4. Topics
Introduction
Review of EMS Systems
Education
Continuing Education
Professional Attitudes
Primary Responsibilities
5. EMS System
A comprehensive network of
personnel, equipment, and
resources established to deliver
aid and emergency medical care
to the community.
6. OUT-OF-HOSPITAL COMPONENTS OF AN
EMS SYSTEM
MEMBERS OF COMMUNICATIONS EMS
THE SYSTEM PROVIDERS
COMMUNITY
POISON CONTROL FIRE
PUBLIC CENTERS RESCUE
UTILITIES HAZMAT
7. OUT-OF-HOSPITAL COMPONENTS OF AN
EMS SYSTEM
EMERGENCY EMERGENCY AND
NURSES SPECIALTY
PHYSICIANS
ANCILLARY REHABILITATION
SERVICES SERVICES
8. NYS EMS System
State EMS Council
SEMAC
Regional EMS Council
WEREMS, Big Lakes REMS CO
Regional Medical Advisory
Committee
WREMAC
County EMS Coordinator
Medical Director
9. Personal and Professional
Development
Personal and professional
development is your responsibility.
Keep updated with journals,
seminars, computer newsgroups,
and other learning experiences.
Explore alternative or non-traditional
career paths.
10. Education and Certification
Two kinds of EMS education are
initial and continuing education.
Initial education is the original training
course for prehospital providers.
Continuing education programs include
refresher courses for recertification and
periodic in-service training sessions.
11. Initial Education
Based on the EMT-Paramedic:
National Standard Curriculum
published by the U.S. D.O.T.
establishes the minimum content for the
course
divided into 3 specific learning domains:
• Cognitive
• Affective
• Psychomotor
12. Once the initial education is
completed, the paramedic will
become either certified or
licensed.
13. Certification vs. Licensure
Certification is the process by which
an agency grants recognition to an
individual who has met its
qualifications.
Licensure is the process of
occupational regulation.
14. National Registry of EMTs
(NREMT)
Prepares and administers
standardized tests for the First
Responder, EMT-Basic, EMT-
Intermediate, and EMT-Paramedic.
Establishes the qualifications for
registration and re-registration, and
for establishing a minimal standard
of competency.
15. Belonging to a Professional
Organization is a good way
to keep informed about the
latest technology.
16. Professional Organizations
Include:
National Association of EMTs
National Association of Search and
Rescue
National Association of State EMS
Directors
National Association of EMS Physicians
National Flight Paramedics Association
National Council of State EMS Training
Coordinators
17. A variety of journals are available to
keep the paramedic aware of the latest
changes in this ever-changing industry.
18. These Professional Journals
Include:
Annals of Emergency Medicine
Emergency Medical Services
Emergency
Journal of Emergency Medical
Services
Journal of Emergency Medicine
20. Research (1 of 2)
Research programs are essential for
moral, educational, medical,
financial, and practical reasons.
Future EMS research must address
the following issues:
Which interventions actually reduce morbidity
and mortality?
Are the benefits of a procedure worth the risk?
What is the cost-benefit ratio?
21. Research (2 of 2)
Has your organization
participated in research?
22. The Components of a Research
Program: (1 of 2)
Identify a problem.
Identify the body of knowledge
on the subject.
Select the best design for the
study.
Begin the study and collect raw
data.
23. The Components of a Research
Program: (2 of 2)
Analyze the data.
Assess and evaluate the results.
Write a concise, comprehensive
description of the study for
publication in a medical journal.
26. Professional Attributes
Leadership Time management
Integrity skills
Empathy Diplomacy in
Self-motivation teamwork
Professional Respect
appearance and Patient advocacy
hygiene
Communication Careful delivery of
skills service
27. Professional Attitudes
True professionals establish
excellence as their goal
and never allow themselves
to become complacent about
their performance.
28. As the leader of the EMS team, the
paramedic must interact with patients,
bystanders, and other rescue personnel in
a professional manner.
29. Primary Responsibilities of the
Paramedic
Preparation Disposition and
Response transfer
Scene size-up Documentation
Patient Clean-up,
assessment maintenance,
Treatment and and review
management
34. Recognition of Illness or Injury
First aspect of patient
prioritization.
Usually based on the urgency
for transport.
35. Patient Management
Protocols ensure consistent
patient care.
Communication with medical
direction.
Movement of the patient from
one location to another.
37. Patient Transfer
While moving the patient from one
facility to another the first priority
is patient care.
Request a verbal report from
primary-care provider.
At destination provide a report to
receiving care provider.
38. Documentation
Complete a patient care report as
soon as possible after emergency
care has been provided.
Necessary to ensure continuity of
care.
Be complete, neat, and legible.
40. Returning to Service
Prepare the unit to return to service
Clean and decontaminate.
Restock.
Refuel.
Review the call with crew members.
Be aware of signs of critical incident
stress.
41. Patient Advocacy
An EMT is an advocate for
patients, defending them,
protecting them, and acting in their
best interest. Except when your
safety is threatened, you should
always place the needs of your
patient above your own.
42. Additional Responsibilities
Community involvement.
Support for primary care.
Citizen involvement in EMS.
Personal and professional
development.
