Emergency medical services , also known as ambulance services or paramedical services (abbreviated with EMS , EMAS , EMARS or SAMU in some countries), is a type of emergency service dedicated to providing acute medical care outside the hospital, transportation to definitive care, and transportation medical care for patients with diseases and injuries that prevent patients from transporting themselves. Emergency medical services can also be locally known as paramedical services, first aid teams, FAST squads, emergency squads, rescue teams, ambulance teams, ambulance services, ambulance corps, or life forces.
The goal of most emergency medical services is to provide care for those in need of urgent medical care, with the aim of treating the conditions satisfactorily, or arranging to discharge patients in a timely manner to the next definitive treatment point. This is most likely an emergency at the hospital. The term emergency medical services evolved to reflect a change from a simple ambulance system that only provides transportation, to a system where early medical care is provided at the scene and during transport. In some developing regions, the term is not used, or may be used inaccurately, because the service does not provide patient care, but only the provision of transportation to the point of care.
In most parts of the world, EMSs are called by community members (or other emergency services, businesses or authorities) through an emergency telephone number that places them in contact with a control facility, which then sends the appropriate source to deal with the situation.
In some parts of the world, emergency medical services also include the role of moving patients from one medical facility to another; usually to facilitate the provision of higher levels or more specialized treatment areas but also to transfer patients from special facilities to local hospitals or nursing homes when they no longer require the services of specialized hospitals, such as following a successful cardiac catheterization due to a heart attack. In such services, EMS is not called by community members but by clinical professionals (eg doctors or nurses) at the referral facility. Special hospitals that provide high-level care may include services such as neonatal intensive care (NICU), child-intensive care (PICU), regional state burn centers, special care for spinal and/or neurosurgery, regional stroke, care special heart (cardiac catheterization), and special/regional trauma treatments.
In some jurisdictions, EMS units can handle technical rescue operations such as discharge, water saving, and search and rescue. The level of training and qualifications for emergency medical service members and employees varies widely around the world. In some systems, members may attend eligible just to drive an ambulance, without medical training. In contrast, most systems have personnel that retain at least the first-aid certification, such as Basic Life Support (BLS).
Video Emergency medical services
Histori
Emergency treatment in the field has been given in various forms since the beginning of recorded history. The New Testament contains a parable of the Good Samaritan, in which a man who was beaten was treated by the Samaritans. Luke 10:34 (NIV) - "He went to him and wrapped his wounds, poured oil and wine, and put the man in his own donkey, brought him to a lodging place and took care of him." Also during the Middle Ages, Ksatria Hospitaller was known for providing assistance to wounded soldiers on the battlefield.
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The first use of an ambulance as a special vehicle, in combat arose with the ambulance volantes designed by Dominique Jean Larrey (1766-1842), chief surgeon Napoleon Bonaparte. Larrey was present at the battle of Spiers, between France and Prussia, and was distressed by the fact that the wounded soldiers were not picked up by ambulances (Napoleon needed to be placed two and a half miles back from the battle) until after the feud had ceased, and began to develop a new ambulance system. Having decided not to use the Norman horse system, he chooses a two or four-wheel-drawn carriage, which is used to transport soldiers who fall from the battlefield (active) after they receive earlier. treatment in the field. The Larrey project for the 'flying ambulance' was first approved by the Public Security Committee in 1794. Larrey then entered the service of Napoleon during the Italian campaign in 1796, where his ambulance was used for the first time in Udine, Padua and Milan, and he adapted his ambulance to conditions , even developing the garbage that camels can carry for a campaign in Egypt.
In a civilian ambulance, major advances were made (which in the coming years would come to form policy on hospitals and ambulances) with the introduction of transport cars for cholera patients in London during 1832. Statement on trains, as printed in The The Times said: "The curative process begins when the patient is put in the train; the time saved can be given for patient care; the patient can be taken to the hospital quickly so that the hospital may be fewer and located at a distance further than one to another ". This ambulance teaching provides instant care, allowing the hospital to be placed further apart, presenting itself in modern emergency medical planning.
