I. You are the Provider

This is the first activity of the course. As such, this introduces the student to the interactive learning process. Additionally, this activity allows you to initiate dialog with the student about the professional responsibilities of being an EMT and of the many career opportunities in prehospital care.

Purpose

To introduce the student to the profession of prehospital care services and to the responsibilities of being an EMT.

Instructor Directions

1. Direct students to read the “You are the Provider” scenario found throughout Chapter 1.

2. You may wish to assign students to a partner or a group. Direct them to review the discussion questions at the end of the scenario and prepare a response to each question. Facilitate a class dialogue centered on the discussion questions.

3. You may also use this as an individual activity and ask students to turn in their comments on a separate piece of paper.

I. Course Overview  

A. Paperwork/course administrative details

1. Local

2. State

B. Course description and expectations

1. This course is designed to meet and/or exceed the DOT 1994 EMT-B National Standard Curriculum in the 1994 National EMS Education and Practice Blueprint.

2. The EMT-B course includes four types of learning activities:

a. Reading assignments

b. Step-by-step demonstrations

c. Summary skills sheets

d. Case presentations and scenarios

3. Study tips

4. Expectations and desires

a. Student

b. Instructor

c. Community

d. EMS system

C. Three main categories of EMT-B training focus and requirements

1. Care of life-threatening or potentially life-threatening conditions

2. Care of conditions that, although not life-threatening, are key components of emergency care or are necessary to prevent further harm before the patient is moved

3. Important issues related to the EMT-B’s ability to provide emergency care

D. Review criteria for certification

1. Specific state requirements

2. General criteria, including:

a. High school diploma or equivalent

b. Proof of immunization against certain communicable diseases

c. Valid driver’s license

d. Successful completion of BLS/CPR course

3. Successful course completion

4. Written examination

5. Practical examination

6. Mentally/physically meet criteria of safe and effective practice of job functions

7. State and local provisions

E. Implications of Americans with Disabilities Act of 1990 (ADA), state and local policies

1. Protects individuals with a disability from being denied access to programs and services provided by state or local governments

2. Prohibits employers from failing to provide full and equal employment to the disabled

II. Student Introductions

Purpose

To allow students an opportunity to meet fellow students and describe their personal goals and desires for the class.

III. Overview of the Emergency Medical Services System

A. History of EMS

1. World War I: motor vehicles and volunteer ambulance squads were used.

2. World War II: trained corpsmen brought casualties to aid stations.

3. Korean conflict: further development of the field medic; casualties transported to Mobile Army Surgical Hospitals via helicopter.

4. Domestic emergency care lagged behind.

5. Into the 1960s, prehospital care could range from interns to individuals without training.

a. The sick and injured were often transported by private vehicle.

b. Staffed emergency departments were often limited to large urban areas.

6..  Accidental Death and Disability (a.k.a. The White Paper) published in 1966

a. Reported the inadequacies of prehospital care.

b. Recommended:

i. Development of training

ii. Development of federal guidelines and policies

iii. Adoption of the means to provide emergency care and transport

iv. Establishment of staffed emergency departments

7. Highway Safety Act and the Emergency Medical Act created funding sources and development programs.

8. Early 1970s: DOT developed the first National Standard Curriculum for the training of EMTs.

9. Late 1970s to early 1980s: DOT developed a recommended National Standard Curriculum for the training of paramedics.

10. Circa 1980: EMS established in most of the United States.

a. Responsibility of municipalities to provide prehospital care

b. Recognized standards developed for training and equipment

B. National Highway Traffic Safety Administration (NHTSA)

1. Technical Assistance Program Assessment Standards 1996

2. 10-point assessment criteria include:

a. Regulation and policy

b. Resource management

c. Human resources and training

d. Transportation equipment and system

e. Medical and support facilities

f. Communications system

g. Public information and education

h. Medical direction

i. Trauma system and development

j. Evaluation

C. Levels of training

1. Basic First Aid

a. Trains individuals in the workplace, teachers, coaches, babysitters, and others

b. Individuals trained in basic first aid are taught to provide necessary critical care prior to arrival of EMTs.

