Emergency Medical Services (EMS) comprises diverse and complex systems and personnel treating over twenty million patients a year. The patients with complicated and traumatic medical conditions require medical personnel with considerable skills, knowledge, and judgment to effectively address the healthcare issues in an out-of-hospital setting. Critically ill and injured persons require proper care to mark a difference between life and death. Thus, medical crisis can be a matter of life and death. This affirms high quality out-of-hospital emergency care is form an important part of the health care system. Consequently, the licensure of EMS personnel is part of integrated and comprehensive systems striving to improve patient care, safety and public protection (Yuk-Sang & Chang, 2006).
Emergency Medical Services however faces various challenges especially in developing systems establishing national standards for personnel licensure. Personnel’s minimum competencies and flexibility to meet and fulfill unique medical needs requires the need for freedom within limits. As a result, modern civilian Emergency Medical Services has been developed to provide medical care to soldiers wounded and injured during military conflicts. This system comprises of rescue squads and ambulance services emerging from the civilian sector. The personnel also trained, equipped, and organized to ensure they regulate medical standards existing to meet medical needs effectively (Frank, 2008).
Essentially, the Emergency Medical Services (EMS) was developed to recognize and address medical needs among patients in order to reduce the nation’s highway fatalities and injuries. Although EMS developed in 1960s, an unprecedented level of funding from the Federal Government prompted establishment and spread of regional EMS systems and demonstration projects throughout the country. Consequently, the Emergency Medical Services Systems Act of 1973 was enacted as Title XII of the Public Health Service Act by Congress. It has yielded eight years and over three hundred million dollars of investment in Emergency Medical Services systems through the process of planning and implementation of available EMS personnel. The funds are utilized in training competent medical personnel with skills and talents to medical nation’s medical needs in an out-of- the-hospital situation.
This research will therefore discuss Emergency Medical Services and determine the best practices that can be deployed through ambulance services. It will affirm that, Emergency Medical Services cannot be effectively and efficiently offered without deploying ambulance services. Consequently, it will analyze the current practices deployed through ambulance services to provide Emergency Medical Services. The scope of the practices will enable review of regulations describing Emergency Medical Services in order to recognize and enable development of high quality support systems to benefit the EMS systems.
Ambulance Service Deployment Practices
Ambulance services are commissioned to encourage shared ownership of urgent medical and healthcare care within the healthcare systems. The ambulance service system therefore needs a congruent view of urgent care requirements and priorities. Through a consortium of Primary Care Trusts (PCTs) with agreed decision making processes and a lead commissioner, the ambulance services has become a common practice universally. In United States, the Department of Health has integrated ambulance commissioning programs through strategic commissioning plans to address all urgent and emergency health care issues. The commissioning ensures out of hours ambulance service provide urgent health care services to produce coherent healthcare model. Ambulance Trust resources are also included in capacity plans for primary care and for urgent care (Frank, 2008).
In order to access, deliver, and manage EMS, ambulance services should be effective and efficient in any particular area. Ambulance services raise public awareness and understanding concerning the range of medical services required to address patients’ needs. They also identify problems experienced by patients as they seek urgent and emergency medical care services. Ambulance services therefore ensure that, patients are dealt with by the first service they contact in order for the medical care services to be offered immediately and smoothly. However, some healthcare issues require the patients either transferred and/or referred to the hospital.
During such incidences, emergency and urgent ambulance services are pressured affecting the entire health and social care system. This is because faster and more convenient accessibility to emergency care services ought to be delivered and sustained. As a result, Emergency Care Networks (ECNs) provide a guide to create key mechanisms enabling ambulance services achieve and manage the co-operation while relying on the best practices in delivery of urgent medical care. This guide reaffirms availability of intelligent data is vital for ambulance services to manage the s Emergency Medical Services systems. For example, Ambulance Trusts provide demand and clinical data addressing actual medical emergencies on a regular basis. This supports medical practices taking ownership of activities undertaken to provide medical services supporting appropriate actions during hospital care (Siobhan, 2013).
Emergency Medical Services (EMS) Performance Systems Benchmarks
The main purpose of analyzing data is to understand the demand levels in order to assist Ambulance Trusts in improving response mechanisms. Ambulances should spend the most minimum time possible between the period they receive an emergency call and the time the vehicle arrives at scene. Matching ambulance service resources to natural patterns of demand can therefore support decisions and policies seeking further investments towards ambulance services and other community-based programs providing Emergency Medical Services. Thus, operational planning should explicitly link with commissioned ambulance service activities and resultant financial needs. This is crucial in development of structures by operational managers capable of identifying the causes of performance problems in delivery of Emergency Medical Services. Recognizing and addressing the challenges hindering ambulance services to provide Emergency Medical Services can focus on strategies that can improve efforts required to meet and fulfill medical needs urgently, effectively, and efficiently (Pickering, 2006).