The first hospital-based ambulance service known to operate outside Commercial Hospital, Cincinnati, Ohio (now Cincinnati General) in 1865. This was soon followed by other services, notably the New York service provided at Bellevue Hospital which began in 1869 with an ambulance carrying Medical equipment, such as splints, abdominal pumps, morphine, and brandy, reflects contemporary medicine.
In June 1887, the St John Ambulance Brigade was established to provide first-aid services and ambulances at public events in London. It is modeled on military style command and discipline structure.
The earliest emergency medical service reported was a rescue community founded by Jaromir V. Mundy, Count JN Wilczek, and Eduard Lamezan-Salins in Vienna after a great fire in Vienna Ringtheater in 1881. Named the "Vienna Voluntary Rescue Society," served as a model for similar societies around the world.
Also at the end of the 19th century, cars were being developed, and in addition to horse-drawn models, the early twentieth-century ambulance was supported by steam, gasoline and electricity, reflecting the competing automotive technologies that existed at the time. However, the first motorized ambulance was taken to service in the last year of the 19th century, with Michael Reese Hospital, Chicago, taking delivery of the first ambulance car, donated by 500 prominent local businessmen, in February 1899. This was followed in 1900 by New York City , who praised his virtues with higher speeds, safer for patients, faster stops and smoother travel. The two ambulances of this first car are electrically powered with 2 hp motors on the rear axle.
American historians claim that the first component of the world's first pre-hospital civilian treatment began in 1928, when "Julien Stanley Wise started Roanoke Life Saving and First Aid Crew in Roanoke, Virginia, which is the first land-based rescue team in the nation." The Canadian historian denies this with the city of Toronto claiming "The first formal training for ambulance officers was done in 1892."
During the First World War, further advances were made in providing care before and during transport - traction splints were introduced during World War I, and were found to have a positive effect on the morbidity and mortality of patients with broken leg bones. Two-way radios became available soon after World War I, allowing the delivery of more efficient ambulance radios in some areas. Before World War II, there were several areas where modern ambulances carry advanced medical equipment, administered by doctors, and sent by radio. In many locations, the ambulance is a hearse - the only vehicle available that can take the patient on his back - and thus often run by funeral homes. These vehicles, which can serve any purpose, are known as a combination car.
Before World War II, hospitals provided ambulance services in many major cities. With a severe labor shortage caused by the war effort, it became difficult for many hospitals to maintain their ambulance operations. The city authorities in many cases divert the ambulance service to the police or firefighters. There is no law that requires minimal training for ambulance personnel and no training program beyond the first basic assistance. In many firefighting departments, the task of ambulance becomes an unofficial form of punishment.
Progress in the 1960s, particularly the development of CPR and defibrillation as a standard form of care for cardiac arrest outside the hospital, along with new drugs, led to a change in ambulance duties. In Belfast, Northern Ireland, the first cellular coronary care ambulance successfully alerted patients using this technology. One well-known report in the US during that time was the Deaths from Accidents and Disabilities: the Abandoned Disease of the Modern Society. This report is commonly known as The White Paper. These studies, together with the White Paper report, put pressure on the government to improve general emergency care, including the care provided by ambulance services. In the US before the 1970s, ambulance services were largely unregulated. While some of the ambulance areas managed by first-degree beneficiaries of advanced assistance, in other areas, it is common for local administrators, to have the only transportation in the city where people can lie down, to operate both local furniture stores (where he will make coffins as a sideline) and local ambulance services. Government reports resulted in standard-setting in ambulance construction concerning the internal height of patient care areas (to allow an officer to continue treating patients during transport), and the ambulance equipment (and thus weight) that the ambulance has to carry, and several other factors.
In 1971, a progress report was published at the annual meeting, by the then American President, Trauma, Sawnie R. Gaston MD, Dr. Gaston reported that the study was "remarkable white paper" that "jolted and awakened the entire organized structure." The report is made as a "prime mover" and makes "the largest contribution of its kind to improved emergency medical services." From now on, concerted efforts have been made to improve emergency medical care in prehospital hospitals such advancements including Dr. R Adams Cowley created the country's first state EMS program, in Maryland.
