EMT/Paramedics Working in the Emergency Department Survey
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First Responder (2013)
THE NATIONAL ACADEMIES PRESS This PDF is available at http://nap.edu/22451 SHARE The Legal Definitions of First Responder (2013) DETAILS 30 pages | 8.5 x 11 | PAPERBACK ISBN 978-0-309-28369-4 | DOI 10.17226/22451 CONTRIBUTORS GET THIS BOOK Bricker, Lew R. C.; Petermann, Tanya N.; Hines, Margaret; and Sands, Jocelyn FIND RELATED TITLES SUGGESTED CITATION National Academies of Sciences, Engineering, and Medicine 2013. The Legal Definitions of First Responder . Washington, DC: The National Academies Press. https://doi.org/10.17226/22451. Visit the National Academies Press at NAP.edu and login or register to get: – Access to free PDF downloads of thousands of scientific reports – 10% off the price of print titles – Email or social media notifications of new titles related to your interests – Special offers and discounts Distribution, posting, or copying of this PDF is strictly prohibited without written permission of the National Academies Press. (Request Permission) Unless otherwise indicated, all materials in this PDF are copyrighted by the National Academy of Sciences. Copyright © National Academy of Sciences. All rights reserved. The Legal Definitions of “First Responder” November 2013 NATIONAL COOPERATIVE HIGHWAY RESEARCH PROGRAM Responsible Senior Program Officer: Stephan A. Parker Research Results Digest 385 THE LEGAL DEFINITIONS OF “FIRST RESPONDER” This digest presents the results of NCHRP Project 20-59(41), “Legal Definition of ‘First Responder’.” The research was conducted by Lew R. C. Bricker, Esquire, and Tanya N. Petermann, Esquire, of Smith Amundsen, Chicago, IL; Margaret Hines, Esquire; and Jocelyn Sands, J. D. James B. McDaniel was the Principal Investigator. INTRODUCTION Congress and in some congressional bills that were not enacted into law. -
Tracheal Intubation Following Traumatic Injury)
CLINICAL MANAGEMENT UPDATE The Journal of TRAUMA Injury, Infection, and Critical Care Guidelines for Emergency Tracheal Intubation Immediately after Traumatic Injury C. Michael Dunham, MD, Robert D. Barraco, MD, David E. Clark, MD, Brian J. Daley, MD, Frank E. Davis III, MD, Michael A. Gibbs, MD, Thomas Knuth, MD, Peter B. Letarte, MD, Fred A. Luchette, MD, Laurel Omert, MD, Leonard J. Weireter, MD, and Charles E. Wiles III, MD for the EAST Practice Management Guidelines Work Group J Trauma. 2003;55:162–179. REFERRALS TO THE EAST WEB SITE and impaired laryngeal reflexes are nonhypercarbic hypox- Because of the large size of the guidelines, specific emia and aspiration, respectively. Airway obstruction can sections have been deleted from this article, but are available occur with cervical spine injury, severe cognitive impairment on the Eastern Association for the Surgery of Trauma (EAST) (Glasgow Coma Scale [GCS] score Յ 8), severe neck injury, Web site (www.east.org/trauma practice guidelines/Emergency severe maxillofacial injury, or smoke inhalation. Hypoventi- Tracheal Intubation Following Traumatic Injury). lation can be found with airway obstruction, cardiac arrest, severe cognitive impairment, or cervical spinal cord injury. I. STATEMENT OF THE PROBLEM Aspiration is likely to occur with cardiac arrest, severe cog- ypoxia and obstruction of the airway are linked to nitive impairment, or severe maxillofacial injury. A major preventable and potentially preventable acute trauma clinical concern with thoracic injury is the development of Hdeaths.1–4 There is substantial documentation that hyp- nonhypercarbic hypoxemia. Lung injury and nonhypercarbic oxia is common in severe brain injury and worsens neuro- hypoxemia are also potential sequelae of aspiration. -
Emergency Department Resuscitation of the Critically Ill Review by Stephen C
BOOK AND MEDIA REVIEW Emergency Department Resuscitation of the Critically Ill Review by Stephen C. Morris, MD, MPH 0196-0644/$-see front matter Copyright © 2018 by the American College of Emergency Physicians. Emergency Department Resuscitation of the crashing morbidly obese patient reviews some of the nuanced Critically Ill management we should be striving for as more of our patients become obese, such as specific airway and ventilation Winters ME, Bond MC, Marcolini EG, et al management and use of ideal versus total body weight American College of Emergency Physicians calculations for critical-care-specific medications. Consider It was with great pleasure that I agreed to review the another example from the chapter on left ventricular assist second edition of Emergency Department Resuscitation of the devices. Although these patients have long been the domain Critically Ill, by Michael E. Winters. I had read and relied of specialty centers, with complex physiology and on the first edition posttraining. Like most who work in complications, the longevity now offered by the devices will emergency medicine, I practice a great deal of critical care; ultimately make them the domain of the community however, I have not completed a fellowship in critical care, emergency department. Additionally, at the cutting edge of nor do I review critical care literature with the level of our practice, the text contains a chapter on extracorporeal scrutiny that I would like. For those of us who want to membrane oxygenation, with a discussion of the practical ensure that we are up to date to guarantee clinical and clinical aspects of implementation. -
