research profession and practice ems systems. research profession and practice history of ems...

Research profession and practice

EMS SYSTEMS


• History of EMS

• Components of an EMS System

• National Groups and Associations

Topics


Today we will look at the

History of EMS


History


History (cont’d)• Where do we start when looking at the

history of EMS?

• 25 years ago?

• 50 years ago?

• Further back still?


The History of EMS and EMS systems have developed from the traditional and scientific beliefs

of many cultures.


Ancient Times

First “protocols” established in Mesopotamia. Evidence of medications,

patient assessment techniques, and bandages.

During the 15th century Crusades, special tents for the wounded called

‘ambulancias’ were prepared by King Ferdinand and Queen Isabelle of Spain.


18th and 19th CenturiesFirst efforts of field care developed by one of

Napoleon’s surgeons, Barron Domenic-Jean Larrey, during the Austrian/Prussian conflicts

in 1792.

Even the American Civil War forced changes and advancements onto the medical system.

Triage, a method of sorting patients by severity, was also developed during this time.


20th Century

World Wars I and II and the Vietnam and Korean conflicts resulted in great

advances in patient care delivery systems including transportation and patient care

procedures.

Buses and taxies became ambulances and the soldiers in Korea saw the first

Medevac.


1966-US

• The National Highway Safety Act established the Department of

Transportation which provided grants for EMS.


1969-US

• The EMT-Ambulance program was made public. The first paramedic curriculum followed in 1977.


1971-US

• White House issues $9 million in EMS grants.

• Alberta had first paramedic program.


1972-

• The Department of Health, Education & Welfare funded initiatives to develop regional systems.

• Kingston Paramedic Course


EMS Systems Act of 1973

• Provided funding for a series of trauma projects.

• $300 million was allocated to study EMS planning, operations, expansion, and research.

• Continued funding for regionalsystems until ’81.


To be eligible for funding a system must address:

MANPOWER TRAININGCOMMUNICATION

S

CRITICAL CARE UNITS

PUBLICSAFETY

AGENCIESCONSUMER

PARTICIPATION

TRANSPORTATION ACCESS TO CAREDISASTER

PLANS

EMERGENCY FACILITIES

PATIENT TRANSFER

MUTUAL AID

STANDARDIZED RECORDKEEPING

PUBLIC INFORMATION &

EDUCATION

SYSTEM REVIEW & EVALUATION


Two Items the Legislation Omitted

• System finance

• Medical direction


1975

• Ontario had developed EMCA system

• Ambulance and Emergency Care college course (AEC)- a one year program


1977

• Air Ambulance System started


“Star of Life”“Just as pharmacists have the mortar and pestle and doctors have the caduceus, Paramedics and Emergency Medical Responders have a symbol in the ‘Star of Life.’”


“Star of Life”

• Designed by Leo R. Schwartz, Chief of the EMS Branch, National Highway Traffic Safety Administration (NHTSA), the "Star of Life" was created after the American National Red Cross complained in 1973 that they objected to the common use of an Omaha orange cross on a square background of reflectorized white which clearly imitated the Red Cross symbol.


“Star of Life”

• The newly designed, six barred cross, was adapted from the Medical Identification Symbol of the American Medical Association – registered on February 1, 1977

• Each of the bars of the blue "Star of Life" represents the six system function of the EMS.


“Star of Life”

• The snake and staff in the center of the symbol portray the staff of Asclepias, who, according to Greek mythology, was the son of Apollo .

• Asclepias was usually shown in a standing position, dressed in a long clock, holding a staff with a serpent coiled around it.


“Star of Life”• The Bars in the Star of life represent

the Six System Function of the EMS.– Detection – Reporting– Response– On Scene Care– Care In Transit– Transfer to Definitive Care


1960/70s

• Dr Norman McNally

• Standardized system for ambulances and attendants

• 1972 First Ambulance and Emergency Care course starts at Humber College with 25 students.


1981

• …the passage of the Consolidated Omnibus Budget Reconciliation Act (COBRA) wiped out federal EMS funding.

• Canadian Provinces starting to look at Paramedic Programs

• Ontario Pilot Program 1984 – For ACPS• EMA’s (level I to III)


1988-Components of an EMS system

• Regulation• Resources

Management• Human

Resources/Training• Transportation• Facilities

• Communications• Trauma Systems• Public Information• Medical Direction• Evaluation


Modern Trends

• Within the last 10 years, moved from a variety of “Ambulance Services”, operated by:– Privately Managed– Hospitals– Fire Services and Municipal Governments

• To more true EMS Systems


1990’s

• OPALS-Ontario Advanced Life Support Study (Dr. Steele)-Ottawa

• Stiell IG, Wells GA, De Maio VJ, Nesbitt L et al. Advanced Cardiac Life Support in Out-of-Hospital Cardiac

Arrest. N Engl J Med 2004; 351:647-656. – Two separate streams

• Cardiac Arrest• Critical Care

• SR/Defib– PCP version of above– Not a study


2000’s• 2000 – Colleges change to 2 year PCP program• EMCA exam – changed to Advanced EMCA to account for

SR/Defib content• Downloading of ambulance services to UTM’s from other source

(MOH, private or cities)• Technology advances. Computers on board ambulances, advanced

airways, more meds, monitoring• 2004 –Stroke bypass (various regions)• 2007 + PTCA bypasses (Ottawa, York, TO, LDN)• 2009 Revision of DNR, Combining of BH groups• 2011 Change in ALS standards, BLS standards Deceased pt

standard,• 2012 PTBO regional considering STEMI bypass for EMS

research profession and practice ems systems. research profession and practice history of ems...

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