Emergency Medical Services At the Crossroads (2007) / Chapter Skim
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4 Supporting a High-Quality EMS Workforce
4 Supporting a High-Quality EMS Workforce
Pages 119-148
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From page 119... ...
These services form a continuum of care that includes the dispatcher in the 9-1-1 emergency call center, fire and/or EMS personnel arriving on scene, and providers at the hospital emergency department (ED) or trauma center.
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From page 120... ...
. The report established standard knowledge and practice expectations for four levels of EMS personnel: first responder, emergency medical technician (EMT)
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From page 121... ...
National EMS Core Content The National EMS Core Content encompasses the entire domain of out-of-hospital medicine. It provides a list of knowledge, skills, and tasks required to provide care in out-of-hospital settings, detailing what EMS personnel must know and how they must practice (NHTSA and HRSA, 2005)
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From page 122... ...
National EMS Scope of Practice Model Based on the direction provided by the Education Agenda, the Blueprint was revised and renamed the National EMS Scope of Practice Model. This model defines, by name and by function, the levels of out-of-hospital EMS personnel based on the National EMS Core Content (NHTSA, 2000)
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From page 123... ...
The purpose of the effort is not to impose national scope of practice standards, but to encourage greater consistency across the states. The committee supports this effort, but further recommends that state governments adopt a common scope of practice for emergency medical services personnel, with state licensing reciprocity (4.1)
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From page 124... ...
. Standards for EMTs developed by the National Registry of Emergency Medical Technicians (NREMT)
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The only nationally recognized accreditation available for EMS education is through the Committee on Accreditation of Emergency Medical Services Professions (CoAEMSP) under the auspices of the Commission on Accreditation of Allied Health Education Programs (CAAHEP)
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From page 126... ...
. The committee supports the goals of the Education Agenda and recommends that states accept national certification as a prerequisite for state licensure and local credentialing of emergency medical services providers (4.3)
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EMERGENCY MEDICAL SERVICES PERSONNEL EMTs and paramedics are the backbone of prehospital emergency care in the United States. They provide essential care for patients in emergency situations and are frequently able to reduce patient morbidity and mortality.
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EMERGENCY MEDICAL SERVICES AT THE CROSSROADS BOX 4-2 Tasks Performed by the Majority of First Responders • Obtain vital signs • Obtain a medical history • Deliver supplemental oxygen • Perform an assessment to determine the need for spinal immobilization • Perform spinal immobilization • Perform a rapid trauma assessment • Control severe external bleeding with direct pressure, a pressure dressing, and/or pressure points • Splint an extremity • Auscultate breath sounds • Use a bag valve mask • Perform manual cardiopulmonary resuscitation • Perform a physical examination • Use an automated or semiautomated external defibrillator • Perform manual airway maneuvers • Perform eye irrigation • Manually remove a foreign body airway obstruction • Use a pulse oximeter SOURCE: NREMT, 2005. BOX 4-3 Tasks Performed by the Majority of EMT-Basics All tasks performed by first responders, plus: • Insert an oropharyngeal or nasopharyngeal airway • Perform upper airway suctioning • Perform manual airway maneuvers • Determine the Glasgow Coma Score (GCS)
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From page 129... ...
• Use manual and automated external defibrillators to administer lifesaving shocks to a stopped or erratically beating heart • Use advanced airway techniques and equipment to assist those patients experiencing a respiratory emergency • Perform endotracheal and nasotracheal intubations • Perform needle chest decompression SOURCE: NREMT, 2005. EMT-Ps are the most highly skilled emergency medical workers, and they provide the most extensive care.
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From page 130... ...
Demographics of the EMS Workforce The majority of EMS personnel in the United States are young, white males, although in some rural jurisdictions, females outnumber males in the volunteer workforce. Fully 65 percent of EMS personnel nationwide were men in 2003, compared with 35 percent women.
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From page 131... ...
. Racial/ethnic distribution varied between urban and rural areas: while only 2.1 percent of EMS personnel in rural areas were African American and only 1.2 percent Hispanic, the numbers in large cities were 7.8 and 12.4 percent, respectively.
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In urban areas, there has been an increasing trend for emergency medical/ambulance services to be assumed by municipal fire departments. In 2003, EMS personnel were most likely to be employed by fire department–based services (37.6 percent)
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From page 133... ...
SOURCE: NREMT, 2003. 4-7 Public Private Total 40 37.6% 32.5% 30 Percentage 24.3% 21.7% 20 15.5% 14.4% 10.7% 10 7.7% 6.9% 6.0% 4.0% 1.4% 0 Volunteer rescue Hospital-based Fire department– County/ based municipal–based Employment Settings FIGURE 4-8 Public versus private employment settings of EMS personnel, United 4-8 States, 2003.
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From page 134... ...
. Even before factoring in this added demand, there is currently a perceived shortage of EMS personnel in the United States.
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RECRUITMENT AND RETENTION EMS personnel have indicated in surveys that their work provides them with a sense of accomplishment and belonging in the community. However, overall job satisfaction is often very low because of concerns regarding personal safety, stressful working conditions, irregular hours, limited potential for career advancement, excessive training requirements, and modest pay and benefits (Cydulka et al., 1997; Brown et al., 2003; Patterson et al., 2005)
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From page 136... ...
. The most dangerous times for EMS personnel are when they are inside an ambulance while it is moving or when they are working at a crash scene near other moving vehicles (Garrison, 2002)
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The Emergency Medical Serices Agenda for the Future: Implementation Guide described the need to eliminate legal barriers to intra- and interstate reciprocity for EMS provider credentials. The committee supports this position, and maintains that reciprocity for licensing across states should be improved and requirements standardized.
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From page 138... ...
. Since the development of EMS systems began in the 1960s, countless millions of hours have been contributed by rural EMS personnel to the care of neighbors, friends, and complete strangers.
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From page 139... ...
SUPPORTING A HIGH-QUALITY EMS WORKFORCE EMT-Paramedic 5.2% EMT-Paramedic EMT-Intermediate 5.2% 5.3% EMT-Intermediate 5.3% EMT-Basic 89.5% FIGURE 4-10a Volunteer NREMT registrants, United States, 2003. EMT-Basic SOURCE: NREMT, 2003.
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From page 140... ...
SOURCE: NREMT, 2003. 4-11 Bystander Care Although not a part of the EMS workforce, bystanders are often first on the scene in emergency medical situations.
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From page 141... ...
Training for EMDs is conducted mainly by private companies using their own curriculum. NHTSA sought to develop a national standard EMD curriculum in the early 1990s (similar to the curricula for other levels of EMS personnel)
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From page 142... ...
Recent experience in Richmond, Virginia, indicates that, based on a review of dispatch determinants and volume, call referrals can reduce on-scene responses by approximately 15 percent. EMS MEDICAL DIRECTORS EMS care has been called "medical care on wheels." Accordingly, nonphysician EMS personnel, whether dispatchers, fire department first responders, EMTs, or paramedics, are required to operate under the orders of a physician medical director.
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The 1998 Emergency Medical Serices Agenda for the Future: Implementation Guide called for the designation of EMS as a physician subspecialty (see Box 4-6)
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SOURCE: NHTSA, 1998. mends that the American Board of Emergency Medicine create a subspecialty certification in emergency medical services (4.4)
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From page 145... ...
2003. Compensation, benefits, and satisfaction: The Longi tudinal Emergency Medical Technician Demographic Study (LEADS)
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From page 146... ...
2002. Occupational fatalities in emergency medical services: A hidden crisis.
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2005. Recruitment and reten tion of emergency medical technicians: A qualitative study.
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