Maps Emergency medical services
Service provider
Emergency medical services exist to meet the basic first aid principles of Protecting Life, Preventing Further Injury, and Promoting Recovery. This common theme in medicine is shown by the "star of life". The Star of Life is shown here, where each 'arm' for a star represents one of six points, used to represent the six stages of high quality pre-hospital care, which are:
- Early detection - public members, or other agencies, find the incident and understand the problem
- Initial reporting - the first person on the premises to call the emergency medical service (911) and provide details to allow the response to be fitted
- Initial response - first professional savior (EMS) sent and arriving on the spot as soon as possible, enabling maintenance to start
- Good site care - emergency medical services provide timely and timely intervention to treat patients at the scene without further harm.
- Treatment in transit - emergency medical services load patients into appropriate transportation and continue to provide appropriate medical care during the trip
- Transfer to definitive care - the patient is submitted to the appropriate care settings, such as the hospital emergency department, to the doctor's care
Care level
Emergency Medical Services is provided by a variety of individuals, using a variety of methods. To some extent, this will be determined by the state and locally, with each country having its own 'approach' on how the EMS should be provided, and by whom. In some parts of Europe, for example, the law affirms that efforts in providing advanced life support services (ALS) Mobile Intensive Care Units (MICU) must have doctors' staff, while others allow some elements of the skill set for the nurse specially trained, but no paramedics. Elsewhere, such as in North America, Britain and Australasia, ALS services are performed by paramedics, but rarely with the direct doctor type of leadership that is "seen" in Europe. Increasingly, especially in England and in South Africa, this role is provided by specially trained paramedics who are independent practitioners in their own right. Beyond the national care model, the type of Emergency Medical Services will be determined by local jurisdictions and medical authorities, based on community needs, and economic resources to support them.
The category of emergency medical services known as 'medical retrieval' or 'rendez vous MICU protocol' in some countries (Australia, NZ, Great Britain, and Francophone Canada) refers to transportation of critical care of patients between hospitals. pre-hospital). Such services are a key element in a regional hospital care system where intensive care services are centered on several specialist hospitals. An example of this is the Medical Emergency Retake Service in Scotland. In the United States, this is referred to as "Critical Care Transport" and the qualifications for this role vary by country and may include nurses, paramedics and/or EMT.
In general, the level of available services will fall into one of three categories; Basic Life Support (BLS), Advanced Life Support (ALS), and Transportation Critical Care (CCT) by traditional health care professionals, meaning nurses and/or doctors working in pre-hospital settings and even in ambulances. In some jurisdictions, the fourth level, Intermediate Life Support (ILS), which is essentially a BLS provider with a fairly expandable skill set, may be present, but this level rarely works independently, and where it is present may replace BLS in emergency of service. When this happens, the remaining staff at the BLS level is usually downgraded to non-emergency transport functions. Job titles usually include Emergency Medical Technicians, Ambulance Technicians, or Paramedics. These ambulance care givers are generally professional or paraprofessional and in some countries their use is controlled through training and enrollment. While these offices are protected by law in some countries, this protection is by no means universal, and anyone may, for example, refer to themselves as 'EMT' or 'paramedic', regardless of their training, or lack of it. In some jurisdictions, both technicians and paramedics can be more determined by the environment in which they operate, including titles such as 'Wilderness', 'Tactical', and so on.
Basic life support (BLS)
First responder
Emergency Officers (Police Officers, Fire Brigades, Volunteer Ambulances) whose duties include providing life-saving direct care in the event of a medical emergency; advanced first aid, oxygen delivery, lung resuscitation (CPR), and use of an automatic external defibrillator (AED). The first respondent training is considered minimal for emergency service workers who may be sent in response to an emergency call. The first respondent is usually sent by the ambulance service to come quickly and stabilize the patient before the ambulance can arrive and then assist the ambulance crew.
Ambulance Driver
Most jurisdictions require two providers of pre-licensed hospitals to operate licensed ambulances. Some jurisdictions separate the 'driver' and 'attendant' functions, hiring ambulance staff without medical qualifications (or just first-aid certificates), whose job is to drive an ambulance. While this approach takes place in some countries, such as India, it is generally becoming increasingly scarce. An ambulance driver can be trained in radio communications, ambulance operations, and emergency driving skills.