The Nebraska Office of Emergency Health Systems Trauma Program Is Pleased That You Wish to Participate in the Statewide Trauma System
Revised July 2019 INSTRUCTIONS FOR FILLING OUT PRE-REVIEW QUESTIONNAIRE (PRQ) The Nebraska Office of Emergency Health Systems Trauma Program is pleased that you wish to participate in the statewide trauma system. The Nebraska Statewide Trauma System is comprised of hospitals and clinics striving to improve trauma patient care. Through this system all facilities offering trauma care may become centers of excellence. Thank you for participating in this process. In order to prepare for your on-site review, please complete this questionnaire. All answers should directly follow the questions. The entire questionnaire is available on the web in a downloadable format @ http://dhhs.ne.gov/Pages/EHS-Statewide-Trauma-System-of-Care.aspx. The PRQ should be completed electronically if possible otherwise, you may submit a hard copy. Note: If a hard copy is printed a color printer should be used so that information and questions printed in blue appear on the page to the applicant. Return the completed questionnaire to: Sherri Wren EHS Trauma Program Manager Office of Emergency Health Systems P.O. Box 95026 Lincoln, NE 68509-5026 Phone: (402) 471-0539 E-mail: [email protected] If you have questions or concerns while filling out the PRQ, please contact: State of Nebraska Trauma Nurse Specialist OR your Regional Trauma Program Manager (please reference website list of Designated Trauma Centers on the website cited above for names and contact information). I. PURPOSE: A. The purpose of this questionnaire for Consultation Visits is: 1. To provide your institution with an outline of what site visitors will be discussing with you. -
Talking Points
DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard, Mail Stop S2-12-25 Baltimore, Maryland 21244-1850 Center for Medicaid and State Operations/Survey and Certification Group Ref: S&C-07-19 DATE: April 26, 2007 TO: State Survey Agency Directors FROM: Director Survey and Certification Group SUBJECT: Provision of Emergency Services - Important Requirements for Hospitals Memorandum Summary • All hospitals are required to appraise medical emergencies, provide initial treatment and referral when appropriate, regardless of whether the hospital has an emergency department. • A hospital is not in compliance with the Medicare Conditions of Participation (CoPs) if it relies on 9-1-1 services as a substitute for the hospital’s own ability to provide services otherwise required in the CoPs. This means, among other things, that a hospital may not rely on 9-1-1 services to provide appraisal or initial treatment of individuals in lieu of its own capability to do so. In this memorandum we affirm and explain current regulatory requirements pertaining to a hospital’s ability to meet the emergency needs of individuals. Any hospital participating in Medicare, regardless of the type of hospital and regardless of whether the hospital has an emergency department must have the capability to provide basic emergency care interventions. Requirements Applicable to All Hospitals (except Critical Access Hospitals) The following Medicare hospital Conditions of Participation (CoP) apply to all participating hospitals (except Critical Access Hospitals) and provide a foundation for safe care for all persons, including those with emergency care needs. Critical Access Hospitals (CAHs) are governed by regulations separate from those governing hospitals, and may be found at 42 CFR 485.618. -
Accident Knowledge and Emergency Management
Ris0-R-945(EN) DK9700056 Accident Knowledge and Emergency Management Birgitte Rasmussen, Carsten D. Gr0nberg Ris0 National Laboratory, Roskilde, Denmark March 1997 VOL 2 p III 1 2 Accident Knowledge and Emergency Management Birgitte Rasmussen, Carsten D. Gr0nberg Ris0 National Laboratory, Roskilde, Denmark March 1997 Abstract. The report contains an overall frame for transformation of knowledge and experience from risk analysis to emergency education. An accident model has been developed to describe the emergency situation. A key concept of this model is uncontrolled flow of energy (UFOE), essential ele- ments are the state, location and movement of the energy (and mass). A UFOE can be considered as the driving force of an accident, e.g., an explosion, a fire, a release of heavy gases. As long as the energy is confined, i.e. the location and movement of the energy are under control, the situation is safe, but loss of con- finement will create a hazardous situation that may develop into an accident. A domain model has been developed for representing accident and emergency scenarios occurring in society. The domain model uses three main categories: status, context and objectives. A domain is a group of activities with allied goals and elements and ten specific domains have been investigated: process plant, storage, nuclear power plant, energy distribution, marine transport of goods, marine transport of people, aviation, transport by road, transport by rail and natural disasters. Totally 25 accident cases were consulted and information was extracted for filling into the schematic representations with two to four cases pr. specific domain. The work described in this report is financially supported by EUREKA MEM- brain (Major Emergency Management) project running 1993-1998. -