Fire Department based Emergency Medical Services Practices
More than ninety percent of citizens in United States rely on fire departments to provide pre-hospital medical care and transportation services. The fire service-based Emergency Medical Services systems however consistently face the uncomfortable quandary of offering timely and proper Emergency Medical Services responses amidst rising costs and expanding demands. A large group of citizens also call fire departments appealing urgent medical services for non-emergency conditions. This further fuels the departments’ dilemmas and challenges. However, the fire service-based Emergency Medical Service providers understand the use of current emergency medical dispatch equipment for delivery of emergency healthcare services (NHTSA, 2007).
For the past twenty-five years, their expertise as emergency responders has therefore significantly improved. More so, the EMTs and paramedics are required to acquire hundreds of hours of training as the managers and supervisors recognize education is significant in the Emergency Medical Services world. This ensures modern, well-trained, and specialized dispatchers with appropriate tools and instructions are ready to achieve and sustain public safeties minimizing medical emergencies at affordable prices. Ultimately, the dispatchers are required to occupy the indispensable position in Emergency Medical Services deciding who, how, when, and whether to respond. Thus, the Emergency Medical Services provided by fire department systems involve trained dispatchers making major decisions about processes and medical supporting tools to rely on in responding to emergency medical calls (Turner & Snooks, 2006).
Budget controls have been influencing Emergency Medical Services systems. As a result, EMS managers have to ensure human and material resources are effectively and efficiently deployed to address urgent medical needs. This challenge has been expanding as Emergency Medical Services needs have been rising. Increasing public demands for Emergency Medical Services are using existing EMS resources efficiently and effectively. However, Emergency Medical Services system managers require the budgets increased in order to meet the increasing public demands. The managers recognize that, diagnosis is the most intricate task in delivery of medical service through Emergency Medical Services systems. For example, medical complaints due to chest pains can be caused by hundreds of potential underlying reasons. However, it is neither rational nor medically suitable to permit ambulance services to be deployed to diagnose a caller’s medical complaint or problem (Turner & Snooks, 2006).
It is also unreasonable to accept a caller’s analytic opinion as a basis for ensuing dispatch and response-based medical activities. Thus, each call should be directly and instantly evaluated through a programmed and medically standardized examination sequence relying on pre-determined, fully scripted key questions. They assess the rigorousness of a caller’s complaint or type of medical emergency response required. The complainants’ consciousness, age, gender and breathing status should be determined to ensure Emergency Medical Services are appropriately dispatched with the required tools and equipment to address the medical urgency immediately (Jonathan, 2013).
Response Determinant Code
Dispatcher should also be directed to authenticate the requirement for medical emergency interventions. For example, a dispatcher can affirm that, a patient is breathing appropriately without any difficulties. However, the patient may have called Emergency Medical Services for ambulance services to be deployed. The dispatcher should appropriately assess the complaint or medical incident. Consequently, they can determine the protocol to be chosen and the urgent emergency medical services to be dispatched. However, a continuous interrogation period between the patient and the dispatcher should continue for a period of more than thirty seconds (NHTSA, 2007).
The dispatcher should ask at least four or more questions per procedure to determine the level of medical urgency required. The questions however should be medical as the interrogation period is deployed to sufficiently ascertain the Response Determinant Code rather than the diagnosis. It is also important to understand that, Response Determinant Codes reflect on health check statistical probability across diverse pre-planned stages of response. For example, Emergency Medical Services response grids addressing chest pains should not evoke different pre-planned level of response in addressing medical responses to address a ten-year-old patient and a fifty seven year old complainant (AIPC, 2007).
More so, the Response Determinant Codes used by a dispatcher are equivalent to the diagnosis related groups used to invoice medical incidents at the hospital. Although the Response Determinant Codes are worldwide spread, the regional responses linked to the codes should therefore be assigned based on a user agency basis. Such unit response groups can therefore reflect an agency’s availability concerning response configurations. The management policies and decisions made by the fire suppression and medical unit can be relied upon during the response assignments. However, they should be studied carefully to ensure they collaborate and cooperate with medical control during emergency medical services incidences (Jonathan, 2013).
Several dispatch agencies send the most available and adjoining responders and paramedics on all emergency medical calls. They however require deployment of ambulance services as they may lack clear details concerning the actual medical services to be deployed. Thus, the dispatchers should use of lights and sirens as the ambulances drive to the scene. This is a maximal response philosophy seeking to claim that, providing Emergency Medical Services to persons in dire need of health care response in order to immediately help them recover as quickly as possible is vital. It has been proven that, safe and medical correctness among dispatchers and paramedics especially deployed from fire departments during Emergency can fail to use lights and sirens. Incidents requiring Emergency Medical Services require deployment of ambulances. The dispatched ambulance service team should therefore drive with lights and sirens as they head to the scene and drive away from the area. This is because the medical service requests are called upon to address time critical and life-threatening medical emergencies. Thus, they justify the approach of using lights and sirens in order to attract attention from other drivers. Consequently, other road users can offer the ambulance service team an opportunity to drive away even during traffic jam in order to provide the emergency medical services being required (AIPC, 2007).