43. Community Involvement
Help the public:
Recognize an emergency;
Know how to provide BLS;
Know how to properly access
the EMS system.
44. Support For Primary Care
Help develop services that decrease
the need for EMS.
Establish protocols that specify the
mode of transportation for non-
emergency patients.
Team up with hospitals to provide
an alternative to the emergency
department.
46. Medical Direction
A medical director is a
physician who is legally
responsible for all clinical
aspects of the system.
EMT-Critical Care Technicians
operate as “physician extension”
47. Medical Direction
The medical director’s role in a
system is to:
educate and train personnel
participate in equipment and personnel selection
develop clinical protocols
participate in problem resolution and quality
improvement
provide direct input into patient care
interface with the EMS system
advocate within the medical community
serve as the “medical conscience” of the
EMS system
48. The Medical
Director can
provide on-line
guidance to
EMS personnel
in the field.
This is
known as
on-line
medical
direction.
49. Off-line medical
direction refers to
medical policies,
procedures, and
practices that medical
direction has set up in
advance of a call,
such as standard
protocols or standing
orders.
50. Protocols are the policies and
procedures for all elements of an
EMS system.
51. Protocols are designed around the
four “T’s” of emergency care.
Triage
Treatment
Transport
Transfer
52. On-scene Physician
Be currently licensed in NYS
Assume responsibility for the
patient’s care
Realize EMS providers will not
comply with orders that exceed
their scope of practice
Accompany patient to hospital if
requested
53. KEY POINT
MC is ultimately
responsible for
the actions of the
EMS provider and
must be
contacted.
54. Special Note:
n-s cene
T he o ust
sicianm
phy his
cum ent
do ions
in ter vent
55. Quality Assurance and
Improvement
Quality Assurance is designed to
maintain continuous monitoring and
measurement of the quality of
clinical care.
Continuous Quality Improvement
(CQI) is designed to refine and
improve an EMS system,
emphasizing customer satisfaction.
56. CQI – A Dynamic Pocess
Identify Problems
Elaborate on the cause
Develop remedies
Lay out plan to correct problems
Enforce the plan
Reexamine the problem
57. An EMS system must be
designed to meet the needs
of the patient. Therefore,
the only acceptable quality
of an EMS system is
EXCELLENCE!
60. Topics
Wellness of the AEMT
Impact of Shift Work on the
AEMT
Proper Body Mechanics
Managing Hostile Situations
61. Introduction
Well-being is a fundamental
aspect of top-notch performance
in EMS. It includes:
Physical well-being
Mental and emotional well-being
Safe lifting
Seize the information about safe
practice and apply it to your life.
62. Basic Physical Fitness
The benefits of
physical fitness
are well known:
Decreased resting heart
rate and blood pressure
Increased oxygen-
carrying capacity
Increased muscle mass
and metabolism
Increased resistance to
illness and injury
Enhanced quality of life
64. Muscular Strength
Achieved with ISOMETRIC
exercise is
regular active
exercise exercise
Exercises may performed
against
be isometric stable
and isotonic resistance.
ISOTONIC
exercise is
active
exercise
65. Cardiovascular Endurance
Is a result of exercising at
least three days a week
vigorously enough to raise your
pulse to its target heart rate.
66. Flexibility…the Forgotten
Element of Fitness
To achieve or Stretch daily.
regain Never bounce
flexibility, when stretching.
stretch main
Hold a stretch
muscle groups
for at least 60
regularly.
seconds.
68. Nutrition
It is a myth that people in EMS
cannot maintain an adequate
diet.
The most difficult part is
changing bad habits.
Good nutrition is fundamental
to well-being.
69. Learn the major food groups and eat
a variety of foods from them daily.
3 to 5 servings
6 to 11 servings
2 to 4 servings
2 to 3 servings 2 to 3 servings
70. Avoid or minimize intake of fat, salt,
sugar, cholesterol, & caffeine.
71. Check food
labels for
information
about the
nutritional
content of the
food you eat.
72. Good sense says…
Eating on the run can be less
detrimental if you plan ahead –
Avoid fast foods.
Carry a small cooler filled with whole-
grain sandwiches, fruits, and
vegetables.
Monitor your fluid intake. Drink plenty
of water.
73. Habits and Addictions
Many in high-stress jobs abuse
substances such as nicotine
and caffeine. Those in EMS are
no exception.
74. Habits & Addictions (cont)
Choose a
healthier life
and avoid
overindulging
in harmful
substances.
75. Habits & Addictions (cont)
Consider substance abuse
programs, nicotine patches,
or a 12-step program.
77. Back Safety
EMS is a physically demanding
career.
Lifting and moving patients
is frequently required.
To avoid back injury, you must
keep your back fit for the work
you do.
80. Important Lifting Principles
(1 of 2)
Move a load only if you can handle it.
Ask for help if you need it.
Position load close to your body.
Keep your palms up—when possible.
Do not hurry.
Bend with your knees.
“Lock-in” the spine.
81. Important Lifting Principles
(2 of 2)
Always avoid twisting and turning.
Let the leg muscles do the work.
Exhale during lifting.
Given a choice, push. Do not pull.
Look where you are going.
Only one person should be in
charge of verbal commands.