THE BUSINESS of EMERGENCY MEDICINE … MADE EASY! Sponsored by AAEM Services, the Management Education Division of AAEM
THE BUSINESS OF EMERGENCY MEDICINE … MADE EASY! Sponsored by AAEM Services, the management education division of AAEM UDisclaimer The views presented in this course and syllabus represent those of the lecturers. The information is presented in a generalized manner and may not be applicable to your specific situation. Also, in many cases, one method of tackling a problem is demonstrated when many others (perhaps better alternatives for your situation) exist. Thus, it is important to consult your attorney, accountant or practice management service before implementing the concepts relayed in this course. UGoal This course is designed to introduce emergency physicians with no formal business education to running the business of emergency medicine. The title “The Business of Emergency Medicine Made Easy” is not meant to be demeaning. Instead, the course will convince anyone with the aptitude to become an emergency physician that, by comparison, running the business of emergency medicine is relatively simple. With off- the-shelf software and a little help from key business associates, we can run an emergency medicine business and create a win-win-win situation for the hospital, patients, and EPs. By eliminating an unnecessary profit stream as exists with CMGs, we can attract and retain better, brighter EPs. AAEM’s Certificate of Compliance on “Fairness in the Workplace” defines the boundaries within which independent groups should practice in order to be considered truly fair. Attesting to the following eight principles allows a group the privilege -
California Emergency Services
CALIFORNIA EMERGENCY SERVICES ACT CALIFORNIA DISASTER ASSISTANCE ACT EMERGENCY COMPACTS • INTERSTATE CIVIL DEFENSE AND DISASTER COMPACT (1951) • EMERGENCY MANAGEMENT ASSISTANCE COMPACT (2005) CALIFORNIA DISASTER AND CIVIL DEFENSE MASTER MUTUAL AID AGREEMENT Edmund G. Brown, Jr. Governor 2015 Edition Publishing Information This document was produced by: California Governor’s Office of Emergency Services 3650 Schriever Avenue Mather, CA 95655 Phone: (916) 845-8510 The statutes contained in this publication may also be searched at: www.caloes.ca.gov (Laws and Regulations) or www.leginfo.ca.gov The State of California makes no warranty, express or implied, and assumes no liability for omissions or errors contained within this publication. Table of Contents California Emergency Services Act..................................... 1 Article 1 – Purpose....................................................................1 § 8550. Findings and Declaration ................................................ 1 § 8551. Short title ........................................................................ 2 Article 2 – General Definitions ...................................................2 § 8555. Definitions governing construction ................................ 2 § 8556. “Governor” defined ........................................................ 2 § 8557. Definitions....................................................................... 2 § 8558. Conditions or degrees of emergency; “state of war emergency”, “state of emergency”, and “local emergency” defined........................................................................................ -
Emergency Medical Services at the Crossroads
Future of Emergency Care Series Emergency Medical Services At the Crossroads Committee on the Future of Emergency Care in the United States Health System Board on Health Care Services PREPUBLICATION COPY: UNCORRECTED PROOFS THE NATIONAL ACADEMIES PRESS 500 Fifth Street, N.W. Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This study was supported by Contract No. 282-99-0045 between the National Academy of Sciences and the U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality (AHRQ); Contract No. B03-06 between the National Academy of Sciences and the Josiah Macy, Jr. Foundation; and Contract No. HHSH25056047 between the National Academy of Sciences and the U.S. Department of Health and Human Services’ Health Resources and Services Administration (HRSA) and Centers for Disease Control and Prevention (CDC), and the U.S. Department of Transportation’s National Highway Traffic Safety Administration (NHTSA). Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project. International Standard Book Number 0-309-XXXXX-X (Book) International Standard Book Number 0-309- XXXXX -X (PDF) Library of Congress Control Number: 00 XXXXXX Additional copies of this report are available from the National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu. -
Anytown Trauma Center Trauma Protocols
