The State of EMS in our Community
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Transcript The State of EMS in our Community
The State of EMS
in our Community
William Fales, MD, FACEP
Medical Director
Kalamazoo County Medical Control
Authority
What is EMS?
“Emergency medical services system”
means a comprehensive and integrated
arrangement of the personnel, facilities,
equipment, services, communications,
medical control, and organizations
necessary to provide emergency medical
services and trauma care within a particular
geographic region.
Michigan Public Health Code: 333.20904
EMS 101
Core Components
EMS system access
Bystander Care
Medical First Responders
Paramedics / Ambulance
Hospitals
Medical Control Authority
Local Government
EMS System Access
911 Public Safety Answering Points (PSAP)
Universal System Access
Currently 5 PSAPS in Kalamazoo County
Determine EMS need and transfer to EMD Center
Kalamazoo City. Twp., County Co-located PSAPs
Plus Portage, WMU
Emergency Medical Dispatch Center
Determine call Priority
Who needs to go and need for emergency response?
Provide pre-arrival first aid instructions to caller
CPR, obstructed airway, child birth, etc.
Provided by EMS Agency
Secondary PSAP
Medical First Responders
The backbone of the EMS system
Provided by fire and public safety agencies
Rapid response before ambulance arrival
Perform Basic Life Support
CPR, AED, airway support, oxygen, control bleeding
Assist paramedics in patient care and handling
Specialized technical rescue services
Training similar to EMT
~80 hours / Licensed by the State of Michigan
Paramedics
An extension of the emergency room
Provided by private ambulance services
Extensive initial training (~1 year)
Advanced scope of practice
Specialized
airway management
Placement of intravenous lines
Medication administration (25)
EKGs, advanced cardiac interventions
Kalamazoo Hospitals
Two excellent tertiary care hospitals
Specialty Care
Cardiac, neuro, trauma, cancer, OB, peds, burns
Smallest city with 2 Level I Trauma Centers
Joint programs
West Michigan Cancer Center
West Michigan Air Care
MI State Univ. Kalamazoo Ctr. for Medical Studies
Kalamazoo County Medical Control Authority
Kalamazoo County
Medical Control Authority
Joint hospital partnership
Funded by hospitals and ambulance services
State designated, quasi-governmental
Responsible for coordination of EMS system
Establish/enforce clinical and operational protocols
Credential agencies and personnel
Monitor quality, investigate complaints
Provide medical director
Administratively housed at MSU/KCMS
Unique partnership with academic organization
Local Government and EMS
May operate or contract for EMS
Single or combination of local governments
May charge for services or levy special
assessments
May regulate (via ordinance) ambulance
operations
Establish higher standards than state or MCA
Abridged EMS History
1979-86
Kalamazoo Fire Dept.
Citywide paramedic service
1986-93
Unregulated private
ambulance services
“Ambulance Wars”
1993-Present
Performance based
competitive EMS contract
Attributes of High Performance
Ambulance Service Contract
Establishes high standards of care / operations
Exceed local / state standards
Excellent response time performance
National accreditation
Contracted service accountable for performance
Ideally multi-jurisdictional
Defined breaches and penalties
Enhanced economy of scale
Minimal (or no) government subsidy