Oregon's EMS System 9_06 by zhangyun

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									Oregon’s EMS System




                1
               Objectives

 Describe the environment in which the first
  ‘ambulances’ responded
 Identify the first volunteer ambulance
 Identify the agency that was tasked,
  through Legislation, with developing the
  Emergency Medical Services
                                                2
              Objectives
 State when Legislation was passed to
  develop Oregon’s Trauma System

 List the Oregon Revised Statutes and
  Oregon Administrative Rules that outline
  the responsibilities of Oregon’s EMS
  Office

 List three things an EMT can do to assist
  the EMS Office in providing service to
                                              3
  him/her
              Objectives
 State the difference between Level 1, Level
  2, Level 3 and Level 4 Trauma Hospitals in
  Oregon

 List three reportable actions defined in
  OAR 333-265-0160

 Identify three functions of the Medical
  Director                                   4
                 Way Back
 Napoleonic War
   – Horse drawn wagons

 Civil War

 NYC 1869

 1899 – The first
  motorized ambulance
   – Chicago                5
         In the beginning…
 1913 – Ben C. Buck started the nation’s
  first private ambulance service in Portland,
  Oregon
 1918 – Mr. Buck donated one of the few
  motorized ambulances used in WW-I
 1920 – First volunteer ambulance service,
  Roanoke, Virginia
 1942 – Buck Ambulance became the first
  to carry oxygen as standard equipment
                                                 6
                    More Recent
 CPR, 1960s
   – Dr. Leonard Rose, Cardiac Tech

 8% WWI, 4.5% Korea,
       2% Vietnam
 Accidental Death & Disability, The Neglected
  Disease of American Society, 1966

 1966 – DOT – EMS

                                                 7
   America’s deaths from influenza were
greater than the number of U.S. servicemen
  Thousands
              killed in any war
   900
   800
   700
   600
   500
   400
   300
   200
   100
     0
         Civil   WWI    1918-19 WWII   Korean Vietnam
         War           Influenza        War     War
       Historical Perspective
              Civilian Evolution
• Civilian evolution varied from
  region to region in U.S.


• Rural areas – Undertakers
      Fire departments and volunteer
       ambulance replaced funeral
       directors
• Urban areas
      Hospital-based
      Fire departments
      Police departments
      Independent ambulance
       companies                        9
10
         More Modern Times

 1973-82 Title 12 Grants
   – $12 million to Oregon

 June 30, 1981
 1987 Trauma System
 1989 BME           OHD
    - Now DHS-EMS


                             11
            State EMS Office
(DHS, Emergency Medical Services and Trauma Systems)

 Statutory responsibility
   – Oregon Revised Statutes Chap. 682, 431
   – Oregon Administrative Rules Chap. 333-200, 250,
     255, 260, 265, Chap. 847
 State EMS office
 State EMS Committee
   – Subcomm. EMT Cert. and Discipline
 STAB, ATAB
                                                       12
           State EMS Office
 Charge – minimum standards
  – FR
  – EMTs
  – Ambulance vehicles
  – Ambulance services
  – Trauma hospitals
 Certification, CME
 Accreditation process
                               13
         State EMS Office
 Be nice to them
 Do your research
 Start locally
 Read, then follow directions
 Know your responsibilities
 Document, conduct business in writing
 Don’t shop for answers
                                          14
       Things in the works!
•   “Certification” of First Responders
•   Revision of Oregon EMT-Intermediate
    Curriculum (rethinking)
•   ACEP/OHD-EMS Supervising Physician
    Course
•   40 Hour Oregon Version DOT National
    Standard EMS Instructor Course
•   National Registry Exam
•   Manage Grant Programs
Total of All Certification Levels as of March 17, 2006

EMT-B                  4187            51.31%

EMT-I                  1422            17.43%

EMT-P                  2551            31.26%

TOTAL EMTS ALL LEVELS          8160
Oregon’s EMTs All Levels by ZIP code
Oregon’s EMT-Basics by ZIP code




                                  4075

                                  51.23%
                                  of total EMTs
Oregon’s EMT-Intermediates by ZIP code




                                         1472

                                         18.51%
                                         of total EMTs
Oregon’s Paramedics by ZIP code




                                  2407

                                  30.16%
                                  of total EMTs
          Statewide ALL EMS
               Agencies




N = 654
          Statewide Transport
               Agencies




N = 136
          Statewide Non-transport
                 Agencies




N = 518
          Trauma Section

 State wide trauma system
 Hospital designation 1-4

 Data gathering

 Triage criteria

 911 System                 25
                                          1
                                          1.
                                                  Level I
                                                 Legacy Emanuel Hospital & Health Center, Portland


         Oregon Trauma System Hospitals
                                          2.     Oregon Health & Science University, Portland

                                          2       Level II

                                          3.     Good Samaritan Regional Medical Ctr., Corvallis
                                          4.     Sacred Heart Medical Center, Eugene
                                          5.     St. Alphonsus Regional Medical Center, Boise, ID *
                                          6.     St. Charles Medical Center, Bend
                                          7.     SW Washington Medical Center, Vancouver, WA *