However, systems that send out lights and siren replies to all calls can be at risk. This is because it can be difficult to provide timely Emergency Medical Service responses to genuine medical emergencies at all times. Dispatch savvy attorneys assert that, deployment of ambulance services should be determined by policies and decisions implemented in a particular Emergency Medical Services and fire response team department. This involves assessing the call seeking deployment of Emergency Medical Service ambulance services and the vehicle to be used. This can ensure the tens of thousands persons requiring emergency medical responses rely on effectiveness of using lights and sirens to receive immediate medical help. However, this performance renders crews to additional hazards of full emergency responses arriving a few minutes in advance for non-critical patients (Clawson & Olola, 2007).
Emergency health check dispatchers have exclusive set of duties and responsibilities in the Emergency Medical Services department. They are trained hence, provided with significantly different skills and qualifications setting them apart with other providers of medical and healthcare services. For example, fire departments necessitate a minimum of a health check dispatch course for all dispatchers in the station. Others require firefighters, first responders and/or paramedics to be trained in order to uphold individual training programs in the department. However, their training programs are partially relevant as they provide in-house programs lacking consistency and appropriateness. Thus, formal dispatcher training should be initiated across all fire departments in United States and other global countries. The training programs should also provide participants with certificates to affirm the program is governmentally credited. This can further affirm that, Emergency Medical Services are safely, competently, and effectively deployed by dispatchers understanding the underlying philosophy of addressing, resolving and delivering urgent medical services (Clawson & Olola, 2007).
Thus, the functions of the emergency health check dispatchers should be defined and the concepts in delivery of the medical services discussed in detail based on the protocols to be followed. They should be taught the four core components associated with delivery of Emergency Medical Services through deployment of ambulance services. They include Case Entry, Key Questions, Post-Dispatch and Pre-Arrival Instructions, and Response Determinants. These are commonly known as the ‘four commandments of medical dispatch’. They are reinforced as fundamental examination elements that should be attained and communicated to respondents on every Emergency Medical Services calls. Concerning the Key Question component, it is important to identify either attendance or non-attendance of precedence symptoms depending on how they are defined by the Emergency Medical Services systems and departments. For example, chest pains coupled with difficulty in breathing and changes in level of awareness and perception as well as severe hemorrhage should be emphasized. Consequently, the dispatching of life support instructions via the phone depends on the answers provided to the Key Questions. They should also establish the correct, quality, and consistent level of emergency health check rejoinders. Thus, urgent and/or maximal rejoinders permitted during doubtful situations should be greatly reduced to ensure Emergency Medical Services are properly deployed to address the medical incidence at hand following appropriate protocols (Turner & Snooks, 2006).
Gaps in the Published Literature
It is important to develop and enable a research culture in the emergency service discipline. Analysis of strategic gaps is essential in driving coordinated research and development through scientific and technological investment. The gap analysis identified in this research provides model for collaborative participation and prioritization in evolving research initiatives for all Emergency Medical Services systems. The process model developed through this research seeks to recommend integration of ambulance services and Emergency Medical Services while prioritizing and allocating human and financial resources to meet and fulfill future emergency medical needs. The model should be passed on to the police and fire chiefs associations. This can guarantee it is adapted and adopted appropriately (Dean, 2012).
More so, it can identify opportunities and priorities allowing science and technology researches in relation to Emergency Medical Services to be conducted enhancing investment decisions implemented to coordinate rationalized approaches with the ability to improve ambulance services in the future research. Sharing the outcomes with medical and healthcare organizations and the industry at large can enable creation of opportunities building concepts seeking to improve overall quality of medical services delivered through Emergency Medical Services and ambulance services in the future. Thus, all agencies with greater understanding of research priorities and the opportunities to incorporate positive changes in delivery of Emergency Medical Services based on the current operations can identify future funding priorities. This can assist other allied agencies to develop sound benchmarking evidence based practices recognizing and upholding operational requirements achieving accountability within the Emergency Medical Services systems. Thus, it is crucial for Emergency Medical Services systems to strive meeting goals and objectives allied to improvement of healthcare services and through effective and efficient deployment of ambulance services. Ultimately, the expanding demands for urgent emergency medical services can be addressed at lower costs (Dean, 2012).
Ambulance services play a key role in shaping models of medical service delivery. Thus, they should be considered as part of the wider context seeking to implement changes to enhance delivery of Emergency Medical Services effectively and efficiently. The vision in developing Emergency Medical Services (EMS) was allied to use of emergency ambulance response services in order to delivery robust clinical services. This is a fundamental and embedded component of the wider unscheduled Emergency Medical Services system. The Emergency Medical Services therefore rely on the element of deploying ambulance services to deliver planned, unplanned, emergency, and non-emergency medical services and care in an out-of-the-hospital setup. Transporting the patients to the hospital for further healthcare checkup should also rely on responsive and cost-effective ambulance services and provided on clear eligibility and accessibility criteria forming the core part of Emergency Medical Services systems. Thus, ambulance services ought to be considered with a high priority, as they are responsible in delivery of Emergency Medical Services. More importantly, ambulance services should acquire more indispensable skills in order to develop an internal capacity undertaking sophisticated medical services challenging efforts to achieve and maintain high quality healthcare conditions in the country. The skills however should be complemented by better allocation of resources and implementation of decisions and policies striving to improve the quality of planning and delivery of emergency medical services in long-term basis.
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