Chapter 1

Introduction to Emergency Medical Services

Competency
Applies fundamental knowledge of the EMS system, safety/well-being of the EMT, and medical/legal
and ethical issues to the provision of emergency care.

Core Concepts
The chain of human resources that forms the
EMS system
How the public activates the EMS system
Your roles and responsibilities as an EMT
The process of EMS quality improvement
 Outcomes

After reading this chapter you should be able to:

1. Describe the components of the EMS system.

Describe the connections between EMS history and EMS today

Recognize EMS components that make up the EMS systems
Diagram the chain of human resources in EMS systems
Describe the communication systems by which the public can access
EMS

2. Summarize the roles and responsibilities of EMS

Explain the different levels of EMS training

Describe the tasks within the roles and responsibilities of an EMT
Explain the traits of an EMT that convey professionalism
Explain the EMTs role in quality improvement
Explain the role of an EMS system physician Medical Director
3.Describe the connection between public health and EMS
*List ways that EMS systems can support public health
4. Summarize the role of evidence-based research in EMS
*Identify ways research impacts EMS
*Explain the evidence-based process for EMTs
*Explain the different methods of medical research
*Explain how to evaluate medical research
KEY TERMS
evidence-based techniques
medical direction
Medical Director
911 System
off-line medical direction
on-line medical direction
patient outcomes
peer reviewed
protocols
quality improvement
standing orders
The earliest
documented
Emergency Medical
Services was in the
1790’s and later
called Napolean’s
“flying ambulances”
which were used to
move wounded from
the battlefield to
where they would
get medical care.
Clara Barton assisted treating wounded during the
Civil War and established the Red Cross.
During WWI, volunteers joined battlefield
ambulance corps.
During the Korean conflict and Vietnam War,
medical teams were made further advances in
*field care. Many of these led to advances in the
civilian sector, including trauma centers.
In the early 1900’s, Nonmilitary ambulance
services began transport service which did not
provide prehospital medical care.
In the late 1940’s the Undertaker used a hearse to
provide the ambulance transport in smaller
communities but did not provide medical care.
If the patient got medical care enroute to the
hospital, the service was the responsible agency.
 So how did we get to the EMS we have today?
The development of the modern EMS systems began in the
1960’s
1966, the US DOT was put in charge by the National Highway
Safety Act with developing EMS standards and helping states
upgrade the quality of their prehospital care (most current
EMT courses are based on models DOT developed)
1970, NREMT was founded and established professional
standards.
1973, the National Emergency Medical Systems Act was
passed by Congress as a federal effort to implement and
improve EMS systems across the U.S.
 The National Highway Traffic **YOU NEED TO KNOW ABOUT Established an assessment program
Safety Administration (NHTSA) THIS** with a set of standards for EMS
systems.

Regulation and Policy: Resource Management: Human Resources and Training:

Each state EMS system must have in There must be a centralized At a minimum, all transporting
place enabling legislation (laws that coordination of resources so all prehospital personnel (those who ride
allow the system to exist), a lead EMS patients have equal access to basic the ambulances) should be trained to
agency (Maine EMS), a funding emergency care by certified the EMT level using National EMS
mechanism, regulations, policies, and personnel, in a licensed and equipped Education Standards that are taught
procedures. ambulance, to an appropriate facility. by qualified instructors. (Our EMT
class for example)

Transportation: Facilities: Public Information and Education:

Safe and reliable ambulance Critically ill or injured patients must be EMS personnel may participate in
transportation is critical. Majority of transported to the closest appropriate educating the public about their roles I
patients can be transported by ground facility in a timely manner. the system, how to access the system,
ambulance. Some critically injured or and injury prevention.
ill patients, or those in remote areas
may need transportation by helicopter
or airplane.
Medical Direction: Each EMS system must have a physician as Medical Director who is
accountable for the activities of EMS personnel within that system. The Medical
Director is involved with all aspects of the patient care system including protocol
development, training, and quality improvement.

Trauma Systems: Enabling legislation must exist in each state to develop a trauma
system including one or more trauma centers (Maine Medical Center, Central Maine
Medical Center, Eastern Maine Medical Center), triage and transfer guidelines for
trauma patients, rehab programs, data collection, mandatory autopsies, and means for
managing and ensuring the quality of the system.

Evaluation: Each state must have a program for evaluating and improving the
effectiveness of the EMS system, known as QA/QI (quality assurance/quality
improvement) or TQM (total quality management.
This means that EMS services were now
held to a standard and held responsible.

EMS services were no longer just

“Ambulance Drivers” who put patients into
the ambulance and took them out of it.

”Victims” were now called patients.