                                          3        Level III
                                  30
                                          8.     Bay Area Hospital, Coos Bay
                                          9.     Columbia Memorial Hospital, Astoria
                                          10.    Good Shepherd Medical Center, Hermiston
                                           III
                                          11.    Grande Ronde Hospital, La Grande
                                          12.    Holy Rosary Medical Center, Ontario
                                          13.    McKenzie-Willamette Hospital, Springfield
                                          14.    Mercy Medical Center, Roseburg
                                          15.    Merle West Medical Center, Klamath Falls
                                          16.    Mid-Columbia Medical Center, The Dalles
                                          17.    Peace Harbor Hospital, Florence
                                          18.    Pioneer Memorial Hospital, Prineville
                                          19.    Providence Hood River Memorial Hospital, Hood River
                                          20.    Providence Medford Medical Center, Medford
                                          21.    Rogue Valley Medical Center, Medford
                                          22.    Salem Hospital, Salem
                                          23.    Samaritan Albany General Hospital, Albany
                                          24.    Samaritan Lebanon Community Hospital, Lebanon
                                          25.    St. Anthony Hospital, Pendleton
                                          26.    St. John Medical Center, Longview, WA *
                                          27.    St. Mary Medical Center, Walla Walla, WA *
                                          28.    Three Rivers Community Hospital, Grants Pass
                                          29.    Tillamook County General Hospital, Tillamook
                                          30.    Walla Walla General Hospital, Walla Walla, WA *
                                          31.    Willamette Valley Medical Center, McMinnville


                                          4       Level IV
                                          32.    Ashland Community Hospital, Ashland
                                          33.    Blue Mountain Hospital, John Day
                                          34.    Central Oregon Community Hospital, Redmond
                                          35.    Coquille Valley Hospital, Coquille
                                          36.    Curry General Hospital, Gold Beach
                                          37.    Harney District Hospital, Burns
                                          38.    Lake District Hospital, Lakeview
                                          39.    Lower Umpqua Hospital, Reedsport
                                          40.    Mountain View Hospital, Madras
                                          41.    Pioneer Memorial Hospital, Heppner
                                          42.    Providence Newberg Hospital, Newberg
                                          43.    Samaritan North Lincoln Hospital, Lincoln City
                                          44.    Samaritan Pacific Communities Hospital, Newport
                                          45.    Santiam Memorial Hospital, Stayton
                                          46.    Silverton Hospital, Silverton
                                          47.    St. Elizabeth Health Services, Baker City
                                          48.    Sutter Coast Hospital, Crescent City, CA
   Revised 3/20/02
Revised: 1/23/04                          49.    Wallowa Memorial Hospital, Enterprise
                                          50.    West Valley Community Hospital, Dallas
                                                               * ID WA Designated
                                                                            IV
                  TRIAGE CRITERIA AND DECISION SCHEME


VITAL SIGNS & LEVEL OF CONSCIOUSNESS:
Systolic blood pressure <90 mmHg; or
Respiratory distress with rate<10 or >29; or
Airway management required; or
Glasgow Coma Scale <12

                                                                           TO
                                                                           TRAUMA
ANATOMY OF INJURY:
Penetrating injury of the head, neck, torso, or groin; or   YES            HOSPITAL
Amputation above the wrist or ankle; or
Spinal cord injury with limb paralysis; or                  →
Flail chest; or                                             MANDATORY
                                                            TRAUMA
Two or more obvious long-bone (humerus/femur) fractures.    SYSTEM ENTRY




MECHANISM OF INJURY:
Death of a same car occupant; or
Ejection of patient from an enclosed vehicle; or
Heavy extrication time >20 minutes.
                             NO↓


HIGH ENERGY TRANSFER SITUATIONS:
Falls >20 feet; or                                                   YES             These criteria shall cause
Pedestrian hit at 20 mph or thrown 15 feet; or
Rollover; or                                                          →              a high index of suspicion
                                                                                     that a patient may have
Motorcycle, ATV or bicycle crash; or                                 DISCRETIONARY
                                                                                     sustained a severe injury.
                                                                     TRAUMA SYSTEM
Significant impact or intrusion into occupant space of vehicle.      ENTRY           Trauma system entry for
                                                                                     patients meeting two or
                                                                                     more of these criteria is
                                                                                     strongly encouraged.
CO-MORBID FACTORS:
Extremes of age <5 or >55 years; or
Patient with bleeding disorder or patient on anticoagulants; or
Medical illness: cardiac or respiratory disease, insulin-dependent
diabetes, cirrhosis, or morbid obesity; or
Pregnancy; or
Immunosuppressed patients; or
Presence of intoxicants.
        Prehospital Standards
 Reporting criteria (ORS 682.220(4))
 Applications and recertification.
 Backgrounds
 E-4
 The nasty stuff
  –   Sexual assault elderly
  –   Walking around in sox
  –   Diverting drugs to owner
  –   Convicted double homicide         29
          Medical Directors
 Under BME
 Standing orders (protocols)
 Advocate, training
 Scope of Practice
  – Don’t violate
 Only under an agency's protocols
 Teamwork
                                     30
Questions??

								
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