Emergency Medical Services

An Introduction

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EMS Tutorial: The EMS Responder


What's an ambulance driver?

Actually someone does need to drive the ambulance, however, emergency personnel do provide additional services.

From the Occupational Outlook Handbook, 2000-2001 edition: “People’s lives often depend on the quick reaction and competent care of emergency medical technicians (EMTs) and paramedics. Incidents as varied as automobile accidents, heart attacks, drownings, childbirth and gunshot wounds all require immediate medical attention. EMTs and paramedics provide this vital attention as they care for and transport the sick or injured to a medical facility.”

Out-of-hospital emergency medical responders come in four basic flavors: First Responder, EMT-Basic, EMT-Intermediate, and EMT-Paramedic. Registered Nurses do participate in out-of-hospital medicine, more often during interfacility transports than in the prehospital phase. Physician participation in out-of-hospital health care is variable but overall it is low. This has not always been the case. During the first half of the last century, ambulance services were provided by the local hospital. With a ready supply of physicians in training (interns), it was natural for them to rotate on the ambulance. They provided needed care and received valuable experience. This included one of the first female interns, Emily Dunning Barringer. Unfortunately, as hospitals got out of the ambulance business, they took their docs with them. Physician interest in out-of-hospital medicine was not significantly resuscitated until the 1980’s.

The following descriptions are based on the national standard curricula developed for each level by the National Highway Traffic Safety Administration (NHTSA). For a more detailed review, the complete curriculum for each level is available for viewing or download from NHTSA

  • First Responders: A ‘first responder’ in small caps is the first individual on scene regardless of training. ‘First Responder’ in large caps is an individual that "uses a limited amount of equipment to perform initial assessment and intervention and is trained to assist other EMS providers." The 40-hour training program covers patient assessment, basic airway management, medical emergencies, bleeding and soft tissue injuries, injuries to muscles and bone, childbirth, and basic care for infants and children.
  • EMT-Basic: The foundation provider for out-of-hospital medicine. 110 hours of training that includes all the First Responder topics plus bag valve mask ventilation; cervical spine stabilization; oral medication administration (oxygen, oral glucose, activated charcoal); assisting patient medication administration of prescribed nitroglycerine, multi-dose inhaler and epinephrine auto injector; operation of an automatic external defibrillator; ambulance operations; communications; documentation.
  • EMT-Intermediate: The current recommended training program length is 300-400 hours (175-225 classroom/practical laboratory, 50-75 clinical, 75-100 field internship). The EMT-I has all the knowledge of the EMT-B plus more advanced patient assessment skills; administers a limited number of medications by mouth, inhaled into the lungs or through a needle in a vein (intravenous) or into the bone marrow (intraosseous); administers intravenous or intraosseous fluid; insert a breathing tube in the windpipe (tracheal tube insertion or dual lumen airway); use of Magill forceps (long graspers) for foreign body removal; needle decompression of the chest (remove air from the chest through a needle to treat a collapsed lung).
  • EMT-Paramedic: The current recommended training program length is 1000-1200 hours. The EMT-P has all the knowledge of the EMT-I plus a more extensive background in disease processes; more advanced patient assessment skills; a much expanded medication capability to include many additional drugs and the use of medication infusions for adult and pediatric patients; in addtion to all of the procedures described above, the paramedic can establish an emergency surgical airway by inserting a needle or making a small cut into the trachea (wind pipe). The Paramedic is the highest level for Emergency Medical Technicians.

So . . . First Responders and EMT-Basics provide Basic Life Support (BLS) level of care. EMT-Intermediates and EMT-Paramedics provide care at the Advanced Life Support (ALS) level.

It is important to realize that each state determines its own training curricula and scope of practice (what the EMT can actually do in the field). Adoption of the national standard curricula will vary from state to state as will the scope of practice. To find out what is applicable in your area, check with your state EMS office. Contact information for all state EMS directors is available courtesy the National Association of State EMS Directors or contact the National Council of State EMS Training Coordinators .

Next let's look at some of the variables that make up the out-of-hospital part of the EMS system.


EMS Tutorial Content

Overview

History

The EMS Response

The EMS Responder

Out-of-Hospital

EMS Summary

Medical Oversight Tutorial

 

 

A Brief Simulated Patient Encounter

EMT's arrive at the scene of a motorcyclist thrown from his bike. They provide basic life support care to include cervical spine stabilization, removal of blood and mucous from the mouth and request a transporting unit. (See picture below)

Basic life support is continued with the addition of oxygen and bag mask ventilation because of the patient's slow rate of breathing. (See picture below)

Advanced life support care for this patient includes a breathing tube placed into the trachea (wind pipe), intravenous fluids for a low blood pressure and the insertion of a needle into the right chest to relieve a build up of air pressure which is preventing the heart and lungs from functioning properly. (See picture below)