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Maine EMS On-Line Medical Control Training Program Module 1: EMS systems Module : Maine EMS On-Line Medical Control Training Program Module 1: EMS systems Module :

Module 1: EMS Systems • Objectives – By the end of this module, you Module 1: EMS Systems • Objectives – By the end of this module, you will be able to: • Identify at least 6 components of an EMS system • Differentiate between a Basic Life Support and Advanced Life Support EMS Service • Describe protocols • Define scope of practice • Describe the structure of Maine EMS © EMRCI 2008 Module : 1

Overview of EMS • EMS – Provision of care outside of hospital by personnel Overview of EMS • EMS – Provision of care outside of hospital by personnel with varying levels of training – Personnel are physician extenders • Not delegated practice • Individually licensed • Require physician endorsement © EMRCI 2008 Module : 1

16 Components • • Manpower Training Communication Transportation Emergency Facilities Critical Care Units Public 16 Components • • Manpower Training Communication Transportation Emergency Facilities Critical Care Units Public Safety Agencies • Disaster Planning • Medical Direction © EMRCI 2008 • Consumer Participation • Access to Care • Patient Transfers • Standardized Record Keeping • Public Information and Education • System Review and Evaluation • Mutual Aid Module : 1

Level of Practice • Basic Life Support – Staffing by EMT-Basics • Defined by Level of Practice • Basic Life Support – Staffing by EMT-Basics • Defined by level of training • Based on NHTSA / DOT National Standard Curriculum – Limited equipment • Limited medications • AED • +/- Advanced Airway © EMRCI 2008 Module : 1

Level of Practice • Advanced Life Support – Either EMT-Intermediate, Critical Care Technician or Level of Practice • Advanced Life Support – Either EMT-Intermediate, Critical Care Technician or Paramedic – Staffing by EMT-Paramedics • Much more training (1000+ hours) – Full complement of medications – Cardiac monitor / defibrillation / pacemaker / cardioversion – Advanced airway (intubation) © EMRCI 2008 Module : 1

Protocols • Written documents that guide the EMT’s care • Series of instructions • Protocols • Written documents that guide the EMT’s care • Series of instructions • Based on chief complaint or clinical impression • Define what interventions may / must be done © EMRCI 2008 Module : 1

Protocols • Protocols divided into 2 parts – Standing orders • Authorized by protocol Protocols • Protocols divided into 2 parts – Standing orders • Authorized by protocol • EMT may perform these items if indicated without contacting medical control • Defined by service medical director – Orders requiring on-line medical control • EMT must contact and consult with medical control before initiating these protocols © EMRCI 2008 Module : 1

Protocols • Define care for majority of patients • Some patients fall outside protocols Protocols • Define care for majority of patients • Some patients fall outside protocols – Medical control may authorize EMT to utilize any protocol – Medical control may make orders outside protocols if the orders fall in EMT’s Scope of Practice © EMRCI 2008 Module : 1

Scope of Practice • The breadth of practice of a provider defined by licensure, Scope of Practice • The breadth of practice of a provider defined by licensure, education, and medical director authorization © EMRCI 2008 Module : 1

Scope of Practice © EMRCI 2008 Module : 1 Scope of Practice © EMRCI 2008 Module : 1

Scope of Practice State License © EMRCI 2008 Module : 1 Scope of Practice State License © EMRCI 2008 Module : 1

Scope of Practice Education © EMRCI 2008 Module : 1 Scope of Practice Education © EMRCI 2008 Module : 1

Scope of Practice Medical Director (System) © EMRCI 2008 Module : 1 Scope of Practice Medical Director (System) © EMRCI 2008 Module : 1

Scope of Practice State License Education Medical Director (System) © EMRCI 2008 Module : Scope of Practice State License Education Medical Director (System) © EMRCI 2008 Module : 1

Overview of Maine EMS • Maine is relatively unique – No requirement for ALS Overview of Maine EMS • Maine is relatively unique – No requirement for ALS services to have a medical director • Medical direction carried out at regional and state level • Statewide protocols • State QI © EMRCI 2008 Module : 1

State Level Organization © EMRCI 2008 Module : 1 State Level Organization © EMRCI 2008 Module : 1

