Emergency Medical Services and Prehospital Care

Chapter 69 Emergency Medical Services and Prehospital Care



Hazel Guinto-Ocampo, MD



1 Describe the American Heart Association’s pediatric chain of survival link


Prevention of injury or arrest → Early and effective cardiopulmonary resuscitation → Early emergency medical services (EMS) activation → Early advanced life support, including stabilization, transport, and rehabilitation.


The chain of survival and emergency medical services for children. In Hazinski MF (ed): PALS Provider Manual. Dallas, TX, American Heart Association, 2002, pp 1–16.



2 What is enhanced 911?


Enhanced 911 automatically provides computerized identification of the telephone number and location of the caller, regardless of the quality of information provided.



3 What is the role of an EMS dispatcher?


An EMS dispatcher is a specialized operator who gathers essential information regarding the nature and location of the emergency, and relays this information to the EMS system for dispatch of a first responder. The dispatcher’s responsibilities include calming the caller, learning the complaint, making a triage decision, and obtaining the location of the emergency.



4 What are dispatcher protocols?


These are written guidelines, often computerized, that are developed and utilized so that dispatchers can accurately instruct callers in pediatric cardiopulmonary resuscitation, relief of foreign-body airway obstruction, and essential first aid maneuvers, until EMS personnel arrive. Their use reduces the variability of the information provided by the dispatchers, and ensures that accurate emergency information is provided to every caller.



5 Name the three general categories of prehospital personnel




1 First responders


2 Basic life support (BLS) providers


3 Advanced life support (ALS) providers


The categories vary in levels of training and degrees of capabilities. At the federal level, the National Highway Traffic Safety Association (NHTSA) has developed the National Standard Curricula for certification for each category, but state or local requirements supersede these standards. Intermediate levels of providers with varied capabilities have evolved as many jurisdictions offer supplemental training modules.


Blackwell T: principles of emergency medical services systems. In Marx JA, Hockberger RS, Walls RM (eds): Rosen’s Emergency Medicine Concepts and Clinical Practice Vol. III, 5th ed. St. Louis, Mosby, 2002, pp 2616–2625.



6 What is a first responder?


First responders have limited but significant life-saving capabilities. By definition, first responders are typically the first to arrive at the scene of an incident. The Department of Transportation (DOT) recommends a 40-hour didactic curriculum for certification, and 16–36 hours for refresher training. Most are trained to administer BLS, help clear an obstructed airway, control hemorrhage, and splint an injured extremity. The use of an automated external defibrillator (AED) should be a mandatory procedure for first responders. Spinal immobilization is usually beyond the first responder’s capabilities. Except in some rural EMS systems, first responders usually do not provide ambulance transport.


Woodward GA, King BR, Garrett AL, Baker MD. Prehospital care and transport medicine. In Fleisher GR, Ludwig S, Henretig FM (eds). Textbook of Pediatric Emergency Medicine, 5th ed. Philadelphia, Lippincott, Williams & Wilkins, 2006, pp 93–134.



7 What are BLS providers?


BLS providers are usually called emergency medical technician–basic, or simply emergency medical technicians (EMTs). They have capabilities that exceed those of the first responders. In 1995, NHTSA developed a revised BLS provider curriculum, which requires 110 hours of didactic and clinical instruction. The DOT recommends a 24-hour refresher course, 48 hours of continuing education, and a BLS course every 2 years, for recertification. BLS providers are capable of patient assessment, spinal immobilization, noninvasive ventilatory assistance, and application of pneumatic antishock garment. They are trained to recognize respiratory distress, shock, altered mental status, mechanisms of injury, and death. As ambulance transport personnel, they perform initial triage and route patients to receiving medical facilities.


Woodward GA, King BR, Garrett AL, Baker MD. Prehospital care and transport medicine. In Fleisher GR, Ludwig S, Henretig FM (eds). Textbook of Pediatric Emergency Medicine, 5th ed. Philadelphia, Lippincott, Williams & Wilkins, 2006, pp 93–134.

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Sep 1, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Emergency Medical Services and Prehospital Care

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