Assistant maintenance ambulance
Ambulance Care Assistants (ACAs) have various levels of training around the world. In many countries, such staff are usually only required to perform patient transport tasks (which may include stretcher cases or wheelchairs), rather than acute care. However, there are still both individual countries and jurisdictions where the economy will not support ALS services, and individual efforts may represent the only EMS available. Depending on the provider (and available resources), they can be trained in first aid or additional skills such as the use of AED, oxygen therapy, pain relievers and other life-saving or palliative skills. In some services, they can also provide emergency cover when other units are not available, or if accompanied by a qualified technician or paramedic.
Emergency medical technician
Emergency medical technicians, also known as Ambulance Technicians in the UK and EMT in the United States. In the United States, EMT usually consists of 3 levels. EMT-B, EMT-I (EMT-A in some states) and EMT-Paramedic. The National Registry of EMT New Educational Standards for EMS was renamed the following provider levels: Emergency Medical Response (EMR), Emergency Medical Technician (EMT), Advanced EMT (AEMT), and Paramedic. EMT is usually capable of performing various emergency care skills, such as automatic defibrillation, spinal cord injury and oxygen therapy. In some jurisdictions, some EMTs can perform tasks as IV cannulas and IOs, limited drug administration, more sophisticated airway procedures, CPAP, and limited cardiac monitoring. Most advanced procedures and skills are not within the scope of national practice for EMT. Therefore most countries require additional training and certification to perform above the national curriculum standards. In the US, EMT certification requires intensive courses and field skills training. A certification expires after two years and holds the requirement to take 48 CEU (continuing education credit). 24 of these credits must be in a refresh program while another 24 can be taken in various ways such as emergency driving training, pediatrics, geriatric, or bariatric care, specific trauma, etc.
Desert Emergency Medical Technician
Some emergency medical technicians, known as Wilderness Emergency Medical Technicians (WEMTs), are trained with protocols tailored for non-urban, rural (remote, hard, or resource-poor) environments. Not officially called as such, systems like the desert desert (WEMS) have been developed to provide standardization and professionalism for medical and educational responses in the wilderness arena. Examples include international safety organizations, the National Ski Patrol or an Appalachian Determination and Rescue Conference that responds regionally (USA-based). Like traditional EMS providers, all desert emergency medical providers (WEM) must continue to operate under on-line or off-line medical supervision. To assist physicians in the skills required to provide this oversight, the Wilderness Medical Society and the National Association of EMS Physicians jointly supported the development in 2011 of the unique "Wilderness EMS Medical Director" certification course, cited by the Journal of EMS as one of 10 Best EMS Innovations in 2011. Skills taught in the WEMT course outperform the EMT-Basic scope of practice including catheterization, antibiotic administration, use of the Intermediate Blind Intermediate Air Device (ie King Laryngeal Tube), Nasogastric Intubation, and simple sewing; However, the scope of practice for WEMT is still below the level of BLS care. Many organizations provide WEM training, including private schools, non-profit organizations such as the Appalachian Center for Desert Medicine and the EMS Wilderness Institute, military branches, colleges and universities, EMS-campus-hospital collaboration, and others.
Emergency medical dispatcher
Emergency medical officers are also called EMD. An increasingly common addition to EMS systems is the use of highly trained shipping personnel who can provide "pre-arrival" instructions to callers who report medical emergencies. They use carefully structured questioning techniques and provide written instructions to enable callers or observers to begin definitive care for critical problems such as airway obstruction, bleeding, labor, and heart attacks. Even with rapid response times by first responders measured in minutes, some medical emergencies evolve within seconds. Such a system provides, in essence, a "zero response time," and can have a profound effect on positive patient outcomes.
