Emergency care system

1. Introduction to Emergency
Medical Services (EMS)

2. Emergency medical assistance (EMS) is a type
of medical care provided to citizens in the event
of illness, accidents, injuries, poisoning and
other conditions requiring urgent medical
intervention. Emergency calls are available in
every country.

3. History of EMS
The beginnings, rudiments and attempts at first aid date back to the early
Middle Ages. The most ancient institution that provided first aid can be
attributed to the xendochium, a shelter for travellers, the poor and the sick. In
contrast to pandogeions and mitates, which provided their services for a fee
and were exclusively secular in nature, xenodohia were philanthropic
institutions based on the principles of Christian hospitality. Already at this
stage, "the sick were brought to the doctor" and not, as later, "doctor to
patient". The prototype of the ambulance is also seen in the activities of the
Hospitallers. The first equipped ambulance stations were set up in 1417 in the
Netherlands due to the presence of many canals and the large number of
drowning persons. The main task of the stations was to rescue and assist those
who were drowning.Translated with www.DeepL.com/Translator (free
version)

4. In the CIS, ambulance services are provided by ambulance
stations or departments attached to hospitals in towns and rural
areas. Emergency stations are organized in cities and regional
centres with population over 50 thousand people and are separate
preventive treatment institutions or are included in the structure
of city emergency hospitals as structural subdivisions. In towns
with smaller populations, there are emergency units at city,
district and other hospitals. In remote and inaccessible areas,
emergency medical care is also provided in some cases by the
emergency and routine consultative medical care units of
regional (provincial))

5. According to regulations adopted back in the Soviet era, all emergency
stations are divided into categories.
Stations carrying 75 thousand and more calls per year are considered
first category, from 50 thousand to 75 thousand are second category,
from 25 thousand to 50 thousand are third category, and finally from 10
thousand to 25 thousand are fourth category.
The first and second category stations are independent institutions and
in their work report directly to the municipal (city) health care
authority. The stations of the third and the fourth category are
organized at the large municipal and central regional hospitals and
work on the rights of the departments of these medical preventive
institutions.

6. General characteristics
Characteristic features that fundamentally distinguish
emergency medical aid from other types of medical aid
are as follows:
-Immediate nature of its provision in cases of
emergency medical care and delayed nature in cases of
urgent conditions (emergency medical care)
-Non-refusal nature of care
-Free-of-charge procedure for the provision of SOC
-Diagnostic uncertainty under time pressure
-Strong social relevance

7. Conditions of emergency medical care:
• Outside the medical organization (at the place
of call of the team, as well as in the vehicle
during medical evacuation)
• Outpatient (in conditions not providing round-
the-clock medical supervision and treatment)
• Inpatient (in an environment with round-the-
clock medical supervision and treatment)

8. Basic functions
Emergency medical assistance is provided to citizens in cases of
conditions requiring urgent medical attention (accidents, injuries,
poisonings and other conditions and illnesses). In particular,
ambulance stations (departments) provide

9. • Round-the-clock rendering of timely and qualitative medical
aid in accordance with the standards of medical aid to the sick
and injured outside medical and preventive institutions,
including in case of catastrophes and natural disasters.
• Timely transport (and also transport at the request of medical
personnel) of sick persons, including infectious diseases,
victims and maternity patients in need of emergency inpatient
assistance.
• Provision of medical assistance to patients and casualties who
have sought assistance directly to the emergency station, in an
office for the reception of ambulatory patients.

10. Notify the municipal health authorities of all
emergencies and accidents in the service area of
the ambulance station.
Ensuring uniform staffing of the mobile
ambulance teams by medical personnel for all
shifts and providing them with full equipment
according to the approximate list of equipment
for the mobile ambulance team.

