EMS Words of Wisdom - Put The ‘Extra’ Into Your Service

 

EMS Training Opportunity - Prehospital Trauma Life Support (PHTLS)

 

Colorado Cardiac CPR are offering a PHTLS at the start of March (3 & 4). This is a great opportunity for emergency medical responders, EMTs, Paramedics, Nurses, Physician Assistants and Doctors.

Description: The mission of PHTLS is to promote excellence in trauma patient management by all providers involved in the delivery of prehospital care. PHTLS is developed by NAEMT in cooperation with the American College of Surgeons' Committee on Trauma.

PHTLS is the global gold standard in prehospital trauma education and is taught in over 80 countries. 

Content: The aim of PHTLS courses is to improve the quality of trauma care and decrease patient mortality. 

The program is based on a philosophy stressing the treatment of the multi-system trauma patient as a unique entity with specific needs. 

The course covers the following topics:

• Physiology of life and death
• Scene Assessment
• Patient Assessment
• Hemorrhage Control
• Airway, Breathing, Ventilation & Oxygenation
• Circulation & Shock
• Special Populations

The course emphasizes application of trauma education through case studies, skills practice, and patient simulations.

Date: March 3 & 4, 2025 9:00 AM to 5:00 PM

Cost: $315.00

Discount: 3CPR

Location: Littleton (Broadway & Davies), Colorado

Outcome: Upon successful course completion you will be issued an NAEMT PHTLS provider card and receive 16-hours of CAPCE credits.

For more information and to register, access this link:

https://3cpr.enrollware.com/enroll?id=10735378

EMS Geriatric Emergencies - GEMS Diamond Assessment System

The GEMS Diamond Assessment System was developed by the National Association of Emergency Medical Technicians (NAEMT) in collaboration with experts in geriatric care. 

It was created as part of an effort to enhance the education and training of EMS Providers in understanding and managing the unique challenges associated with caring for geriatric patients in prehospital settings. 

This system is integrated into educational programs, such as the Geriatric Education for Emergency Medical Services (GEMS) course, which provides specialized training for emergency medical professionals. 

A Comprehensive Tool for EMS Providers

The GEMS Diamond Assessment System is an essential framework designed to assist EMS providers in navigating the complexities of caring for geriatric patients. 

This tool emphasizes a multifaceted approach that incorporates clinical, environmental, and social elements to ensure comprehensive patient evaluation. 

Here's what EMS providers need to understand about the GEMS system:

G – Geriatric Patient: Geriatric patients often present atypically, meaning that symptoms of serious medical issues may differ from those seen in younger populations. 

For example, conditions like myocardial infarction may present as generalized weakness or confusion rather than the classic chest pain. 

EMS providers should recognize and anticipate normal physiological changes associated with aging, such as decreased skin elasticity, altered pain perception, and slower cognitive responses. 

Importantly, geriatric patients deserve respect and should be approached with patience and empathy, never infantilized.

E – Environmental Assessment: The patient's environment can offer critical clues about their health status and potential risks. 

EMS Providers should take a quick but thorough look at the surroundings to assess whether it’s safe and conducive to the patient’s well-being. 

Indicators to consider include:

- Condition of the Home: Is it clean or cluttered? Is there evidence of neglect, such as dirty living conditions, unventilated spaces, or broken fixtures?

- Safety Hazards: Check for things like trip hazards, excessive clutter, or broken glass.

- Adequacy of Care: If the patient lives with a caregiver or in a nursing home, observe whether the care appears sufficient. 

Signs of elder abuse or neglect, such as the patient being confined to one room or visible signs of poor hygiene, should be taken seriously.

- Signs of Substance Abuse: Empty liquor bottles may indicate alcohol misuse, a common issue in geriatric populations.

- Medication Review: Take note of any outdated medication bottles lying around, as polypharmacy can lead to dangerous drug interactions.

M – Medical Assessment: Geriatric patients often have multiple chronic health issues that can obscure or complicate the assessment of acute symptoms. 

