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Chapter 2

Emergency Care Systems

National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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Objectives

2.1

List six attributes of an emergency care system.

2.2

List four nationally recognized prehospital emergency care provider levels.

2.3

Compare and contrast direct medical oversight and indirect medical oversight.

2.4

Describe the purpose of quality improvement.

National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

BRADY

Topics

 History  EMS Agenda for the Future  Emergency Personnel  Facilities  Continuity of Care  The Importance of Commonality  Public Health  Research

continued

National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

BRADY

Topics

 Communication Systems  Medical Oversight  Protocols  Documentation  Quality Improvement  Continuing Education  Chapter Summary National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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Case Presentation

You are skiing with some friends when one of your companions falls. As you ski up to her, you find her lying on her side, clutching her ankle. She appears to be in great distress. A quick examination reveals intense pain in the woman’s right lower leg/ankle which is bent at an unnatural angle. She is awake and has no other injuries; however, she is unable to stand, and cannot get down the mountain on her own.

National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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History

11 C 1799-1815 1928 1914 - 1918 1950 -1953 1943 -1945 Napoleonic wars Royal flying Doctors of Australia Korean War Crusades World War I World War II

continued

National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

History

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Copyright Jerry Young / Dorling Kindersley Media Library

National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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History

Copyright Edward McNamara

National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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EMS Agenda for the Future

 1970- 1973 - The National Registry of Emergency Medical Technicians (NREMT) founded to establish professional standards  1973 - Congress passed the National Emergency Medical Service System Act  1977 - DOT published the first EMT Paramedic Curriculum

continued

National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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EMS Agenda for the Future



National Highway Traffic Safety Administration (1966)

◦ Outlined key goals and 14 attributes of an effective emergency care system ◦ Provided strategies to help fully integrate out-of-hospital activities with the overall health care system.

continued

National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

EMS Agenda for the Future

BRADY National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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Emergency Personnel

 Four Nationally Recognized Levels ◦ ◦ ◦ Emergency Medical Responder (EMR) Emergency Medical Technician (EMT) Advanced Emergency Medical Technician (AEMT) ◦ Paramedic

continued

National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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Emergency Personnel

 Emergency Medical Responder (EMR) ◦ Serves as the first responder of an ◦ ◦ emergency care system Often the first formally trained healthcare provider to access the patient. Trained to provide immediate life-saving treatment and stabilization to critically ill or injured patients while awaiting additional emergency response.

continued

National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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Emergency Personnel

Copyright Edward McNamara continued

National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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Emergency Personnel

 Emergency Medical Technician (EMT) ◦ Completed a NHTSA-approved EMT National Standard training course or its equivalent ◦ Functions with medical oversight to provide basic life support interventions

continued

National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

BRADY

Emergency Personnel

 Advanced Emergency Medical Technician (AEMT) ◦ Completed a NHTSA-approved AEMT ◦ ◦ National Standard training course or its equivalent. Functions under medical oversight May perform all of the skills performed by an EMT

continued

National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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Emergency Personnel

 Paramedic ◦ Allied healthcare professional who has successfully completed a NHTSA approved Paramedic course that includes extensive didactic, practical, and clinical training requirements.

continued

National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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Emergency Personnel

Copyright Edward McNamara continued

National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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Emergency Personnel

 Other EMS Personnel ◦ ◦ ◦ ◦ ◦ ◦ Physicians (MD, DO) Physicians Assistants (PA) Nurse Practitioners (NP) Registered Nurses (RN) Licensed Practical Nurses (LPNs) Allied Health Care Professionals

continued

National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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Emergency Personnel

Copyright Edward McNamara continued

National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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Emergency Personnel

Copyright Edward McNamara continued

National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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Emergency Personnel

 Tiered approach ◦ Tier 1 - EMR • • Arrive quickly at the scene Initiate basic emergency care ◦ Tier 2 - EMT • Arrive shortly after emergency medical responders • Provide basic life support measures

continued

National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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Emergency Personnel

continued Copyright Scott LaPrade

National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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Emergency Personnel

Copyright Studio 404 continued

National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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Emergency Personnel

continued Copyright CORBIS-NY

National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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Emergency Personnel

 Tiered approach ◦ Tier 3 – AEMT, Paramedics • • • Arrive after EMRs/EMTs Provide advanced life support measurers Transport the patient to a definitive care facility

continued

National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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Emergency Personnel

Copyright Studio 404 continued

National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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Emergency Personnel

 Tiered approach ◦ Tier 4 – Critical Care Providers • Additional life support equipment, therapies, interventions to the scene • Transport the patient to specialized hospital

continued

National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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Emergency Personnel

continued

National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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Facilities