Advanced life support (ALS)
Paramedic
A paramedic has pre-hospital medical training at a high level and usually involves major skills not performed by a technician, often including kanulasi (and hence the ability to use various drugs for pain relief, correct heart problems, and endotracheal intubation), monitoring heart, tracheal intubation, pericardiocentesis, cardioversion, needle decompression and other skills such as cricothyrotomy. The most important paramedical function is to identify and treat life-threatening conditions and then carefully assess the patient for any complaints or other findings that may require emergency care. In many countries, this is a protected title, and its use without the relevant qualifications may result in criminal prosecution. In the United States, paramedics represent the highest licensed level of pre-hospital emergency care. In addition, some certifications exist for Paramedics such as Wilderness ALS Care, Aviation Paramedic Certification (FP-C), and Certification of Critical Emergency Medical Transportation Program.
paramedical critical care
Recent studies have seen a new level of pre-hospital care. What has been developed is a critical care medic, also called Paramedic advanced practice in some parts of the United States and Canada. This provider represents a higher level of license above that of the DOT or the respective paramedics curriculum. Training, permitted skills, and certification requirements vary from one jurisdiction to the next. This provider transports critically ill or injured patients from one hospital to a receiving hospital with a higher level of care (eg cardiac catheterization, trauma services or special ICU services) is not available at the referral facility.
These paramedics received additional training beyond normal EMS medications. The Board for Critical Care Transport Certification (BCCTPCÃ,®) has developed certification exams for paramedics for critical aviation and terrestrial care. Some of the educational facilities that provide this training are UMBC Critical Care Emergency Medical Transport Program or Cleveland CICP Clinic Program Cleveland. . Individualized services such as "Wake County EMS". and "MedStar EMS". has developed advanced paramedical practice provider at home. This provider has a wide range of medicines to deal with medical patients and complex trauma. Examples of treatment are Dopamine, Dobutamine, Propofol, blood and blood products to name a few. Some examples of skills including, but not limited to, life support systems are usually limited to ICU or critical hospital care settings such as mechanical ventilators, intra-aortic balloon pumps (IABP) and external pacemaker monitoring. Depending on the medical service, these service providers are trained on the placement and use of UVC (Umbilical Arterial Catheters), UAC (Umbilical Arterial Catheter), surgical airways, central pathways, artery ducts and chest tubes.
Practitioner paramedic/emergency care practitioner
In the UK and South Africa, some serving paramedics receive additional university education to become practitioners in their own right, giving them absolute responsibility for their clinical judgment, including the ability to prescribe drugs independently, including medicines normally reserved for doctors, such as antibiotic programs. Emergency care practitioners are positions that are sometimes referred to as 'super paramedics' and are designed to bridge the relationship between ambulance care and general practitioner care. ECP is a university graduate in Emergency Medical Care or qualified paramedics who have undergone further training, and is authorized to perform specialized techniques. In addition some may prescribe medicines (from a limited list) for long-term treatment, such as antibiotics. In relation to the settings of Primary Health Care, they are also educated in various Diagnostic techniques.
Traditional health profession
Registered Nurses
Use of registered nurses (RNs) in general pre-hospital settings in many countries. In some areas of the world nurses are the primary health care workers who provide emergency medical services. In European countries such as France or Italy, it also uses nurses as a means to provide ALS services. This nurse may work under the direct supervision of a physician, or, in more rare cases, independently. In some places in Europe, especially Norway, paramedics do exist, but the role of ambulance nurses continues to be developed, as it is felt that nurses can bring unique skills to some of the situations faced by ambulance crew.
