Research, Profession and Practice
EMS SYSTEMS
Components of an EMS System
Research, Profession and Practice
Today’s EMS System
• Every EMS system must develop an
EMS system that best meets its
needs.
• Provincial and regional-level EMS
systems are often responsible for
planning, developing protocols, and
establishing standards.
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What Constitutes an EMS
System
• By accepted definition, an EMS System
is:
– A comprehensive network of personnel,
equipment, and resources established to
deliver aid and emergency medical care to
the community.
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OUT-OF-HOSPITAL COMPONENTS
OF AN EMS SYSTEM
MEMBERS OF
THE
COMMUNITY
PUBLIC
UTILITIES
COMMUNICATIONS EMS PROVIDERS
SYSTEM
POISON CONTROL
CENTERS
FIRE
RESCUE
HAZMAT
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IN-HOSPITAL COMPONENTS OF AN
EMS SYSTEM
EMERGENCY
NURSES
EMERGENCY AND
SPECIALTY
PHYSICIANS
ANCILLARY
SERVICES
REHABILITATION
SERVICES
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Some
Systems are
tiered in
which BLS
arrives first
and then, if
required, ALS
arrives later.
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Medical Direction
• A medical director is a
physician who is legally
responsible for all clinical
aspects of the system.
• Ontario Base Hospital Group.
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Medical Direction
• The medical director’s role in a
system is to:
–
–
–
–
–
–
–
–
–
educate and train personnel
participate in equipment and personnel selection
develop clinical protocols
participate in problem resolution and QA/QI
provide direct input into patient care
interface with the EMS system
advocate within the medical community
serve as the “medical conscience” of the EMS system
Certify and License personnel to practice
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The Medical
Director can
provide on-line
guidance to
EMS personnel
in the field.
This is
known as
on-line medical
direction.
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Off-line medical
direction refers to
medical policies,
procedures, and
practices that medical
direction has set up in
advance of a call,
such as standard
protocols or standing
orders.
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Protocols are the policies
and procedures for all
elements of an EMS
system.
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Protocols are designed around the
four “T’s” of emergency care.
•
•
•
•
Triage
Treatment
Transport
Transfer
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Patient Transportation
• Patients should be taken to the
nearest facility whenever possible.
• Medical direction should designate
the facility.
• Patients may be transported by
ground or air.
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The helicopter has become an
integral part of prehospital
care.
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Military helicopters
frequently assist civilian
EMS systems.
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A Type-I Ambulance
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A Type II Ambulance
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A Type III Ambulance
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An Emergency Response
Unit
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Air Ambulance
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Not all receiving facilities are equal
in emergency and support service
capabilities.
Local systems and
regions categorize
hospitals based on
capabilities.
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American Trauma Center
Levels
• Level I – provides the highest level of
trauma care
• Level II – may not have specialty
paediatrics or a neurosurgeon on site
• Level III – generally does not have
immediate surgical facilities available
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Canadian Trauma Centre
Levels
• Tertiary Trauma Centre (TTC)
• District Trauma Centre (DTC)
• Primary Trauma Centre (PTC)
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Mutual Aid and MassCasualty Preparation
•
•
•
A formalized mutual aid agreement
ensures that help is available when
needed.
Agreements should be between
neighbouring departments,
municipalities, systems, or provinces.
Each system should also put a disaster
plan in place for catastrophes that can
overwhelm available resources.
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KEY POINT
An EMS system
should have a
disaster plan in place
that is practiced
frequently.
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Quality Assurance and
Improvement
• Quality Assurance is designed to
maintain continuous monitoring and
measurement of the quality of
clinical care.
• Continuous Quality Improvement (CQI)
is designed to refine and improve an
EMS system, emphasizing customer
satisfaction.
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An EMS system must be
designed to meet the needs
of the patient. Therefore,
the only acceptable quality
of an EMS system is
EXCELLENCE!
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Service Quality
Customer satisfaction
can be created or
destroyed with a simple
word or deed.
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Public Education
• An essential and often overlooked
component of EMS is the public.
• EMS systems should develop plans
to educate the public on recognizing
an emergency.
… accessing the system.
… initiating BLS procedures.
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Communications
A coordinated, flexible communications
plan should include:
• Citizen Access
• Single Control Centre
• Operation Communication Capabilities
• Medical Communication Capabilities
• Communications Hardware
• Communications Software
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Education and Certification
• Two kinds of EMS education are initial
and continuing education.
Initial education is the original training
course for pre-hospital providers.
Continuing medical education programs
include refresher courses for recertification
and periodic in-service training sessions.
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Initial Education
• Ideally based on the PAC NOCP’s
establishes the minimum competencies for
the course
CMA accredits education courses
http://www.paramedic.ca under ‘initiatives’
Not all programs follow NOCP guidelines
tightly
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Once the initial
education is completed,
the paramedic will
become either certified
or licensed.
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Certification vs. Licensure
• Certification is the process by which
an agency grants recognition to an
individual who has met its
qualifications.
• Licensure is the process of
occupational regulation.
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4 Certification Levels
•
•
•
•
Emergency Medical Responder
Primary Care Paramedic
Advanced Care Paramedic
Critical Care Paramedic
Make sure you know the scope of practice
and CME requirements for these
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The First Responder is usually
the first EMS-trained provider to
arrive on the scene.
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The PCP is trained to do all that
a first responder can do, plus
other complex skills.
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The ACP Should Possess All the
Skills of a PCP and Be
Competent in Advanced Airway,
IV Therapy, and Other Skills.
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The CCP is the most
advanced EMS provider.
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Paramedic
Association of
Canada
• Canada’s only national organization
• ‘May’ Regulate Practice
• ‘May’ Approve Training Programs
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For next Week
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