EMTIntermediate FOUNDATIONS:

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EMT-IntermediateFOUNDATIONS

• Captain Michael W. Robinson, MA, NREMT-P
• Baltimore County Fire Department
• Fire-Rescue Academy
• EMS Training Program

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EMT-I/FOUNDATIONSPROGRAM OVERVIEW

• EMS History
• EMT-I Roles Responsibilities
• EMT-I Wellness
• EMS Systems Overview/Medical Oversight
• EMS Medical Legal Issues
• EMT-I Ethics

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EMT-I FoundationsProgram Requirements

• ATTENDANCE is REQUIRED
• Completion of Foundations Exam
• READ/STUDY/WORK HARD!
• ABSORB the MATERIAL!

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EMSHISTORICAL PERSPECTIVESWhere did we come
from?

• Presented by
• Captain Michael W. Robinson, MA, NREMT-P
• Baltimore County Fire Department
• FIRE-RESCUE ACADEMY

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HISTORICAL PERSPECTIVESOverview

• Historical Influences
• Ancient EMS
• National Development
• State Development
• Baltimore County Development
• The Future???

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HISTORICAL INFLUENCESEMS

• WAR
• RELIGION
• PESTILENCE
• Science Technology

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ANCIENT EMS

• Greeks Hippocrates Father of Medicine
• 1500-Egyptians-Book of Wounds
• Cult of Aesculipaedes-Star of Life
• Native America- Neurosurgery (trephining)
• Babylonians-resuscitation/Hammurabi
• Trauma/illness related to divine influences

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EMS in the Middle AgesDEVELOPMENTS

• Order of St. John Volunteer Ambulance-1065 (in
  existence today)
• Crusades-identified need for EMS
• Hospital Systems/Evacuation
• Influence of the Church (Christian/Moslem)

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EMS Industrialized SocietyDEVELOPMENTS

• Napoleonic Wars-Triage System/Jean Larrey
• U.S. Civil War-Clara Barton (Red Cross)
• World Wars-IVs/Blood Transfusions
• Korea/Vietnam-PSAGs, Medevacs
• 1865 Cincinatti-EMS/1869 New York City
• Modern Military
• Space Program

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EMS DEVELOPMENTNational Level (1945-today)

• Ambulances (health depts., funeral services, some
  FDs, volunteers)
• Interstate Highway Systems-Cold War
• 50,000 annual Highway deaths-1966
• 1966 WHITE PAPER Accidental Death and
  Disability the Neglected Disease of Modern
  Society
• Development of Resuscitation-Baltimore
• EMS Training Programs

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NATIONAL EMS DEVELOPMENTLegislative Initiatives

• 1966-Executive Order/NHTSA- Grants
• 1972-DHEW Demonstration grants-5
• 1973-PL93-154 EMS SYSTEMS ACT
• 306 EMS Regions Defined
• 15 Components of EMS System Defined
• Star ofLife evolved
• Ambulance Design-Criteria (KKK-1822)
• Public Awareness (media)

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NATIONAL EMS DEVELOPMENTTransitional Trends

• COBRA-Limited EMS funding
• Managed Care-HMOs
• Emergence of Commercial EMS
• Community Development Grants BLOCK
• Increased liability-Litigious Society
• Customer oriented -TQM/QI
• FLSA-mandates

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MARYLANDEMS DEVELOPMENT

• Why did we do it this way!

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MARYLAND EMSDevelopment

• 1960s Dr. R. Adams Cowley-deathlab
• NAS/Armed Forces Institute Grants
• MSP-Medevac-1970s-patient stealing
• EMT/CRT (1968-1972)
• 1970-Heartmobile-Montgomery County
• 1973-HEW grant/EMRC-demonstration project
  regional communications
• 1981-EMT-P/Anne Arundel County

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MARYLAND EMSLegislative Influences

• Governor Marvin Mandel-Influence
• D.H.M.H.-EMS Division
• 1973-Executive Order-created MIEMSS
• EMS act divided state into 5 regions
• 1974 Statewide Communications System
• 1983 EMT-P authorized/ Senate Bill 397
• 1986-MEHAC (helicopter study) authorized

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MARYLAND EMSLegislative Influences

• 1993-Senate Bill 1220/ State EMS Board
• 11 members-Governor appointed
• 27 member advisory board SEMSAC
• Shock Trauma became part of UMMS
• Tag Fees to offset EMS operations/EMS Fund
• Physician-State EMS Director
• Dr. Robert R. Bass
• Dr. Richard Alcorta- state medical director

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MARYLAND EMS FUNDIMPACT

• MIEMSS Budget-funded in total
• MFRI Budget-funded in total
• MSP Aviation-funded 80-90
• Helicopter replacement
• Shock Trauma Center-subsidized
• 508 Jurisdictional Grants
• 8/tag-goes to fund
• EMS Board approves annual expenditures

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MARYLAND EMSTrends towards the future

• Statewide system committment
• Futile Resuscitation Protocol-1996
• EMS Licensure-1997 legislature
• EMT-B implementation
• EMT-P revision/EMT-I
• National EMS Blueprint
• Enhanced funding/facilities

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BALTIMORE COUNTY EMSEvolution Development
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BALTIMORE COUNTY EMSEarly Developments

• 1929-first ambulance Cockeysville V.F.C.
• 1942 Career EMS/3 Ambulances _at_ Catonsville,
  Essex, Towson, (5800/ea..)
• 1944-Ambulance SchoolCity Hospital
• 1960 Ambulance Section-Fire Academy
• Captain Harold Evans-Father of EMS
• BC Martin McMahon-Baltimore City
• EMS was punishment Class-A uniforms

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BALTIMORE COUNTY EMSGetting there!!

• 1960s EMT Training/1970-IV Training
• Dr. Robert Wilder/Dr. Frank Barranco
• 1972 Dr. Gustav Voight CRT Program at City
  Hospital A-6/A-7 became telemetry equipped
  ambulances
• Pikesville/Middle River-Volunteer ALS
• 1975 career transition to all ALS
• Increase in EMS Cadre at Academy

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BALTIMORE COUNTY EMSImproving the System!

• Late 70s need for field supervision
• EMS Coordinators-EMS-4
• EMS-1, 2, 3, (geographic deployment)
• 1981 (6 supervisors-mirrored battalions)
• 1983 EMS Dual Entry hiring-
• Additional Medics 15 since 1983
• EMT-P 1986 limited to supervisors
• ALS Engine Program 1995

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BALTIMORE COUNTY EMSImproving the System!

• 1986 EMS Battalion Chief
• 1987 AMTRAK Incident-625 patients
• 1987 EMS Shift Commander
• 1988 Supervisors upgraded to Lieutenants
• 1990 EMS Blue Ribbon Panel controversy
• 1990 EMS training at the F.R.A.
• 1991-Shift Captains/Staff Captains

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BALTIMORE COUNTY EMSThe Paradigm Shift??

• Paramedic level of care
• Peak demand staffing/systems status
• Priority dispatch-EMD
• Response profiles
• AED/12 lead EKG
• FLSA/Career directions-Fire/EMS
• Leadership transitions BC Dave Murphy
• Medical direction-Dr. Ramzy

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Baltimore County EMSTHE FUTURE?

• Reorganization?
• Technology ( medics, 12-lead, medications)
• Service demands v. service delivery
• Level of Care (EMT-I/P, ALS v. BLS)
• Quality Assurance/Improvement
• Enhance scope of practice/ treat-release?
• Managed Care

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Baltimore County EMSThe Future.

• YOU ARE THE FUTURE ????
• WHO WILL YOU BE ?
• WHERE WILL WE GO ?