Module :

Maine EMS On-Line Medical Control

Training Program

Module 1: EMS systems

© EMRCI 2008 Module : 1

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 with varying levels of training– Personnel are physician extenders

• Not delegated practice• Individually licensed• Require physician endorsement

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16 Components• Manpower

• Training

• Communication

• Transportation

• Emergency Facilities

• Critical Care Units

• Public Safety Agencies

• Disaster Planning

• Medical Direction

• Consumer Participation• Access to Care• Patient Transfers• Standardized Record

Keeping• Public Information and

Education • System Review and

Evaluation • Mutual Aid

© EMRCI 2008 Module : 1

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

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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

• Based on chief complaint or clinical impression

• Define what interventions may / must be done

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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

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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, education, and medical director authorization

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Scope of Practice

© EMRCI 2008 Module : 1

Scope of Practice

State License

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Scope of Practice

Education

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Scope of Practice

Medical Director (System)

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Scope of Practice

State License

Medical Director (System)

Education

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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

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State Level Organization

R e g io na l E M S O ffices S te ve n E . D ia z , M DE M S M e d ica l D ire c to r

B o a rd o f E M S (1 7)

Ja y B ra d sh awD ire c to r

A n ne H . Jo rd anC o m m iss io n er

D e p artm en t o f P u b lic S a fe ty

G o vern o r Jo h n E lia s B a ld a cci

© EMRCI 2008 Module : 1

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)

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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 Station

• Augusta, ME 04333

• (207) 626-3860

• Maine.EMS@maine.gov

• www.maine.gov/dps/ems

© EMRCI 2008 Module : 1

Regional Offices

E d u ca tion C oo rd ina to r Q u a lity Im p ro ve m en t C oo rd in a to r A d m in is tra tive S u pp o rt

R e g ion a l C o o rd in a to r M e d ica l D ire c to r

B o a rd o f D ire c to rs

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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

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Medical Directions and Practices Board

• Reviews and establishes Protocols

• Reviews/approves certain medical devices

• Establishes Quality Assurance benchmarks

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Quality Improvement

• Centralized function

• Services send data to region– Goes to state– Entered in statewide database– QI committees– Hospital QI nurse / coordinator

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MEMS

• Other Committees

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York, Cumberland, & Sagadahoc

• Southern Maine EMS

• 496 Ocean St.

• So. Portland, ME 04106

• (207) 741-2790

• smems@smems.org

• Donnell Carroll, Regional Coordinator

• Tony Bock, MD, Medical Director

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Androscoggin, Franklin, & Oxford

• Tri County EMS

• 300 Main St.

• Lewiston, ME 04240

• (207) 795-2880

• info@tricountyems.org

• Joanne LeBrun, Regional Coordinator

• Kevin Kendall MD, Medical Director

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Kennebec & Somerset

• Kennebec Valley EMS

• 71 Halifax St

• Winslow, ME 04901

• (207) 877-0936

• office@kvems.org

• Rick Petrie, Regional Coordinator

• Timothy Pieh MD, Medical Director

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Hancock, Penobscot, Piscataquis, &

Washington• Northeast EMS

• 354 Hogan Rd

• Bangor, ME 04401

• (207) 974-4880

• neems@emcc.edu

• Rick Petrie, Regional Coordinator

• Jonnathan Busko MD, Medical Director

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Aroostook

• Aroostook EMS

• 111 High St.

• Caribou, ME 04736

• (207) 492-1624

• Arems@maine.rr.com

• Steve Corbin, Regional Coordinator

• Peter Goth MD, Medical Director

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Lincoln, Waldo, & Knox

• Mid Coast EMS

• P O Box 610

• Union, ME 04862

• (207) 785-5000

• office@midcoastems.org

• Bill Zito, Regional Coordinator

• Colin Coor MD, Medical Director

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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)

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Maine EMS Service License Levels

• Basic Life Support

• Advanced Life Support

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Service Levels of Performance

• First Responder

• Emergency Medical Technician (EMT)

• EMT-Intermediate

• Paramedic permit

• Paramedic service

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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

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Basic Life Support

• First responder

• Ambulance Attendant*

• Emergency Medical Technician (EMT)

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Advanced Life Support

• EMT-Intermediate

• EMT-Critical Care*

• EMT-Paramedic

• Paramedic Interfacility Transfer

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Federal Grants / Projects

• Rural Access to Emergency Devices: $1m (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

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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)

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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

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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 same

• Maine EMS– Oversees– Monitors– Supports

• Statewide protocols

© EMRCI 2008 Module : 1

End of Module 1

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