Maine EMS On-Line Medical Control Training Program

1. Maine EMS On-Line Medical Control Training Program Module 1: EMS systems Module :

2. Module 1: EMS Systems • Objectives • By the end of this module, you will be able to: • Identify at least 6 components of an EMS system • Differentiate between a Basic Life Support and Advanced Life Support EMS Service • Describe protocols • Define scope of practice • Describe the structure of Maine EMS Module : 1

3. Overview of EMS • EMS • Provision of care outside of hospital by personnel with varying levels of training • Personnel are physician extenders • Not delegated practice • Individually licensed • Require physician endorsement Module : 1

4. Manpower Training Communication Transportation Emergency Facilities Critical Care Units Public Safety Agencies Disaster Planning Medical Direction Consumer Participation Access to Care Patient Transfers Standardized Record Keeping Public Information and Education System Review and Evaluation Mutual Aid 16 Components Module : 1

5. Level of Practice • Basic Life Support • Staffing by EMT-Basics • Defined by level of training • Based on NHTSA / DOT National Standard Curriculum • Limited equipment • Limited medications • AED • +/- Advanced Airway Module : 1

6. Level of Practice • Advanced Life Support • Either EMT-Intermediate, Critical Care Technician or Paramedic • Staffing by EMT-Paramedics • Much more training (1000+ hours) • Full complement of medications • Cardiac monitor / defibrillation / pacemaker / cardioversion • Advanced airway (intubation) Module : 1

7. Protocols • Written documents that guide the EMT’s care • Series of instructions • Based on chief complaint or clinical impression • Define what interventions may / must be done Module : 1

8. Protocols • Protocols divided into 2 parts • Standing orders • Authorized by protocol • EMT may perform these items if indicated without contacting medical control • Defined by service medical director • Orders requiring on-line medical control • EMT must contact and consult with medical control before initiating these protocols Module : 1

9. Protocols • Define care for majority of patients • Some patients fall outside protocols • Medical control may authorize EMT to utilize any protocol • Medical control may make orders outside protocols if the orders fall in EMT’s Scope of Practice Module : 1

10. Scope of Practice • The breadth of practice of a provider defined by licensure, education, and medical director authorization Module : 1

11. Scope of Practice Module : 1

12. Scope of Practice State License Module : 1

13. Scope of Practice Education Module : 1

14. Scope of Practice Medical Director (System) Module : 1

15. Scope of Practice State License Education Medical Director (System) Module : 1

16. Overview of Maine EMS • Maine is relatively unique • No requirement for ALS services to have a medical director • Medical direction carried out at regional and state level • Statewide protocols • State QI Module : 1

17. State Level Organization Module : 1

18. Board of EMS Members • Regional Councils (6) • Ambulance Services (2) • Non Transporting Services • Public (2) • Emergency Physician • Emergency Nurse (RN) • Emergency Medical Dispatch • Hospitals • Fire Services (2) Module : 1

19. Maine EMS Office (MEMS) • Director • Jay Bradshaw • Staff • Training and Education: Jan Brinkman, RN EMT-P • Licensing Agent: Alan Leo, EMT • Licensing Agent: Dawn Kinney, EMT-P • Licensing Assistant: Karen Cutler • Data & Preparedness Coordinator: Jon Powers, NREMT-P • EMD Coordinator: Drexell White, EMT-P Module : 1

20. Contact Information • Maine Emergency Medical Services • 45 Commerce Drive • 152 State House Station • Augusta, ME 04333 • (207) 626-3860 • Maine.EMS@maine.gov • www.maine.gov/dps/ems Module : 1

21. Regional Offices Module : 1

22. Medical Directions and Practice Board • State Medical Director • Steve Diaz MD • Medical Direction and Practice Board • State Medical Director • 6 regional medical directors • Maine ACEP representative Module : 1

23. Reviews and establishes Protocols Reviews/approves certain medical devices Establishes Quality Assurance benchmarks Medical Directions and Practices Board Module : 1

24. Quality Improvement • Centralized function • Services send data to region • Goes to state • Entered in statewide database • QI committees • Hospital QI nurse / coordinator Module : 1