This makes obtaining a detailed and accurate medical history vital, regardless of the patient's chief complaint. 

Conditions such as heart disease, diabetes, and chronic pain syndromes are prevalent and can mask or exacerbate other medical issues. 

EMS providers must exercise vigilance in differentiating between baseline conditions and new or worsening symptoms.

S – Social Assessment: The social well-being of a geriatric patient is an aspect often linked to their overall health. EMS providers should evaluate whether the patient has a support system. 

Key questions include:

Does the patient have friends or family who visit regularly?

Is there evidence of social isolation, which can contribute to or exacerbate depression?

Can the patient manage daily activities such as bathing, dressing, toileting, and eating independently? If not, is there adequate support in place?

Is there regular access to essentials like food and clean water?

A comprehensive social assessment also includes observing the patient's interactions and listening for signs that they may be experiencing loneliness or neglect.

Conclusion

The GEMS Diamond Assessment System serves as a vital guide for EMS providers when managing geriatric patients. 

By focusing on the unique needs and considerations outlined — Geriatric, Environmental, Medical, and Social — providers can deliver a well-rounded, empathetic approach to care. 

In addition to using the GEMS framework, EMS Providers must remain mindful of the importance of thorough injury assessments, effective communication strategies, and maintaining respect for the autonomy and dignity of older adults. 

These practices not only improve the quality of care but also foster trust and cooperation with patients, their families, and caregivers.

As the geriatric population continues to grow, the ability to deliver tailored, patient-centered care becomes increasingly vital. 

By incorporating the GEMS Diamond Assessment System into their practice, EMS providers can confidently navigate the challenges of geriatric emergencies, ensuring safer outcomes and making a meaningful difference in the lives of their patients. 

The GEMS structure exemplifies the intersection of clinical expertise, empathy, and respect that defines high-quality care in emergency medical services.

Further Reading

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

NAEMT (2023) Geriatric Education for Emergency Medical Services (3rd Ed). Burlington, Massachusetts: Jones & Bartlett Learning

Peate, I. & Sawyer, S (2024) Fundamentals of Applied Pathophysiology for Paramedics. Hoboken, New Jersey: Wiley Blackwell

Peterson, L. K., Fairbanks, R, J., Hettinger, A. Z., & Shah, M. N. (2009) Emergency Medical Service Attitudes Toward Geriatric Prehospital Care & Continuing Medical Education In Geriatrics. Journal of the American Geriatrics Society 57 (3): 530-5. Accessed November 8, 2024

Shah, M. N., Rajasekaran, K., & Sheahan, W. D., Wimbush T., & Karuza J. (2008) The Effect Of The Geriatrics Education For Emergency Medical Services Training Program In A Rural Community. Journal of the American Geriatrics Society 56 (6):1134-9. Accessed November 8, 2024

EMS Celebrations - National First Responders Day

Let's take a moment to express our gratitude for the dedication, courage, and compassion of our first responders

Every day, these amazing people put their lives on the line to protect and serve our communities.

From the first call until they return to quarters, they are the heroes who make a difference.

Thank you for your unwavering commitment to keeping us safe.

EMS Ethics - Key Concepts for Prehospital Healthcare Providers Part Two

In addition to the foundational ethical principles that guide EMS providers in delivering patient care, there are several other key ethical concepts that are equally important in the practice of prehospital medicine. 

These concepts focus on ensuring fairness, respect, honesty, integrity, and advocacy in all interactions with patients. 

EMS providers frequently encounter diverse populations and situations that require a deep commitment to ethical standards, reinforcing the importance of treating every individual with dignity and fairness, while also advocating for those who cannot speak for themselves. 

Part Two explores five additional ethical principles that are vital for EMS providers to uphold in their daily practice.

6. Justice

As it pertains to healthcare, justice refers to the level of fairness by which medical services are distributed. 

In EMS, medical care is provided on an emergency basis equally to all persons in need regardless of race, sex, religion, or socioeconomic status. 

Systems of triage also observe the ethical principle of justice when determining each patient’s priority for care depending on the urgency of their needs.

