Lesson 1

Introduction to Emergency Medical Care

Duration: 1 hr and 15 minutes
Preparation: slides, overhead projector

OBJECTIVES
Cognitive:
1. Define Emergency Medical Services (EMS) systems.
2. Differentiate the roles and responsibilities of the EMT-Basic from other prehospital care providers.
3. Discuss the roles and responsibilities of the EMT-Basic towards the safety of
self, the crew, the patient, and bystanders.
4. Define quality improvement and discuss the EMT-Basics role in the process.
5. Define medical direction and discuss the EMT-Basics role in the process
6. State the specific statutes and regulations in your place regarding the EMS
system.
Affective:
7. Assess areas of personal attitude and conduct of the EMT-Basic
8. Characterize the various methods used to access the EMS system in your
community.

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CONTENT

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. INTRODUCTION
Cognitive Objectives
1. Define Emergency Medical Services (EMS) systems.
2. Differentiate the roles and responsibilities of the EMTBasic from other pre-hospital care providers.
3. Discuss the roles and responsibilities of the EMT-B
towards personal safety, safety of the crew, the patient
and bystanders.
4. Define quality improvement and discuss the EMTBasic's role in the process.

1) Introduce instructor and assistant instructor

2) Present lesson
3) Present lesson objectives

II. DEVELOPMENT
The student will use this information throughout the course to enhance his
understanding and provide direction for the EMT-Basic's relationship to the
individual components of the EMS system. The lesson will provide the student with a
road map for learning the skill and knowledge domains of the EMT-Basic. This will
likewise set the foundation for the remaining teaching/learning process.
The students will be entering an exciting field of EMS. A positive, helpful
attitude presented by the instructor is essential to assuring a positive attitude
from the student.
<Ask the participants for their own definition of an EMS system then give book
definition>

Emergency Medical Services

This is a system consists of a team of health care
professionals, who, in each area of jurisdiction, are
responsible for and provide emergency care and
transportation to the sick and injured.

1. Emergency Medical Services is a system consists of a team of

health care professionals, who, in each area of jurisdiction, are
responsible for and provide emergency care and transportation to
the sick and injured. Brady book page ..
2. Certification Requirements
< In other countries, certification and recertification of EMTs is a state
function, subject to the laws and regulations of the state in which the EMT
practices>
< In the Philippines, once EMS Bill No 3579 is enacted, Registration and recertification of EMTs in the Philippines shall be governed by the Technical Education
and Skills Development Authority (TESDA) for non-degree courses, and by the
Professional Regulation Commission (PRC) for degree courses, in accordance with
PRC rules and regulations and without prejudice to the enactment of a licensure law
for EMTs. A certification is valid for a period of three (3) years. TESDA and PRC shall
re-certify Emergency Medical Technicians upon submission of a competency-based
assessment statement from a recognized Emergency Medical Services Medical
Director>

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Criteria for certification (US criteria) Ref: page 6 .... AAOS

1. Successful course completion
2. Mentally/physically meet criteria of safe and effective practice of job
functions
3. Written examination
4. Practical examination
5. State and local provisions

3. History of EMS
History of Emergency Medical
Services (1 of 3)
Emergency care developed during warfare at the
beginning of the 20th century.
By the 1960s, domestic emergency care lagged
behind.
Staffed emergency departments were often limited to
large urban areas.

<Inform the participants that this is just a brief overview, refer to page 7 AAOS
EMERGENCY Care and Transportation of the Sick and Injured>

Emergency care developed during warfare at the beginning of the 20th

century.

By the 1960s, domestic emergency care lagged behind.

Staffed emergency departments were often limited to large urban areas.

Accidental Death and Disability: The Neglected Disease of Modern Society (1966)
Recommended:

Development of training

Development of federal guidelines and policies

Provide emergency care and transport

Establish staffed emergency departments

Highway Safety Act and the Emergency Medical Act created funding

DOT developed the first National Standard Curriculum for training EMTs in
the early 1970s

EMS established in most of the United States by 1980

4. Levels of Training
Levels of Training
First Responder
EMT-Basic
EMT-Intermediate
EMT-Paramedic

< Remind students that our reference material is AAOS 9th Ed and try to
compare with country practice)
<With increased awareness of the need for immediate emergency care,
laypeople are trained in BLS/CPR, simple first aid, for them to give aid before
the EMT-Basics or the ambulance arrive> AAOS page 8
a. First Responder individuals trained to initiate immediate care and
assist the EMT on their arrival. (Law enforcement officers, fire
fighters, park rangers or organized rescuers who often arrive at the
scene before the ambulance).