25. MEMS • Other Committees Module : 1

27. York, Cumberland, & Sagadahoc • Southern Maine EMS • 496 Ocean St. • So. Portland, ME 04106 • (207) 741-2790 • smems@smems.org • Donnell Carroll, Regional Coordinator • Tony Bock, MD, Medical Director Module : 1

28. Androscoggin, Franklin, & Oxford • Tri County EMS • 300 Main St. • Lewiston, ME 04240 • (207) 795-2880 • info@tricountyems.org • Joanne LeBrun, Regional Coordinator • Kevin Kendall MD, Medical Director Module : 1

29. Kennebec & Somerset • Kennebec Valley EMS • 71 Halifax St • Winslow, ME 04901 • (207) 877-0936 • office@kvems.org • Rick Petrie, Regional Coordinator • Timothy Pieh MD, Medical Director Module : 1

30. Hancock, Penobscot, Piscataquis, & Washington • Northeast EMS • 354 Hogan Rd • Bangor, ME 04401 • (207) 974-4880 • neems@emcc.edu • Rick Petrie, Regional Coordinator • Jonnathan Busko MD, Medical Director Module : 1

31. Aroostook • Aroostook EMS • 111 High St. • Caribou, ME 04736 • (207) 492-1624 • Arems@maine.rr.com • Steve Corbin, Regional Coordinator • Peter Goth MD, Medical Director Module : 1

32. Lincoln, Waldo, & Knox • Mid Coast EMS • P O Box 610 • Union, ME 04862 • (207) 785-5000 • office@midcoastems.org • Bill Zito, Regional Coordinator • Colin Coor MD, Medical Director Module : 1

33. Local EMS Services in Maine • 285 licensed agencies • Transporting (Ambulance) • Ground • Fixed wing (Airplane) • Rotor wing (Helicopter) • Non-transporting • Unregulated industrial / private first response agencies (e.g. ski patrols) Module : 1

35. Maine EMS Service License Levels • Basic Life Support • Advanced Life Support Module : 1

36. Service Levels of Performance • First Responder • Emergency Medical Technician (EMT) • EMT-Intermediate • Paramedic permit • Paramedic service Module : 1

37. State Levels of Certification / Practice • First responder (282) • Licensed ambulance attendant (15) • EMT (3,952) • EMT Intermediate (841) • EMT-Critical Care (27) • EMT- Paramedic (1,016) • PIFT Module : 1

38. Basic Life Support • First responder • Ambulance Attendant* • Emergency Medical Technician (EMT) Module : 1

39. Advanced Life Support • EMT-Intermediate • EMT-Critical Care* • EMT-Paramedic • Paramedic Interfacility Transfer Module : 1

41. Federal Grants / Projects • Rural Access to Emergency Devices: $1m (4 years) • Free AEDs to rural responders and community centers • Discounted AEDs available statewide • ~ 10,000 people trained in CPR/AED • Ended 8/31/06 Module : 1

42. Trauma / EMS • Maine EMS Trauma Plan • 1990: Federal Trauma System Grant • Trauma Advisory Committee established • October 1996: Trauma Plan Implemented • 2004: Technical Assistance Teams • Formerly supported by federal grant ($40,000/yr) Module : 1

43. Emergency Medical Service for Children • DHHS/MCHB funded $115,000/year • Injury prevention projects • Playground safety • CPS • Health & Safety Fairs • EMS for SHCN patients • Data collection (NEMSIS) • Pediatric Equipment, training, and medical control Module : 1

44. Module : 1

45. Statewide Protocols • Universal protocols statewide • All paramedics practice under the same protocols • Regional variants • Research / Pilot projects by region • CPAP in several Regions • Mid Coast EMS: Stroke protocol • Regions 1 & 4: New PIFT • IO: now ubiquitous Module : 1

46. Summary • EMS is not ED Care • All EMS agencies are not the same • Maine EMS • Oversees • Monitors • Supports • Statewide protocols Module : 1

47. End of Module 1 • Click here to e-mail questions Module : 1