”Ambulance attendants” were now called

Emergency Medical Technicians
 The Chain of Human Resources that Forms the EMS
system

911 Caller
Emergency Medical Dispatcher

Patient

Allied Health Staff EMTs

Emergency Department Staff
1. Patient gets sick or injured
2. Person calls 911 (911 system is available for 99% of the population)
3. Emergency Medical Dispatcher answers the call and dispatches the appropriate responders.
4. Ambulance transports patient to closest appropriate Emergency room and treated by Emergency
Department staff.
5. After initial assessment and treatment, the ER serves as a gateway to any further assessments and
treatments by allied health staff.
Enhanced 911 centers can ID the caller’s landline phone number and location automatically (local
911 in Maine like Sanford Regional Dispatch Center), some can also locate wireless callers (State
Police) in case the caller does not know their location or cannot answer the dispatcher.
Dispatchers can now be trained to be certified emergency medical dispatchers who are trained to
provide medical instructions such as CPR, bleeding control, artificial ventilation, and more.
 Levels of EMS Training
*4 general levels of training
*May vary from state to state

Emergency Medical Responder: Usually the first one on scene (police, industrial health personnel, some firefighters). Trained to
activate the 911 system, provide immediate care for life-threatening injuries, control scene, prepare for ambulance arrival

Emergency Medical Technician (EMT): Usually minimum level of training required for ambulance personnel. Provide basic-level medical and
trauma care and transportation to the medical facility and frequently work with Advance Life Support (ALS) providers.

Advance Emergency Medical Technician (AEMT): Provides the same skills as an EMT plus provides some advanced level of
care which may include IV’s, IO’s, some medications, some fluids, some advanced airway devices, and recognize some cardiac
rhythms on the cardiac monitor.

Paramedic: Same skills as an EMT and AEMT plus advanced level of assessment, decision makings skills, surgical
procedures (surgical cricothyrotomy), chest decompressions, full use of cardiac monitors. Paramedic provide the
highest level of prehospital care.
THINK LIKE AN EMT
Critical decision making is VERY important.
The EMT takes all the information from the scene,
the assessment, and other sources then decides
what the best course of action for the patient will
be.

Some examples of critical decision making

include:

Does this patient need ALS or can you safely transport the
patient at the EMT level?
Which is the closest appropriate hospital?
Are they stable enough to make it to that hospital or do
you need to go to a closer one even though it may not be
the best appropriate one?
Does this patient need you to administer a medication?
What can happen if you administer the medication (will
they get better or worse)?
 Roles and Responsibilities of the EMT
You are not just responsible for patient assessment and patient care!

Personal safety: You must watch out for your own safety. If you get hurt, you can’t help the
patient that needs you. You have extra dangers at fire scenes, from other people, motor vehicle
crashes, animals, and more.

Safety of crew, patient, and bystanders: The dangers that can hurt you can hurt everyone else
involved. You also need to watch out for their safety.

Working with other public safety professionals: As an EMT, you will be working closely with
other EMS providers, firefighters, police, hazmat teams, FEMA, and many others.

Patient assessment: One of the most important jobs you have is assessing the patient (finding
out what’s wrong). You have to assess them in order to provide the best appropriate care.
Patient care: The care you will provide based on your assessment findings.
Sometimes it might be bleeding control, splinting fractures, providing high quality CPR
and defibrillation, or simply holding their hand to provide emotional support.

Lifting and moving: If you cannot safely lift and move the patient, you cannot get them to the
hospital.

Transport: It is a serious responsibility to be able to operate an ambulance at any time in any time
of situation, and in any type of weather condition. It includes safe operation of the ambulance,
securing and caring for the patient in the ambulance.

Transfer of care: You will turn over patient care to the ER staff once you arrive at the hospital.
You will need to tell them the patients name, age, chief complaint, assessment findings,
treatment provided enroute to the hospital, etc. You NEVER abandon the patient in the ER. You
wait until you transfer care to ER personnel before you leave them.

Patient Advocacy: As an EMT, you are the for the patients. You are the person who speaks up
for the patient and pleads their cause. Actions that seem minor to you, may be really important
and mean a lot for your patient.
Traits of a
GOOD
EMT
Physical Traits

Physically be in good health and fit to carry out

your duties.
Should be able to lift and carry up to 125 lbs.
(Some department requirements vary).
Remember cot linen, patient clothing, medical
equipment, etc all add to that weight.
Be able to see clearly with or without
glasses/contacts.
Have good hearing with or without hearing
assistance devices. (If you can’t hear what the
patient is telling your or their v/s. How will you
help them?)
Personal Traits

Pleasant to inspire confidence and help keep the patient calm

Sincere to be able to convey an understanding of the situation the
patient’s feelings
Cooperative to allow for better and faster care when working with
other first responders, patient’s families/caregivers, and will help
give them confidence in you.
Resourceful to be able to adapt and overcome obstacles and adjust
techniques to meet your situation
Self-Starter show initiative. Be able to accomplish what has to be
done without relying on others to do it.
Emotionally stable to overcome the unpleasant and difficult things
you will encounter in EMS. DO NOT be afraid to talk about your
feelings or ask for help! Some things you will see will be extremely
difficult to process. Your mental well being is vital!
Able to lead take necessary steps to control the scene, organize
bystanders, deliver emergency, and take charge when necessary.
Neat and clean in appearance. You have to appear neat, professional, and practice good
hygiene. Patients and bystanders will not have confidence in you or want you anywhere
near them if you don’t.