7. Respect For Persons

Simply tending to an emergency medical need is not enough; patients must be afforded dignity and respect. In our often dark and gloomy profession, it is easy to fall into the trap of viewing our patients as cargo to be transported. 

This is a natural psychological self-defense reaction that EMS providers must guard against in order to maintain ethical healthcare practices.

8. Honesty

EMS providers must be truthful in all dealings. Lying can at best destroy any trust built between EMS and the public, and at worst result in legal ramifications for the provider and the agency. 

Honesty must be exercised in our documentation, and in our direct communication with our patients and other healthcare providers.

9. Integrity

An EMR with integrity adheres to ethical principles despite any pressures or temptations to do otherwise. 

The provider must be always stalwart in the face of challenges to their ethics, and make only decisions that they know to be good and true.

10. Advocacy

One of the best ways we can care for our patients is to be their advocate. Advocating for a patient may simply entail making phone calls to coordinate assistance for them, or contacting their primary care physician to help clarify any confusion the patient may have about their doctor’s instructions. 

In some situations, the patient may be unable to advocate for themselves at all, such as in cases of child or elder abuse, and it becomes the legal and ethical responsibility of the EMS provider to advocate for the patient’s safety and well-being.

Conclusion

EMS practice is inherently complex and challenging, demanding not only clinical skills but also a steadfast commitment to ethical principles. By upholding justice, respect for persons, honesty, integrity, and advocacy, EMS providers can ensure they are delivering care that is fair, respectful, and protective of patient rights. 

These ethical principles are crucial in fostering trust, maintaining professional standards, and advocating for the well-being of all patients, especially those who are most vulnerable. 

As EMS professionals continue to serve on the front lines of healthcare, their adherence to these ethical guidelines is essential in upholding the integrity of the profession and ensuring that all patients receive equitable and compassionate care.

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Brown, J. F. (1999) Ethics, Emergency Medical Services, and Patient Rights: System and Patient Considerations. Topics in Emergency Medicine 21 (1): 49-57 Accessed August 9, 2024

Harris, D. (2014) Contemporary Issues in Healthcare Law and Ethics (4th Ed). Illinois: Health Administration Press.

Iserson, K. V. (2006)  Ethical Principles - Emergency Medicine. Emergency Medicine Clinics of North America 24(3): 513 - 545   Accessed August 9, 2024

Larkin G. L. & Fowler, R. L. (2002) Essential Ethics for EMS: Cardinal Virtues and Core Principles. Emergency Medicine Clinics of North America 20 (4): 887-911. Accessed August 9, 2024

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

Moskop, J. C. (2006) Informed Consent and Refusal of Treatment: Challenges for Emergency Physicians. Emergency Medicine Clinics of North America 24 (3): 605-618. Accessed August 7, 2024

National Association of Emergency Medical Technicians (2013) Code of Ethics for EMS Practitioners. Accessed August 7, 2024

Winston, B. & Moskop, J. C. (2014) A Review of the Updated NAEMT Code of Ethics. Journal of Emergency Medical Services 39 (6): 50-53 Accessed August 9, 2024

EMS Ethics - Key Concepts for Prehospital Healthcare Providers Part One

Ethics play a crucial role in the field of Emergency Medical Services (EMS), where decisions must often be made quickly and under pressure. 

As prehospital care responders, EMS providers are frequently faced with challenging situations that require a strong understanding of ethical principles to ensure that patient care is delivered effectively and compassionately. 

Ethics in EMS encompass various concepts that guide providers in respecting patient rights, ensuring informed decision-making, and protecting their confidentiality, all while striving to do good and avoid harm. 

This piece outlines part one of essential ethical principles that every EMS provider should understand to provide the highest standard of care in prehospital settings.

1. Autonomy

Also known as self-determination, autonomy refers to the right of the patient to make decisions about their own medical care. In EMS, we often encounter this ethical concept when well-meaning family members attempt to supersede the wishes of a patient who is otherwise capable of making their own choices. 

