- EMS is a system comprised of various components including public access to 911, EMS response, clinical care, medical control, legislation/regulation, evaluation/quality improvement, transport to hospitals, and prevention/public education. - As an AEMT, you are an important part of the EMS system and will provide emergency medical care to sick and injured patients within your authorized scope of practice under the supervision of a medical director. Your role involves professional conduct, effective patient interaction, and following legal and regulatory requirements.

1. EMS Systems
Chapter 1Chapter 1

2. • This textbook is the primary resource for
the AEMT course.
• EMS is a system.
• This chapter discusses:
– That system’s key components
– How they influence and affect AEMTs
– Administration, medical direction, quality
control, and regulation of EMS services
– Roles and responsibilities of AEMTs
Introduction

3. • Emergency medical services (EMS)
– Team of health care professionals
– Provides prehospital emergency care and
transport for the sick and injured
– Part of a local or regional EMS system
– Governed by state laws and typically
regulated by a state EMS office
• People who provide emergency care,
except licensed physicians, must be
state-licensed or certified.
Course Description

4. Course Description
• levels:
– EMR, formerly
first responder
– EMT, formerly
EMT-Basic
– AEMT, formerly
EMT-I
– Paramedic,
formerly EMT-
Paramedic
Source: © Corbis

5. Course Description
• EMRs have very
basic training.
– Provides care before
ambulance arrives
– May assist within
ambulance
• EMTs have training in
basic life support
(BLS), including:
– Automated external
defibrillation
– Airway adjuncts
– Assistance with
certain medications

6. Course Description
• AEMTs have training in specific aspects
of advanced life support (ALS), including:
– Intravenous (IV) therapy
– Administration of certain emergency
medications

7. Course Description
• Paramedics have extensive ALS training,
including:
– IV therapy
– Pharmacology
– Cardiac monitoring
– Other advanced assessment and
treatment skills

8. Course Description
• AEMT role and former EMT-I roles:
– Formerly, there were two EMT-I curricula.
• 1985 and 1999
– AEMT role resembles EMT-I 1985 curriculum.
• AEMTs do not perform skills that were part of
EMT-I 1999 level training, such as intubation.
• AEMTs can assist with administering certain
medications, but not others.

9. Course Description
• Upon completion of this course, you
should be able to take the state
certification exam.
• After passing the exam, you are eligible
to apply for licensure.
• Almost every state’s requirements follow
or exceed the guidelines in the current
NHSTA EMS Education Standards.

10. AEMT Training: Focus and
Requirements
• AEMTS provide emergency care to the
sick and injured.
– Some patients are in life-threatening
situations.
– Others require only supportive care.
– The skills to deliver this care are found
within this text.

11. AEMT Training: Focus and
Requirements
• Some of the subjects discussed include:
– Scene size-up
– Patient assessment
– Treatment
– Packaging
– EMS as a career

12. Licensure Requirements
• Requirements differ state to state;
general requirements to be an AEMT are:
– High school diploma or equivalent
– Proof of immunization against certain
communicable diseases
– Valid driver’s license

13. Licensure Requirements
• AEMT requirements (cont’d):
– Successful completion of:
• BLS/CPR course
• State-approved AEMT course
• State-approved written certification exam
• State-approved practical certification
exam

14. Licensure Requirements
• AEMT requirements (cont’d):
– Demonstrated ability to meet mental and
physical criteria to perform the job
– Compliance with other state, local, and
employer provisions

15. • State-recognized written and practical
exam may be the National Registry Exam
based on the individual state.
– Requires re-registration every 2 years
– Most states recognize NREMT
certification
– Provides reciprocity
Licensure Requirements

16. Licensure Requirements
• Americans With Disabilities Act (ADA)
– Protects people with disabilities from
being denied access to programs and
services provided by state and local
governments
– Prohibits employers from failing to provide
full and equal employment to the disabled
• States may exclude certain people from
AEMT certification, such as those
convicted of certain felonies.

17. History of EMS
Our History and the Lessons We
Can Apply to Our Future

18. History of EMS
• Origins of EMS include:
– Volunteer ambulances in WWI
– Specially trained field care providers in
WWII
– Field medic and rapid helicopter
evacuation in Korean conflict
– Advances in trauma care resulting from
casualty experiences in Korean and
Vietnam conflicts

19. History of EMS
• Horse-drawn
ambulances
introduced in the Civil
War
• Early motorized
ambulance

20. History of EMS
• As late as the early 1960s, emergency
ambulance service and care varied
widely in the United States.
• Modern EMS originated in 1966 with the
publication of Accidental Death and
Disability: The Neglected Disease of
Modern Society.
– Congress mandated federal changes.
– DOT published first EMT training
curriculum in early 1970s.