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b. EMT-Basic requires a minimum of 110 hours and includes the essential

knowledge and skills required to provide basic emergency care in the
field. (Skills included use of automated external defibrillator (AED), use
of non-visualized airways such as Combitube, endotracheal intubation,
and assisting patients with the use of their physician prescribed
medications such as nitroglycerine, epinephrine and metered dose
inhalers.
c. EMT- Intermediate this course is designed to add knowledge and

skills in specific aspects of ALS to individuals who have been trained and
have experience in providing emergency care as EMT-Bs.
Additional skills include IV therapy, interpretation of cardiac rhythm

and in many states, the knowledge and skills necessary to

administer certain medications.

d. EMT- Paramedic has completed an extensive course of training that

significantly increase knowledge and mastery of basic skills and covers
wide range of ALS skills based on the 1999 Paramedic National Standard
Curriculum. Ranges from 800- 1,500 hours of
combined classroom and internship training. Skills taught:
ECG monitoring and interpretation of cardiac rhythms
Advance cardiac life support (ACLS) protocols and skills
Manual defibrillation and external cardiac pacing
Orotracheal and nasotracheal intubation
Needle cricothyroidtomy
Needle decompression for tension pneumothorax
IV therapy
Advanced pharmacology: drug calculations and medication
administration
5.

ACCESS

HOSPITAL
STAFF

Components of the EMS System

ADMINIS
TRATION
& POLICY

SPECIALTY
CENTERS

(1) Access Easy access to help needed in an emergency is essential. In

MEDICAL
DIRECTION
& CONTROL

EMS
AMBULANCE

QUALITY
CONTROL &
IMPROVEMENT
EQUIPMENT
REGULATION

the US, an emergency communications centre that dispatches fire,

police, rescue and EMS units can be reached by dialling 911.
At the communication center, trained dispatchers obtain the necessary
information from the caller and following dispatch protocols, dispatch
the ambulance crew and their equipment and responders that may be
needed.

OTHER
PHYSICIAN
OUTPUT
10

< In the Philippines emergency units can be reached by dialing 117. Emphasize
the need to know the emergency number in their localities>

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(2) Administration and Policy - EMS is usually administered by a senior

EMS official, who oversees the daily operations and overall direction
of the service. To provide clear guidelines, most services have
written operating procedures and policies. Except for medical
matters, he or she operates as the chief of the EMS.
(3) Medical Direction and Control each EMS system has a physician
medical director who authorizes the EMT in the service to provide
medical care in the field.
Role of Medical Director:
a. Responsible for the clinical and patient care aspects of an EMS
system.

Role of the Medical Director

Responsible for the clinical and patient care aspects of
an EMS system.
Responsible for reviewing quality improvement

b. Responsible for reviewing quality improvement

Types of Medical Direction:

Online or Direct telephone and radio
Off-line or Indirect protocols, standing orders

Types of medical direction

(1) On-line or direct
(a) Telephone
(b) Radio
(2) Off-line or indirect
(a) Protocols
(b) Standing orders

10

Relationship of the EMT-Basic to medical direction

a. Designated agent of the physician
b. Care rendered is considered an extension of the medical
Directors authority (varies by state law or in the Phil varies
from each agency).

Relationship of the EMT-Basic to medical

direction
Designated agent of the physician
Care rendered is considered an extension of the
medical Directors authority

11

(4) Quality Control and Improvement - a system of internal/external

reviews and audits of all aspects of an EMS system so as to identify
those aspects needing improvement to assure that the public
receives the highest quality of pre-hospital care.
The role of the EMT-Basic in quality improvement
a. Documentation
b. Run reviews and audits
c. Gathering feedback from patients and hospital staff
d. Conducting preventative maintenance
e. Continuing education
f. Skill maintenance

The role of the EMT-Basic in quality

improvement

Documentation
Run reviews and audits
Gathering feedback from patients and hospital staff
Conducting preventative maintenance
Continuing education
Skill maintenance