Aside from situations where an inability to make appropriate decisions has been demonstrated (e.g. threat of suicide), a patient who is alert, oriented, and able to comprehend the gravity of their situation has the right to determine the course of their own medical care.

2. Informed Consent

A patient exercising autonomy can only make appropriate decisions regarding their medical care if they possess enough information to make informed choices. 

It is, therefore, the ethical obligation of EMS providers to present a full and accurate picture to our patients of the risks and benefits of their self-determined healthcare decisions.

3. Confidentiality

Information received while in a patient-provider relationship must remain protected from those who do not need to know. Consequences for the negligent disclosure of private medical information include embarrassment to the patient; the erosion of trust between EMS providers and the public we serve; and hefty fines to the agency. 

In the case of HIPAA violations, fines can be as high as $50,000 per infraction, with a maximum penalty of $1.5 million per year.

4. Beneficence

The term beneficence describes actions that are carried out for the benefit of others. Administering D50 to a hypoglycemic patient while on the scene, instead of immediately transporting them to the hospital while unconscious, is an example of beneficence in EMS. 

In this situation, providing IV dextrose with the knowledge that the patient could very likely return to consciousness and be left safely in their home is beneficial in terms of lower cost to the patient, and less of their time wasted waiting for an unnecessary ER evaluation.

5. Non-Maleficence

Primum Non Nocere - first, do no harm - is the original guiding principle of medicine. If faced with a choice between doing nothing or taking an action that will cause more harm, the correct decision in most cases is to take no action. 

Similarly, if inaction would likely result in harm befalling a patient, EMS providers are obligated to take appropriate steps for the protection of those in our care.

Conclusion

Ethical considerations are integral to the practice of EMS and are essential for maintaining trust between providers and the communities they serve. By adhering to ethical principles such as autonomy, informed consent, confidentiality, beneficence, and non-maleficence, EMS providers ensure that they are making decisions that respect patient rights and promote well-being. 

Understanding and applying these concepts helps providers navigate the complex and often unpredictable nature of prehospital care, ultimately leading to better patient outcomes and a more ethical healthcare environment. 

As the field of EMS continues to evolve, ongoing education and reflection on ethical practices will remain vital for all providers.

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Brown, J. F. (1999) Ethics, Emergency Medical Services, and Patient Rights: System and Patient Considerations. Topics in Emergency Medicine 21 (1): 49-57 Accessed August 9, 2024

Harris, D. (2014) Contemporary Issues in Healthcare Law and Ethics (4th Ed). Illinois: Health Administration Press.

Iserson, K. V. (2006)  Ethical Principles - Emergency Medicine. Emergency Medicine Clinics of North America 24(3): 513 - 545   Accessed August 9, 2024

Larkin G. L. & Fowler, R. L. (2002) Essential Ethics for EMS: Cardinal Virtues and Core Principles. Emergency Medicine Clinics of North America 20 (4): 887-911. Accessed August 9, 2024

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

Moskop, J. C. (2006) Informed Consent and Refusal of Treatment: Challenges for Emergency Physicians. Emergency Medicine Clinics of North America 24 (3): 605-618. Accessed August 7, 2024

National Association of Emergency Medical Technicians (2013) Code of Ethics for EMS Practitioners. Accessed August 7, 2024

Winston, B. & Moskop, J. C. (2014) A Review of the Updated NAEMT Code of Ethics. Journal of Emergency Medical Services 39 (6): 50-53 Accessed August 9, 2024

EMS Operations - Rural Paramedics Making House Calls

In Terlingua, Texas, a new community paramedicine program is helping reduce emergency room visits by having paramedics regularly check on residents with chronic health issues.

This initiative addresses the lack of nearby hospitals and doctors, providing preventative care and support, especially for elderly and reclusive individuals.

Funded by a USDA grant, the program aims to prove its cost-effectiveness by lowering readmissions, despite current challenges with insurance reimbursements for paramedic house calls.

The goal is to sustain these programs through demonstrated economic and health benefits.