21. Focus of the Emergency Care
of the 1950’s and 60’s
• Emergency Care of
the 1950’s and 60’s
was presumed to
begin upon arrival at
the hospital
• Pre Hospital activities
focused only upon
speedy transportation

22. The Seminal Events that Lead to the
Formation of the EMS System
• 1950’s, CPR was proven to be
beneficial
– Able to be taught to lay
people proven in early 60’s
• 1966 Report titled Accidental
Death and Disability: The
Neglected Disease of Modern
Society.
• 1967 meeting of the American
Medical Association
• National Traffic and Motor
Safety Act of 1966
• Highway Safety Act of 1966

23. Miami, Florida (1967)

24. Freedom House (1967)
• Pittsburgh, PA
• Founded by Peter
Safar and Nancy
Caroline
• Underemployed and
unemployed African
Americans

25. http://www.youtube.com/watch?
v=hHUA0E3KYgA

26. Seattle, Washington (1968)

27. Moby-Pig

28. They do it right in Seattle!

30. And elsewhere..in the land of the
dead…

31. Haywood County, North
Carolina (1969)

32. Los Angeles County
December 1969

33. The National EMS Act of 1973
• Provided federal guidelines for EMS
Systems
• Outlined 15 components of an EMS
System
• Provided Federal funding for additional
programs

34. Funding Efforts in the Early
Days
• US Department Health, Education and
Welfare allocated 16 million dollars for
systems in 5 states
• Robert Wood Johnson Foundation
provides 15 million dollars to fund 44 EMS
projects in 32 states

35. History of EMS
• The AAOS prepared the first EMT
textbook in 1971.
– Your textbook is the AEMT level of that
book.
• Through the 1970s, EMS system
developed.

36. The Paramedic Program is
Recognized!
• Emergency!

40. History of EMS
• Availability of ALS-level care grew.
– Definitions of EMS providers began to
vary.
– Efforts are underway to standardize levels
of EMS education nationally.

41. Things that make you go
HMMMMM..
• QUESTION FOR DISCUSSION:
– Is the spread of ALS care a good thing?
• Why or Why not?
• Is there a down side?

42. EMS systems

43. EMS Systems
•If you have seen one
EMS System…
•…You’ve seen one
EMS system

44. EMS Models
• 3rd
Service
• Fire Service
• Law Enforcement
• Public Utility
• Private For Profit
• Hospital Based
– HEMS often fall under this model
• Industrial
• Military/Federal

45. Levels of Training
• Licensure is a state
function
– Creates some variation
between AEMTs
• Federal level:
– National EMS Scope of
Practice Model
provides guidelines for
EMS skills at each
level.
• State level:
– Laws regulate EMS
provider operations.
• Local level:
– Medical director
decides day-to-day
limits.

46. • Millions of laypeople are trained in
BLS/CPR.
– Many have taken basic first aid courses.
• Designed to provide necessary critical
care before responders can arrive
– Teachers, coaches, babysitters, etc.
– People who regularly accompany groups
on trips to remote locations are trained in
first aid.
Public BLS and Immediate Aid
(AKA “First Aid”)

47. • Detect treatable life-threatening cardiac
arrhythmias and deliver appropriate
electrical shock
• Designed to be used by untrained
laypeople
• Included in every level of prehospital
emergency training
Public Access Automated
External Defibrillators (PA-AEDs)

48. Emergency Medical Responders
(EMR)
• In EMS because
presence of trained
person on scene
cannot be ensured
• EMRs include:
– Law enforcement
officers
– Fire fighters
– Park rangers
– Ski patrollers
– Industrial Settings
Courtesy of Robert Kaufmann/FEMA

49. Emergency Medical Responders
(EMR)
• Trained to initiate immediate care and
assist other EMS personnel on their
arrival
• Good Samaritans trained in first aid and
CPR often show up at a scene.
– They can provide valuable assistance.
– They can also interfere with operations
and endanger themselves and others.
– Identify during scene size-up.

50. Emergency Medical Technicians
(EMT)
• EMT course requires about 150 hours.
– More in some states
– Includes the essential knowledge and
skills to provide basic emergency care
• On arrival at scene, EMT and other
providers assume responsibility for
assessment, care, packaging, and
transport of patient.

