Chapter 1: Introduction to Advanced Pre-hospital Care.

Part 1: Introduction to Advanced Pre-hospital Care

The Paramedic is the highest level of pre-hospital care and the leader of the prehospital care team. EMS has made significant advances over the last 30 yrs. Paramedic must always be an advocate for the patient and assure that the patient receives the best possible care without regard to the patients ability to ay or insurance. Paramedic accepts and adheres to a code of professional ethics and etiquette. Paramedic must possess KNOWLEDGE, SKILLS & ATTITUDES consistent w/ expectations of the public and Profession. Paramedic Characteristics: Confident LEADER Excellent JUDGMENT Prioritize DECISIONS Function INDEPENDENTLY

Paramedic Roles Public education Health promotion Participation in illness prevention. Opportunities for the paramedic o Critical care Transport o Primary care o Tactical EMS o Industrial Medicine o Sports Medicine

Part 2: EMS System

EMS (Emergency Medical Services System) is a comprehensive network of personnel, equipment, and resources established to deliver aid and emergency medical care to the community. BLS (Basic Life Support) refers to basic life-saving procedures such as artificial ventilation and CPR. ALS (Advanced Life Support) refers to advanced lifesaving procedures such as IV therapy, drug therapy, incubation, and defibrillation. An EMS System should have a disaster Plan!!!

History of EMS
o 4,000-5,000 yrs. Ago Sumerians inscribed clay tablets w/ some of the earliest medical records, similar to todays Protocols. o 19th Century Napoleon formed the ambulance volante or flying ambulance, which focused efforts on providing emergency surgery as close to the battle as possible. Triage- a method of sorting patients by the severity of their injuries. Medical direction- medical policies, procedures, and practices that are available to providers either on-line or off-line. Medical director- a physician who is legally responsible for all of the clinical and patient care aspects of an EMS system. Trauma center- medical facility that has the capability of caring for the acutely injured patient. . The 3 Levels of Hospitals I. Provides the highest level of trauma care. II. May not have specialty pediatrics or a neurosurgeon on site. III. Generally does not have immediate surgical facility Protocols- are the policies and procedure for all components of an EMS system.

4 Ts of Emergency Care
1. 2. 3. 4. Triage Treatment Transport Transfer

The National Standard Curriculum is divided into 3 domains:

1. Cognitive- consists of facts, or information knowledge 2. Affective- requires students to assign emotions, values, and attitudes to that information 3. Psychomotor- consists of hands-on-skills Certification is the process by which an agency or association grants recognition to an individual who has met its qualifications. i.e. Paramedics, EMTs, PAs. Licensure- is a process of occupational regulation. i.e. Dr., nurse practitioners. Ethics- are the rules or standards that govern the conduct of members of a particular group or profession.

Part 3: Roles & Responsibilities of the Paramedic

Primary Responsibilities
o Preparation o Response o Scene size-up o Patient assessment o Patient management o Disposition and transfer o Documentation o Clean-up, maintenance, and review. Patient Assessment - Initial Assessment - Physical Exam - Patient History - Ongoing Assessment

Part 4: The Well-Being of the Paramedic

BSI (Body Substance Isolation)- is a strict form of infection control that is based on the assumption that all blood and other body fluids are infectious. Hand washing- Probably the most important infection control practice. Decontamination of Equipment - Cleaning- refers to washing w/ soap and water and picking up trash - Disinfecting- use of a commercial disinfectant or bleach diluted in water. - Sterilizing- is the use of a chemical, or a physical method such as pressurized steam, to kill all microorganisms on an object

Stages of Loss
1. 2. 3. 4. 5. Denial Anger Bargaining Depression Acceptance

Part 5: Illness & Injury Prevention

Epidemiology- the study of factors that influence the frequency, distribution, and causes of injury, disease, and other health-related events in a population.

Part 5: Illness & Injury Prevention

Morals- social, religious, or personal standards of right and wrong. Ethics- are the rules and standards that govern the conduct of members of a particular group or profession. Laws- similar to ethics but, laws are rules or standards that govern wrong behavior and ethics define good and bad behavior. Bioethics: Fundamental Principals Beneficence- the principle of doing good for the patient. o Maleficence- means doing harm (opposite of beneficence) Nonmaleficence- the obligation not to harm the patient. Autonomy- a competent adult patients right to determine what happens to his own body. Justice- the obligation to treat all patients fairly.

Legal

Ethical

Legal, Ethical, & Medical issues overlap.

Medical

Always ask your self what is in the Patients best interest.