2. First Responder

a. Trains individuals to initiate immediate care and to assist the EMTs when they arrive

b. Focuses on providing immediate basic life support and urgent care with limited equipment

3. EMT-Basic

a. Requires approximately 110 hours of training (more in some states) in the essential knowledge and skills required for providing basic emergency care in the field

b. Includes skills for automated defibrillation, definitive airway adjuncts, and assisting patients with certain medications

4. EMT–Intermediate (EMT–I)

a. Designed to increase knowledge and add skills in specific aspects of advanced life support (ALS)

b. Additional skills include IV therapy, interpretation of cardiac rhythms and defibrillation, orotracheal intubation, and administration of certain prescribed drugs.

5. EMT–Paramedic (EMT–P)

a. An EMT–P has completed an extensive course of training that significantly increases knowledge and mastery of basic skills and covers a wide range of ALS skills.

b. Skills include IV therapy, pharamacology, and cardiac monitoring.

6. If your state differs from the national blueprint, explain the levels of training recognized.

IV. Components of an EMS System

A. Access to the system

1. Easy access to necessary help in an emergency is essential.

2. 9-1-1

a. 9-1-1 system provides immediate access to central emergency dispatch service.

b. Enhanced 9-1-1 system also displays address of the phone making the call.

c. Describe cellular GPS—enhanced 9-1-1 systems that identify the cellular number from which call was made and exact geographic coordinates of the phone.

d. Describe Emergency Vehicle GPS tracking—rescue squads can transmit their position to dispatch, and dispatch can transmit the location of a call to a moving digital map in the squad.

3. Non 9-1-1

a. In some areas, a different special published emergency number may be used to call for EMS.

4. Discuss the emergency number in your area, training the public how to access 9-1-1 is important.

5. Dispatcher may have Emergency Medical Dispatcher training and be able to give pre-arrival instructions.

6. Describe the local access and dispatch system.

B. Administration and policy

1. Policies and procedures are essential.

2. An EMS service provider generally operates in specific areas called primary service areas (PSA).

3. Senior EMS personnel generally administer daily operations.

4. Administrators perform administrative tasks such as scheduling, personnel budgeting, and purchasing.

C. Medical direction and control

1. Each EMS service has a physician medical director who authorizes the EMTs in that service to provide medical care in the field.

2. The appropriate care for each injury, condition, or illness encountered in the field is determined by the medical director and is described in a set of written standing orders or protocols.

3. Medical director

a.  A physician responsible for the clinical and patient care aspects of an EMS system

b. Required for every ambulance service/rescue squad

c. Types of medical direction

i. Online

    (a) Emergency service personnel can reach a medical director for medical direction while on a call; also known as direct medical control.

    (b) Telephone

    (c) Radio

ii. Off-line

    (a) The medical director provides the ongoing working liaison between the medical community, hospitals, and the EMTs in the service.

    (b) Protocols

    (c) Standing orders

4. The relationship of the EMT-B to medical direction

a. EMT-B is the designated agent of the physician.

b. Care rendered by an EMT-B is considered an extension of the medical director’s authority (varies by state law).

D. Quality control and improvement

1. The medical director is responsible for ensuring that all staff involved in patient care meets appropriate medical care standards on each call.

2. Each written patient run report must be reviewed.

3. Continuous quality improvement (CQI) is a circular system of continuous internal and external reviews and audits of all aspects of an EMS call.

4. The medical director also ensures that appropriate continuing education and training is available.

5. The role of the EMT-B

a. Refresher training

b. Continuing education

c. Run reviews, audits, and documentation

d. Gather feedback from medical director and hospital staff

E. Other physician input

1. Local physicians and specialists may be active on the local level in the development of EMS.

2. State and national organizations may also participate in development.

F. State-specific statutes and regulations regarding EMS

1. Training, protocols, and practices must conform with the EMS legislation, rules, regulations, and guidelines adopted by the state.