82. Personal Protection from
Disease
There’s a lot you can do to
minimize the risk of infection.
Begin by developing a habit of
doing the things promoted in
this chapter.
83. Body Substance Isolation
A strict form of infection control
that is based on the assumption
that all blood and other body
fluids are infectious.
Take BSI precautions with every
patient.
84. BSI is achieved through the
use of PPE.
Appropriate personal
protective equipment
should be available in
every emergency
vehicle.
Protective gloves
Masks and protective
eyewear
HEPA and N-95
respirators
Disposable
resuscitation
equipment
95. …Cleaned, Disinfected, or
Sterilized
Cleaning refers to washing an object
with soap and water.
Disinfecting is cleaning with an
agent that can kill some
microorganisms on an object
Sterilizing is the use of a chemical
or steam to kill all microorganisms
on an object.
96. Post-Exposure Procedures
In most areas, an EMS provider who
has had an exposure should:
Immediately wash the affected area.
Get a medical evaluation.
Take the immunization boosters.
Notify the agency’s infection control liaison.
Document the event.
98. Infectious Disease
Caused by pathogens, such as
bacteria or viruses.
May be spread from person to
person.
For example, infection by way of
bloodborne pathogens can occur
when the blood of an infected
person comes in contact with
another person’s broken skin.
104. Hepatitis
Management Precautions
Use disposable gloves and wash hands following
contact
Sterilization of all equipment used
Red bag and label any specimens and linen
Follow-up if protective measures were not used
(a) file exposure report
(b) Immunization with ISG (Immune serum Globulin)
105. Tuberculosis
Infectious disease caused by
tubercule bacillus
Signs and Symptoms
Cough
Fever
Night sweats
Weight loss
Fatigue
Hemoptysis
107. Tuberculosis
Management Precautions
Mask and gloves
Avoid prolonged contact
Fresh air (well ventilated patient
compartment)
Avoid contact with sputum
Regular PPD skin test
Chest x-ray as needed, per CDC
recommendations
108. Meningitis
Inflammation of the membranes of
the spinal cord or brain
Signs and Symptoms
Fever
Headache
Nausea and vomiting
Stiff neck
Rash
109. Meningitis
Incubation period 2-10 days
Management Precautions
(1) Mask (on you or patient)
(2) Gloves and wash hands after contact
110. Acquired Immune Deficiency
Syndrome (AIDS)
Signs and Symptoms
Fever with profuse night sweats
Weight loss (10 - 20 lbs. per month
Red/purple skin lesions
Pneumonia
111. AIDS
Incubation period from 2 months to
2 years or more
Mode of transmission
Blood contact
Contact with other bodily secretions
Sexual contact
112. AIDS
Management Precautions
Ware disposable gloves when in contact
with blood or body fluids
Wash hands following care of the patient
113. Stress and Stress Management
(1 of 2)
A stimulus that causes stress is
known as a stressor.
114. Stress and Stress Management
(2 of 2)
Adapting to stress is a dynamic,
evolving process:
Defensive strategies
Coping skills
Problem-solving skills
115. Your job in managing stress is to
learn these things:
Your personal stressors.
Amount of stress you can take
before it becomes a problem.
Stress management strategies
that work for you.
116.
117.
118. To manage stress:
Use controlled breathing…focus
attention on your breathing.
Use reframing…mentally reframe
interfering thoughts.
Attend to the medical needs of the
patient…even if you know them.
119. Shift Work Is Inherently
Stressful Due to the Disruption
of Circadian Rhythms and
Sleep Deprivation.
120. Shift Work Disruption
IF YOU HAVE TO SLEEP IN THE
DAYTIME:
Sleep in a cool, dark place.
Stick to a common sleeping time and
pattern.
Unwind appropriately after a shift in
order to rest.
Post a “day sleeper” sign on your front
door, turn off the phone’s ringer and
lower the volume of the answering
machine.
121. Critical Incident Stress
Management (CISM)
an adaptive short term helping
process that focuses solely on an
immediate and identifiable problem
to enable the individual(s) affected to
return to their daily routine(s) more
quickly and with a lessened
likelihood of experiencing post-
traumatic stress disorder.
122. Incidents when CISM may
be helpful
Line of duty deaths
Suicide of a colleague
Serious work related injury
Multi-casualty / disaster / terrorism incidents
Events with a high degree of threat to the personnel
Significant events involving children
Events in which the victim is known to the personnel
Events with excessive media interest
Events that are prolonged and end with a negative
outcome
Any significantly powerful, overwhelming distressing
event
123. Death and Dying
Situations involving death and
dying are the most personally
uncomfortable for most AEMTs.
Each person faces a death situation
based on his or her prior experience
of loss, coping skills, religious
convictions, and other personal
background.
127. Topics
Impact of Unintentional
Injuries
Community Hazards and
Crime Areas
Community Resources
Illness and Injury Prevention
128. Introduction
Injury is one of our nation’s
most important health problems.
Injuries result from interaction
with potential hazards in the
environment, which means that
they may be predictable and
preventable.
129. Facts About Injury…
Injury is the 3rd leading cause of death.
Unintentional injuries result in 70,000
deaths annually.
