Foundations of EMS Systems / Edition 3

by Bruce Walz, Jason Zigmont

Overview

Foundations of EMS Systems, Third Edition is an introductory text in the Fire and Emergency Services Higher Education (FESHE) emergency medical services (EMS) series. It provides an overview for students, administrators, government officials, and others who need to know about the emergency medical services system. Because EMS is both an evolving system and a technical field, change is constantly occurring both in the clinical aspects of patient care and in the delivery of EMS services. This change has been evident in EMS over the past few years as a result of the significant changes in the scope of practice and education of EMS providers. The Third Edition has been completely updated to include the latest information on the following: Significant developments in EMS of the last decade. Reimbursement for EMS services as the result of the Affordable Care Act. Federal legislation and federal agency activity related to EMS. Changes in disaster response, with a special emphasis on NIMS integration. The expanding role of prehospital providers as an integrated part of the health care system including the role of the community paramedic..

Product Details

ISBN-13:	9781284041781
Publisher:	Jones & Bartlett Learning
Publication date:	09/09/2016
Pages:	308
Product dimensions:	7.20(w) x 9.00(h) x 0.80(d)

About the Author

Bruce J. Walz, PhD, is professor and past chair of the Department of Emergency Health Services at the University of Maryland, Baltimore County (UMBC). As a professor, he teaches management and clinical courses as well as serving on graduate thesis committees. He has been in the University System of Maryland since 1979, having served with the Maryland Fire and Rescue Institute until 1987 when he joined the faculty of UMBC. He served as department chair 1994 to 2016. Bruce Walz has been involved in many aspects of EMS education and development. Most notably, he served as a group leader for the development of the 1998 National Standard Paramedic Curriculum and the 1999 National Standard Intermediate Curriculum. He headed the educational infrastructure workgroup for the development of the National EMS Education Standards. He is a charter member of the National Association of EMS Educators and served as president in 1998. He is a past president of Advocates for EMS. Additionally, he served as a site visitor for the Committee on Accreditation of Educational Programs for the EMS Professions (CoAEMSP) and is on the editorial board of Prehospital Emergency Care. He wrote the chapter on education in the National Association of EMS Physician’s medical director’s handbook Prehospital Systems and Medical Oversight. He has presented at numerous international, national, and regional EMS conferences. In addition to his professional experience, Bruce Walz has been active in the volunteer fire service since 1970. He has served in many administrative and line positions including president and chief officer. In 1975 he was certified as one of the first 50 Cardiac Rescue Technicians in the State of Maryland. In 1990, he became a nationally registered paramedic. He is an approved Maryland paramedic instructor. He is a nationally certified Fire Officer IV and Fire Instructor IV.

Jason J. Zigmont PhD, Paramedic, is a learning innovator and founder of Learning in Healthcare. He has previously worked as the System Director of Learning Innovation for OhioHealth. In this role he provides leadership for an integrated clinical learning infrastructure that includes Simulation, Learning Consulting, Learning Management System and Continuing Medical Education (CME) and Nursing Continuing Education (CE). Jason served on the Society for Simulation in Healthcare’s Education committee and headed the sub-committee on preparation for the Certified Healthcare Simulation Educator. He holds a PhD in Adult Learning specifically focused on Experiential Learning. He is a paramedic and EMS instructor who has served in both paid and volunteer EMS and fire departments for over 15 years. He founded VolunteerFD.org, and was a regular columnist for JEMS. Jason’s mission in life is to improve healthcare through learning. His research focuses on creating learning initiatives that have demonstrated outcomes in clinical quality, customer service, work life and finance.