2. An advisory committee made up of representatives of EMS system, medical directors, and others provides input.

G. Equipment

1. A wide range of different emergency equipment is available.

2. It is the responsibility of the EMT-B to know indications and contraindications of using each piece of equipment.

3. The EMT-B should check each key piece of equipment before going on duty to ensure that it is in its assigned place and working properly, and that the EMT-B is familiar with the specific model.

H. Ambulance

1. Before going on duty, the EMT-B should check all the equipment and supplies.

2. The EMT-B should check to make sure that the ambulance is fully fueled and has sufficient oil and other key fluids, and that the tires are in good condition.

3. The EMT-B should test each of the driver's controls and each built-in unit and control in the patient compartment to ensure proper functioning.

I. Specialty centers

1. Many EMS systems include specialty centers such as trauma, burn, poison, or psychiatric centers.

2. Some areas have specialty centers for children.

3. Describe resources in the local area.

J. Interfacility transports

1. Transportation of patients from a health care facility to home, nursing home, or other hospital

2. Patient may be accompanied by other health care providers (ie, respiratory therapists, nurses)

K. Hospital staff

1. EMTs need to understand how their care integrates into the system and affects the patient's hospital care.

2. Many hospital staff members are willing to help the EMT-B develop in the profession.

3. Physicians

4. Nurses

5. Other health professionals

L. Working with public safety agencies

1. EMT-Bs should understand the role of each public safety agency.

2. Some public safety workers have EMS training.

3. Personnel from certain agencies may be better prepared than the EMT-B to perform certain functions.

4. EMS and public service agencies need to work together and recognize that each person has a special talent and a job to do at the scene.

5. The most efficient patient care is achieved through cooperation among agencies.

6. Public safety agencies may include law enforcement and state and federal agencies.

M. Training

1. Quality of care depends on training.

2. In most states, instructors responsible for coordinating and teaching the EMT-B course are approved and certified by the state EMS office.

3. To be certified, an instructor must have extensive medical and education training and teach under supervision.

4. Most ALS training is done in the hospital or in a college setting.

N. Three phases of coordinated continuum of care

1. The first phase consists of the patient or bystanders identifying an emergency and initiating the EMS system.

2. The second phase consists of patient assessment, initial prehospital care, proper packaging, and safe transport to the hospital (out of hospital).

3. In the third phase, the patient receives continued assessment and stabilization in the hospital emergency department.

4. In the fourth phase, the patient receives the necessary specialized definitive care.

V. Roles and Responsibilities of the EMT-B

A. Personal safety

1. Should always be the EMT-B’s top priority

2. Determined by sizing up the scene during the approach

B. Safety of crew, patient, and bystanders

1. Ability to safely operate the ambulance

2. Sizing up the scene for threats

C. Patient assessment

1. Should be thorough and accurate

2. Includes a SAMPLE history

3. Recognize that assessment findings will affect treatment decisions and a poorly done assessment may lead to inappropriate treatment

D. Patient care based on assessment findings

1. Reaching a clinical impression and providing care

2. Identifying patients who need immediate intervention and those who will benefit from a detailed assessment

E. Lifting and moving patients safely

1. Properly packaging the patient and safely moving him or her

2. Using proper lifting mechanics to protect the EMT

F. Transport/transfer of care

1. Transporting the patient to the destination

2. Giving necessary radio reports

3. Giving a verbal report to health care facility staff

G. Record keeping/data collection

1. Documenting patient care report

2. Completing other needed reports (ie, incident report)

H. Patient advocacy (patient rights): Considers the patient as a whole and safeguards the patient's rights

1. HIPAA

a. Federal legislation passed in 1996.

b. Limits availability of patients’ health care information.

c. Penalizes violations of patient privacy.

