EMS Tutorial: The
At this point, it may be instructional
to look at the stages of an EMS Response. Using the stages outlined by
Position Statement on Emergency Medical Services and Emergency Medical
Services Systems, we will briefly define the scope of an EMS
system. These thirteen stages include:
- Transport and Facility Notification
- Emergency Department/Receiving
- Interfacility Transport
- Critical Care
- Inpatient Care
Now with a little more detail.
Everyone should be involved; it is more efficient to prevent illness
and injury in terms of decreased human suffering and
conservation of health care dollars.
We can't fix'em if we can't find'em. This is more of a problem in rural/frontier
environments due to the sparsely populated, wide open spaces. Technology
may help in the future as devices such as automated crash detectors
are installed on more and more vehicles.
Who you gonna call? Not all areas are covered by 911 and must use a
seven digit emergency number.
The dispatcher is responsible for getting information about the emergency
and notifying the right emergency provider in a timely manner. The equipment
they use can range from a simple radio system to the latest computer
assisted communication devices. Rural dispatchers
often suffer from low pay, little training,
and high stress.
Once the EMS Providers receive a call, they must begin to think about
what they may need once they get on scene
of the medical emergency. Fire suppression? Law enforcement? Hazardous
material expertise? Extrication equipment? More medical personnel? They
must then activate available resources to maximze care at the scene.
The number 1 priority is scene safety. This
must be accomplished before patient care can begin. All EMS Providers
must protect themselves and assist with maintaining the safety of other
emergency personnel or bystanders present on scene. The injury
of one emergency provider by a scene hazard decreases available resources
and increases the number of patients requiring care.
- Transport and Facility
Notification: Transport the patient to the most appropriate
available healthcare facility by the most appropriate available transport
mode. Receiving facility notification from the field providers
should be early and contain information that can be used by the receiving
facility to prepare for continued care of the patient.
- Emergency Department/Receiving
Facility: Rural receiving facilities are often clinics or small
hospitals with limited resources. Those illnesses or injuries that cannot
be treated locally are stabilized and transported to a larger facility.
- Interfacility Transport:
Patients can be transported from one healthcare facility to the next
by various methods depending on local availability. To determine the
most appropriate method, at least three questions must be answered:
1. How fast do I need to get the patient to the next level of
care? 2. What is the type of care needed during transport (basic vs
advanced and/or specialty care such as neonatal)? 3. What transport
options are available in my area?
- Critical Care:
What are the local capabilities to care for the severely ill or injured?
Where is the nearest specialty care ie: trauma center, interventional
cardiology (balloon, bypass), stroke team, burn care, etc.
- Inpatient Care:
Again, what are the local capabilites and what is the access to specialty
The process to regain function lost as a result of injury or illness.
The goal is a return to pre-illness/injury functional status.
Most patients seen in the emergency department are treated and returned
to the community within a brief time period. Patients with severe illness
or injury may require prolonged hospitalization and will need reassessment
once they return to the community to determine any ongoing
lets look at the responders who provide care during the out-of-hospital
phase of our EMS response.