Board of EMS Members • • • Regional Councils (6) Ambulance Services (2) Non Board of EMS Members • • • Regional Councils (6) Ambulance Services (2) Non Transporting Services Public (2) Emergency Physician Emergency Nurse (RN) Emergency Medical Dispatch Hospitals Fire Services (2) © EMRCI 2008 Module : 1

Maine EMS Office (MEMS) • Director – Jay Bradshaw • Staff – – – Maine EMS Office (MEMS) • Director – Jay Bradshaw • Staff – – – Training and Education: Jan Brinkman, RN EMT-P Licensing Agent: Alan Leo, EMT Licensing Agent: Dawn Kinney, EMT-P Licensing Assistant: Karen Cutler Data & Preparedness Coordinator: Jon Powers, NREMT-P – EMD Coordinator: Drexell White, EMT-P © EMRCI 2008 Module : 1

Contact Information • • Maine Emergency Medical Services 45 Commerce Drive 152 State House Contact Information • • Maine Emergency Medical Services 45 Commerce Drive 152 State House Station Augusta, ME 04333 (207) 626 -3860 Maine. [email protected] gov www. maine. gov/dps/ems © EMRCI 2008 Module : 1

Regional Offices © EMRCI 2008 Module : 1 Regional Offices © EMRCI 2008 Module : 1

Medical Directions and Practice Board • State Medical Director – Steve Diaz MD • Medical Directions and Practice Board • State Medical Director – Steve Diaz MD • Medical Direction and Practice Board – State Medical Director – 6 regional medical directors – Maine ACEP representative © EMRCI 2008 Module : 1

Medical Directions and Practices Board • Reviews and establishes Protocols • Reviews/approves certain medical Medical Directions and Practices Board • Reviews and establishes Protocols • Reviews/approves certain medical devices • Establishes Quality Assurance benchmarks © EMRCI 2008 Module : 1

Quality Improvement • Centralized function • Services send data to region – Goes to Quality Improvement • Centralized function • Services send data to region – Goes to state – Entered in statewide database – QI committees – Hospital QI nurse / coordinator © EMRCI 2008 Module : 1

MEMS • Other Committees © EMRCI 2008 Module : 1 MEMS • Other Committees © EMRCI 2008 Module : 1

York, Cumberland, & Sagadahoc • • Southern Maine EMS 496 Ocean St. So. Portland, York, Cumberland, & Sagadahoc • • Southern Maine EMS 496 Ocean St. So. Portland, ME 04106 (207) 741 -2790 [email protected] org Donnell Carroll, Regional Coordinator Tony Bock, MD, Medical Director © EMRCI 2008 Module : 1

Androscoggin, Franklin, & Oxford • • Tri County EMS 300 Main St. Lewiston, ME Androscoggin, Franklin, & Oxford • • Tri County EMS 300 Main St. Lewiston, ME 04240 (207) 795 -2880 [email protected] org Joanne Le. Brun, Regional Coordinator Kevin Kendall MD, Medical Director © EMRCI 2008 Module : 1

Kennebec & Somerset • • Kennebec Valley EMS 71 Halifax St Winslow, ME 04901 Kennebec & Somerset • • Kennebec Valley EMS 71 Halifax St Winslow, ME 04901 (207) 877 -0936 [email protected] org Rick Petrie, Regional Coordinator Timothy Pieh MD, Medical Director © EMRCI 2008 Module : 1

 • • Hancock, Penobscot, Piscataquis, & Washington Northeast EMS 354 Hogan Rd Bangor, • • Hancock, Penobscot, Piscataquis, & Washington Northeast EMS 354 Hogan Rd Bangor, ME 04401 (207) 974 -4880 [email protected] edu Rick Petrie, Regional Coordinator Jonnathan Busko MD, Medical Director © EMRCI 2008 Module : 1

Aroostook • • Aroostook EMS 111 High St. Caribou, ME 04736 (207) 492 -1624 Aroostook • • Aroostook EMS 111 High St. Caribou, ME 04736 (207) 492 -1624 [email protected] rr. com Steve Corbin, Regional Coordinator Peter Goth MD, Medical Director © EMRCI 2008 Module : 1

