Effective communication is key; express empathy. Ask an open-ended question: Can you tell me what happened? What seems to be the problem? Can you tell me what’s different today? How do you feel? Tell me about? Express empathy: I understand why you’re asking these questions. I’m here to help you. Avoid these types of responses: Projecting — this happened to me once, so I know how it feels. Minimizing — at least you are around other people so we could find you. Generalization — we all have nights like this. Directives — you should be feeling terrible right now. Summarize — let me summarize — is there something else you’d like to add?
EMS is a team of health care professionals who are responsible for and provide emergency care and transportation for the sick and injured. There are four levels of EMT training and licensure. Emergency Medical Responder has basic emergency care and operations training and is focused on managing the emergency scene and initiating immediate life-saving care before the ambulance arrives. They can use oral airways, bag-mask devices, upper airway suctioning, nasal cannula, manual CPR, auto/semi-automatic defibrillation, intramuscular auto-injector, intranasal, premeasured. Called upon before EMTs arrive at the scene, providing immediate care with limited equipment prior to the arrival of an ambulance. An Emergency Medical Technician focuses on initial stabilization of the scene and fundamental emergency care and is the primary link between the emergency scene and the health care system. Nasal airway, CPAP, pulse oximetry, oxygen humidifiers, mechanical CPR, telemetry monitoring devices, oral medication and sublingual. EMS courses are competency-based. 150–200 hours. An Advanced EMT has education in advanced life support and intravenous therapy, advanced airway management, and administration of certain emergency medicine. Can use supraglottic airway, tracheobronchial suctioning, ETCO2 monitoring, subcutaneous, intravenous. Add knowledge and skills in specific aspects of ALS to providers who have been trained as EMTs. A Paramedic has passed an ALS assessment, diagnostic and treatment tools and techniques, heart rhythms, advanced airway management, and emergency pharmacology. Endotracheal intubation, cricothyrotomy, airway obstruction removal by direct laryngoscopy, high-flow nasal cannula, cardioversion, electrical, manual defibrillation, transdermal, rectal. 1000 to 2000 hours divided between classroom and internship training.
Volunteer ambulances were organized and personnel went overseas to provide care for the wounded in WWI. In WWII this evolved into the field medic and rapid helicopter transport. It was not until the 1960s and 1970s that EMS service developed — 1966 Accidental Death and Disability: The Neglected Disease of Modern Society. National Highway Traffic Safety Administration under the US Department of Transportation — EMS Development Act of 1973 — published the Orange Book.
The guiding principles of EMS Agenda 2050 are as follows. Standardize the levels of EMS education and EMS providers. A people-centered EMS system. Inherently safe and effective, so the entire system from start to finish is designed to minimize exposure to injury, infections, illness, or stress. Integrated and seamless, where EMS is fully integrated with all other aspects of health care and is engaged with other emergency services and within the communities in which they operate. Reliable and prepared, ensuring EMS care is delivered consistently and compassionately and is guided by sound research at all times, by all EMS providers, at all levels, and from all agencies. Socially equitable. Sustainable and efficient, minimum of waste and a maximum of accountability. Adaptable and innovative, evolving to meet the changing needs.
Medical direction authorizes the EMTs in the service to provide medical care in the field. Standing orders are part of protocols, and they designate what the EMT is required to do for a specific complaint or condition. Providers are not required to consult medical direction before implementing standing orders. Liaison between the medical community, hospital, and EMT in service. Physician at a receiving hospital.
Mobile integrated health care and community paramedicine is a method of delivering health care that utilizes the prehospital spectrum of care resources. Health care is provided within the community rather than at a hospital. Assess patients who are homebound or disabled. Community paramedicine adds education to provide services to the community.
Keep vehicles and equipment ready for an emergency, ensure the safety of yourself, your partner, the patient, and bystanders, operate the emergency vehicle, be an on-scene leader, evaluate the scene, call for additional resources as needed, gain patient access, perform a patient assessment, give medical care, emotional support, work with other medical professionals, resolve emergency incidents, uphold medical and legal standards, ensure and protect patient privacy, give administrative support, continue professional development, cultivate community relations, give back.
Attributes an EMT is expected to possess are integrity, empathy, self-motivation, appearance and hygiene, self-confidence, time management, communication, teamwork and diplomacy, respect, patient advocacy, careful delivery of care.
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