51. Advanced Emergency Medical
Technicians (AEMT)
• AEMT course
provides knowledge
and skills in specific
aspects of limited
ALS.
• Depending on area,
the student is:
– Building on EMT
training
– Entry level

52. Paramedics
• Extensive course of
training
– 800 to 1500 hours
or more
– May be offered
within context of
associate or
bachelor degree
program
• Wide range of ALS
skills

53. Components of the
EMS System
• Modern-day EMS system is a complex
network of coordinated services.
– These services work in unison to meet
needs of the community.
– As an AEMT, you are part of this network
and must stay active.

54. Public Access (EMD and 911)
• Easy access to help
in an emergency is
essential.
• 9-1-1 system is
usually the public
safety access point.
– Trained dispatchers
obtain information
and dispatch
responders.

55. EMD and 911
• Enhanced 9-1-1 systems provide
additional data, like address, phone
number of caller.
• Training the public on how to summon an
EMS unit is an important part of the
public education responsibility.

56. EMD and 911
• EMD system assists dispatchers in giving
callers instructions until EMS arrival.
– Reality of call may differ from dispatch
description.

57. • From caller information, dispatcher
selects parts of emergency system to
activate.
• EMS may be:
– Part of fire department
– Part of police department
– Independent
• New technology helps responders locate
their patients.
EMD and 911

58. Clinical Care and
Medical Control

59. Clinical Care and Operations
• You will use a wide range of equipment.
• Check equipment before going on duty to
ensure:
– It is in the assigned place.
– It is working properly.
– You are familiar with the specific model.

60. Clinical Care and Operations
• You may be called on to drive the ambulance.
– Become familiar with roads in PSA or sector.
– Before going on duty, check:
• Equipment and supplies
• Communications equipment
• Vehicle, for key fluids and condition of
tires
• Driver’s controls
• Built-in units and controls in patient
compartment

61. Medical Direction and
Control
• Physician medical
director authorizes
providers to give
medical care in
field.
• Appropriate care
is described in
standing orders
and protocols.
© Andrei Malov/Dreamstime.com

62. Medical Direction and
Control
• Medical director acts as liaison among
medical community, hospitals, and AEMTs.
• Medical control can be off-line or online.
– Online (direct)
• Physician directions given over the phone or
radio
• Can be communicated by designee (In some
states)
– Off-line (indirect)
• Standing orders, training, supervision

63. Legislation and Regulation
• Training, protocols, and practice follow
state legislation, rules, regulations, and
guidelines.
– Medical directors, along with EMS
supervisors and others, develop protocols
for service areas.
– EMS services are usually administered by
senior EMS official.
– Daily operation and direction of service
are provided by an appointed chief

64. Evaluation/CQI
• Medical director maintains quality control.
– Reviews patient care reports with other
staff
• CQI, also known as QA, reviews and
audits all aspects of an EMS call.
– Review meetings are held and feedback
given.
• Refresher training and continuing
education is important.
– Skill decay can occur.

65. Evaluation /CQI
• Eliminating errors is the goal. For example:
– Understand the circumstances and main
sources of errors.
– Be aware of your environment.
– Handing off patients is a high-risk activity
– When you are about to perform a skill, ask
yourself, “Why am I doing this?”
– Use “cheat sheets.” , “Check Lists”
– Use downtime to refresh infrequently used
skills.
– Discuss troublesome calls with your partner.

66. Transport to Specialty
Centers
• Some centers focus on specific types of
care, such as trauma, or specific types of
patients, such as children.
• Transport time may be longer.
– But patients will receive definitive care
more quickly.
• Know location of specialty centers and
protocol for transport.

67. Interfacility Transports
– Provided to
nonambulatory
patients or patients
requiring medical
monitoring
– May be between
hospitals, skilled
nursing facilities,
home residence
– AEMTs are

68. Working With Hospital Staff
• Become familiar with hospital by
observing:
– Equipment and how it is used
– Functions of staff members
– Policies and procedures in emergency
areas
• AEMTs may consult medical staff by
radio.
• Best patient care occurs with rapport
between all emergency care providers.

69. Working With Public Safety
Agencies
• Some public safety
workers have EMS
training.
– Become familiar with
their roles and
responsibilities.
– They may be better
prepared to perform
certain functions.
– Best patient care is
achieved through
cooperation.
Courtesy of MIEMSS

70. Prevention and Public
Education
• Focus is on public health.
– Works to prevent injury by being proactive
• EMS works with public health agencies
on:
– Primary prevention
– Secondary prevention
• AEMTs may be involved in illness and
injury surveillance.

71. Prevention and Public
Education
• AEMTs can help educate the public.
– One-on-one after an accident
– By going to local schools
– Working with health care institutions
– Teaching people immediate aid skills
• Public education increases respect and
can lead to increased funding.

