Chapter 1 EMS Systems
A) Course Description
a) Emergency Medical Services is a system – consists of a team of health care professionals,
who in each area or jurisdiction, are responsible for and provide emergency care and
transportation to the sick and injured
b) Certification – used to ensure all health care providers have at least the same basic level
of knowledge and skill
c) Licensure – the process by which states ensure applicant competency in an examination
setting
d) Four Training and Licensure Levels:
i) Emergency medical responder
• Very basic training and provides care before ambulance arrives
ii) Emergency medical technician
• Has training in basic life support (BLS) including automated external
defibrillation (AED), use of airway adjuncts, and assisting with certain
medication
iii) Advanced EMT
• Trained in some advanced life support: IVs and administration of emergency
medicine
iv) Paramedic
• Extensive training in ALS, including endotracheal intubation, emergency
pharmacology, cardiac monitoring, and other advanced assessment and treatment
skills
e) Most state’s requirements follow or exceed guidelines recommended by current National
Highway Traffic Safety Administration
B) EMT Training: Focus and Requirements
a) Scene Size-up
i) Involves awareness of scene safety and a big-picture awareness of overall situation.
Primary job is to ensure it is as safe as possible.
b) Patient assessment
i) It is the foundation of every EMS call, must determine what is wrong with the patient
c) Treatment
i) EMTs can provide oxygenation and medication therapies. Control bleeding and assist
in childbirth
d) Packaging
i) Will learn how to transport patients with a wide variety of illnesses and injuries
e) EMS as a career
i) Important to learn how to take care of yourself
C) Licensure Requirements
a) Usually include:
i) High school diploma
, ii) Proof of immunization
iii) Completion of background check and drug screening
iv) Driver’s license
v) Completion of BLS and CPR course
vi) Completion of state-approved EMT course
vii) Completion of state-recognized certification exam
viii) Completion of state-recognized practical certification exam
ix) Demonstrate mental and physical ability necessary to perform
b) States have requirements prohibiting people with certain legal infractions from becoming
EMS providers
D) History of EMS
a) Volunteer ambulances were organized during WWI
b) In WWII, military trained special corpsmen to provide care in the field and bring
casualties to aid stations
c) In the 1960s/70s, states had no standards to uphold. Emergency care could have been
provided by first aid modern ambulances, funeral homes, police or fire department, etc.
d) Only large urban cities hospitals had an emergency department
e) 1966 publication
i) Accidental Death and Disability: The Neglected Disease of Modern Society
ii) Known more commonly as The White Paper
iii) Prepared by the Committees on Trauma and Shock of the National Academy of
Sciences / National Research Council
iv) Revealed the inadequacy of prehospital emergency care
v) Because of this, Congress mandated that two federal agencies address this issue:
• NHTSA of the DOT – Highway Safety Act of 1966
• Department of Health, Education, and Welfare (today the Dept. of Health and
Human Services) – Emergency Medical Services Development Act of 1973
f) In 1970s, DOT made first curriculum as guideline for EMT training: The Orange Book
g) In 1980s, many areas enhanced the EMT national standard curriculum
h) In 1990s, NHTSA made the EMS Agenda for the Future to standardize the levels of EMS
education throughout the country
E) Medical Direction
a) Medical director – a physician who authorizes the EMTs in the service to provide
medical care in the field
i) The appropriate care is described in a set of written standing orders and protocols
ii) Determine the continuing education and training that are required of each EMT
b) Medical control – provided either offline (indirect) or online (direct) as authorized by the
medical director
i) Online: direction given over the phone or radio directly from the medical director, a live
person.
ii) Offline: consists of standing orders, training, and supervision authorized by the
medical director.
iii) Standing Order: Not required to consult a doctor, specific protocol for specific
conditions.
, F) Mobile Integrated Healthcare (MIH)
a) This is a new method of delivering health care that utilizes the prehospital spectrum
i) Has evolved because of the Patient Protection and Affordable Care Act
b) Continuity of care: pass off patient to equal or higher level of care. Must have legal
documentation.
G) Evaluation
a) Quality Control – ensuring all staff members who are involved in caring for patients meet
appropriate medical care standards on each call
i) Maintained by the medical director
ii) Done by reviewing PCRs, audit administrative records, and survey patients
b) Continuous Quality Improvement – a circular system of continuous internal and external
reviews and audits of all aspects of an EMS system
i) Periodic run review meetings are held with those involved in patient care to review
the run reports and then discuss any areas of care that appear to need change or
improvement
ii) Also determine ways to limit or eliminate human error
iii) Three types of errors:
• Rules-based failure – practicing outside scope of practice
• Knowledge-based failure – occurs if EMT does not know all pertinent
information
• Skills-based failure – operating equipment improperly
H) Professional Attributes of EMTs
a) Integrity – honest behavior
b) Empathy
c) Self-motivation
d) Appearance
e) Self-confidence – a state of being where you know what you know AND know what you
do not know; able to ask for help
f) Time management
g) Communications
h) Teamwork and diplomacy
i) Respect
j) Patient advocacy
k) Careful delivery of care
Chapter 2 Workforce Safety and Wellness
A) General Health and Wellness
a) Your health and the health of the patient are intertwined
b) Wellness is a state of complete mental, physical, and social well-being
A) Course Description
a) Emergency Medical Services is a system – consists of a team of health care professionals,
who in each area or jurisdiction, are responsible for and provide emergency care and
transportation to the sick and injured
b) Certification – used to ensure all health care providers have at least the same basic level
of knowledge and skill
c) Licensure – the process by which states ensure applicant competency in an examination
setting
d) Four Training and Licensure Levels:
i) Emergency medical responder
• Very basic training and provides care before ambulance arrives
ii) Emergency medical technician
• Has training in basic life support (BLS) including automated external
defibrillation (AED), use of airway adjuncts, and assisting with certain
medication
iii) Advanced EMT
• Trained in some advanced life support: IVs and administration of emergency
medicine
iv) Paramedic
• Extensive training in ALS, including endotracheal intubation, emergency
pharmacology, cardiac monitoring, and other advanced assessment and treatment
skills
e) Most state’s requirements follow or exceed guidelines recommended by current National
Highway Traffic Safety Administration
B) EMT Training: Focus and Requirements
a) Scene Size-up
i) Involves awareness of scene safety and a big-picture awareness of overall situation.
