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Introduction to Emergency Medical Care

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Introduction to Emergency Medical Care © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Introduction to Emergency © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 1 NOTMedical FOR SALE OR DISTRIBUTION Care NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett CHAPTER Learning, OUTLINE LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION The Emergency Medical Services System and the EMT Overview of the Emergency Medical Services System The Healthcare System © Jones & Bartlett Learning, LLCRoles and Responsibilities© ofJones the EMT & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Professional Attributes of the EMT Quality Improvement Medical Direction © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 1 © Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. 2 Chapter 1 Introduction to Emergency Medical Care Sce nario The origins of EMS date back to antiquity, as in the story of © Jones & Bartlett Learning, LLC © Jonesthe “Good & Samaritan.”Bartlett Learning,The response toLLC another human in need NOT FORIt is your SALE fi rst day OR as anDISTRIBUTION emergency medical technician (EMT), and NOTis theFOR driving SALE force OR for theDISTRIBUTION EMSS and for all individuals who you respond to a call to aid a victim in a motor vehicle crash. On ar- participate when called to aid someone in distress. rival at the scene, you fi nd police directing traffi c, making the scene safe. Fire department rescue personnel are removing the driver’s Battlefi elds as Laboratory side door to gain access to the patient, and a trained fi rst responder The growth and development of EMS has occurred primarily is in the vehicle stabilizing the© victim’s Jones head & to Bartlett prevent further Learning, spi- over LLC the past 50 years. Although© much Jones of this & Bartlettgrowth has Learning, re- LLC nal injury. You enter the vehicleNOT and FOR perform SALE your initialOR DISTRIBUTIONassess- sulted from increased knowledgeNOT and FORtechnological SALE advances, OR DISTRIBUTION ment. The patient is complaining of pain in the neck and abdomen the value of a coordinated response to expected injury was fi rst and is breathing rapidly, and you note the skin is pale and sweaty. identifi ed, ironically, on the battlefi elds. Ambulances were de- You work with the fi refi ghters to remove the patient from the vehi- ployed during the Napoleonic Wars, when a French Army sur- cle, continue your assessment and treatment, and begin transport. geon, Baron Dominique-Jean Larrey, introduced his ambulance You notify ©the Jones local trauma & Bartlett center of Learning,the patient’s condition LLC and volantes, a French© Jones term meaning & Bartlett “fl ying fi Learning,eld hospital.” PatientsLLC approximateNOT time FORof arrival. SALE OR DISTRIBUTION were deliveredNOT by ambulances FOR SALE to fi eld ORhospitals, DISTRIBUTION where surgeons On arrival at the emergency department, the trauma team is wait- would tend to their wounds. Before this time, soldiers often ing and continues care. Before you leave, the trauma surgeon tells you were left to die on the fi eld of battle ( Table 1-1 ). he suspects the patient has a neck fracture and a ruptured spleen. In the United States, horse-drawn ambulances were intro- duced during the Civil War, under the direction of Dr. Jonathan © Jones & Bartlett Learning, LLC © JonesLetterman & (Bartlett Figure 1-1 ).Learning, LLC Emergency treatment applied in the fi eld of battle included NOT FOR LEARNING SALE OBJECTIVE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION traction splinting of fractured femurs. Originally developed by • Defi ne emergency medical services (EMS) system. the orthopedic surgeon Hugh Owen Thomas (1834 - 1891) in Liverpool, the “Thomas splint” decreased the mortality of com- pound fractures of the femur from 80% in 1916 to less than 8% The Emergency Medical© Jones Services & Bartlett System Learning, in LLC 1918. The traction splint is still© Jones applied to& fracturesBartlett of Learning, the LLC and the EMT NOT FOR SALE OR DISTRIBUTIONfemur. NOT FOR SALE OR DISTRIBUTION During the Korean War in the 1950s, helicopters were used An emergency is an unforeseen combination of circumstances to evacuate wounded soldiers to mobile army surgical hospi- or the resulting state that calls for immediate action. The term tals (MASH units), where, if necessary, immediate lifesaving medical means relating to or concerned with the practice of surgery was performed before transfer to more permanent medicine.