VI. Professional Attributes of the EMT-B

A. Professional attributes of the EMT-B

1. Puts patient's needs as a priority without endangering self

2. Maintains a professional appearance and manner

3. Expected to perform under pressure with composure and self-confidence

4. Treats patients and families under stress with understanding, respect, and compassion

5. Is nonjudgmental

6. Extends compassion, respect, and the best care possible to every patient, regardless of the patient's attitude

7. Respects patient confidentiality because EMS is an extension of the emergency medical care provided in the emergency department by physicians

8. Does not discuss findings or any disclosures made by the patient with anyone except those who are treating the patient or as required by law

B. Continuing education

1. An EMT-B is required to attend a certain number of hours of continuing education (CE) each year.

2. Review state requirements for renewal.

3. An EMT-B must also maintain a current knowledge of local, state, and national issues affecting EMS.

4. Maintaining knowledge and skills is a substantial responsibility; the
EMT-B must regularly practice or refresh seldom-used skills.

 

I. Prep Kit Activities

A. Assessment in Action

This activity is designed to assist the student in gaining a further understanding of issues surrounding the provision of prehospital care. The activity incorporates both critical thinking and application of basic EMT-B knowledge.

Purpose

This activity allows the student an opportunity to analyze an emergency care scenario and develop responses to critical thinking questions.

Instructor Directions

1. Direct students to read the “Assessment in Action” scenario located in the Prep Kit at the end of Chapter 1.

2. Direct students to read and individually answer the quiz questions at the end of the scenario. Allow approximately 10 minutes for this part of the activity. Facilitate a class review and dialogue of the answers, allowing students to correct responses as may be needed. Use the quiz question answers noted below to assist in building this review. Allow approx­imately 10 minutes for this part of the activity.

3. You may wish to ask students to complete the activity on their own and turn in their answers on a separate piece of paper.

Answers to Multiple-Choice Questions

1. Answer: B  Intravenous therapy

The role of the EMT-B has been revised and expanded by the DOT. This makes it even more important for students to be able to define their scope of practice.

2. Answer: B  Wait for the paramedic to arrive, since it is above your scope of practice.

This type of situation can be overwhelming to the newly certified EMT-B and this should be discussed so that the EMT-B knows the scope of practice.

3. Answer: B  Medical Director

The DOT sets the standards of training. The EMS directors and emergency department physicians certainly help mold the protocols. It is the responsibility of the medical director, however, to write and approve the protocols. The system practices under the license of the medical director.

4. Answer: D  All of the above

It is important for the EMT-B to be proficient in all aspects of EMS.

5. Answer: C  Continuing education is vital to successful EMS systems as medicine and technology is ever changing.

It is important for the student to be receptive to other medical professionals, be compassionate to all who call for help, and understand that the education is an ongoing process. 

6. Continuous quality improvement provides an ongoing system of audits and reviews that ensures that the public receives the highest standard of patient care. 

7. It is important that every patient be treated with compassion and understanding. Even though you may feel that a call is not a real emergency, the person who activated the 9-1-1 system believes it was.

B. Points to Ponder

This activity will allow you to help your students probe the more difficult situations that they face. Use this as an opportunity to allow them to express difference of opinion and approach, while directing them to be thorough and decisive in their answers. Encourage challenges.

Purpose

To allow students an opportunity to apply critical thinking analysis to a given case study.

Instructor Directions

1. Direct students to read the “Points to Ponder” scenario found in the Prep Kit at the end of Chapter 1.

2. You may assign students to a partner or a group and direct them to review the discussion question at the end of the scenario and prepare a response. Allow approximately 10 minutes for this part of the activity. Facilitate a class dialogue centered on the discussion point. Allow approximately 10 minutes for this part of the activity.

3. You may ask students to complete the activity on their own and turn in the answers on a separate piece of paper.

4. Personally review the scenario and discussion question based on your knowledge and experience. Develop your own key points for guiding this discussion.

 

Scenario

You have been working as an EMT-B in the same area for many years and you know all of the frequent callers. You are dispatched to a man down at 3 o’clock in the morning. You have been on several calls already that night and you just got back into bed. Upon your arrival on scene you recognize the patient immediately as a local drunk. He smells of alcohol and is lying in the front yard of someone’s home. Your partner is upset because he transported this man to the hospital two days ago. Your partner calls for police response and starts shaking and yelling at the man to wake up or he’s going to have the police arrest him for abusing the 9-1-1 system.