Primary job is to ensure it is as safe as possible.
b) Patient assessment
i) It is the foundation of every EMS call, must determine what is wrong with the patient
c) Treatment
i) EMTs can provide oxygenation and medication therapies. Control bleeding and assist
in childbirth
d) Packaging
i) Will learn how to transport patients with a wide variety of illnesses and injuries
e) EMS as a career
i) Important to learn how to take care of yourself
C) Licensure Requirements
a) Usually include:
i) High school diploma
, ii) Proof of immunization
iii) Completion of background check and drug screening
iv) Driver’s license
v) Completion of BLS and CPR course
vi) Completion of state-approved EMT course
vii) Completion of state-recognized certification exam
viii) Completion of state-recognized practical certification exam
ix) Demonstrate mental and physical ability necessary to perform
b) States have requirements prohibiting people with certain legal infractions from becoming
EMS providers
D) History of EMS
a) Volunteer ambulances were organized during WWI
b) In WWII, military trained special corpsmen to provide care in the field and bring
casualties to aid stations
c) In the 1960s/70s, states had no standards to uphold. Emergency care could have been
provided by first aid modern ambulances, funeral homes, police or fire department, etc.
d) Only large urban cities hospitals had an emergency department
e) 1966 publication
i) Accidental Death and Disability: The Neglected Disease of Modern Society
ii) Known more commonly as The White Paper
iii) Prepared by the Committees on Trauma and Shock of the National Academy of
Sciences / National Research Council
iv) Revealed the inadequacy of prehospital emergency care
v) Because of this, Congress mandated that two federal agencies address this issue:
• NHTSA of the DOT – Highway Safety Act of 1966
• Department of Health, Education, and Welfare (today the Dept. of Health and
Human Services) – Emergency Medical Services Development Act of 1973
f) In 1970s, DOT made first curriculum as guideline for EMT training: The Orange Book
g) In 1980s, many areas enhanced the EMT national standard curriculum
h) In 1990s, NHTSA made the EMS Agenda for the Future to standardize the levels of EMS
education throughout the country
E) Medical Direction
a) Medical director – a physician who authorizes the EMTs in the service to provide
medical care in the field
i) The appropriate care is described in a set of written standing orders and protocols
ii) Determine the continuing education and training that are required of each EMT
b) Medical control – provided either offline (indirect) or online (direct) as authorized by the
medical director
i) Online: direction given over the phone or radio directly from the medical director, a live
person.
ii) Offline: consists of standing orders, training, and supervision authorized by the
medical director.
iii) Standing Order: Not required to consult a doctor, specific protocol for specific
conditions.
, F) Mobile Integrated Healthcare (MIH)
a) This is a new method of delivering health care that utilizes the prehospital spectrum
i) Has evolved because of the Patient Protection and Affordable Care Act
b) Continuity of care: pass off patient to equal or higher level of care. Must have legal
documentation.
G) Evaluation
a) Quality Control – ensuring all staff members who are involved in caring for patients meet
appropriate medical care standards on each call
i) Maintained by the medical director
ii) Done by reviewing PCRs, audit administrative records, and survey patients
b) Continuous Quality Improvement – a circular system of continuous internal and external
reviews and audits of all aspects of an EMS system
i) Periodic run review meetings are held with those involved in patient care to review
the run reports and then discuss any areas of care that appear to need change or
improvement
ii) Also determine ways to limit or eliminate human error
iii) Three types of errors:
• Rules-based failure – practicing outside scope of practice
• Knowledge-based failure – occurs if EMT does not know all pertinent
information
• Skills-based failure – operating equipment improperly
H) Professional Attributes of EMTs
a) Integrity – honest behavior
b) Empathy
c) Self-motivation
d) Appearance
e) Self-confidence – a state of being where you know what you know AND know what you
do not know; able to ask for help
f) Time management
g) Communications
h) Teamwork and diplomacy
i) Respect
j) Patient advocacy
k) Careful delivery of care
Chapter 2 Workforce Safety and Wellness
A) General Health and Wellness
a) Your health and the health of the patient are intertwined
b) Wellness is a state of complete mental, physical, and social well-being