In North America, and to a lesser extent elsewhere in the English-speaking world, some jurisdictions use trained nurses specifically for medical transport work. These are mostly medical-air personnel or critical care care providers, often working with technicians, paramedics or doctors on emergency transport interfacility. In the United States, the most common use of ambulance-based nurses is in the care of Critical Care/Cell Intensive Care, and in Aeromedical EMS. Such nurses are usually requested by their employer (in the US) to seek additional certification beyond the primary nursing license. Four states have an Intensive Care or Prehospital Nurse license that is above the Paramedic. Many countries allow registered nurses also become registered paramedics according to their roles in emergency medical services teams. In Estonia, 60% of ambulance teams are led by nurses. Ambulance nurses can perform almost all emergency procedures and administer pre-hospital medicines like doctors in Estonia. In the Netherlands, all ambulances are managed by registered nurses with additional training in emergency care, anesthesia or critical care, and EMT-drivers. In Sweden, since 2005, all emergency ambulances must be managed by at least one registered nurse as only nurses are allowed to administer medicines. And all Ambulances of Advanced Life Support have staff at least by registered nurses in Spain. In France, since 1986, fire-based rescue ambulances have the option of providing reanimation services using specially trained nurses, operating on protocols, while the SAMU-SMUR unit is administered by doctors and nurses
Doctor
There are many places in Europe, especially in France, Italy, German-speaking countries (Germany, Switzerland, Austria), and Spain where the EMS model is different, and physicians take a more direct 'direct' approach to pre-hospital care. In France, Italy, and Spain, responses to emergency calls with high levels of acuity are led by doctors, as does the French SMUR team. Paramedics are not in the system, and most ALS is performed by doctors. In German-speaking countries, paramedics do exist, but special doctors (called Notarzt) respond directly to high-acting calls, overseeing the paramedic ALS procedure directly. In these countries, paramedics can perform many procedures under "Notfallkompetenz" ("emergency competency"), which means that they can independently perform maintenance, such as defibrillation or drug administration, if no doctor at the scene, and life-threatening conditions are present, otherwise they can only act on doctor's instructions. Some systems - especially air ambulances in the UK. will hire doctors to lead clinics in ambulances; bringing additional skills such as the use of drugs that are outside the range of paramedical expertise. The doctor's response to emergency calls is routine in many parts of Europe, but not common in the UK, where physicians are generally assigned to high priority calls voluntarily. In the United Kingdom the Pre-Hospital Care sub-specialization is being developed for Physicians, which will enable training programs and consultant posts to be developed in one area of ​​this practice.
This 'straightforward' approach is less common in the United States. While a person sometimes sees a doctor with an ambulance crew on an emergency call, it is much more likely to become a Medical Director or partner, inaugurate newly trained paramedics, or perform routine medical quality assurance. In some transport jurisdictions critical care adults or children sometimes use doctors, but it is generally only when it seems likely that patients may require pharmacological or surgical intervention beyond the EMT, paramedical or nursing skills during transport.
Doctors are leaders of the medical search teams in many western countries, where they can help transport critically ill patients, injured, or special needs to tertiary care hospitals, especially when longer transport times are involved. In this case the doctor's role is extended to ensure the highest level of care provided during transportation and diagnosis of serious medical conditions.
Delivery of pre-hospital care
Depending on the country, region within the country, or clinical needs, emergency medical services may be provided by one or more different types of organizations. This variation can cause major differences in the level of care and scope of expected practice.
The most basic emergency medical services are provided only as a transport operation, just to take the patient from his location to the nearest medical care. This often happens in historical contexts, and is still true in developing countries, where diverse operators such as taxi drivers and administrators can operate this service.
Most developed countries now provide state-funded emergency medical services, which can be run at the national level, as in the United Kingdom, where a national network of ambulance trust operates emergency services, is paid through central taxation, and is available to anyone in need, or can be run on more regional models, as in the United States, where individual authorities have a responsibility to provide these services.
An ambulance service can be a stand-alone organization, but in some cases, emergency medical services are operated by the local fire service or police. This is very common in rural areas, where maintaining a separate service is not always cost effective. This may cause, in some cases, illness or injury attended by vehicles other than ambulances, such as fire trucks. In some areas, firefighters are the first responders to request emergency medical assistance, with separate ambulance services that provide transportation to the hospital when necessary.
Some charities or non-profit corporations also operate emergency medical services, often along with patient transport functions. It often focuses on providing ambulances for the community, or for shelter at private occasions, such as sporting events. The Red Cross provides this service in many countries around the world on a voluntary basis (and the other as a Personal Ambulance Service), as do several other small organizations such as St. John Ambulance. and Ordo Malta Ambulance Corps. In some countries, this voluntary ambulance may be seen to provide support to the full-time ambulance crew during times of emergency, or simply to help cover the busy period.
There are also private ambulance companies, with paid employees, but often with contracts to local or national governments. Many private companies only provide the transport elements of patients from ambulance care (ie non-insurgents), although in some places these private services are contracted to provide emergency care, or to form 'second tier' responses, where they respond only to emergencies when all crew a busy full-time emergency ambulance or responding to a non-emergency home call. Private companies are often contracted by private clients to provide special event covers, as do voluntary EMS crews.
