ems & disaster response
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Emergency Medical Services &
Disaster ResponsePaleerat Jariyakanjana, MD, FTCEP
Faculty of medicine
Naresaun university
Emergency Medical
Services
EMS: extension of emergency medical care into
the prehospital setting
History
ชวงเวลาท 1สภาอณาโลมแดงแหงชาตสยาม มลนธปอเตกตง & มลนธรวมกตญญชวงเวลาท 2ต ารวจจราจรชวยเหลอผปวยฉกเฉน ศนยกชพนเรนทรชวงเวลาท 3พฒนาระบบบรการการแพทยฉกเฉน ใหลงไปสระดบชมชน และมความ
ครอบคลมพนททวประเทศ
Tsunami
Key elements
Manpower
Personnel Comment Duration
First responder First professional or trained
layperson to arrive at a medical
emergency
16 hr
EMT-B (Basic) Oxygen, CPR, AED, extrication,
immobilization, hemorrhage
control
110 hr
EMT-I (Intermediate) EMT-B plus IV insertion, some
medication administration, ECG
interpretation
2 yr
EMT-P (Paramedic) Advanced resuscitation
techniques such as intubation
4 yr
Training
initial provider training
continuing education
Communications
1. collect the necessary information from the
caller, dispatch appropriate medical resources,
and offer first aid information or prearrival
instructions
2. Ambulance personnel should also be able to
communicate with the destination hospital
3. online medical control
Transportation
BLS ambulances
carry equipment appropriate for personnel
trained at the EMT-B level
oxygen, bag-mask ventilation devices,
immobilization and splinting devices, and
dressings for wound care and hemorrhage
control
do not carry medication and cannot transport
patients requiring IVs or cardiac monitoring,
although some may carry AEDs
BLS ambulances
Transportation
ALS ambulances
equipped for EMT-Ps or other advanced health
care personnel
IV supplies, IV medication, intubation devices,
cardiac monitoring and defibrillation, and
equipment for other specialized techniques
unique to specific areas, such as hypothermia
application after cardiac resuscitation
ALS ambulances
Transportation
http://www.manafeth.com/index.php/en/products/view/Ambulance-Type-I#
Transportation
Ground transportation is appropriate for the
majority of patients, especially in urban and
suburban areas.
air transport
helicopter
considered for critically ill patients when the
ground transport time would be dangerously long
or if the terrain is difficult to navigate
Air transport
Boat ambulance
Facilities and Critical-Care Units
closest appropriate hospital or to the hospital of
the patient's choice
divert patients to other hospitals
ED overcrowding
Public Safety Agencies
strong ties with police and fire departments
1. providing scene security
2. provide first responder services
Consumer Participation
encourage representation of the general public
on the membership of regional EMS councils
public can participate by volunteering for local
EMS agencies
Access to Care
no barriers or disincentives preventing timely
access to the system
Patient Transfer
all patients must receive a medical screening
exam and be stabilized before transfer to
another facility
explicit acceptance of the transfer by the
receiving hospital
Coordinated Patient Record Keeping
Standardization of EMS medical records
Public Information and Education
train the public how to access them when
needed and how to use them appropriately
convey to the public is the importance of
learning CPR, first aid, and basic disaster
preparedness principles
Review and Evaluation
radio communications, response times, scene
times, and patient care records
Outcome: cardiac arrest, stroke, and trauma
EMS research
Disaster Plan
written policies and procedures
stockpiling supplies
participating in regional disaster drills with other
emergency response agencies and hospitals
Mutual Aid
mutual aid agreements with neighboring
jurisdictions so that uninterrupted emergency
care is available when local agencies are
overwhelmed or unable to provide services
Phases of EMS response
Response
Disaster Response
Definition
Major Incidents: any incident where the number,
severity, type or location of live casualties
requires extraordinary resources
Disaster: need > resource
Mass casualty incident: Healthcare need >
resource
Disaster Management Cycle
Major Incident Medical
Management and Support (MIMMS)
major incident training
course
systematic, 'all
hazards' approach to
the principles of pre-
hospital, multiple-
casualty incident
medical management
Management and Support
Principles
Command
Safety
Communication
Assessment
Triage
Treatment
Transport
DISASTER Paradigm
Detection
Incident command
Scene security and safety
Assess hazards
Support
Triage and Treatment
Evacuation
Recovery
Management and Support Principles
DISASTER Paradigm
Detection
Incident command
Scene security and
safety
Assess hazards
Support
Triage and Treatment
Evacuation
Recovery
MIMMS
Command
Safety
Communication
Assessment
Triage
Treatment
Transport
CommandCSCATTT
Safety
The 1-2-3 of Safety
1. Staff
2. Situation
3. Survivors
CSCATTT
CommunicationCSCATTT
Assessment
My call sign/Major incident declared
Exact location: Grid ref.
Type of incident
Hazards: Present/Potential
Access: Roads, Landing area
Number of casualties: Type, Severity
Emergency services: Present and Required
CSCATTT
TriageCSCATTT
Triage sieveCSCATTT
Triage sortCSCATTT
Triage sortCSCATTT
START (Simple triage and rapid
treatment)
SALT (Sort, Assess, Life-Saving Interventions,
Treatment and/or Transport)
Treatment
Aim: “do the most for the most”
CSCATTT
Transport
Aim: get the right casualty to the right place in
the right time
Casualties should be dispersed to different
hospitals, most appropriate to their need.
Mechanism of injury
Injury found or suspected
Signs (vital signs)
Treatment given
CSCATTT
Take home message
EMS
extension of emergency medical care into the
prehospital setting
15 key elements of EMS systems
6 phases of EMS response
Disaster response
MIMMS: CSCATTT
DISASTER Paradigm
Triage: Sieve & Sort, START, SALT
Reference
Tintinalli's Emergency Medicine, 7th edition
http://www.emsworld.com/article/10319356/the-
star-of-life
https://sites.google.com/site/dimersarred/disaste
r-management-cycle
https://sites.google.com/site/sarbook1/excerpt-
incident-command
Any questions?