Emergency Medical Services At the Crossroads (2007) / Chapter Skim
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1 Introduction
1 Introduction
Pages 15-30
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From page 15... ...
ground ambulances staffed by individuals with different levels of training, depending on the requirements of the state; and air medical EMS units, which are usually staffed by paramedics or critical care nurses, but may sometimes carry a physician. EMS represents the first stage in a full continuum of emergency care that also includes hospital emergency departments (EDs)
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From page 16... ...
In areas where trauma systems have developed, EMS and trauma providers are interdependent, working closely within an established protocol to help ensure that patients are transported to the most appropriate facility as quickly as possible. EMS personnel form the backbone of the prehospital care system despite working under conditions that are stressful and at times dangerous.
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From page 17... ...
In 2003, an average of 6.5 different diagnostic tests and services were ordered or performed for transport cases -- about 40 percent higher than the average for nontransport cases. While transport patients tend to have more severe conditions than walk-in patients, a significant percentage of those treated by EMS personnel do not have life-threatening problems.
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From page 18... ...
As a result, the prehospital emergency care system provides a stark example of how standards of care and clinical protocols can take root despite an almost total lack of evidence to support their use. Because of this lack of supporting evidence, EMS systems often must operate blindly in addressing such questions as how available EMS personnel should be deployed, what services should be provided in the out-ofhospital setting, and what approach to organizing the EMS system is best.
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From page 19... ...
Safety Prehospital emergency care services are delivered in an uncertain, stressful environment where the need for haste and other potential distractions produce threats to patient care and safety. In addition, shift work and around-the-clock coverage contribute to fatigue among EMS providers (Fairbanks, 2004)
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Questions related to core aspects of current clinical EMS practice remain unresolved, and EMS personnel must often rely on their best judgment in the absence of evidence. Not infrequently, treatments with established effectiveness and
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Recent EMS research has been able to contribute to the knowledge base regarding appropriate and effective EMS care. For example, the Ontario Prehospital Advanced Life Support study demonstrated that an optimized EMS system with rapid defibrillation capabilities may not benefit from the addition of ALS interventions.
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These prolonged response times occur at each step in EMS activation and response, including time to EMS notification, time from EMS notification to arrival at the scene, and time from EMS arrival on the scene to hospital arrival. Even across cities, however, there are substantial differences in EMS response times (Davis et al., 2003)
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. Efficiency The health sector in general and emergency and trauma care services in particular lag behind other industries in adopting engineering principles and information technologies that can improve process management, lower costs, and enhance quality.
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Hospital-Based Prehospital Pediatric Emergency Care Emergency Care Emergency Medical Services Subcommittee Subcommittee (13 members) Subcommittee (11 members)
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EMS system refers to the organized delivery system for EMS within a specified geographic area -- local, regional, state, or national -- as indicated by the context. Emergency care is broader than EMS and encompasses the full continuum of services involved in emergency medical care, including EMS, hospital-based ED and trauma care, specialty care, bystander care, and injury prevention.
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From page 26... ...
will examine prehospital EMS and include an assessment of the current organization, delivery, and financing of EMS and EMS systems, and assess progress toward the Emergency Medical Services Agenda for the Future. The subcommittee will consider a wide range of issues, including: • The evolving role of EMS as an integral component of the overall health care system, including dispatch, medical direction, and integration with trauma systems, pediatric EMS, public health, prevention, and emergency department overcrowding; • EMS system planning, preparedness, and coordination at the federal, state, and local levels; • EMS funding and infrastructure investment, including equipment, communications, new technologies, and progress toward the development of interoperable EMS information systems; • EMS workforce trends and professional education; and • EMS research priorities and funding.
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From page 27... ...
The chapter demonstrates that having an emergency care system that functions efficiently and effectively on a daily basis is fundamental to having a system that is ready to handle larger public health and public safety crises. In addition, the chapter describes EMS equipment and training needs, including greater distribution of personal protective equipment and development of more effective communications systems, as well as improved hospital surge capacity.
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From page 28... ...
2005. Assessment of air medical coverage using the atlas and database of air medical services and correlations with reduced highway fatality rates.
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Prehospital Emergency Care 9(4)
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From page 30... ...
0 EMERGENCY MEDICAL SERVICES AT THE CROSSROADS Wright JL, Klein BL.
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