Many colleges and universities, especially in the United States, maintain their own EMS organization. These organizations operate on capacities ranging from first response to ALS transport. The EMS campus in the United States is overseen by the National Emergency Medical Service Foundation.
Strategy to provide care
Important decisions in pre-hospital care are whether the patient should be immediately taken to the hospital, or advanced care resources taken to patients where they are lying. The "spoons and runs" approach is exemplified by MEDEVAC aeromedical evacuation helicopters, whereas "stay and play" is exemplified by the mobile emergency unit of SMUR France and Belgium or the German "Notarzt" system (preclinical emergency physician). The use of helicopters pioneered in the Korean war, when the time to reach medical facilities was reduced from 8 hours to 3 hours in World War II, and again up to 2 hours by the Vietnam war.
The strategy developed for prehospital trauma care in North America is based on the Golden Hour theory, that is, the survivor's best chance of survival is in the operating room, with the goal of having patients in operation within an hour of a traumatic event. This seems to be true in the case of internal bleeding, particularly penetrating trauma such as gunshot wounds or punctures. Thus, the minimum time is spent on providing pre-hospital care (spine immobilization; "ABC", ie ensuring that irway, b reathing and c irculation, external bleeding control, endotracheal intubation) and the victim is transported as quickly as possible to the center of the trauma.
The goal in "Scoop and Run" treatment is generally to transport patients within ten minutes of arrival, so that the birth of the phrase, "platinum ten minutes" (in addition to "golden hour"), is now commonly used in EMT. Exercise program. "Scoop and Run" is a method developed to treat trauma, not a strict medical situation (eg, heart or breathing emergencies), but this may change. Increasingly, studies into ST-segmented ST-infarction (STEMI) STD management occur outside hospitals, or even within community hospitals without their own PCI laboratories, suggesting that time to treatment is a significant clinical factor in heart attack, and that patients trauma may not be the only clinically appropriate 'loading and leaving' patient. In such conditions, the gold standard is the door to the time of the balloon. The longer the time interval, the greater the damage to the myocardium, and the worse the long-term prognosis for the patient. Current research in Canada has shown that doors to balloons times are lower when the exact patient is identified by paramedics in the field, not the emergency room, and then transported directly to the waiting PCI laboratory. The STEMI program has reduced STEMI deaths in the Ottawa area by 50 percent. In a related program in Toronto, EMS has begun using the procedure to 'save' STEMI patients from the Emergency Room at a hospital without a PCI laboratory, and transport it, in an emergency, to wait for PCI laboratories in other hospitals.
Care model
Although different philosophical approaches are used in the provision of EMS services worldwide, they can generally be placed in one of two categories; one doctor is led and the other is led by a pre-hospital allied medical staff such as an emergency medical technician or paramedic (who may, or may not have the supervision of the accompanying physician). These models are usually identified by their original location.
The Franco-German model is a doctor led, with doctors responding directly to all major emergencies that require more than just first aid. In some cases in this model, like France, paramedics, as they are in Anglo-American models, are not used, although the term 'paramedic' is sometimes used in general, and they have similar training to EMT-B AS. Team doctors and in some cases, nurses, provide all medical interventions for patients, and non-medical members of the team only provide driving and lifting services. In other applications of this model, as in Germany, the paramedical equivalent does exist, but is severely limited in terms of the scope of practice; it is often not permitted to perform Advanced Life Support (ALS) procedures unless the physician is physically present, or in case of life-threatening conditions directly. Ambulances in this model tend to be better equipped with more advanced medical devices, in essence, bringing emergency departments to patients. High-speed transport to hospitals is considered, in many cases, unsafe, and a preference to remain and provide definitive care to patients until they are medically stable, and then reach transport. In this model, doctors and nurses may actually be ambulance staff along with a driver, or perhaps a quick response vehicle staff, not an ambulance, providing medical support to multiple ambulances.
