Introduction to
Emergency Medical Care
History of EMS
Developed during warfare in the 20th
century
By 1960, domestic emergency care lagged
behind
Staffed emergency departments were
often linked to large urban areas
Funeral homes provided most emergency
transport with no training
History of EMS
1966 publication of Accidental death and
Disability: The Neglected Disease of
Modern Society recommended:
– Development of training
– Federal guidelines and policies
– Provide emergency care and transport
– Established staffed emergency rooms
History of EMS
Highway safety Act and the Emergency
Medical Act created federal funding
DOT developed first National Standard
Curriculum for EMT training (early 70’s)
By 1980 EMS is established in most of the
United States
Layers of Training
Lay Responder
First Responder
EMT-Basic
EMT-Intermediate
EMT-Paramedic
King County EMS
System
King County
King County
coverage area
map.
King County
Dispatch Centers
follow CriteriaBased Guidelines.
•
•
•
•
•
Seattle
Eastside Communications
Port of Seattle
Valley Communications
Enumclaw
King County
Fire/EMS Agencies.
• 38 Fire Departments
• 4000 EMTs
King County
Medic One.
• 5 agencies
• 250 paramedics
King County
Hospitals
• Medical control
hospitals
• Other hospitals
Layers of Care
• Citizens
• Emergency dispatchers
• EMTs
• Paramedics
• Emergency Departments
Chain of Accountability
• Washington State RCW and WAC
• County Medical Program Director
• Program Medical Directors
• Emergency physicians at medical
control hospitals
• EMTs and paramedics
Roles & Responsibilities
Personal Safety
– Safety of self, crew, patient, and bystanders
Patient Assessment
– Patient car based on assessment findings
Lifting and moving patients safely
Transport and transfer of care
Record keeping/data collection
Patient Advocacy
EMT Top 10 List
10. Be Professional
Act the part
Focus on the patient’s problem
Listen to the patient!
Keep family informed
Bedside manner
Respect privacy of patient
– Confidentiality
9. Always Be a Student
Certification every 3 years, on-going
through CBT
EMS Online resource website
Remember every patient can teach you
something
Don’t forget to talk with the doctor
The day you stop learning is the day you
retire from this profession
8. Document Everything
Documentation is your friend and will
protect you when you memory fails
Vital signs
Patient information
Descriptive narratives
Always document unusual situations
If you did not document it, it did not
happen!
7. Embrace Change
New protocols and guidelines for CPR,
FBAO, and resuscitation
ROC
SPHERE
Alert Cards
New protocols and procedures!
6. Follow Established Guidelines
US Department of Transportation
curriculum
Washington State certification
King County guidelines (blue book
protocols)
Local policies as outlined by agency
5. Seek Help
Stay humble
Help from your partners
Help from your paramedics
Help from hospital control
4. Be Safe
Above all else, your safety is tantamount
to all that we do.
Take care of yourself
Remember to be proactive in the use of
PPE/BSI
Drive safely…it’s not your emergency
Everyone goes home at the end of the
shift
3. Stick to the Basics
SICK or NOT SICK!
Vital signs, MOI, NOI, IOS
Common sense and good judgment
Remember, it’s okay if you cannot
diagnose what is wrong with the patient,
it’s not okay if you fail to take care of what
you know how to take care.
2. Take Pride in our System
International reputation
Highest cardiac arrest survival rate in the
world
Highest rates of bystander CPR
Highest taxpayer support (Medic 1 Levy)
Highest trained paramedics in the world
Best EMT training
1. Take Pride in Yourself
Helping others is a proud and noble
profession
Provide care, comfort, and compassion to
all patients…equally
Exceed expectations, strive to be your
best in every situation
Approach each day with courage and
conviction
EMT Well-Being
The Well- Being of the EMT
Personal health, safety, and well-being are
vital to any EMS operation
Intrinsic dangers and hazards of our
occupation vary greatly from call to call
You will be constantly faced with mental
and physical stresses on the job
Even the most experienced provides have
difficulty overcoming personal reactions
Understand the causes of stress
to prevent it from negatively
affecting you!
Remember, if you cannot take
care of yourself, how will you
take care of others?
Stressful Situations
Death and dying
Mass-casualty incidents
Severe trauma
Abuse
Co-worker death or injury
Vehicle accident caused by EMS
personnel
Violent scenes
Warning Signs
Physical
– Fatigue
– Changes in
appetite
– Headaches
– Insomnia
– Irritability
Warning Signs
Psychological:
– Fear
– Depression
– Anger
– Frustration
– Inability to cope
Stress Management
Understand the effects of stress
Find balance in your life
Change or eliminate stressors
Avoid complaining or worrying about
things you cannot change
Expand your social support system
Take care of yourself: diet, exercise, sleep
Stress Management Resources
Partners and co-workers
– Be open with and aware of each other
Family members
Chaplains
Wellness Counseling and EAP
CISM
Critical Incident Stress Debriefing
Held within 48-72 hours of a major incident
All information is confidential
CISD leaders and mental health
professionals offer suggestions for
overcoming stress
Can be initiated by anyone
CISM System
Pre-incident stress
education
Peer support
CISD
Follow-up services
Spouse and family
support system
Scene Safety
Hazardous materials
– Identification and isolation
Electricity
– Live electricity is difficult to see
– Power off at source
Fire
– Protective gear
– Do only what you have been trained to do!
Scene Safety
Violent Scenes
– Civil disturbances, domestic disputes, crime
scenes, large gatherings (mobs)
Motor vehicle accidents
– Safety at scene
Highways, streets, and roads
– Moving traffic is a major hazard!
Body Substance Isolation
Minimum protection
on all calls: gloves
and eye protection
Mask and gowns per
RGT policy
Hand washing and
sanitizer use
Sharps disposal
Body Substance Isolation
Always use Body Substance isolation
precautions
Always us a barrier between yourself and
the patient
Always wash/sanitize your hands after
each patient contact
Make certain immunizations are up to date
Be careful handling sharps
Remember, to always take
care of yourself first…
...BSI and Scene Safety