The estimated lifetime cost of injuries
will exceed $144 billion.
For every death caused by injury,
there are an estimated 19
hospitalizations.
130. Epidemiology
The study of the factors that
influence the frequency,
distribution, and cause of injury,
disease, and other health-
related events in a population.
131. Injury (1 of 2)
Intentional or unintentional
damage to a person resulting
from acute exposure to thermal,
mechanical, electrical, or
chemical energy or from the
absence of such essentials as
heat and oxygen.
132. Injury (2 of 2)
Unintentional injury is an
accident.
Intentional injury is
purposefully inflicted on a
person, i.e., homicide.
134. Prevention (1 of 2)
EMS providers can focus on primary
prevention, or keeping an injury from ever
occurring.
Such prevention can occur as teachable
moments that occur shortly after an
injury when the patient and observers
remain acutely aware of what has
happened and may be receptive to
learning how to prevent a similar incident
in the future.
135. Prevention (2 of 2)
Secondary prevention occurs
during medical care.
Tertiary prevention occurs
during rehabilitation activities.
136. Prevention within EMS
Few experience the aftermath of trauma
more directly than EMS providers.
EMTs and paramedics are widely
distributed in the population and are
often role models for the community.
Paramedics have become prime
candidates to be advocates of injury
prevention.
137. The more than 600,000 EMS providers
in the United States comprise a great
arsenal in the war to prevent injury
and disease.
139. Primary responsibilities include:
Protection of EMS Providers
Education of EMS Providers
Data Collection
Financial Support
Empowerment of EMS
Providers
140. When appropriate, specific EMS
education and training in specialized
safety procedures should be available
to you.
141. Funding for illness/injury campaigns
may be contributed by corporations and
advertising agencies, as well as non-
profit agencies.
142. Data should be collected and incorporated
into patient documentation.
143. EMS Provider Commitment
Body Substance Isolation (BSI)
Precautions.
Physical Fitness.
Stress Management.
Seeking Professional Care.
Driving Safety.
Scene Safety.
144. BSI equipment, such as protective
gloves and eyewear, is one of a
provider’s basic lines of defense.
145. Keep your safety equipment in good
condition and readily available in
your emergency vehicle.
146. Prevention in the Community
EMS has a responsibility not only
to prevent injury and illness among
workers, but also to promote
prevention among the members
of the public.
EMS providers can be an
appropriate and effective means of
prevention in several situations.
147. Areas in Need of Prevention
Activities (1 of 2)
Low birth weight in newborns.
Unrestrained children in motor
vehicles.
Bicycle-related injuries.
Household fire and burn
injuries.
Unintentional firearms injuries.
148. Areas in Need of Prevention
Activities (2 of 2)
Alcohol-related motor vehicle
collisions.
Fall injuries in the elderly.
Workplace injuries.
Sports and recreation injuries.
Misuse or mishandling of
medication.
Early discharge of patients
149. Implementation of Prevention
Strategies
Preserve the safety of the response
team.
Recognize scene hazards.
Document findings.
Engage in on-scene education.
Know your community resources.
Conduct a community needs
assessment.
150. Summary
Impact of Unintentional Injuries
Community Hazards and Crime
Areas
Community Resources
Illness and Injury Prevention
153. Introduction (1 of 2)
In one survey, almost 15% of ALS
calls in an urban system generated
ethical conflict.
In another survey, EMS providers
reported frequent ethical problems
related to patient refusals, hospital
destinations, and advance directives.
154. Introduction (2 of 2)
Other aspects include patient
confidentiality, consent, the
obligation to provide care, and
research.
155. Ethics VS. Morals
Ethics and morals are closely
related concepts but distinctly
separate.
Morals are the social, religious, or
personal standards of right and
wrong.
Ethics are the rules or standards
that govern the conduct of members
of a particular group or profession.
157. Approaches to Making Ethical
Decisions (1 of 2)
Ethical relativism suggests that
each person must decide how
to behave and whatever
decision that person makes
is okay.
Some say, “Just do what is
right.”
158. Approaches to Making Ethical
Decisions (2 of 2)
The deontological method
suggests that people should
simply follow their duties.
Followers of consequentialism
believe that actions can only be
judged after we know the
consequences.
159. Code of Ethics
Many organizations have developed
a code of ethics over the years for
their members.
Most codes of ethics address broad
humanitarian concerns and
professional etiquette.
Very few provide solid guidance on
the kind of ethical problems
commonly faced by practitioners.
160. To gain and maintain the
respect of their colleagues and
their patients, it is vital that
individual paramedics exemplify
the principles and values of
their profession.
161. The single most important question a
paramedic has to answer when
faced with an ethical challenge is:
WHAT IS IN THE PATIENT’S BEST
INTEREST?
162. 4 Principles to Resolve Ethical
Problems
Beneficence is the principle of doing
good for the patient.
Nonmaleficence is the obligation not
to harm the patient. Primum non
nocere, “first, do no harm”
Autonomy is a competent adult
patient’s right to determine what
happens to his or her own body.
Justice refers to the obligation to
treat all patients fairly.
164. Quick Ways to Test Ethics
Impartiality test---asks whether you
would be willing to undergo this
procedure or action if you were in the
patient’s place.