© Service Jones refers & toBartlett the occupation Learning, or function LLC of serv- care units. The© VietnamJones War& Bartlett experience Learning, reinforced the LLC value ing, or a contributionNOT FOR toSALE the welfare OR ofDISTRIBUTION others. Finally, system of rapid transportNOT and FOR early SALE surgery OR for traumaDISTRIBUTION victims. The refers to a regular interaction or interdependent group of items death rates of battle casualties who reached a hospital decreased forming a unifi ed whole. An emergency medical services system from 8% in World War I, to 4.5% in Korea, to less than 2% in (EMSS) is the planned confi guration of community resources Vietnam. and personnel necessary to provide immediate medical care to The medical and transport strategies developed during war © Jonespatients & Bartlett with sudden Learning, or unexpected LLC illness or injury. An EMSS © Jonesalso served & asBartlett a model forLearning, change in civilian LLC life. Physicians who NOT FORcan be SALE local, regional, OR DISTRIBUTION or statewide. NOTworked FOR as SALEsurgeons OR in Korea DISTRIBUTION and Vietnam came to appreciate The key word in this definition is “service.” By becoming the value of early fi eld care and transport. When they returned an emergency medical technician (EMT), you have decided home, they were keenly aware that some victims who died from to serve a community. Indeed, you will help a wide variety motor vehicle crashes might have been saved if they had the of people in need of care. Some patients, such as victims of same care as was provided during their wartime experience. sudden cardiac death, will© depend Jones on & you Bartlett to literally Learning, save This LLC revelation led many physicians© Jones to become & Bartlett the “champi- Learning, LLC their lives. Others will relyNOT on yourFOR support SALE and OR care DISTRIBUTION for ons” of civilian EMSS development.NOT FOR SALE OR DISTRIBUTION what may seem a relatively minor complaint to you but that has caused them to become a patient in need. In either case, Civilian Evolution you are playing a critical role in the healthcare system. You The civilian evolution of EMS varied greatly from region to will often be the first medical provider to see and care for region. In rural areas, undertakers had routinely transported the patient.© Jones & Bartlett Learning, LLC victims of “accidents”© Jones because & Bartlett their vehicles Learning, were well LLC suited NOT FOR SALE OR DISTRIBUTION to transport peopleNOT onFOR their SALE back. In OR many DISTRIBUTION communities, fi re Historical Perspective departments and volunteer ambulance companies, who still Emergency medical services (EMS) is a relatively new and ex- provide EMS coverage for many rural populations today, re- citing fi eld that is still evolving. In the 1950s, EMS was little placed undertakers. In urban areas, EMS was often provided by more than fi rst aid and often was provided by the local mor- paid services based at hospitals, fi re departments, police depart- © Jonestician & andBartlett a hearse. Learning, Current systems LLC link ambulances and © Jonesments, or & independent Bartlett Learning, ambulance companies. LLC Organized vol- NOT FORhospitals SALE to optimize OR DISTRIBUTION care for patients with many different NOTunteer FOR EMS SALE squads OR often DISTRIBUTION provided the ambulance service for a conditions. local community or supplemented service, even in urban areas, © Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. http://evolve.elsevier.com/Henry/EPC 3 © Jones & Bartlett Table 1-1 Learning,Emergency LLCMedical Services (EMS) Chronology© Jones & Bartlett Learning, LLC NOT FORYear SALE Event OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 1797 Napoleon’s chief physician implements a “prehospital system” designed to triage and transport injured soldiers from the battlefi eld to aid stations. 1860s Civilian ambulance services begin in Cincinnati and New York City. 1915 First known air© medical Jones transport & Bartlett occurs during Learning, the retreat LLCof the Serbian army from Albania.© Jones & Bartlett Learning, LLC 1920s First volunteer NOTrescue squadsFOR organizeSALE inOR Roanoke, DISTRIBUTION Virginia, and along the New Jersey coast.NOT FOR SALE OR DISTRIBUTION
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