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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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