ANYTOWN TRAUMA CENTER TRAUMA PROTOCOLS TITLE: TRAUMA TEAM ACTIVATION PROTOCOL PURPOSE: The purpose of the protocol is to establish guidelines for trauma team activation and define the members of the responding trauma team to facilitate the resuscitation and management of critical or seriously injured patients who require rapid, organized resuscitation, evaluation and stabilization to promote optimal outcomes. It also serves to provide triage guidelines for adult and pediatric patients. PROCESS: 1. TRAUMA TEAM ACTIVATION PROTCOL A. The criteria for activation of the trauma team is clearly defined and posted at the Emergency Department triage desk, by the EMS communication station and in the resuscitation rooms. B. The trauma team may be activated prior to arrival based on the EMS communication and their assessment. C. The trauma surgeon, emergency medicine physician, emergency department charge nurse/ house supervisor, emergency department nurses and the Trauma Program Manager may activate the trauma team. D. The person calling the trauma activation will initiate the trauma page to group page the trauma team and will specify the MOI, BP, HR, ETA and level of activation required and age if available. E. If the trauma team members are present in the emergency department and alert is still communicated to ensure everyone is notified. F. Trauma team member notification and arrival times will be documented on the trauma flow sheet (paper or electronic). G. Trauma team members will sign-in when they arrive. H. Trauma team members will be activated for all patients who meet the following criteria: 1. Level 1 trauma activation (major): life threatening injuries and/or unstable vital signs, limb-threating or disability threatening injury 2. -
A Uniform Triage Scale in Emergency Medicine Information Paper
A Uniform Triage Scale in Emergency Medicine Information Paper Triage: sorting, sifting (Webster’s New Collegiate Dictionary) from the French verb trier- “to sort.” Triage has long been considered a simple frontline sorting mechanism in hospital-based emergency departments (EDs). However, evolution in the practice of emergency medicine during the past two decades necessitates a change in how this entry point process is performed and utilized. Many triage systems are in use in the US, but there is no uniform triage scale that would facilitate the development of operational standards in EDs. A nationally standardized triage scale would provide an analytic basis for determining whether the health care system provides safe access to emergency care based on design, resources, and utilization. The performance of EDs could be compared based on case mix and acuity, and expected standards for facilities could be defined. Planners and policy makers would have the tools and the data needed to make rational improvements in the health care delivery system. This paper on triage will acquaint the reader with the history of triage, and provide an overview of the Australian and Canadian systems which are already in use on a national level. The reliability of triage is addressed, and the Canadian and Australian scales are compared. Future implications for a national triage scale are described, along with the goals and benefits of triage development. While there is some controversy about potential liability issues, the many advantages of a national triage scale appear to outweigh any potential disadvantages. History of triage The first medical application of triage occurred on the French battlefield where sorting the victims determined who would be left behind. -
Emergency Department - Charge Process
Emergency Department - Charge Process There are five components to the charge process for the Emergency Room: 1. Assignment of evaluation and management level 2. Nursing procedures 3. Hospital technical component of physician procedures 4. Medical supplies 5. Drugs sold to Patients Assignment of the evaluation and management level: The assignment of an ED E&M level is based on Nursing and hospital resources used for treating the Patient. The process is to assign a point value to each Nursing service or resource which cannot be separately charged to the Patient, the sum of the point values are then “fitted” to a scale to determine the level. CMS has stated that it is not expecting to see the same E&M level charged for the Hospital as the Physician. There are six E&M levels to be selected: 1. Brief – exam only with possibly a med script 2. Limited – Requires the assessment of a single symptom with limited testing or time spend with the Patient 3. Intermediate – several different diagnostic tests, child requiring restraint 4. Extended – Interventions and diagnostic testing, possible admit to hospital as observation or inpatient 5. Comprehensive – Major interventions or diagnostic testing, possible admit to hospital as a inpatient 6. Critical – Requires close attendance and major interventions or diagnostic testing for a extended period of time, admit to hospital Hospitals may also charge a “sub brief visit” for the following: 1. Triage only 2. Suture removal 3. Wound check PARA Healthcare Financial Services – November 2011 Page 1 Emergency Department - Charge Process Assignment of the evaluation and management level (continued) HCPCS/CPT® APC 99281 - Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making.