12

< As an EMT-B, you are part of the professional continuum of care provided
to patients who often have life-threatening conditions>

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(5) Other Physician Output Besides the supervision that the medical
director and direct online medical control physicians provide, yoyr
training and practices are based on input from many specialty
professional associations (American Academy of Orthopedic
Surgeons-AAOS, American College of Emergency Physician ACEP)
(6) Regulation trainings, protocols and practices must conform with the
EMT legislation, rules, regulations and guidelines.
< In the Philippines, once the EMS law is enacted this will be done by the
National Pre-Hospital Care Council>
(7) Equipment As an EMT-B you will use wide range of different
emergency equipment.
(8) Ambulance - EMT-Bs must be familiar with the ambulance and its
functions because as an EMT-B you may be called to drive the
ambulance. Check all equipment, supplies, communication
equipment and fuel.
(9) Specialty centers aside from hospital emergency departments,
many EMS systems include specialty centers which focus on specific
types of care such as trauma, burns, poison or psychiatric conditions,
or specific types of patients such as children or the elderly.
(10) Inter-facility Transports may include transferring patient to and
from hospitals, skilled nursing facilities, board and care homes or
even their home residence.
(11)Working with Hospital Staff As an EMT-B you will interact with
hospital staff.
(12) Working with Public Safety Agencies Effective scene and patient
management will result if you work together and recognize that each
person has special talent and job to do. Remember that the best,
most efficient patient care is achieved through cooperation among
agencies.
(13) Training The quality of care that you will provide depends on your
ability and the quality of your training.

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Providing a Coordinated Continuum of Care

The emergency care of patients occurs in four progressive phases:

Providing a Coordinated
Continuum of Care
1st Phaseaccess to EMS system
2nd Phaseout of hospital care

1. First phase early access

3rd Phaseemergency department care

4th Phasedefinitive care

<the patient or the bystanders recognize that there is an emergency

and someone initiates the EMS system>
2.

Second phase out of hospital care

<consists of patient assessment, initial pre-hospital care, proper
packaging and safe transport to the hospital>

3. Third phase emergency care department

<the patient receives continued assessment and stabilization in the
hospital emergency department>.
4. Fourth phase definitive care
<the patient receives the necessary definitive specialized care>
< These 4 phases must be provided in a coordinated continuum of care to
maximize survival and reduce patient suffering and minimize lasting adverse
effects>

Star of Life
1

Early detection
6

Transfer to
definitive care

Early
Reporting

5
Care in
transit

Early
Response

On
OnScene
scene
Care
care
4
16

The Star of Life The Emergency Care Symbol < article from RescueEMS Magazine, July-August 1992>
Just as pharmacists have the mortar and pestle and doctors have the
caduceus, Emergency Medical Technicians have a symbol, its use is
encouraged both by the American Medical Association and the Advisory
Council within the Department of Health, Education and Welfare. The
symbol applies to all emergency medical goods and services which are
funded under the DOT/EMS program.
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. NHTSA investigated and felt the complaint was justified.
The newly designed, six-barred cross, was adapted from the Medical
Identification Symbol of the American Medical Association and was
registered as a certification mark on February 1, 1977 with the
Commissioner of Patents and Trademarks in the name of the National
Highway Traffic Safety and Administration. The trademark will remain in
effect for twenty years from this date.

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The staff on the star represents Medicine and Healing.

The snake and staff in the center of the symbol portray the staff
of Asclepius who, according to Greek mythology, was the son of
Apollo (god of light, truth and prophecy). Supposedly Asclepius
learned the art of healing from the centaur Cheron; but Zeus - king of
the gods, was fearful that because of Asclepius' knowledge, all men
might be rendered immortal. Rather than have this occur, Zeus slew
Asclepius with a thunderbolt. Later, Asclepius was worshipped as a
god and people slept in his temples, as it was rumoured that he
effected cures of prescribed remedies to the sick during their dreams.
Asclepius was usually shown in a standing position, dressed in a
long cloak, holding a staff with a serpent coiled around it. The staff
has since come to represent medicine's only symbol. In the Caduceus,
used by physicians and the Military Medical Corps, the staff is winged
and has two serpents intertwined. Even though this does not hold any
medical relevance in origin, it represents the magic wand of the
Greek deity, Hermes, messenger of the gods.
The Bible, in Numbers 21:9, makes reference to a serpent on a
staff: "Moses accordingly made a bronze serpent and mounted it on a
pole and whenever anyone who had been bitten by a serpent looked
at the bronze serpent, he recovered.
Each of the six "points" of the star represents an aspect of the
EMS System.
1

1.

