EMS & disaster response
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The document summarizes key aspects of emergency medical services (EMS) and disaster response. It outlines the history and development of EMS in Thailand over three periods. The key elements of EMS systems include manpower, training, communications, transportation facilities, and coordination with other agencies. EMS response occurs in six phases. The document also discusses approaches to disaster response, including the MIMMS framework, DISASTER paradigm, and triage methods like START and SALT. The goal in disasters is to do the most for the most casualties by effectively commanding resources, ensuring safety, communicating, assessing scenes, triaging patients, treating injuries, and transporting patients to appropriate facilities.
EMS & disaster response
- 1. LOGO Emergency Medical Services & Disaster Response Paleerat Jariyakanjana, MD, FTCEP Faculty of medicine Naresaun university
- 3. EMS: extension of emergency medical care into the prehospital setting
- 4. History ช่วงเวลาที่ 1 สภาอุณาโลมแดงแห่งชาติสยาม มูลนิธิป่อเต็กตึ๊ง & มูลนิธิร่วมกตัญญู ช่วงเวลาที่ 2 ตารวจจราจรช่วยเหลือผู้ป่วยฉุกเฉิน ศูนย์กู้ชีพนเรนทร ช่วงเวลาที่ 3 พัฒนาระบบบริการการแพทย์ฉุกเฉิน ให้ลงไปสู่ระดับชุมชน และมีความ ครอบคลุมพื้นที่ทั่วประเทศ Tsunami
- 5. Key elements
- 6. Manpower Personnel Comment Duration First responder First professional or trained layperson to arrive at a medical emergency 16 hr EMT-B (Basic) Oxygen, CPR, AED, extrication, immobilization, hemorrhage control 110 hr EMT-I (Intermediate) EMT-B plus IV insertion, some medication administration, ECG interpretation 2 yr EMT-P (Paramedic) Advanced resuscitation techniques such as intubation 4 yr
- 7. Training initial provider training continuing education
- 8. Communications 1. collect the necessary information from the caller, dispatch appropriate medical resources, and offer first aid information or prearrival instructions 2. Ambulance personnel should also be able to communicate with the destination hospital 3. online medical control
- 9. Transportation BLS ambulances carry equipment appropriate for personnel trained at the EMT-B level oxygen, bag-mask ventilation devices, immobilization and splinting devices, and dressings for wound care and hemorrhage control do not carry medication and cannot transport patients requiring IVs or cardiac monitoring, although some may carry AEDs
- 10. BLS ambulances
- 11. Transportation ALS ambulances equipped for EMT-Ps or other advanced health care personnel IV supplies, IV medication, intubation devices, cardiac monitoring and defibrillation, and equipment for other specialized techniques unique to specific areas, such as hypothermia application after cardiac resuscitation
- 12. ALS ambulances
- 13. Transportation http://www.manafeth.com/index.php/en/products/view/Ambulance-Type-I#
- 14. Transportation Ground transportation is appropriate for the majority of patients, especially in urban and suburban areas. air transport helicopter considered for critically ill patients when the ground transport time would be dangerously long or if the terrain is difficult to navigate
- 15. Air transport
- 16. Boat ambulance
- 17. Facilities and Critical-Care Units closest appropriate hospital or to the hospital of the patient's choice divert patients to other hospitals ED overcrowding
- 18. Public Safety Agencies strong ties with police and fire departments 1. providing scene security 2. provide first responder services
- 19. Consumer Participation encourage representation of the general public on the membership of regional EMS councils public can participate by volunteering for local EMS agencies
- 20. Access to Care no barriers or disincentives preventing timely access to the system
- 21. Patient Transfer all patients must receive a medical screening exam and be stabilized before transfer to another facility explicit acceptance of the transfer by the receiving hospital
- 22. Coordinated Patient Record Keeping Standardization of EMS medical records