Of good moral character and respectful of others. Don’t be a jerk! Nobody likes a jerk. Nobody likes
to be disrespected. Nobody likes a liar. You must always be respectful, tactfully honest, and
respectful of your patients. (This includes with their belongings, home, valuables, and towards the
family)

In control of personal habits in order to render proper aid and prevent patient discomfort.
Do not consume alcohol within 8 hours of your shift (most departments have a 12 hour cut
off rule). Do not smoke, use chewing tobacco, or other nicotine products when with a
patient or on a scene.

Be controlled in conversation and be able to communicate properly. Avoid getting angry, having
inappropriate conversations, using foul language that can upset or anger your patient, bystanders, or
other providers. Do NOT talk about your patient to others other than receiving ER personnel.
Remember HIPAA!!
Able to listen to others to be
COMPASSIONATE and
EMPATHETIC, to be accurate with
interview, and to inspire
confidence

Nonjudgmental and fair treating ALL

patients fair and equally regardless
of ethnicity, religion, lifestyle,
culture. You MUST respect your
patients despite cultural differences,
ethnicity, religions, sexual
preference, gender, disabilities.
 Education

You must remain up-to-date with your

knowledge and skills. Medicine is
constantly changing. You have to be able
to change and adjust with it.

There are many ways you can do

this:
1) Refresher training
2) Continuing education classes
3) EMS Conferences
4) In house trainings
 Where will you
become a provider?
Establishes and maintains a national standard and provides
registration for EMR’s, EMT’s, AEMT’s, Paramedics.
Get it by successfully completing NREMT computer and
practical exams.
Holding it helps make reciprocity easier for you (transferring
you license from one state to another.
Most states use National Registry exams as their exams.
A lot of employers prefer you are nationally registers.
 Continuous self review to identify aspects of the system that
need improvement.
You have a vital role to play in it and work towards quality care.

Carefully preparing written documentation. You have

QUALITY 1)
to have well documented and complete run reports.
IMPROVEMENT 2) Becoming involved in the QI process. You can become
part of the QI committee and help review run reports.
3) Obtaining feedback from patients and hospital staff.
Can be done formally or informally. Some departments
mail out review forms to help get feedback.
4) Continuing your education. Medicine and techniques
are constantly evolving. If you do not stay up-to-date
on your skills and knowledge, you cannot provide
quality care.
Medical Direction

Your agency will have a Medical Director – Physician who assumes

ultimate responsibility for Medical Direction – oversight of the
patient care aspects of the EMS System.
Off-line Medical Direction – Standing orders from the Medical
Director that allow EMTs to do certain skills and administer certain
medications without having to speak to the Medical Director.
On-line Medical Direction – Verbal orders given directly to the EMT
in the field by the physician over the radio or phone. You can utilize
online medical directions anytime you need medical advice to that
would be beneficial to the patient.
Protocols – Authorizes EMS providers to perform certain skills or
medications in certain situations. Every state has their own protocols
for EMS providers to follow. (Similar to off-line medical directions)
EMS Role in Public Health
EMS has many roles in the public including:

Injury prevention for geriatric patients – When in their home, you

can help identify things that can cause them to fall. Run blood
pressure clinics. Offer ways they can present medications and past
medical history to EMS providers.
Injury prevention for youth – You can run car seat clinics,
distribute bicycle helmets, etc.
Public Vaccination Programs – EMS providers are being trained to
administer vaccines (like covid) and are allowed to run clinics to
provide these needed vaccines to the public.
Disease Surveillance: EMS reports can help show trends in
spreading illness and increasing injuries such as the flu, Norovirus,
hip fractures, etc.

EMS does more than just respond to emergencies.

You will most likely play a larger role in the
community in which you serve.
 Research

Medicine is based on research. Everything you will do is based on the results from research.

Evidence based decision making means that the procedures and knowledge we use in
determining what care works are based on scientific evidence.

Forming Reviewing Evaluating Adopting

Forming a hypothesis – As an Reviewing literature – You Evaluating the evidence – You Adopting the practice if evidence
experienced provider, you felt searched medical literature to meet with the Medical Director supports it – If the medication
using a new medication would be determine if the medication has to review the literature and if has been studied and the
safe and beneficial for the been studied for use by EMTs. none, they can create a study for medication seems safe, the
patient. it. Medical Director could hold
training sessions before
implementing it into the EMT
scope of practice.
QUESTIONS?
???