Lincoln, Waldo, & Knox • • Mid Coast EMS P O Box 610 Union, Lincoln, Waldo, & Knox • • Mid Coast EMS P O Box 610 Union, ME 04862 (207) 785 -5000 [email protected] org Bill Zito, Regional Coordinator Colin Coor MD, Medical Director © EMRCI 2008 Module : 1

Local EMS Services in Maine • 285 licensed agencies • Transporting (Ambulance) – Ground Local EMS Services in Maine • 285 licensed agencies • Transporting (Ambulance) – Ground – Fixed wing (Airplane) – Rotor wing (Helicopter) • Non-transporting • Unregulated industrial / private first response agencies (e. g. ski patrols) © EMRCI 2008 Module : 1

Maine EMS Service License Levels • Basic Life Support • Advanced Life Support © Maine EMS Service License Levels • Basic Life Support • Advanced Life Support © EMRCI 2008 Module : 1

Service Levels of Performance • • • First Responder Emergency Medical Technician (EMT) EMT-Intermediate Service Levels of Performance • • • First Responder Emergency Medical Technician (EMT) EMT-Intermediate Paramedic permit Paramedic service © EMRCI 2008 Module : 1

State Levels of Certification / Practice • • First responder (282) Licensed ambulance attendant State Levels of Certification / Practice • • First responder (282) Licensed ambulance attendant (15) EMT (3, 952) EMT Intermediate (841) EMT-Critical Care (27) EMT- Paramedic (1, 016) PIFT © EMRCI 2008 Module : 1

Basic Life Support • First responder • Ambulance Attendant* • Emergency Medical Technician (EMT) Basic Life Support • First responder • Ambulance Attendant* • Emergency Medical Technician (EMT) © EMRCI 2008 Module : 1

Advanced Life Support • • EMT-Intermediate EMT-Critical Care* EMT-Paramedic Interfacility Transfer © EMRCI 2008 Advanced Life Support • • EMT-Intermediate EMT-Critical Care* EMT-Paramedic Interfacility Transfer © EMRCI 2008 Module : 1

Federal Grants / Projects • Rural Access to Emergency Devices: $1 m (4 years) Federal Grants / Projects • Rural Access to Emergency Devices: $1 m (4 years) – Free AEDs to rural responders and community centers – Discounted AEDs available statewide – ~ 10, 000 people trained in CPR/AED – Ended 8/31/06 © EMRCI 2008 Module : 1

Trauma / EMS • Maine EMS Trauma Plan – 1990: Federal Trauma System Grant Trauma / EMS • Maine EMS Trauma Plan – 1990: Federal Trauma System Grant – Trauma Advisory Committee established – October 1996: Trauma Plan Implemented – 2004: Technical Assistance Teams – Formerly supported by federal grant ($40, 000/yr) © EMRCI 2008 Module : 1

Emergency Medical Service for Children • DHHS/MCHB funded $115, 000/year – Injury prevention projects Emergency Medical Service for Children • DHHS/MCHB funded $115, 000/year – Injury prevention projects • Playground safety • CPS • Health & Safety Fairs – EMS for SHCN patients – Data collection (NEMSIS) – Pediatric Equipment, training, and medical control © EMRCI 2008 Module : 1

© EMRCI 2008 Module : 1 © EMRCI 2008 Module : 1

Statewide Protocols • Universal protocols statewide • All paramedics practice under the same protocols Statewide Protocols • Universal protocols statewide • All paramedics practice under the same protocols • Regional variants – Research / Pilot projects by region • • CPAP in several Regions Mid Coast EMS: Stroke protocol Regions 1 & 4: New PIFT IO: now ubiquitous © EMRCI 2008 Module : 1

Summary • EMS is not ED Care • All EMS agencies are not the Summary • EMS is not ED Care • All EMS agencies are not the same • Maine EMS – Oversees – Monitors – Supports • Statewide protocols © EMRCI 2008 Module : 1

End of Module 1 • Click here to e-mail questions © EMRCI 2008 Module End of Module 1 • Click here to e-mail questions © EMRCI 2008 Module : 1