Emergency 

 medical 

 services 

background


2000 - Firefighter
2002 - Ambulance Driver
2003 - Emergency Medical Technician - Basic
2007 - Emergency Medical Technician - Intermediate
2008 - Emergency Medical Technician - Paramedic

BACKGROUND

2 Fire agencies (2000-05)
11 Ambulance agencies (2001-10)

  • Lieutenant
  • Training Director
  • Communications Director
  • Medical Command Officer
  • Health & Safety Officer
  • EMT Trainer
  • Driver Trainer
  • Dispatcher Trainer

Types of CERTIFICATIONS

  • Driver
    • CPR, EVOC
  • Certified First Responder (CFR)
    • Stabilization: splits, vitals, bleeding control
  • Emergency Medical Technician - Basic (EMT)
    • Oxygen, medical/trauma assessments, airway management, assist w/ medications, spinal immobilization
  • Advanced Emergency Medical Technician - Intermediate (EMT)
    • IVs, advanced airway management

TYPES OF CERTIFICATIONS


  • Advanced Emergency Medical Technician - Critical Care (Critical Care Tech)
      • Paramedic Light, cookbook medicine
      • Cardiac monitoring, pharmaceutical administration
    • Advanced Emergency Medical Technician - Paramedic (Paramedic)
      • Highest pre-hospital level, in charge of scenes
      • In-depth anatomy/physiology knowledge means more in-field autonomy
      • Surgical procedures, advanced assessments, cardiac monitoring , fluid administration, controlled substances (better drugs)
     

    TRAINING


    EMT-Basic 
    160 hours
    1-6 months

    EMT-Paramedic
    1200 hours
    6 months to 2 years

    Lectures, Labs, Ride time, Clinical time

    ADDITIONAL TRAINING


    EMTs
    CPR, EVOC, ICS, Hazmat, Bloodborne Pathogens, System-specific in-services
    48-hours of CMEs

    Paramedics
    EMT + ACLS, PALS/PEPP, PHTLS/ITLS
    72-hours of CMEs

    Medical control



    Medical Director

    System Protocols

    Dedicated physician at the hospital

    Types of emergencies

    Medical

    • Psychiatric
    • Neurology
    • Cardiology
    • Pulmonary
    • Endocrinology
    • Allergic Reactions
    • Gastroenterology
    • Hematology
    • Urology
    • Toxicology
    • Gynecology/Obstetrics
    • Infectious/Communicable Diseases

    TYPES OF EMERGENCIES

    TRAuMA

    • Hemorrhage
    • Shock
    • Burns
    • Environmental
    • Head/Facial
    • Spinal
    • Thoracic
    • Abdominal
    • Musculoskeletal

    TYPES of EMERGENCIES


    • Neonatal
    • Pediatric
    • Geriatric
    • Abuse/Neglect
    • Special Needs
    • HazMat
    • Mass Casualty Incidents

    Equipment

    Ambulance
    Stretcher
    Stethoscope, Blood pressure cuff, O2, Suction
    Medications, advanced airways
    AED/Heart monitor
    Blankets


    EQUIPMENT

    Bandages, restraints
    Long board, Short board/KED, Splints

    TYpical call

    • "On Post"
    • 911 Dispatcher requests agency
      • Additional resources: Fire, Police, Interpreter
    • If available, closest unit responds
    • If known threat is secure, proceed to scene
    • BSI, determine scene safety
    • Determine mechanism of injury/nature of illness
    • Rapid trauma assessment
    • Determine number of patients, request resources prn
    • Formulate general impression
    • Determine level of responsiveness, chief complaint, life threats

    TYPICAL CALL

    • ABC's
    • Determine transport priority
    • Gather history of event (OPQRSTI)
    • Gather medical history (SAMPLE)
    • Focused assessment of affected system
    • Vitals
      • Interventions
      • Medical Control?
    • Reassessment (3-5 minutes)
    • Radio report to hospital

    TYPICAL CALL

  • Upon arrival at hospital
      • Wait.
      • Vitals
      • Triage report
      • Transfer to bed
      • Clean up, restock
      • Documentation
      • Go on another call before you can finish any or all
        • Attempt to eat

    PROBLEMS

    • High stress
      • Desensitized, difficult to vent, CISM
    • High risk
    • Low pay
      • Multiple jobs, typical to work 60+ hours/week
    • Odd hours
    • Lift injuries
    • High burnout rate
      • Management/Administration, Nurses, leave
    • Continuous training
    • Fire Department
      • Ambulance drivers

    STrengths


  • Dynamic workplace
  • People, places, problems
  • Rewarding
  • Family
      • Supportive
        • Venting, coping
      • Camaraderie
    • Develops critical thinking
      • Launchpad

    MYTHS

    • Flatline is shockable
    • Double-tap the door
    • Red lights and siren all the time, everywhere
      • Red lights and sirens save time
      • Stopping in the middle of the road
    • Ambulances get priority in the ER
    • Cardiac arrest = heart attack
    • CPR always works
      • 5-10%
    • All calls are true emergencies
      • 10%



    Emergency medical services


    More than just ambulance drivers

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    By Craig Freeman

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