Universalizability test---asks whether you
would want this action performed in all
relevantly similar circumstances.
Interpersonal justifiability test---asks
whether you can defend or justify your
actions to others.
165.
166. Ethical Issues in Contemporary
Paramedic Practice
Resuscitation Attempts
Confidentiality
Consent
Allocation of Resources
Obligation to Provide Care
Teaching
Professional Relations
Research
167. Resuscitation Attempts
Learn the local laws regarding
do not resuscitate (DNR) orders.
Understand your local policy.
“When in doubt, resuscitate.”
168. Confidentiality
Your obligation to every patient is
to maintain as confidential the
information you obtained as a result
of your participation in the medical
situation.
Reporting certain information such
as child neglect or elder abuse are
exceptions.
169. Consent (1 of 2)
Patients of legal age have the
right to decide what healthcare
they will receive.
Implied consent may apply in
cases where the patient is
incapacitated or unable to
communicate.
170. Consent (2 of 2)
Patients are generally able to
consent or refuse care if they are
alert and oriented, aware of their
surroundings, and making sound
judgments.
When leaving the patient, he or she
must understand the issues at hand
and be able to make an informed
decision.
171. Allocation of Resources
Several approaches to consider…
All patients could receive the same amount of
attention.
Patients could receive resources based on
need.
Patients could receive what someone has
determined they’ve earned.
Triage is a common field activity
that demonstrates one method of
allocating scarce resources.
172. Obligation to Provide Care
A paramedic…
Has a responsibility to help others.
Is obligated to provide care
without regard to the ability to
pay or other criteria.
Has a strong ethical obligation to
help others even while off-duty.
173. Teaching
Two possible ethical questions are
raised when a student is caring for
patients:
Whether or not patients should be
informed that a student is working on them
How many attempts a student should be
allowed to have in performing an
intervention.
174. To avoid problems…
Clearly identify students as such.
The preceptor should, when
appropriate, inform the patient of the
student’s presence and obtain the
patient’s consent.
Take the student’s experience and
skill level into account and have a
pre-determined limit identified for the
number of attempts at a procedure.
175. Professional Relations
A paramedic answers to the
patient, the physician medical
director, and to his employer.
Sometimes conflict arises
out of such relationships.
Know your policies…and
communicate.
176. Research
EMS research is only in its infancy
but is essential to the advancement
of EMS.
Strict rules and guidelines must be
followed when conducting patient
care-related studies.
Gaining the patient’s consent is
paramount.
179. Topics
Legal Duties and Ethical Responsibilities.
The Legal System.
Laws Affecting EMS and the AEMT.
Legal Accountability of the AEMT.
AEMT-Patient Relationships.
Resuscitation Issues.
Crime and Accident Scenes.
Documentation.
180. Best Protection
Your best protection from
liability is to perform systematic
assessments, provide
appropriate medical care, and
maintain accurate and complete
documentation.
181. Legal Duties and Ethical
Responsibilities (1 of 2)
Promptly respond to the needs of
every patient.
Treat all patients and their families
with respect.
Maintain your skills and medical
knowledge.
Participate in continuing education.
182. Legal Duties and Ethical
Responsibilities (2 of 2)
Critically review your performance,
and constantly seek improvement.
Report honestly and with respect
for
patient confidentiality.
Work cooperatively and with
respect
for other emergency professionals.
183. Each EMS response has the potential
of involving EMS personnel in the
legal system.
184. Sources of Law (1 of 2)
Constitutional—based on the
U.S. Constitution.
Common—also called case law
derived from society’s
acceptance of customs and norms.
185. Sources of Law (2 of 2)
Legislative—created by law-
making bodies such as
Congress and state assemblies.
Administrative—enacted by
governmental agencies at either
federal or state levels.
186. Categories of Law
(1 of 3)
Criminal—division of the legal
system that deals with wrongs
committed against society or
its members.
187. Categories of Law
(2 of 3)
Civil—division of the legal
system that deals with non-
criminal issues and conflicts
between two or more parties.
188. Categories of Law
(3 of 3)
Tort—a civil wrong committed
by one individual against
another.
189. Components of a Civil
Lawsuit
Incident Discovery
Investigation Trial
Filing of Decision
complaint Appeal
Answering Settlement
complaint
191. Scope of Practice
Range of duties and skills
AEMTs are allowed and
expected to perform.
192. You may function as
a AEMT only under the direct
supervision of a licensed
physician through a delegation
of authority.
193. Possessing and administering
controlled substances
Public Health Law Article 30
Public Health Law Article 33
State EMS Code Part 800
New York State Rules and
Regulations Part 80
NYS-EMS Policy Statements
194. Licensure and Certification
Certification refers to the
recognition granted to an individual
who has met predetermined
qualifications to participate in a
certain activity.
Licensure is a process used to
regulate occupations generally
granted by a governmental body to
engage in a profession or
occupation.
