The responsibilities of medical directors at any level typically include, but are not limited, to establishing medical protocols for dispatchers, EMTs and paramedics providing medical supervision online and offline promoting evidence-based practices supervising ongoing medical quality improvement supervising training and continuing education establishing controlled substance policies and providing medical discipline ( ACEP, 2012a).Įmergency Medical Services Personnel. The state medical director oversees the entire EMS system and evaluates performance within each link in the chain of survival, while local medical directors support EMS agencies at the local, city, or county level. When providing patient care, both EMTs and advanced-level providers operate under a combination of physician-approved standing orders (i.e., offline medical direction), as well as real-time medical control. They also transport the patient to the most appropriate definitive care facility-usually the closest hospital that is best equipped to care for a cardiac arrest patient.
EMTs and paramedics may assess the scene to confirm whether the patient is in cardiac arrest and initiate resuscitation. For example, 911 call takers or emergency medical dispatchers 2 may help identify a cardiac arrest and dispatch the appropriate EMS providers. Within an EMS system, a number of trained professionals act in concert when responding to a cardiac arrest (see Box 4-1). The final section of the chapter focuses on opportunities to improve the timeliness and quality of cardiac arrest care, which can lead to improved patient outcomes in communities across the United States.ĮMS Personnel Involved in Cardiac Arrest Response The second section covers elements of the EMS response itself, including the facilitation of bystander CPR and early defibrillation strategies. Because the overall structure, organization of services, and capabilities of EMS systems affect cardiac arrest care, the chapter begins with an overview of the EMS system, including discussion of the relevant personnel and oversight at the federal, state, and local levels. This chapter focuses on the EMS system's response to cardiac arrest and covers the EMS role across all of the links in the chain-of-survival model. Berg et al., 2010), including early recognition of a cardiac arrest by bystanders 1 and 911 call takers, as well as the delivery of initial treatments (i.e., CPR and defibrillation) by bystanders or trained first responders prior to the arrive of EMS providers (i.e., emergency medical technicians and paramedics).Īlthough the ability of an EMS system to respond effectively to cardiac arrest within a community depends to some extent on basic infrastructure and the training of EMS personnel, there are specific character-characteristics and capabilities of EMS systems that are correlated with higher cardiac arrest survival rates. Together, the first three steps comprise the fundamental actions within basic life support (BLS) strategies for cardiac arrest (R.
This conceptual model illustrates the sequence of events that can optimize care and outcomes for the approximately 395,000 individuals who experience an OHCA in the United States each year ( Daya et al., 2015). This presents important challenges and opportunities to improve EMS system performance across the country.Īs described in Chapter 1, the chain of survival includes five interconnected links: (1) immediate recognition of cardiac arrest and activation of the emergency response system, (2) early cardiopulmonary resuscitation (CPR), (3) rapid defibrillation, (4) effective advanced cardiac life support (ACLS), and (5) integrated post-resuscitative care (M. Although a few EMS systems have demonstrated the ability to significantly increase survival rates ( Nichol et al., 2008 Sasson et al., 2010b), a fivefold difference in survival-to-discharge rates exists among communities in the United States ( Nichol et al., 2008). Overall outcomes from out-of-hospital cardiac arrest (OHCA), both in terms of survival and neurologic and functional ability, are poor: only 11 percent of patients treated by emergency medical services (EMS) personnel survive to discharge ( Daya et al., 2015 Vellano et al., 2015).