Table of Contents

Foreword xi

Preface xii

About the Authors xvi

Acknowledgments xvii

Introduction xviii

1 Introduction to Emergency Medical Systems 1

The Emergency Medical Services System 1

Components of an EMS System 3

Revision of the 15 Components 4

EMS Agenda for the Future 5

The 14 Attributes of an EMS System 6

Comparison of Components and Attributes 9

Critical Patient Areas 9

2 History of Emergency Medical Systems 12

History of Emergency Medical Systems 12

Preindustrial Era (1600-1850) 12

Resuscitation 16

Anesthesia 17

Transportation 18

Industrial Era (1850-1970) 19

Causes of Death 20

First Aid Training 20

Resuscitator Calls 21

Motor Vehicle Injuries 22

Transportation 22

Military 24

Cardiac Care 25

Government Involvement 26

EMS Development 27

Modern Era (1970-2000) 30

1970s 30

1980s 33

1990s 35

Twenty-First Century 36

September 11, 2001 37

Institute of Medicine Reports 38

Katrina and Disaster Response 38

Emergency Medical Direction in the Federal Government 38

FICEMS/NEMSAC 40

Ambulance Fee Schedule 40

EMS Caucus 41

Provider Levels and Training 41

Other Developments 41

Star of Life 42

3 Human Resources 46

Historical Background 46

Prehospital Provides 48

Emergency Medical Responder 48

Emergency Medical Technician 49

Advanced Emergency Medical Technician 50

Paramedic 51

Specialized Prehospital Providers 52

Hospital-Based Providers 54

Other Providers and System Personnel 56

Sources of Providers 60

Volunteer Providers 60

Career Providers 61

4 Educational Systems 65

Introduction 65

Controversies in EMS Education 67

National Standard Curriculum 68

EMS Education Agenda for the future 68

National EMS Core Content 68

National EMS Scope of Practice Model 70

National EMS Education Standards 73

National EMS Education Program Accreditation 74

National EMS Certification 74

The National Registry of EMTs 75

CoAEMSP 75

Settings for EMS Education 76

Hospitals 76

Fire Departments 77

Technical Centers 78

Community Colleges 79

Colleges and Universities 79

Military 80

Provider Courses 80

Specialized Courses 85

Continuing Education and Refresher Training 85

Technology in Education 86

Asynchronous Learning 88

Mobile Learning Applications 88

5 Transportation 91

The Transportation Attribute 91

Service Providers 92

Fire Service 92

Commercial Service 93

Third Service 95

Public Safety Agency 95

Police or Sheriff-Based Service 96

Hospital-Based Service 97

First Responder 97

Public Utility Model 98

Integrated System 99

Delivery Systems 99

Fixed-Post Staffing 99

Event-Driven Staffing 100

ALS Intercept 102

Interfacility Transport 102

Staffing Configuration 103

BLS Staffing 103

ALS Staffing 104

Mobile Health Care 105

EMS Vehicles 105

Type I 106

Type II 106

Type III 108

Medium Duty 109

Air Medical Transport 109

Alternative Transport Modes 111

Ambulance Equipment 111

6 Medical Oversight 114

Historical Background 114

Models of Medical Oversight 117

Indirect Medical Oversight 117

Direct Medical Oversight 125

Regulation and Legislation 126

7 Public Access and Communications 128

Public Access 128

9-1-1 129

9-1-1 Operation 130

Public Safety Answering Point 131

Call Procesing 132

Call Taking 132

Dispatch Center 133

Dispatch Life Support 133

Nonemergency Access Numbers 134

Pathway Management 135

Public Education 136

Communications 136

Role of Communications 137

Systems Communications Technology 139

Systems Communications 139

Medical Communications 141

Telemedicine 142

National Emergency Response Communication System 142

8 Clinical Care and Hospital Emergency Medicine 144

Clinical Care 144

History of Emergency Medicine 145

Scope of Emergency Medicine 146

The Emergency Department 146

Overcrowded Emergency Departments 150

Approaches to Relieving ED Overcrowding 151

Categorization and Designation 153

Trauma Care System 154

The Trauma Center 155

Specialty Referral Centers 156

Trauma Registry 157

EMTALA Legislation 158

Critical Care Transport 159

Expanded Scope of Practice and Services 160

9 System Finances 163

System Finance 163

System Organization 164

Nongovernmental Organizations 165

Governmental Services 166

Volunteer Companies 166

Sources of Funds 167

Nongovernmental Organizations 167

Governmental Services 168

Volunteer Organizations 169

Financing Other EMS Components 170

Accounting and Budgeting 173

Nongovernmental For-Profit Company 173

Governmental Services 173

Nonprofit and Volunteer Organizations 174

Issues for the Future 174

10 Legislation and Regulation 176

Overview of Legislation and Regulation 176

The Federal Legislative Role 179

Legislation 180

Funding 181

EMTALA 183

Federal Regulations 184

Congressional EMS Caucus 184

Federal Lead Agency 185

Field EMS Modernization and Innovation Act (2015) 186

Patient Protection and Affordable Care Act 187

The State Role 188

Components of a State Lead Agency 189

State Legislation 190

Model State EMS Systems 191

Advocacy 192

11 Public Education and Injury Prevention 194

Introduction 194

Forms of Public Education 196

Benefits of Public Education 198

Public Education Process 198

Public Service Announcements 200

Public Education and Technology 201

Injury Prevention 201

The Injury Event 202

Injury Types 203

Injury Prevention Concepts 207

Interventions 208

Surveillance 208

EMS and Injury Prevention 209

Developing an Injury Prevention Program 212

12 Emergency Medical Services and Disaster Response 215

Disasters 215

What is a Disaster? 216

Natural Disasters 217

Technological Disasters 218

Disaster Management 220

Mitigation 220

Preparedness 223

Response 225

Recovery 230

Mass Event 231

Federal Role in Disasters 231

Presidential Declaration of a Disaster 232

Federal Role and EMS 233

13 Information Systems and Evaluation 237

Information Systems 238

Strategic Information Planning 238

Information System Integration 239

Information System Design Considerations 240

Data Formats 242

Data Collection Tools 243

Data Collection 245

Data Validation 247

Data Transfer, Secure Storage, and Analysis 247

Data Usage 248

Quality and Performance Evaluation 249

Quality, Cost, and Performance 249

Measuring Overall Performance 249

High Performance EMS Systems 251

Leadership System 252

Strategic Quality Planning 252

Information and Analysis 253

Process Assurance and Improvement 255

Scope of Performance Improvement Efforts 257

14 Research 261

What is Research? 261

Why Research? 261

Improve Patient Care 262

Improve the System 262

Understand the System 262

Reduce Hazards 263

Provide Legal Protection 263

Improve the Profession 263

Introduction to the Scientific Method 263

Statistics 264

Research Design 265

Quantitative and Qualitative Methods 265

Observational Studies 266

Interventional Studies 266

The Research Study 268

Identify the Problem or Question 268

Review the Literature 269

Formulate a Hypothesis 269

Define The Team 270

Design the Study 271

Perform the Study 272

Analyze the Data 273

Use the Information 273

Share the Findings 273

Future Challenges 274

Using Research in EMS 274

Appendix: Fire and Emergency Services Higher Education (FESHE) Course Correlation Grid 277

Glossary 278

Index 298