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Ems System

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The Emergency Medical Services system is a complex world incorporating the latest techniques and ideas in healthcare with emergency response, technical rescue, and efficient and safe transport to definitive care. Through hundreds of years of progression and developments in both healthcare and training, EMS today has come to be an efficient and truly life-saving service.

The emergency medical provider in the prehospital arena is a highly trained and capable individual entrusted with the care of those people who are extremely sick or critically injured at their most vulnerable times. Among those in prehospital healthcare, there are several tiers of provider. Generally speaking, in the United States, healthcare professionals are classified as First Responders and Emergency Medical Technicians, at the Basic, Intermediate, and Paramedic levels. Each has a very important and unique function, and often heavily rely on each other on a daily basis. The EMT-Paramedic ("paramedic" here on) is the most highly trained prehospital care technician, and is capable of providing lifesaving techniques on par with some nurses and doctors in hospitals. The care provided by paramedics is most commonly called Advanced Life Support, or ALS, in the United States.

While there is an abundance of EMT-Basic ("EMT" here on) providers in practically every community, frequently there are fewer paramedics, especially in the large majority of rural areas in most of the US. ALS is a valuable and sometimes difficult to obtain service in many places, where most of EMS is provided by EMTs on the local fire or rescue service. Often, however, there is a need for specialized and emergent care that exceeds the abilities of even the best EMT. This creates a need for ALS services that are easily accessible and relable for local rescue organizations.

Presently in the United States there are several forms of ALS services. Examples of such include fire department-based, third service-based, third service or private intercepts, and hospital-based ALS. Each has its advantages and disadvantages for the system it provides, and some work better than others for their respective systems. This paper will be an exploration of and argument for the advantages of having a hospital-based EMS system in a suburban and rural setting.

The hospital based EMS system runs on the principle that ALS services are activated when certain types of calls come into a local emergency communications center, or when a need for ALS is determined by EMS already on scene. Such needs are determined by the emergency call-taker or EMT based on the patient's condition, such as chest pain, difficulty breathing, unconsciousness, or significant trauma. Once the need has been determined by EMS on scene or their dispatch center, a call is placed to the hospital-based paramedics to respond to the scene or intercept with the EMTs en route to begin advanced patient care. Once the paramedics have met up with EMTs already caring for the patient, the healthcare team moves with the patient to the hospital. Sometimes the patient care needed exceeds the local hospital's abilities, and the patient is transported directly to a specialized facility, but most often the patient is transported to the hospital from which the paramedics came for definitive or stabilizing care. The patient is then transferred to emergency room staff, and the paramedics give a detailed report on the patient's condition and their interventions en route. Sometimes, EMS crews (both basic and paramedic) will stay on with a patient in the ER and assist the nurses and doctors until the transition has been completed.

This continuation of care even after transport and arrival at the hospital is an important argument in basing EMS providers out of the hospital. As EMS is essentially an extension of the emergency room out to the patient at home or in the community, EMS providers should be considered part of the healthcare team. Unfortunately, some of the old stigmas of "ambulance drivers" associated with emergency healthcare in the 60's and 70's still remain, even among some who work in the hospitals. Because of this, EMTs and paramedics are often not considered "healthcare providers" on par with nurses and doctors, but the reality is that EMS has made great advances in healthcare technology, training, and knowledge base, and should be considered an integral and necessary part of the healthcare team. To base paramedic services in a hospital is to recognize the importance of unifying that team, and strengthen the relationship and ease patient transition between the prehospital realm and the emergency room.

The advantages in integrating ALS into the ER are not restricted to serving the patient's ease of entrance into the hospital. All parties benefit, from the outlying local rescue services, to the paramedics themselves, to the ER staff and doctors involved. Local EMS providers know that the care that is so essential to their friends and neighbors is coming from a well-trained and respected ALS system; the paramedics gain from being hospital employees and its associated benefits; ER staff have extra hands when necessary and receive patients who have already been triaged and received essential care; and physicians at the hospitals know that not only can they keep a critical eye and lend a guiding hand to ALS providers, but they can easily incorporate new technology and ideas into prehospital care.

As a medical professional, an EMT-Paramedic receives a great deal of education in the various illnesses and injuries the human body can endure, and also has the means to treat any number of conditions with which a patient might present. This education is in many ways equivalent to that of a Registered Nurse, and encompasses skills that in some cases only Physicians generally perform. With this education comes great responsibility, and the value of the services provided as well as the liability of his employer should a



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