STUDY GUIDE FOR EMT. SUCCESS.

1. Review types of consent (implied, expressed, etc) o Consent is generally required from every conscious adult before care can be started. The foundation of consent is decision-making capacity. o Implied consent legal assumption that treatment was desired. ▪ Applies to patients who are unconscious or are otherwise incapable of making a rational, informed decision about care. It applies only when a serious medical condition exists and should never be used unless there is a threat to life or limb. ▪ The principle of implied consent is known as the emergency doctrine. ▪ Sometimes what represents a “serious threat” is unclear, and it may become a legal question. o Expressed consent patient gives express authorization for provision of care or transport. The patient acknowledges he or she wants you to provide care or transport. ▪ To be valid, the patient must provide informed consent, which means you have explained the treatment being offered, along with the potential risks, benefits, and alternatives, as well as the potential consequences of refusing treatment. Informed consent is valid if given orally. Always document when a patient provides informed consent, or have someone witness the patient’s consent. o Involuntary consent Applies to patients who are mentally ill, in a behavioral (psychological) crisis, are developmentally delayed. ▪ You should obtain consent from the guardian or conservator; however, it is not always possible to obtain such consent, so understand your local provisions (sometimes need a law enforcement authority to be present to take person to medical facility) 2. Review what your actions should be if you come across an MVC as an EMT on duty and off duty o If you are off duty and come upon a crash, you are not legally obligated to stop and assist patients. 3. Recall the functions of the National Registry, AHA, DOT, Trauma centers, Local EMS offices, State EMS offices o National Registry of Emergency Medical Technicians (NREMT) is a nongovernmental agency that provides national standardized EMS testing and certification in much of the United States. May states use the National Registry standards in certifying their EMTs and grant licensing reciprocity to NREMT-certified EMTs ▪ EMS is regulated ENTIRELY by the state in which you are licensed o American Heart Association (AHA) Every 3 to 5 years, the AHA unveils a revised set of guidelines based on large amounts of evidence and serves as a standard for basic life support (BLS) and cardiopulmonary resuscitation (CPR). o Department of Transportation (DOT) DOT published the first EMT training curriculum in the early 1970s. In the late 1970s, the DOT developed a recommended National Standard Curriculum. o Trauma Centers Trauma centers are categorized as either adult trauma centers or pediatric trauma centers, but not necessarily both. The goal of a trauma system is to get the right patient to the right facility in the right amount of time. ▪ Trauma patients with shock, or a suspicious MOI, generally should go to a trauma center. ▪ Trauma centers are classified from levels I III, with level I being able to handle every trauma. o Local EMS offices At the local level, each EMS service operates in a designated PSA in which it’s responsible for the provision of prehospital emergency care and the transportation of the sick and injured to the hospital. The medical director decides day-to-day limits of EMS personnel. Examples include the medications that will be carried on an ambulance or where patients are transported. o State office of EMS is the standards for prehospital emergency care and the individuals who provide it are typically regulated by the state office of EMS ▪ EMT training in nearly every state meets or exceeds the guidelines recommended by the National Highway Traffic Safety Administration (NHTSA) 4. Review types of medical direction, and know situations that would dictate the use of each type o Medical direction a physician medical director authorizes EMTs to provide medical care in the field. Appropriate care is described in standing orders and protocols. ▪ Medical control can be off-line or online. Off-line (indirect) - Standing orders, training, supervision Online (direct) - Physician directions given over the phone or radio 5. Review the components of an EMS system o There are 14 components of the EMS system o The EMS Agenda for the Future outlines 14 components of an EMS system ▪ Public access easy access to help in an emergency is essential. The 9-1-1 system is the public safety access point. At the communication center, trained dispatchers obtain information and dispatch the ambulance crew and other equipment and responders. An emergency medical dispatch (EMD) system has been developed to assist dispatchers in providing callers with vital medical instructions until EMS arrival. ▪ Communication systems From caller information, the dispatcher selects the appropriate parts of the emergency system to activate. EMS may be: part of the fire department, part of the police department, Independent (either public or private). New technology helps responders locate their patients for example cellular telephones linked to global positioning system (GPS) units. ▪ Clinical care Describes the pieces of equipment, scope of practice for using that equipment and familiarizes EMTs with their primary service area (PSA), or main area in which an agency operates. Overall, it familiarizes EMTs with ambulance controls. ▪ Human resources Focuses on the people who deliver the care such as their compensation, interaction with other members of medical community and well-being. Efforts are underway to allow EMS providers to move from state to state more seamlessly. The EMS Agenda for the Future encourages the creation of systems to help protect the well-being of EMS providers, including building career ladders. ▪ Medical direction Physician medical director authorizes EMTs to provide medical care in the field. Appropriate care is described in standing orders and protocols. ▪ Legislation and regulation Although each EMS system, medical direction, and training program has latitude, its training, protocols, and practice must follow state legislation, rules, regulations, and guidelines. A senior EMS official is usually in charge of necessary administrative tasks such as scheduling, personnel, budgets, purchasing, and vehicle maintenance, and the daily operations of ambulances and crews. ▪ Integration of health services Prehospital care by the EMT is coordinated with care administered by the receiving hospital. Care simply continues in the hospital emergency department. This ensures that the patient receives comprehensive continuity of care. ▪ Evaluation The medical director maintains quality control. CQI reviews and performs audits of the EMS system to identify areas of improvement and/or assign remedial training. Information and skills in emergency medical care change constantly. Refresher training and continuing education are important. Minimizing errors is the goal. ▪ Information systems Systems are used to document the care provided. Once stored electronically, the information can be used to improve care. For example, stored information can help determine: Average on-scene time for trauma patients, Need for educational sessions, National trends ▪ System finance Finance systems vary depending on which organization is involved. Personnel may be paid, volunteer, or a mix. EMTs may be involved in gathering insurance information, attending fund- raisers, or other activities that will help the department secure its finances. ▪ Education systems EMS instructors are licensed in most states. ALS training is usually provided in college, adult career center, or hospital settings. Continuing education is needed to update knowledge and refresh skills. ▪ Prevention and public education Prevention and public education are aspects of EMS where the focus is on public health. Public health examines the health needs of entire populations with the goal of preventing health problems. 6. Recall the following terms and know the importance in the prehospital setting Negligence, Abandonment, CQI, PCR, EMS administrator, Medical Director, DNR, living will. o Negligence Failure to provide standard of care ▪ It’s based on the following four factors: duty, breach of duty, damages, and causation. All four elements must be present for the legal doctrine of negligence to apply and for a plaintiff to prevail in a lawsuit against an EMS service or provider. o Abandonment Unilateral termination of care. It’s termination of care without the patient’s consent and without making provisions for the transfer of care to a medical professional with skills at the same level or at a higher level than your own skills. Abandonment is legally and ethically a very serious act. o Continuous Quality Improvement (CQI) A system of internal reviews and audits of the EMS system to identify areas of improvement and/or assign remedial training. Positive feedback is also discussed. If a problem appears to be repeated by a single EMT or crew, the medical director will discuss the details with the individual involved.