- 23. Public Information and Education train the public how to access them when needed and how to use them appropriately convey to the public is the importance of learning CPR, first aid, and basic disaster preparedness principles
- 24. Review and Evaluation radio communications, response times, scene times, and patient care records Outcome: cardiac arrest, stroke, and trauma EMS research
- 25. Disaster Plan written policies and procedures stockpiling supplies participating in regional disaster drills with other emergency response agencies and hospitals
- 26. Mutual Aid mutual aid agreements with neighboring jurisdictions so that uninterrupted emergency care is available when local agencies are overwhelmed or unable to provide services
- 27. Phases of EMS response
- 28. Response
- 31. Definition Major Incidents: any incident where the number, severity, type or location of live casualties requires extraordinary resources Disaster: need > resource Mass casualty incident: Healthcare need > resource
- 33. Major Incident Medical Management and Support (MIMMS) major incident training course systematic, 'all hazards' approach to the principles of pre- hospital, multiple- casualty incident medical management
- 35. DISASTER Paradigm Detection Incident command Scene security and safety Assess hazards Support Triage and Treatment Evacuation Recovery
- 36. Management and Support Principles DISASTER Paradigm Detection Incident command Scene security and safety Assess hazards Support Triage and Treatment Evacuation Recovery MIMMS Command Safety Communication Assessment Triage Treatment Transport
- 37. Command CSCATTT
- 38. Safety The 1-2-3 of Safety 1. Staff 2. Situation 3. Survivors CSCATTT
- 42. Assessment My call sign/Major incident declared Exact location: Grid ref. Type of incident Hazards: Present/Potential Access: Roads, Landing area Number of casualties: Type, Severity Emergency services: Present and Required CSCATTT
- 43. Triage CSCATTT
- 47. START (Simple triage and rapid treatment)
- 48. SALT (Sort, Assess, Life-Saving Interventions, Treatment and/or Transport)
- 49. Treatment Aim: “do the most for the most” CSCATTT
- 50. Transport Aim: get the right casualty to the right place in the right time Casualties should be dispersed to different hospitals, most appropriate to their need. Mechanism of injury Injury found or suspected Signs (vital signs) Treatment given CSCATTT
- 51. Take home message EMS extension of emergency medical care into the prehospital setting 15 key elements of EMS systems 6 phases of EMS response Disaster response MIMMS: CSCATTT DISASTER Paradigm Triage: Sieve & Sort, START, SALT
- 52. Reference Tintinalli's Emergency Medicine, 7th edition http://www.emsworld.com/article/10319356/the- star-of-life https://sites.google.com/site/dimersarred/disaste r-management-cycle https://sites.google.com/site/sarbook1/excerpt- incident-command
- 53. Any questions?
Editor's Notes
- #7: Emergency medical technician: EMT
- #9: prearrival instructions On-line vs off-line protocol
- #10: Type of ambulance
- #14: รูปรถ amb
- #16: Terrain: ภูมิประเทศ
- #19: Facilities: สิ่งอำนวยความสะดวก
- #23: Explicit: ชัดเจน
- #25: Convey: สื่อ
- #27: Stockpiling: การซ้อน
- #28: mutual aid: ฃ่วยเหลือซึ่งกันและกัน Jurisdictions: เขตอำนาจศาล
- #29: Star of life
- #34: Mitigation(การบรรเทา): Measures that prevent or reduce the impact of disasters. Preparedness: Planning, training, & educational activities for things that cant be mitigated. Response: The immediate aftermath of a disaster, when business is not as usual. Recovery: The long-term aftermath of a disaster, when restoration efforts are in addition to regular services.
- #39: Liaison: ประสานงาน
- #40: Scene size-up Self, Scene , Survivor
- #45: The expectant category. If the P system is in use then the use of a 4th category is very much a decision for the senior personnel involved.
- #46: ขาด disability
- #52: Dispersed: แยกย้ายกันไป MIST is a useful acronym for describing duties on the handover of a patient or casualty.