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?
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“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.
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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
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EMS System Access
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911 Public Safety Answering Points (PSAP)
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Universal System Access
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Currently 5 PSAPS in Kalamazoo County
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Determine EMS need and transfer to EMD Center
Kalamazoo City. Twp., County Co-located PSAPs
Plus Portage, WMU
Emergency Medical Dispatch Center
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Determine call Priority
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Who needs to go and need for emergency response?
Provide pre-arrival first aid instructions to caller
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CPR, obstructed airway, child birth, etc.
Provided by EMS Agency
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Secondary PSAP
Medical First Responders
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The backbone of the EMS system
Provided by fire and public safety agencies
Rapid response before ambulance arrival
Perform Basic Life Support
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CPR, AED, airway support, oxygen, control bleeding
Assist paramedics in patient care and handling
Specialized technical rescue services
Training similar to EMT
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~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
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 Specialized
airway management
 Placement of intravenous lines
 Medication administration (25)
 EKGs, advanced cardiac interventions
Kalamazoo Hospitals
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Two excellent tertiary care hospitals
Specialty Care
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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
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Kalamazoo County
Medical Control Authority
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Joint hospital partnership
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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
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Administratively housed at MSU/KCMS
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Unique partnership with academic organization
Local Government and EMS
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May operate or contract for EMS
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Single or combination of local governments
May charge for services or levy special
assessments
May regulate (via ordinance) ambulance
operations
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Establish higher standards than state or MCA
Abridged EMS History
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1979-86
Kalamazoo Fire Dept.
 Citywide paramedic service
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1986-93
Unregulated private
ambulance services
 “Ambulance Wars”
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1993-Present
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Performance based
competitive EMS contract
Attributes of High Performance
Ambulance Service Contract
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Establishes high standards of care / operations
Exceed local / state standards
 Excellent response time performance
 National accreditation
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Contracted service accountable for performance
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Ideally multi-jurisdictional
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Defined breaches and penalties
Enhanced economy of scale
Minimal (or no) government subsidy