The second treatment structure, termed Anglo-American model, utilizes pre-hospital allied health staff, such as emergency medical technicians and paramedics, to staff ambulances, which can be classified according to the varying skill levels of the crew. In this model it is very rare to find doctors who work routinely in pre-hospital settings, although they can be used on a large or complex injury or disease. In this system, the physician's involvement most likely is the provision of medical supervision for the work of the ambulance crew, which can be achieved in terms of off-line medical control, by protocol or 'standing orders' for certain medical types. procedures or treatment, or on-line medical control, where technicians must establish contact with a doctor, usually in a hospital, and receive direct orders for various types of medical interventions. In some cases, such as in the UK, South Africa and Australia, a paramedic may be an autonomous health care professional, and does not require permission from a physician to manage interventions or medications from an agreed list, and may perform roles such as Tailoring or prescribing medications to patients.
In this model, the patient may still be treated at the scene until the crew skill level is present, and then transported to definitive care, but in most cases, reduced skills of the ambulance crew and patient needs show shorter. intervals for patient transport rather than cases in the Franco-German model.
Clinical governance
Paramedics in countries that follow the Anglo-American model usually function under the authority (medical guidance) of one or more physicians who are allegedly legally establishing emergency medical directions for a particular area. Paramedics are authorized and authorized by these doctors to use their own clinical judgment and diagnostic tools to identify medical emergencies and to administer appropriate treatments, including medicines that usually require physician orders. Credentials may occur as a result of an examination by the National Medical Agency (AS) or the National Registry of Emergency Medical Technicians (USA). In the UK, and in some parts of Canada, credentialing can occur through the College of Paramedicine. In this case, paramedics are regarded as self-regulating health professions. The last common method of credentialing is through certification by the Medical Director and permission to practice as an extension of the Medical Director's license to practice some medical measures. The authority to practice in a semi-autonomous way is provided in the form of a regulatory protocol (off-line medical control) and in some cases direct medical consultation by telephone or radio (on-line medical control). Under this paradigm, paramedics effectively assume the role of field agents outside the hospital for regional emergency doctors, with clinical decision-making authorities using standing orders or protocols. Recently "Telemedicine" has appeared in the ambulance. Similar to online medical controls, this practice allows paramedics to transmit remote data such as vital signs and 12 and 15 ECG leads to hospitals from the field. This allows emergency departments to prepare themselves to treat patients before their arrival. This allows lower level providers (such as EMT-B) in the United States to take advantage of this advanced technology and ask doctors to interpret it, thus bringing rapid identification of rhythm to areas where paramedics are thin.
In some parts of the world, people in the paramedical professional role are only allowed to practice many of their advanced skills while assisting physicians who are physically present, or they face life-threatening emergency cases. In many other parts of the world, especially in France, Belgium, Luxembourg, Italy, and Spain, but also in Brazil and Chile, all MICU skills in pre-hospital settings are conducted by physicians and nurses and on-line permanent medical supervision conducted by SAME. In some other jurisdictions, such as Britain and South Africa, paramedics may be entirely autonomous practitioners capable of prescribing drugs. In other jurisdictions, such as Australia and Canada, the scope of this expanded practice is under active consideration and discussion.
Organizations in different countries
See also
- In an emergency, a program that enables EMS workers to identify victims and contact their closest relatives for critical medical information
- Model of public utilities, models for organizing Emergency Medical Services
- Battlefield Drugs
- Drug wilderness
- Mass Collection Drug
- Good Samaritan law
- CEN 1789
- White Paper (Official title "Death and Disability by Accident: Modernized Abandoned Disease" - 1966 report that encourages the development of organized EMS in the US)
- Medical amnesty policy
- Star of Life
- List of EMS provider credentials
References
- "first responders". TheFreeDictionary.com .
Further reading
- Emergency Medical Communications Planning: Volume 2, Local/Local Level Planning Guide , (Washington, DC: National Highway Traffic Safety Administration, US Department of Transportation, 1995).
External links
- Emergency Medical Services at Curlie (based on DMOZ)
- "Emergency Medical Service in the European Union: EU coordinated assessment project report"
- World Health Organization: Department of Violence and Injury Prevention "Pre-Hospital Trauma Care System"
Source of the article : Wikipedia
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