11. Forms of territorial organization
• Central municipal (district or united regional (krai/oblast) - in
some regions of Russia) station with regional (inter-municipal)
substations of emergency medical care in its composition.
• Ambulance department, including as a structural subdivision
of the central municipal ambulance station and/or regional
(republic within the Russian Federation, krai or oblast) or
central municipal (district) hospital.
• Emergency medical care hospital - both an independent
structure and a structural subdivision of the central city
(regional) emergency medical care station.
• Emergency department - on the basis of regional, district and
city hospitals.

12. Departments of ambulance
• Operations department
• The acute and somatic hospital unit
• The maternity and gynaecology hospital
unit
• The maternity and gynaecology hospital
unit
• Infections department
• Medical statistics department

13. In the state of Massachusetts there
are four levels of emergency care
providers:
• First Responder
• Emergency Medical Technician (EMT) – Basic
• EMT – Intermediate
• EMT - Paramedic

14. • All of the skills of the first responder plus:
– Trained in the use and operation of the
ambulance
– Certified to administer oxygen, glucose,
epinephrine and some other medications at
the on-line or off-line direction of the closest
emergency department’s lead physician
• Called the “medical control” physician
EMT - Basic

15. EMT - Intermediate
• All of the skills of the EMT-Basic plus:
– Capable of starting an intravenous line and
infusing volume-replacing normal saline
– Trained to place an endotracheal tube in a
patient’s windpipe to create a secure means
of ventilating the lungs

16. • All of the skills of the EMT-Intermediate
plus:
– Administration of intravenous medications for
cardiac, diabetic and other medical conditions
under either off-line or on-line direction
– Many other optional and advanced skills such
as chest decompression and needle
crichothyrotomy, etc.
EMT - Paramedic

17. Basic or Advanced?
• Basic life support called BLS describes the
care given by First Responders and EMT-
Basics
• Advanced life support, called ALS, is the
higher level of care performed by EMT-
Intermediates and Paramedics
– Permitted to perform invasive procedures
• Procedures that introduce foreign substances or
equipment into the patient’s body

18. Training
• The EMS provider is legally prohibited
from performing skills that are beyond his
or her level of training
• Each group of skills requires the proper
certification
• The length of time required for learning the
advanced skills is considerable

19. First Responder Training
• Prerequisite: Health Care Professional
level CPR
– 8 hours
• 24-hour class
• Three-year certification period
– Certification is maintained with a refresher
course
• 12 hours

20. EMT Basic Training
• Prerequisite: Health Care Professional level
CPR
– 8 hours
• 110-hour class plus
– Five patient contacts
• State certification application and fee
• Two-year certification period
– 24-hour refresher course
– 28 hours of continuing education

21. EMT Intermediate Training
• Prerequisite: Health Care Professional
level CPR
– 8 hours
• 180-hour class plus
– 100 hours of clinical observations and skills
• 30 i.v. starts
• 10 intubations
– 100 hours of field observations and skills
• 10 i.v. starts
• 1 intubation

22. EMT Paramedic Training
• Prerequisite: Health Care Professional level
CPR & EMT-B certification
• X contact hours as an EMT-B
• 400-hour class plus
– 200 hours of clinical observations and skills
• 60 i.v. starts
• 10 intubations
– 200 hours of field observations and skills
• 30 i.v. starts
• 1 intubation

23. How Far Do You Want to Go?
• HCP CPR
– Written and practical tests
• Minimum passing grade 84%
• Unlimited repeat attempts are allowed
• First Responder
– Written and practical tests
• Minimum passing grade 80%
• Unlimited repeat attempts are allowed

24. How Far Do You Want to Go?
• EMT Basic
– EMT-B is no longer part of the regular
curriculum
– Apply to take the summer course
• Classes held at Mohawk
• Evenings and alternate Saturdays from June –
Aug.
• Free to qualified Mohawk students

25. Mohawk Evening Class
• Do you want to become an EMT?

26. What is Involved?
• Lectures & written tests
– Called the didactic portion
– Subjects are similar to the first responder
curriculum but everything is covered in more
depth

28. What is Involved?
• Practical skills demonstrations

32. What do the participants say?