CH 2 - EMS Systems
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Sending multiple levels of emergency care personnel to the same incident
Napoleon's chief physician implements a prehospital system designed to triage and transport the injured from the field to aid stations.
Civilian ambulance services begin in Cincinnati and NYC.
Dr. Friedrich Maass performs the first equivocally documented chest compression in humans.
First-known air medical transport occurs during the retreat of the Serbian army from Albania.
First volunteer rescue squads organize in Roanoke, VA, and along the New Jersey coast.
Claude Beck develops first defibrillator and first human saved with defibrillation.
Dr. Peter Safar demonstrates the efficacy of mouth-to-mouth ventilation.
Cardiopulmonary resuscitation (CPR) is shown to be efficacious.
J. Frank Pantridge converts an ambulance into a mobile coronary care unit with a portable defibrillator and recorded ten prehospital resuscitations with a 50% long term survival rate.
The National Academy of Sciences, National Research Council publishes Accidental Death and Disability; The Neglected Disease of Modern Society. (The White Paper)
The Emergency Medical Services Program in the Department of Transportation is established with this act.
Highway Safety Act of 1966
Star of Life is patented by the American Medical Association.
AT&T designates 911 as its new national emergency number.
National Registry of EMTs is founded.
Television show Emergency! debuts on NBC.
Department of Health, Education, and Welfare allocates $16 million to EMS demonstration programs in five states.
The Emergency Medical Services Systems (EMSS) Act provides additional federal guidelines and funding for the development of regional EMS systems; the law establishes 15 components of EMS systems.
National Association of Emergency Medical Technicians (NAEMT) is organized.
Field automated external defibrillators (AEDs) become available.
The Omnibus Budget Reconciliation Act consolidates EMS funding into state preventive health and health services block grants, and eliminates funding under the EMSS act.
Prehospital Trauma Life Support (PHTLS) is developed.
International Trauma Life Support (ITLS), formerly basic trauma life support (BTLS), is developed.
The EMS for Children (EMSC) program, under the Public Health Act, provides funds for enhancing the EMS system to better serve pediatric patients.
National Research Council publishes Injury in America: A Continuing Public Health Problem, describing deficiencies in the progress of addressing the problem of accidental death and disability.
The National Highway Traffic Safety Administration initiates the Statewide EMS Technical Assessment program based on ten key components of EMS systems.
The Trauma Care Systems and Development Act encourages development of inclusive trauma systems and provides funding to states for trauma system planning, implementation, and evaluation.
The Institute of Medicine publishes Emergency Medical Services for Children, which points out deficiencies in our health care system's ability to address the emergency medical needs of pediatric patients.
Congress does not reauthorize funding under the Trauma Care Systems and Development Act.
President Clinton signs bill designating 911 as national emergency number.
Health Insurance Portability and Accountability Act (HIPAA) becomes effective, strictly regulating the flow of confidential information. (written in 1996)
The National Highway Traffic Safety Administration publishes Emergency Medical Services: Agenda for the Future, to guide the development of EMS in the United States in the twenty-first century.
The EMS Agenda for the Future (1966) proposed continued development of 14 core EMS attributes:
- Integration of health services
- EMS research
- Legislation and regulation
- System finance
- Human resources
- Medical direction
- Education systems
- Public education
- Public access
- Communication systems
- Clinical care
- Information systems
The National Academics Institute of Medicine published Emergency Medical Services: At the Crossroads (2006). This paper was critical of many EMS practices and found problems at the federal and governmental levels. The key areas covered were:
- Insufficient coordination
- Limited coordination of transport within regions
- Disparities in response times
- Uncertain quality of care
- Lack of readiness for disasters
- Divided professional identity
- Limited evidence base
AHA Chain of Survival
- 1. Immediate recognition and activation of the EMS system
- 2. Early CPR
- 3. Rapid defibrillation
- 4. Effective Advanced Life Support (ALS)
- 5. Integrated post-cardiac arrest care
A qualified physician gives direct orders to a prehospital care provider by radio or phone.
On-Line medical direction
The four T's of emergency care:
"Sudden death" arrests are deaths that occur within how long of the start of symptoms?
Defibrillation is most effective when delivered within _____ minutes or less after patient collapse.
National EMS Education Instructional Guidelines published by the U.S. DOT establish the minimum content for paramedic programs across the country. Guidelines cover three specific areas:
- Cognitive - facts or information knowledge
- Affective - assign emotions, values, and attitudes
- Psycomotor - hands on skills
The process by which an agency or association (or state) grants recognition to an individual who has met its qualifications.
A government agency (usually a state agency) grants permission to engage in a given trade or profession to an applicant who has attained the degree of competency required to ensure the public's protection.
In 1974, in response to a request from the DOT, the General Services Administration (GSA) developed the "KKK-A-1822 Federal Specifications for Ambulances". The act defined the following basic types of ambulance:
Type I - conventional cab and chassis on which a module ambulance body is mounted, with no passageway between the driver and patient's compartments
Type II - A standard van, body, and cab form an integral unit. Most have a raised roof.
Type III - This is a specialty van with forward cab and integral body. It has a passageway from the driver's compartment to the patient's compartment.
The rules or standards that govern the conduct of members of a particular group or profession.
High-risk areas of EMS practice have been identified by the Institute of Medicine of the National Academies of Sciences in the paper titled To Err is Human: Building a Safer Health System. The three areas identified as highest risk include:
- Skills-based failures
- Rules-based failures
- Knowledge-based failures
Primum non nocere
first, do no harm
High risk areas of EMS:
- Hand-off - failure to provide essential info
- Communications issues
- Medication issues - wrong med, dose, etc
- Airway issues
- Dropping patients
- Ambulance crashes
- Spinal immobilizations
- Death pronouncements
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