A recent NAEMT report listed more than 150 of these kinds of community paramedicine programs across the country yet economic models are challenging.

For more details, visit the article below.

https://www.marketplace.org/2024/06/28/community-paramedicine-visits-west-texas-ems-paramedics/? 

EMS Celebration - History of EMS Week

President Gerald Ford established the first National Emergency Medical Services Week in 1974, and since then it has been celebrated on the third week of May every year. 

The goal of EMS Week was to raise awareness and pay tribute to the crucial work EMS professional do, often times risking their own safety and well-being in the pursuit to provide care to others. 

As it has evolved, we now celebrate it with various events that honor the achievements of EMS professionals, highlight the importance of EMS in healthcare, and advocate for the challenges and issues faced by the EMS community.

For the full article follow the link below: 

https://emsweek.org/2024/03/21/history-of-ems-week/

Further Reading:

Woodyard, D.R. (2023) EMS in the United States: Fragmented Past, Future of Opportunity. Colorado: Donnie Woodyard

EMS Week - What is EMS today?

Is it what you see on TV or in movies? EMS started as an improvement to service to transport you to a hospital, with treatment and care along the way.

For the first time we brought care to you – but only in an emergency. It was an enormous step up from a stretcher in a hearse supplied by a funeral home (because they had the vehicles).

From the extremes of defibrillating a cardiac patient in a marathon to assisting a senior citizen with her or his prescriptions for cancer treatment or congestive heart failure: is EMS an emergency service, a health care service or a preventive medical service?

The answer to that depends on who you ask, as EMS still has several delivery models and philosophical approaches.

Are we a community service in the continuum of healthcare or just the angels of 3:00 AM? We are balancing the original-and-since-improved, yet cobbled-together, EMS system as an essential service with the changing needs of healthcare for our citizenry.

Further Reading:

Woodyard, D. R. (2023) EMS in the United States: Fragmented Past, Future of Opportunity. Colorado: Donnie Woodyard

EMS Celebration - EMS Week 50th Anniversary

“EMS Week celebrates all EMS providers who diligently care for their patients and communities in times of crisis,” states NAEMT President Susan Bailey, MSEM, NRP.

'Honoring Our Past, Forging Our Future’ reflects on the proud history and contributions of EMS practitioners. We must remain focused on evolving, innovating, and ensuring EMS has the necessary support to respond to the public's call for help effectively.

This year, marking the 50th anniversary of National EMS Week, we pay tribute to those who paved the way, challenging norms and setting higher standards.

Simultaneously, we anticipate the future, leveraging their work to shape a path for the next generation of EMS professionals dedicated to community service.

Activities:

Sunday, May 19: Health, Wellness & Resilience Day

Monday, May 20: EMS Education Day

Tuesday, May 21: EMS Safety Day

Wednesday, May 22: EMS for Children Day

Thursday, May 23: Save-A-Life Day (CPR & National Stop the Bleed Day)

Friday, May 24: EMS Recognition Day

Saturday, May 25: EMS Remembrance Day

Further Reading:

Woodyard, D.R. (2023) EMS in the United States: Fragmented Past, Future of Opportunity. Colorado: Donnie Woodyard

EMS Discussion - Use of Lights & Sirens

EMS Providers should be aware of the ongoing discussion surrounding the use of lights and sirens during emergency calls. There is a growing concern about the risks associated with their use, such as an increased likelihood of accidents and harm to patients.

EMS Providers should stay updated on local and national guidelines regarding when to use lights and sirens to ensure the safety of both themselves and the public.

Those operating emergency vehicles must consider alarming statistics showing that ambulance crashes significantly impact clinicians, patients, and the public, with the risk of a crash increasing by over 50% when lights and sirens are activated.

It is crucial for EMS Leaders to implement well-researched guidelines supporting the restricted use of lights and sirens to enhance the safety of all individuals involved in emergency responses.