Detection

2.

Reporting

3.

Response

4.

On Scene Care

5.

Care in Transit

6.

Transfer to Definitive Care

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Time Elapsed

7. Roles and Responsibilities of the EMT-B

Roles and Responsibilities
of the EMT-B (1 of 2)

a.
b.
c.
d.
e.
f.
g.
h.

Personal safety
Safety of crew, patient, and bystanders

Patient assessment
Patient care based on assessment findings

Personal safety
Safety of crew, patient and bystanders
Patient assessment
Patient care based on assessment findings
Lifting and moving patients safely
Transport/transfer of care
Record keeping/data collection
Patient advocacy (patient rights) - confidentiality

8. Professional Attributes of the EMT-B

Professional Attributes
of the EMT-B

a. Puts patient's needs as a priority without endangering self.

b. Performs under pressure (stability under pressure)
c. Treats patient and families with understanding, respect and
compassion.
d. Respects patients confidentiality.
e. Maintains up-to-date knowledge and skills (Continuing education
and Refresher Courses)
f. Maintains current knowledge of local, state, and national issues
affecting EMS.

Puts patients needs as a priority without endangering

self
Performs under pressure
Treats patients and families with understanding,
respect, and compassion
Respects patient confidentiality
Maintains up-to-date knowledge and skills (Continuing
education and Refresher Courses)

g. Maintains professional appearance and manner

- Neat
- Clean
- Positive image

Professional Appearance
Professional Appearance

The EMT-B should maintain

a professional appearance and manner.

21

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Cognitive Objectives

CONTENT

Time Elapsed

III. REVIEW

1. Define Emergency Medical Services (EMS) systems.

2. Differentiate the roles and responsibilities of the EMTBasic from other pre-hospital care providers.
3. Discuss the roles and responsibilities of the EMT-B
towards personal safety, safety of the crew, the patient
and bystanders.

Review lesson objectives on page 1.

4. Define quality improvement and discuss the EMTBasic's role in the process.

IV. EVALUATION
1) Verify that the objectives of the lesson have been met.
2) Give the participants 5 minutes to answer the lesson
evaluation

V. CLOSE
<Comments or suggestions?>
<Thank the participants and introduce the next lesson.>

Revised April 22, 2011

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EMT-B Lesson Evaluation

Do not write your name on this form. Please complete a copy of this form at the end of every lesson.
Your evaluations are very valuable toward improving the course. For ratings, please use a scale system from 1 to 5, as follows:
1
Very poor

2
Poor

3
Average

Course Location: ______________________________

Please fill in the required

information.

Lesson Number

4
Good

5
Excellent

Date: ________________________

Lesson Name

Instructors Name

Use a scale from 1 to 5 as

described above to rate the
various lesson components.

Mark your selection with an

X

Lesson Rating (rate 1 to 5)

Content ________

Instructor ___________

Method _________

Workbook __________

Interaction __________

Instruction Level (mark with an X)

Too basic _________

Appropriate ________

Too advanced _________

Duration (mark with an X)

Too short _________

Appropriate ________

Too long _________

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Was this lesson useful to you?
Rate from 1 to 5

Yes _______

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Overall Lesson Rating

Taking all the above into consideration, I rate this lesson: ______________

If you need additional space,

please use the back of the
sheet.

Comments and Observations

Thank you for your help. Your input is valuable. Please turn in this completed form to the instructor.

Revised April 22, 2011

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Cognitive Objectives
1. Define Emergency Medical Services (EMS) systems.
2. Differentiate the roles and responsibilities of the EMTBasic from other pre-hospital care providers.
3. Discuss the roles and responsibilities of the EMT-B
towards personal safety, safety of the crew, the patient
and bystanders.
4. Define quality improvement and discuss the EMTBasic's role in the process.

Introduction to Emergency Medical Care

Cognitive Objectives
5. Define medical direction and discuss the EMT-Basic's
role in the process.
6. State the specific statutes and regulations in your
state regarding the EMS system.