195. Motor Vehicle Laws
New York State Vehicle and
Traffic Law
§ 114-b Emergency Operations
§ 101 Definition of Authorized
Emergency Vehicles
§ 1104 Privileges and Responsibilities
of Authorized Emergency Vehicles
196. Motor Vehicle Laws
Driver is not relieved from the duty
to drive with Due Regard for the
safety of all persons
Driver is not protected from the
consequences of his/her reckless
disregard for the safety of other
NYS-EMS Policy Statement on use
of lights and siren
197. Mandatory Reporting
Requirements
Spouse abuse
Child abuse and neglect
Elder abuse
Sexual assault
Gunshot and stab wounds
Animal bites
Communicable diseases
198. Abuse and Neglect
Abuse is improper or excessive
action so as to cause harm
Neglect is giving insufficient
attention or respect to someone
who has a claim to that attention
199. Signs and Symptoms of Abuse
Multiple bruises in various stages of healing
Injury inconsistent with the mechanism
described
Repeated calls to the same address
Fresh burns
Parent or guardian seem inappropriately
unconcerned
Conflicting stories
Fear on the part of the patient to discuss how
the injury occured
200. Signs and Symptoms of
Neglect
Lack of adult supervision
Malnourished appearing child
Unsafe living environment
Untreated chronic illness (for
example an asthmatic with no
medications
201. Domestic Violence
Definition – a pattern of coercive
behavior of one individual by
another in order to establish and
maintain power and control
202. Forms of abuse
either by Commission or Omission
Physical
Emotional
Psychological
Environmental
Sexual
Economic
203. Physical Abuse
Inflicting or attempting to inflict
physical pain and withholding
access to medication and medical
care
204. Emotional Abuse
constant criticism, bellitling
someone’s abilities and
competency, name-calling and
other attempts to undermine
someone’s self-image and sense of
worth
207. Sexual Abuse
any exploitive or coercive, non-
consensual sexual contact
including marital, and aquaintance
rape; attacks on the sexual parts of
the body and treating someone in a
sexually derogatory manner.
208. Economic Abuse
attempts to make a person
completely dependant on the
abuser for money and economic
survival
209. Phases of Abuse
Phase 1 - arguing and verbal abuse
Phase 2 - physical and sexual abuse
Phase 3 - Honeymoon; denial and
apologies
Intervention is best accomplished in
phase 1 and 2. Cycle repeats without
intervention, increasing in frequency
and severity
210. Relationships which may lead
to Domestic Violence
Child
Spousal
Elders (parents and others)
Siblings
Living companion
Dating Partners
Health care provider or attendant
211. Role of EMS Provider
Assess and treat the patient
Report observation to hospital
staff and police officers
Conditions at scene
Reactions of patient
Reactions of household member
212. Conditions at the Scene
Environment
Temperature and light
Foul odors
isolation
213. Reactions of patient
Hesitant when questioned
Fearful of those present
Hygiene/clothing/cleanliness
214. Reactions of household
member
Angry
Indifferent
Refusing necessary assistance
Obstructing and questioning care
215. Information Gathering
Out of hearing and sight of the possible
abuser
Stress confidentiality
Does the patient feel safe
At the scene
In the ambulance
Be direct; non-threatening and
empathetic
Listen to what children have to say
216. Information Gathering
Conflicting accounts of the
incident
Physical findings
History of calls to the same
location or patient
History, circumstances, setting,
condition or environment
inconsistent with injury or illness
217. Physical Findings
Old bruises
Sores and ulcers
Topical infections – neglected injuries
Injuries in uncommon places
Back of legs
Soles of feet
Patterned injuries – hand, belt buckle
or other imprints
Thermal injuries – burns and cold
218. The severity of an injury is not
necessarily a good indicator of
the severity of the situation
219. Documentation
Be factual and specific – not
judgmental
Include
Patient condition
Conditions found at the scene
Interaction with those at the scene
History
Patient states “…”
“reported to …”
220. Other Issues
Provider safety
Maintain a professional attitude
Consider emotions of the provider
Consider Critical Incident Stress
Management
221. KEY POINT
Do not accuse in
the field.
Accusation and
confrontation
delays
transportation
222. Legal Protection for the AEMT
Immunity—exemption from liability
granted to governmental agencies.
Good Samaritan Laws—provide immunity
to certain people who assist at the scene
of a medical emergency.
Ryan White CARE Act—requires
notification and assistance to AEMTs
who have been exposed to certain
diseases.
Local laws and regulations.
223. Local laws and regulations.
Assault in the second degree (Penal
Law, § 120.05 and120.08); Assault of an
EMT-Critical Care Technician while
performing duties
Obstructing governmental
administration in the second degree
(Penal Law § 195.05); Obstruction of
EMT-Critical Care Technician in the
performance of his/her duty
225. Negligence
Deviation from accepted
standards of care recognized by
law for the protection of others
against the unreasonable risk of
harm.
226. Always exercise the degree of
care, skill, and judgment expected
under like circumstances by a
similarly trained, reasonable
AEMT in the same community.
227. Components of a Negligence
Claim
Duty to act.
Breach of duty.
Actual damages.
Proximate cause.
228. Duty to Act
…is a formal contractual or
informal legal obligation to
provide care.
229. Duties Include
Duty to respond and render care
Duty to obey laws and regulations
Duty to operate emergency vehicle reasonably
and prudently
Duty to provide care and transportation to the
expected standard
Duty to provide care and transportation
consistent with the scope of practice and local
medical protocols
Duty to continue care and transportation through
to its appropriate conclusion
230. Breach of Duty
…is an action or inaction that
violates the standard of care
expected from a AEMT.
