EMERGENCY MEDICAL SERVICES

1. EMERGENCY MEDICAL SERVICES

2. LECTURE OBJECTIVES • Describe the historical development of the National Emergency Medical Services system • Describe the organizational structure of the State EMS System • Review the types of emergencies that prehospital personnel typically respond to within the school setting • Discuss the ways that the school nurse and local EMS can work together to better meet the emergency care needs of students

3. EMERGENCY MEDICAL SERVICES • Network of services coordinated to provide aid and medical assistance from primary response to definitive care • Personnel trained in rescue, stabilization, transportation, and advanced treatment of traumatic or medical emergencies. • Linked by a communication system that operates on both a local and a regional level • Tiered system of care, typically initiated by citizen action in the form of a telephone call to an emergency number

4. HISTORY OF EMS • Early 1800s: Napoleonic Wars • Baron Dominique Jean Larrey – First modern military surgeon who introduced army ambulance corps • French army used horse-drawn “ambulances” to remove injured soldiers from the battlefield • Baron Dominque Jean Larrey

5. History of EMS • 1860s: U.S. Civil War • Use of field ambulances and medics to treat trauma in the field • Surgeon General Hammond • Organized field care and transport of injured • One ambulance for every 150 soldiers • Two medical supply wagons for each regimental corps

6. History of EMS • 1870: First air medical transport of patients • Franco-Prussian War • Wounded French soldiers evacuated from the battlefront and transported by hot air balloons

7. History of EMS • 1865: First known hospital based ambulance – Commercial Hospital, Cincinnati, Ohio • 1899: First motorized ambulance purchased by local businessmen for Michael Reese Hospital, Chicago • 1900: Interns dispatched with ambulances to provide care en route • 1940s: Funeral-home hearses and commercial vehicles deployed as ambulances Early motorized ambulance Funeral home-owned hearse ambulance

8. EMS Evolution in Wartime • World War I(1914-1918) • Evacuation time: 12-18 hours • Mortality rate: >20% • World War II(1939-1945) • Evacuation time: 4-6 hours • Mortality rate: 3.3% World War I Ambulance

9. History of EMS • Early 1950s: Helicopter evacuation of wounded begins during Korean War

10. EMS Evolution in Wartime • Korean War (1950-1953) • Evacuation time: 2-4 hours • Mortality rate: 2.4% • Vietnam War (1959-1975) • Evacuation time: 35 minutes • Mortality rate: 1.8% Vietnam War-era Medevac helicopter

11. Early emergency care issues • 1950s and 1960s • “Scoop and run” approach • Lack of uniformity • None/inadequate federal, state, local laws and/or standards • Personnel – little/no emergency care training • Emergency room physicians – largely part-time/ moonlighting who didn’t necessarily have experience in emergency/trauma care • Ambulances/equip/supplies – no standards/little consistency • Lack of radio communication with hospitals • 1960: President John F. Kennedy • Declared “Traffic accidents constitute one of the greatest, perhaps the greatest, of the nation’s public health problems.” • 1965: Unsafe at Any Speed, by Ralph Nader

12. 1966

13. 1966 National Academy of Sciences published a ground breaking paper • Accidental Death and Disability: The Neglected Disease of Modern Society • http://www.nap.edu/openbook.php?isbn=POD716 • Referenced 1965 injury data. Cited accidents as • Leading cause of death between ages 1 - 37 • Fourth leading cause of death for all ages

14. 1965 Data • Accidents were responsible for: • 52 million injuries • 107,000 deaths • 49, 000 deaths due to motor vehicle crashes (MVC) • 10 million temporarily disabled • 400,000 permanently impaired • Cost $18 billion • Accidents – became the impetus for federal EMS support

15. National Highway Safety Act of 1966 Federal response to the National Academy of Sciences report • States required to develop • Highway Safety Plan • EMS Plan (as related to motor vehicle incidents) • Development of uniform standards • Ambulances • Communication • Personnel training

16. Federal Milestones • 1966- 1973 – Federal funding provided by the Department of Transportation for EMS development • 1972 – Federal Communications Commission recommends 911 • 1988 – National Highway Traffic Safety Administration (NHTSA) implements EMS Technical Assistance program • 1990 – Trauma Systems Planning and Development Act (HHS) • 1996 – EMS Agenda for the Future (NHTSA/HRSA) • 2000 – EMS Education Agenda for the Future: A Systems Approach (NHTSA/HRSA) • 2004 – Enhance 9-1-1 Act (DOT/DOC) • 2006 - Federal Interagency Committee on Emergency Medical Services (FICEMS) established • 2006 – Institute of Medicine The Future of Emergency CareReport (http://www.iom.edu/Activities/Quality/emergencycare.aspx) • 2008 – EMS Model Plan (Nat’l Assn of State EMS Officials)

17. EMERGENCY MEDICAL SERVICES IN Connecticut

18. CONNECTICUT REGIONS

19. Region 1     Southwestern CT EMS Council • Gwen Summ, Regional Coordinator  •  Walter Dadik, Council President •     (860) 509-7528        • Region 2    South Central CT EMS Council • Tom Lenart, Regional Coordinator   •  Judith Reynolds, Council President    •    (860) 509-7721 •  Region 3    North Central CT EMS Council • David Bailey, Regional Coordinator  • Thomas Murphy, Council President       \ •   (860) 509-7981      •    Region 4    Eastern CT EMS Council • Jonathan Lillpopp, Regional Coordinator   • Greg Allard, Council President • (860) 509-7813 • Region 5   Northwest CT EMS Council • Jean Speck, Regional Coordinator      • Skip Gelati, Council President       •     (860) 509-7829 Department of Public Health   410 Capitol Avenue, MS#12EMS  P.O. Box 340308    Hartford, CT  06134-0308

20. Provider Levels • EMR • EMT • AEMT • Paramedic

21. Division of EMSSchool Nurse Preparedness Find the answers you need NOW! • Do you know the level of care of your local EMS agency, ie EMT’s or Paramedics? • Who would be your contact person at your EMS agency? • Do you have an established relationship with EMS? • What will their response time be? • Do they know which entranceway to enter? • Do you know what hospitals they transport to?

22. Division of EMSSchool Nurse Preparedness Find the answers you need NOW! • Is the EMS agency aware of your students that have chronic medical conditions or special health care needs that may require emergency care intervention? • Does the EMS agency carry age appropriate equipment? • Is there equipment exchange with EMS? • Does your local EMS agency provide public education programs or injury prevention presentations? • Do you collaborate with your local EMS on preparedness planning or injury prevention initiatives? • Have you worked with your local EMS, local health department and hospital on terrorism/disaster planning?

23. Division of EMSSchool Nurse Preparedness Find the answers you need NOW! • Do you have appropriate equipment/supplies for an emergency? • Are these items in an easily accessible area when they need to be obtained quickly? Do you have a portable emergency kit? • Where is your AED located? • Are routine quality checks of the AED conducted? • Who are your staff who are trained in CPR, AED use and First Aid?

24. SUMMARY • Work to ensure that a school emergency plan is developed and in place • Develop the plan with local EMS involvement • Establish a relationship with your local EMS to facilitate the emergency preparedness process

25. QUESTIONS?