 Medical facilities are an important part of the emergency care system  Hospitals  Acute care clinics ◦ ◦ ◦ ◦ Acute pediatric care facility Burn center Stroke center Toxicology center National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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Continuity of Care

 Complex continuum involving each attribute of emergency care ◦ Delivery of high quality emergency medical care ◦ Patient transitions from his initial contact with a first responder through definitive treatment National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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Continuity of Care

Copyright Studio 404

National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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The Importance of Commonality

 A Team Approach ◦ ◦ Common goals Common language • • Medical terms Rescue terms ◦ Common practices and procedures National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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The Importance of Commonality

Copyright Craig Brown

National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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Case Update

Activate the emergency care system: send someone for ski patrol assistance; keep the patient calm and warm. Try not to move the person; stabilize the ankle and leg. Assist ski patrollers upon their arrival: provide information about the incident and the patient.

continued

National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

BRADY

Case Update

Patrollers assess the patient and initiate treatment: they splint the leg to prevent further injury and transport the patient to an awaiting ambulance crew who administer pain medication and take the patient to a definitive care facility.

What is your responsibility?

continued

National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

Case Update

BRADY National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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Public Health

 Designed to promote healthier living: ◦ ◦ ◦ Epidemiology Injury prevention Policy and program development National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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Research

 Research plays an essential role in health care ◦ Identify epidemiological and pathological trends ◦ ◦ Report clinically relevant findings Introduce new technologies, practices and techniques. National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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Research

Copyright Snowbird

National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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Communication Systems

 EMS communication system ◦ ◦ ◦ Hardware Software Specialized professionals

continued

National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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Communication Systems

continued

National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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Communication Systems

 OEC technicians use various communication tools: ◦ Radio • Radio etiquette • • Radio terminology Factors that can adversely affect communications • • NATO Alphabet Military time National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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Communication Systems

continued

National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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Communication Systems

continued

National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

BRADY

Communication Systems

continued

National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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Communication Systems

 OEC technicians use various communication tools: ◦ ◦ Hard wired telephones Cellular telephones National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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Medical Oversight

 A licensed physician must assume legal responsibility for a patient’s care during an emergency.

◦ Direct oversight • • Real-time voice contact Licensed physician ◦ Indirect oversight • Out of hospital providers not authorized to contact a physician before specific treatments • Pre-authorizing National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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Medical Oversight

Copyright Edward McNamara

National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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Protocols

 Developed on a local level by emergency professionals who are familiar with area’s medical needs, available resources, system capabilities and local standard of care.

continued

National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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Protocols

 Written instructions ◦ Guidelines that identify the assessment and treatment considerations for commonly encountered emergencies ◦ Reviewed annually and revised as needed National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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Documentation

 Good documentation  Hallmark of true medical professional  Serves many purposes ◦ ◦ Pertinent clinical details Can be used as a research source

continued

National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

BRADY

Documentation

 Serves many purposes ◦ Provide legal protection for: • • • Care provider Patrol Ski area ◦ Quality improvement purposes National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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Quality Improvement

 Providing the best patient care possible ◦ On-going process that is designed to ensure products and services meet or exceed customer expectations ◦ Quality improvement • • • Prospective Concurrent Retrospective National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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Continuing Education

 Essential requirement of any professional license or certification ◦ ◦ On-going training OEC refresher coursework National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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Continuing Education

Copyright Edward McNamara

National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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Case Disposition

The patient makes a full recovery due to your quick response in activating the local emergency care system. National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

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Chapter Summary

 OEC technicians are an essential part of an emergency care system.

 OEC technicians provide emergency assistance and transportation to patients not served by traditional 9-1 1.

continued

National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

BRADY

Chapter Summary

 An emergency care system is a network of specially trained personnel, equipment, facilities, and other resources that respond to emergencies.

 Ski patrols and ski patrollers are part of the emergency care system.

continued

National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

BRADY

Chapter Summary

 An effective emergency care system has 14 distinct attributes.

 In the United States, there are four types of out-of-hospital emergency care providers: emergency medical responder, EMT, Advanced EMT, and Paramedic.

continued

National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

BRADY

Chapter Summary

 Emergency care system resources are deployed using a tiered approach that is based on specific needs.

 Common goals, language, and practice allow the components of an emergency care system to function as a team.

continued

National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

BRADY

Chapter Summary

 Effective communications permits the emergency care system to operate in a coordinated manner.

 Time is measured using military or universal time.

continued

National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ

BRADY

Chapter Summary

 Medical oversight and quality improvement ensure that the care the patient receives is in accordance with area medical guidelines.

 By using prospective, concurrent and retrospective quality improvement methods, an OEC technician can improve his care.

National Ski Patrol,

Outdoor Emergency Care, 5th Ed.

©2012 by Pearson Education, Inc., Upper Saddle River, NJ