231. Standard of Care
Standard of care is established by
court testimony and reference to
published codes, standards, criteria
and guidelines applicable to the
situation
Public Health Law Article 30
State EMS Code (Part 800)
Standardized Curriculum
Regional Protocols
232. Breaches of Duty
Malfeasance—performance of a
wrongful or unlawful act by a
AEMT.
Misfeasance—performance of a
legal act in a harmful or injurious
manner.
Nonfeasance—failure to perform a
required act or duty.
233. In some cases, negligence may be so
obvious that it does not require
extensive proof
Res ipsa loquitur - the injury could only have
been caused by negligence
Negligence per se - negligence is shown by
the fact that a statute was violated and injury
resulted
235. An action or inaction
that immediately caused
or worsened the damage is
called proximate cause.
236. Defenses to negligence
Good Samaritan laws
Do not generally protect providers from acts
of gross negligence, reckless disregard, or
willful or wanton conduct
Do not generally prohibit the filing of a lawsuit
May provide coverage for paid or volunteer
providers
Varies from state to state
237. Defenses to negligence
Governmental immunity
Trend is toward limiting protection
May only protect governmental agency, not
provider
Varies from state to state
238. Defenses to negligence
Statute of limitations
Limit the number of years after an incident
during which a lawsuit can be filed
Set by law and may differ for cases involving
adults and children
Varies from state to state
239. Defenses to negligence
Contributory negligence
Plaintiff may be found to have contributed to
his or her own injury
Damages awarded may be reduced or
eliminated based on the plaintiff's
contribution to his or her injury
241. Medical Direction (1 of 2)
A AEMT’s medical director and
on-line physician may be sued if:
Medically incorrect orders were
given to the AEMT;
There was a refusal to authorize the
administration of a necessary
medication;
242. Medical Direction (2 of 2)
A AEMT’s medical director and
on-line physician may be sued if:
The AEMT was directed to take
the patient to an inappropriate
facility;
Negligent supervision of a
AEMT is proven.
243. Borrowed Servant Doctrine
While supervising an EMT-I or
EMT-B, a AEMT may be
liable for any negligent act that
person commits.
244. Civil Rights
If medical care is withheld due to
any discriminatory reason, a AEMT
may be sued.
Examples:
Race
Creed
Color
Gender
National origin
Ability to pay (in some cases)
245. Off-Duty AEMTs
Performing procedures that
require delegation from a
physician while off-duty may
constitute practicing medicine
without a license.
247. Legal Principles (1 of 5)
Confidentiality is the principle
of law that prohibits the release
of medical or other personal
information about a patient
without the patient’s consent.
248. Legal Principles (2 of 5)
Defamation is an intentional
false communication that
injures another person’s
reputation or good name.
249. Legal Principles (3 of 5)
Libel is the act of injuring a
person’s character, name, or
reputation by false statements
made in writing or through the
mass media with malicious
intent or reckless disregard for
the falsity of those statements.
250. Legal Principles (4 of 5)
Slander is the act of injuring a
person’s character, name, or
reputation by false or malicious
statements spoken with
malicious intent or reckless
disregard for the falsity of those
statements.
251. Legal Principles (5 of 5)
A AEMT may be accused of
invasion of privacy for the release
of confidential information, without
legal justification, regarding a
patient’s private life, which might
reasonably expose the patient to
ridicule, notoriety, or
embarrassment.
252. The fact that the information
released is true is not a
defense to an action for
invasion of privacy.
253. Consent
The granting of permission to
treat a patient.
You must have consent before
treating a patient.
Patient must be competent to
give or withhold consent.
254. Informed Consent
Consent based on full disclosure of the
nature, risks, and benefits of a procedure.
Must be obtained from every competent
adult before treatment may be initiated.
In most states a patient must be 18 years
of age or older to give or withhold
consent.
In general, a parent or guardian must give
consent for children.
255. Expressed Consent
Verbal, non-verbal, or written
communication by a patient who
wishes to receive treatment.
The act of calling for EMS is
generally considered an expression
of the desire to receive treatment.
You must obtain consent for each
treatment provided.
256. Implied Consent
Consent for treatment that is
presumed for a patient who is
mentally, physically, or emotionally
unable to give consent.
It is assumed that a patient would
want life-saving treatment if able to
give consent.
Also called emergency doctrine.
257. Involuntary Consent
Consent for treatment granted by a
court order.
Most commonly encountered with
patients who must be held for mental-
health evaluation or as directed by law
enforcement personnel who have the
patient under arrest.
May be used on patients whose
disease threatens a community at
large.
258. Special Consent Situations (1 of 2)
Minors
Usually a person under 18 years of age.
Consent must be obtained from a
parent or legal guardian.
Mentally incompetent adult
Consent must be obtained from the
legal guardian.
259. Special Consent Situations (2 of 2)
For Minors & Mentally
incompetent adults…
If a parent or legal guardian cannot be
found, treatment may be rendered
under the doctrine of implied consent.
