3 types of standardized
ambulances.
Revisions in the standards have improved
overall features.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Type I Ambulance
Conventional cab
and chassis on
which a module
ambulance body is
mounted, with no
passageway
between the
driver’s and
patient’s
compartments
© Jeff Forster
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Type II Ambulance
A standard van,
body, and cab form
an integral unit
© Jeff Forster
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Type III Ambulance
A specialty van with
forward cab and
integral body. It has
a passageway from
the driver’s
compartment to the
patient’s
compartment
© Jeff Forster
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Receiving Facilities
Hospitals are placed into categories that
identify their readiness and capability.
All receiving facilities should have the
following capabilities:
– Emergency department with an emergency
physician on duty, surgical facilities, a lab and
blood bank, x-ray capabilities, and critical and
intensive care units
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Receiving Facilities
Emergency facilities
should have:
– A documented
commitment to participate
in the EMS system
– A willingness to receive all
emergency patients in
transport
– Medical audit procedures
to ensure quality care and
medical accountability
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Mutual Aid and Mass
Casualty Preparation
A formalized mutual aid agreement ensures
that help is available when needed.
Agreements should be between neighboring
departments, municipalities, systems, or
states.
Each system should also put a disaster plan
in place for catastrophes that can
overwhelm available resources.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Quality Assurance
and Improvement
The only acceptable quality is excellence.
Quality assurance and improvement
programs must be dynamic and
comprehensive.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Quality Assurance
and Improvement
Quality Assurance is designed to maintain
continuous monitoring and measurement of
the quality of clinical care.
– A problem with QA programs is that they tend to
identify only the problems and therefore focus
only on punitive corrective action.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Quality Assurance
and Improvement
Continuous Quality Improvement (CQI) is
designed to refine and improve an EMS
system, emphasizing customer satisfaction.
– Evaluations of such aspects as billing and
maintenance
CQI focuses on recognizing, rewarding, and
reinforcing good performance.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Research
A formal, ongoing research program is an
essential component of the EMS system.
An area that will rely heavily on research is
funding.
– Managed care will force EMS systems to
scientifically validate their effectiveness and
necessity.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Research
EMS research must address the following
issues:
– Which prehospital interventions actually reduce
morbidity and mortality?
– Are the benefits of certain field procedures worth
the potential risks?
– What is the cost-benefit ratio of sophisticated
prehospital equipment and procedures?
– Is field stabilization possible, or should
paramedics begin immediate transport in every
case?
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Components of a
Research Program
Identify a problem
Identify the body of knowledge on the
subject
Select the best design for the study
Begin the study and collect raw data
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Components of a
Research Program
Analyze and correlate your data in a
statistical application
Assess and evaluate the results against the
original hypothesis or question
Write a concise, comprehensive description
of the study for publication in a medical
journal
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Evidence-Based
Medicine (EBM)
Current standards accepted by physicians
and other health care providers in clinical
medicine
Conscientious, explicit, and judicious use of
the current best evidence in making
decisions about the care of individual
patients
Combines clinical expertise with the best
available clinical evidence from systematic
research
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
System Financing
EMS funding can come from a variety of
sources.
Fee-for-service from Medicare, Medicaid,
private insurance companies, or private
paying patients is common.
Public Utility Models are becoming
increasingly popular.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Summary
History of EMS
Today's EMS Systems
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