In an outstanding demonstration of collaboration on provider, patient, and community safety, 13 national and international associations have partnered on the release of a Joint Statement on Lights and Siren Vehicle Operations in Emergency Medical Services (EMS) Responses (NAEMT, 2022).

The statement articulates principles guiding the use of lights and sirens during emergency vehicle responses to medical calls and initiatives to decrease their use safely. EMS vehicle operations using lights and sirens pose significant risks to both providers and the public. Therefore, their use should be limited to situations where time saved is expected to be clinically important to a patient’s outcome (Merill, 2022).

Communication centers should utilize structured call triage and categorization to identify subsets of calls based on the response resources needed and medical urgency. Physician oversight is crucial in developing response configurations and modes for these protocols.

Agency Leadership should monitor the rates of lights and sirens use, appropriateness, compliance, and outcomes related to their use. Municipal Leaders should be aware of the increased crash risks, and quality care metrics should drive contract agreements.

States and provinces should monitor and report on emergency vehicle crashes to better understand the risks associated with lights and sirens use.

Collaboration between EMS and Fire Agency Leaders is essential in understanding public perceptions and improving education about the risks associated with lights and sirens to create safer expectations.

According to a recent presentation by NEMSQA, 87% of EMS responses were made with the use of lights & sirens, while transports nationally used them 51% of the time. The time savings averaged 102-216 seconds during a response and between 42-228 seconds for transports (from multiple recent studies); yet life-saving interventions are being done in only 6.9% of responses (according to an ESO study of 7.5M records).

At the same time, our odds of being involved in an accident increase by 53% in responses and 184% during transports (not to mention accidents in our wake that do not involve an EMS unit). Furthermore, litigations that involve ambulance incidents are 86% when using L&S.

The data presented highlights concerning statistics surrounding the use of lights and sirens in EMS responses and transports. While time savings are evident, life-saving interventions are performed in only a small percentage of responses.

The increased risk of accidents during both responses and transports underscores the need for a shift towards safer practices. Litigations involving ambulance incidents predominantly occur when lights and sirens are used.

It is crucial to view the use of lights and sirens as a clinical treatment and to follow the guidance to "use only as needed" to ensure the safety of patients, the community, and EMS providers. Prioritizing safe ambulance operations is vital for everyone's well-being and to ensure a safe return home after each shift.

Further Reading:

Merrill, L. (2022) 14 Groups Issue Joint Statement on EMS Use Of lights, Sirens https://www.ems1.com/ambulance-safety/articles/14-groups-issue-joint-statement-on-ems-use-of-lights-sirens-AAfswfKx2gaog3dy/ Accessed February 28, 2024

National Association of Emergency Medical Technicians (2022) Joint Statement on Lights & Siren Vehicle Operations on Emergency Medical Services (EMS) Responses https://naemt.org/docs/default-source/advocacy-documents/positions/joint-statement-on-red-light-and-siren-operations-with-logos---final.pdf?sfvrsn=e586e893_4 Accessed February 28, 2024

National EMS Quality Alliance (2024) Improving Safety in EMS: Reducing the Use of Lights and Siren https://nemsqa.memberclicks.net/assets/LSChangePackage/Improving%20Safety%20in%20EMS%20Reducing%20the%20Use%20of%20Lights%20and%20Siren.pdf Accessed February 28, 2024

Zavadsky, M. (2023) Culture Shift: Reducing Lights and Siren Vehicle Operation https://www.ems1.com/safe-transport-point-b/articles/culture-shift-reducing-lights-and-siren-vehicle-operation-XDonsygscixIghQT/ Accessed February 28, 2024

EMS Week 2020

In 1974, President Gerald Ford authorized EMS Week to celebrate EMS practitioners and the important work they do in our nation's communities. NAEMT partners with the American College of Emergency Physicians (ACEP) to lead annual EMS Week activities.

#EMS Week #EMSStrong 

#AmericanRedCross #NAEMT #NREMT

Training In A Time Of COVID-19

@NREMT @NAEMT #EMS #EMR 

#LifeIsPrecious #COVID19 #DuringATimeOfPlague