260. Emancipated Minors
Person under 18 years of age who is:
Married
Pregnant
A parent
A member of the armed forces
Financially independent living away from home
Emancipated minors may give
informed consent.
261. Withdrawal of Consent
A patient may withdraw consent
for treatment at any time, but it
must be an informed refusal of
treatment.
263. Refusal of Service
Not every EMS run results in
the transportation of the patient
to the hospital.
Emergency care must always
be offered to the patient, no
matter how minor the injury or
illness.
264. If a Patient Refuses
(1 of 4)
Is the patient legally permitted
to refuse care?
Make multiple, sincere attempts
to convince the patient to
accept care.
265. If a Patient Refuses
(2 of 4)
Make sure the patient is
informed in his or her decision.
Consult with on-line medical
direction.
266. If a Patient Refuses
(3 of 4)
Have the patient and a
disinterested witness sign a
release-from-liability form.
Advise the patient he or she
may call again for help.
267. If a Patient Refuses
(4 of 4)
Attempt to get someone to stay
with the patient.
Document the entire situation
thoroughly.
268. Some EMS systems have checklists for procedures
to follow when a patient refuses care.
270. Legal Complications Related
to Consent (1 of 4)
Abandonment is the termination
of the AEMT-patient
relationship without assurance
that an equal or greater level of
care will continue.
271. Legal Complications Related
to Consent (2 of 4)
Assault is an act of unlawfully
placing a person in apprehension
of immediate bodily harm without
his or her consent.
Battery is the unlawful touching
of another person without his or
her consent.
272. Legal Complications Related
to Consent (3 of 4)
False imprisonment is the
intentional and unjustifiable
detention of a person without
his or her consent or other legal
authority.
273. Legal Complications Related
to Consent (4 of 4)
Reasonable force is the minimal
amount of force necessary to
ensure that an unruly or violent
person does not cause injury to
himself, herself, or others.
Involve law enforcement, if
possible.
274. Patient Transportation
Maintain the same level of care
as was initiated at the scene.
Know the closest, most
appropriate facility.
Respect the patient’s choice of
facility without putting patient
care in jeopardy.
276. Advance Directives
A document created to ensure
that certain treatment choices
are honored when a patient is
unconscious or otherwise
unable to express his or her
choice of treatment.
277. A Living
Will allows
a person to
specify
what kinds
of medical Fig. 6-4
treatment
he or she
should
receive.
278. Do Not Resuscitate
Order (DNR)
indicates which, if
any, life-sustaining
measures should be
taken when the
patient’s heart and
respiratory
functions have
ceased.
279. Some systems
have
developed
protocols that
address organ
viability after a
patient’s
death.
280. A death in the field must be
appropriately dealt with and
documented by following local
protocol.
281. Crime and Accident Scenes
(1 of 3)
If you believe a crime has been
committed, involve law
enforcement.
Protect yourself and other EMS
personnel.
282. Crime and Accident Scenes
(2 of 3)
Initiate patient care only when
the scene is safe.
283. Crime and Accident Scenes
(3 of 3)
Preserve the scene as much as
possible:
Observe and document anything
moved;
Leave gunshot or stabbing holes intact
if possible;
If something must be moved, notify
investigating officers and document
your actions.
284. Documentation
Complete promptly after patient
contact.
Be thorough.
Be objective.
Be accurate.
Maintain patient confidentiality.
Never alter a patient care record.
285. Summary
Legal duties and ethical responsibilities.
The legal system.
Laws affecting EMS and the AEMT.
Legal accountability of the AEMT.
AEMT-patient relationships.
Resuscitation issues.
Crime and accident scenes.
Documentation.
Hinweis der Redaktion
From Article 30 of the NYS Public Health Law The State EMS Council consists of representative fro the 18 Regional councils and assists the NYS DOH Bureau of EMS in developing rules and regulations and general guidelines for operations in EMS. The Stet Emergency Medical Advisory Committee (SEMAC) is a subcommittee of the State EMS Council and is responsible for minimum standards for medical control, treatment, triage, transport protocols and use of equipment and drugs. The Regional Medical Advisory Committees (REMAC) develop policies, procedures and triage treatment and tx protocols which are consistent with SEMAC which address specific local conditions. There are currently 14 REMACS WREMS – Wyoming Erie Regional EMS Council WREMS Big Lakes – Niagara, Orleans, Genesee
Ruling out C-Spine in the field
What qualities can you list?
Patient Advocate
It’s designed to help people deal with their trauma one incident at a time by allowing the individual to talk about the incident when it happens without judgment or criticism. The program is peer-driven and the people giving the treatment may come from all walks of life, but most are first responders or work in the mental health field. All interventions are strictly confidential. EAP may be helpful. A number of studies have shown that CISM has little effect, or that it actually worsens the trauma symptoms
Denial – not me Anger – why me Bargaining – okay but first let me Depression – okay but I haven’t Acceptance - Okay I’m not afraid
Can anyone think of a way we can help promote injury and illness prevention in the community. WHALE
Laws describe what is wrong in the eyes of society while ethics goes beyond this and examines what is right or good.
You must utilize reason and exclude emotion while making decisions.
Physical abuse includes withholding medication and medical care