72. EMS Research
• Provides scientific basis for standards
– Evidence-based decision making is
becoming an integral part of functioning in
EMS.
• AEMTs may be involved in research
through gathering data.
• Important to stay current on latest
research
– Make sure you understand what results
mean.

73. Roles and Responsibilities
of AEMTs

74. Who would you trust?

75. Professional Attributes
• Integrity
• Empathy
• Self-motivation
• Appearance and
hygiene
• Self-confidence
• Time management

76. Professional Attributes
• Communications
• Teamwork and diplomacy
• Respect
• Patient advocacy
• Careful delivery of care

77. A professional is:
• Involved in the profession!
• Leads by example first, position second.
• Models what the profession should be…

78. Norris Rule:Norris Rule:
• 1) Don’t be a douche!
• 2) Don’t make the rest of us look bad!

79. National Registry ofNational Registry of
Emergency Medical TechniciansEmergency Medical Technicians

80. NREMT
• Non Lobbying
• Not a GOVT Entity
• NEUTRAL
• A certifying agency only
• National Minimum Standard and
Uniformity is ONLY Goal
• www.nremt.org

81. National Association of EMT’s
• Lobbying
• Medical Malpractice
• PHTLS
• AMLS
• PEPP
• www.naemt.org

82. Advocates for EMS
• Advocates for EMS
– PAC
– Board members include other major EMS
organizations

83. Patient Interaction
• Every patient is entitled to compassion,
respect, and the best care.
• Remember: whether paid or volunteer,
you are a health care professional.
– Bound by patient confidentiality
• Be familiar with the HIPAA requirements.

84. • EMS is the system that provides the
emergency medical care needed by
people who have been injured or have
an acute medical emergency.
• The standards for prehospital
emergency care and the people who
provide it are governed by the laws in
each state and are typically regulated by
a state office of EMS.
Summary

85. • The AEMT course that you are now
taking will present the information and
skills that you will need to pass the
required examination needed to become
a licensed AEMT.
• The EMS ambulance is staffed by
providers who have been trained to the
EMT, AEMT, or paramedic level
according to recommended national
standards and have been licensed by
the state.
Summary

86. • An EMT has training in basic emergency
care skills, including automated external
defibrillation, use of airway adjuncts, and
assisting patients with certain
medications.
• An AEMT has training in specific aspects
of advanced life support (ALS), such as
with intravenous therapy and the
administration of certain emergency
medications.
Summary

87. • A paramedic has extensive training in
ALS, including endotracheal intubation,
emergency pharmacology, cardiac
monitoring, and other advanced
assessment and treatment skills.
• When the dispatcher at the 9-1-1
emergency communications center
receives a call for emergency care, he or
she dispatches to the scene the
designated EMS ambulance squad and
any fire, rescue, or police units that may
Summary

88. Summary
• Emergency medical responders, such as
law enforcement officers, fire fighters,
park rangers, ski patrollers, or other
organized rescuers often arrive at the
scene before the ambulance and
AEMTs.

89. • Key components of an AEMT’s job
include scene size-up, patient
assessment, treatment, and packaging.
After assessing the scene and the
patient, you will provide the emergency
care and transport that is indicated by
your findings and ordered by your
medical director in the service’s standing
order protocols or the physician who is
providing online medical direction.
Summary

90. • As an AEMT, you will work in a primary
service area and will have the
responsibility of ensuring that all
equipment and supplies are functional
and ready for use.
• Each EMS system has a physician
medical director who authorizes the
providers in the service to provide
medical care in the field. Medical control
is off-line (indirect) or online (direct).
Summary

91. • Continuous quality improvement is a
circular system of continuous internal
and external reviews and audits of all
aspects of an EMS call.
• It is important to determine ways to
reduce human error by ensuring that you
understand your protocols, ensuring that
your environment is organized and
functional, and acting as a patient
advocate.
Summary

92. Summary
• As an AEMT, you will work with many other
professionals, including hospital staff and
public safety personnel. Remember that the
best, most efficient patient care is achieved
through cooperation among agencies.
• EMS research and evidence-based decision
making are beginning to have a role in
functioning as an EMS provider. Stay aware of
research, and focus patient care on
procedures that have proven useful in
improving patient outcomes.

93. • AEMT attributes include compassion and
motivation to reduce suffering, pain, and
death in people who are injured or
acutely ill; a desire to provide each
patient with the best possible care;
commitment to obtain the knowledge
and skills that this requires; and the drive
to continually increase knowledge, skills,
and ability.
Summary

94. REVIEW