 

How would you handle this patient? Would you release him to the custody of the police? How do you feel about your partners’ behavior towards the patient and how would you handle it?

Issues

• Personal Attitudes and Conduct

• Professional Interaction

• Recognizing Potential Medical Emergencies

Discussion

On the basis of the information that you gathered, you should consider this to be a HazMat event. The incident is in a chemistry lab, which indicates that chemicals are probably being used. You now have more than one patient, which increases your index of suspicion that this is a HazMat event. You should immediately evacuate the area and notify additional resources such as the fire department and HazMat team. You may want to ascertain what type of chemicals were being used from students or from direct observation. You will also want to find out what type of ventilation system is in place and if it is working properly.

II. Lesson Review

A. What are the requirements to become certified/licensed as an EMT-B? (Lecture I-D)

B. List and describe the five levels of prehospital care training. (Lecture III-C)

C. What does medical direction mean and who provides it? (Lecture IV-C)

D. Describe quality improvement and how the EMT-B participates in this process. (Lecture IV-D)

E. What are the basic roles and responsibilities of the EMT-B? (Lecture V)

F. List the attributes of a professional EMT-B. (Lecture VI)

III. Assignments

A. Review all materials from this lesson and be prepared for a lesson quiz to be administered (date to be determined by instructor).

B. Read Chapter 2: The Well-Being of the EMT-B, for the next class session.

IV. Instructor Keyed Quiz

1. The level of provider that has extensive training in advanced life support is the _________.

A. First Responder              C. EMT-Intermediate

B. EMT-Basic                     D. EMT-Paramedic

Answer: D  p. 10

2. Talking to an emergency room physician via radio while at the scene would be what type of medical control?

A. onlineB. off-line

Answer: A  p. 12

3. List a type of specialty center.

• Trauma              • Poisoning

• Burns                 • Psychiatric

Answer:  p. 14

4. List five roles and responsibilities of the EMT-B.

Answer:  pp. 16-17

• Ensuring your own safety and the safety of your fellow EMT-Bs, the patient, and others at the scene

• Locating and safely driving to the scene

• Sizing up the scene and situation

• Rapidly assessing the patient’s gross neurologic, respiratory, and circulatory status

• Providing any essential immediate intervention

• Performing a thorough, accurate patient assessment

• Obtaining an expanded SAMPLE history

• Reaching a clinical impression and providing prompt, efficient, prioritized patient care based on your assessment

• Communicating effectively with and advising the patient of any procedures you will perform

• Properly interacting and communicating with fire, rescue, and law enforcement responders at the scene

• Identifying patients who require rapid packaging and initiating transport without delay

• Identifying patients who do not need emergency care and will benefit from further detailed assessment and care before they are moved and transported

• Properly packaging the patient

• Safely lifting and moving the patient to the ambulance and loading the patient into it

• Providing safe appropriate transport to the hospital emergency department or other ordered facility

• Giving the necessary radio report to the medical control center or receiving hospital emergency department

• Providing any additional assessment or treatment while en route

• Monitoring the patient and checking vital signs while en route

• Documenting all findings and care on the run report

• Unloading the patient safely and, after giving a proper verbal report, transferring the patient’s care to the emergency department staff

• Safeguarding the patient’s rights

5. The area that an EMS service is designated to be responsible for is called a(n):

Answer: Primary Service Area  p. 12

 

Student Quiz

 1. The level of provider that has extensive training in advanced life support is the _________.

A. First Responder

B. EMT-Basic

C. EMT-Intermediate

D. EMT-Paramedic

2. Talking to an emergency room physician via radio while on the scene would be what type of medical control?

A. online

B. off-line

3. List a type of specialty center.

4. List five roles and responsibilities of the EMT-B.

5. The area that an EMS service is designated to be responsible for is called a(n):