Affective Objectives

Emergency Medical Services

This is a system consists of a team of health care
professionals, who, in each area of jurisdiction, are
responsible for and provide emergency care and
transportation to the sick and injured.

7. Assess areas of personal attitude and conduct of the

EMT-Basic.

8. Characterize the various methods used to

access the EMS system in your community.

History of Emergency Medical

Services (1 of 3)
Emergency care developed during warfare at the
beginning of the 20th century.
By the 1960s, domestic emergency care lagged
behind.
Staffed emergency departments were often limited to
large urban areas.

Revised April 22, 2011

History of Emergency Medical

Services (2 of 3)
Accidental Death and Disability: The Neglected
Disease of Modern Society (1966)
Recommended:
Development of training
Development of federal guidelines and policies
Provide emergency care and transport
Establish staffed emergency departments

Page 12

Levels of Training

History of Emergency Medical

Services (3 of 3)
Highway Safety Act and the Emergency Medical Act
created funding
DOT developed the first National Standard Curriculum
for training EMTs in the early 1970s
EMS established in most of the United States by 1980

First Responder
EMT-Basic
EMT-Intermediate
EMT-Paramedic

TRAINING

ACCESS

Role of the Medical Director

ADMINISTRATION
& POLICY
MEDICAL
DIRECTION &
CONTROL

PUBLIC SAFETY
AGENCIES

QUALITY
CONTROL &
IMPROVEMENT

EMS
HOSPITAL STAFF

OTHER
PHYSICIAN
OUTPUT

INTER-FACILITY
TRANSPORT

Responsible for the clinical and patient care aspects of

an EMS system.
Responsible for reviewing quality improvement
Types of Medical Direction:
Online or Direct telephone and radio
Off-line or Indirect protocols, standing orders

REGULATION

SPECIALTY
CENTERS

AMBULANCE

EQUIPMENT

10

The role of the EMT-Basic in quality

improvement

Relationship of the EMT-Basic to medical

direction
Designated agent of the physician

Care rendered is considered an extension of the

medical Directors authority

11

Revised April 22, 2011

Documentation
Run reviews and audits
Gathering feedback from patients and hospital staff
Conducting preventative maintenance
Continuing education
Skill maintenance

12

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Providing a Coordinated
Continuum of Care

Star of Life
1

1st Phaseaccess to EMS system

2nd Phaseout of hospital care

Early detection
6

Transfer to
definitive care

Early
Reporting

3rd Phaseemergency department care

4th Phasedefinitive care

5
Care in
transit

Early
Response

On
OnScene
scene
Care
care
4
14

Roles and Responsibilities

of the EMT-B (1 of 2)

Roles and Responsibilities

of the EMT-B (2 of 2)

Personal safety

Lifting and moving patients safely

Safety of crew, patient, and bystanders

Transport and transfer of care

Patient assessment

Record keeping/data collection

Patient care based on assessment findings

Patient advocacy/confidentiality

Professional Attributes
of the EMT-B
Puts patients needs as a priority without endangering
self
Performs under pressure
Treats patients and families with understanding,
respect, and compassion
Respects patient confidentiality
Maintains up-to-date knowledge and skills (Continuing
education and Refresher Courses)

Revised April 22, 2011

Professional Attributes
of the EMT-B
Maintains current knowledge of local, state, and
national issues affecting EMS.

Maintains professional appearance and manner

- Neat
- Clean
- Positive image

Page 14

Cognitive Objectives

Professional Appearance

1. Define Emergency Medical Services (EMS) systems.

2. Differentiate the roles and responsibilities of the EMTBasic from other pre-hospital care providers.
3. Discuss the roles and responsibilities of the EMT-B
towards personal safety, safety of the crew, the patient
and bystanders.
4. Define quality improvement and discuss the EMTBasic's role in the process.
The EMT-B should maintain
a professional appearance and manner.

19

Cognitive Objectives
5. Define medical direction and discuss the EMT-Basic's
role in the process.
6. State the specific statutes and regulations in your
state regarding the EMS system.

Affective Objectives
7. Assess areas of personal attitude and conduct of the
EMT-Basic.

8. Characterize the various methods used to

access the EMS system in your community.

Revised April 22, 2011

Page 15