Emergency medical service (known by the acronym of "EMS" in the USA and Canada) is a branch of medicine that is performed in the field, pre-hospital, (i.e., the streets, peoples' homes, etc.) by paramedics, emergency medical technicians (EMTs in US terminology), and Medical first responders (MFRs - US terminology). Acronyms and initialisms are abbreviations formed from the initial letter or letters of words, such as NATO and XHTML, and are pronounced in a way that is distinct from the full pronunciation of what the letters stand for. ... This article needs to be cleaned up to conform to a higher standard of quality. ... An emergency medical technician (EMT) is an emergency responder trained to provide emergency medical services (EMS) to the critically ill and injured. ... Terminology is the set of all the terms related to a given subject field or discipline. ...

In the US, although not commonly understood, EMS systems provide emergency care that is almost on par with that of an emergency room. Equipment and procedures are obviously limited, due to the nature of the environment that EMS personnel must work in. EMS providers work under the license and indirect supervision of a medical director or board-certified physician who oversees the policies and protocols of a particular EMS system or organization. The emergency room is the American English term for a room, or group of rooms, within a hospital that is designed for the treatment of urgent and medical emergencies. ... A Medical Director is typically a board certified physician who is responsible for providing recommendations to EMS agencies. ... A physician is a person who practices medicine. ...

EMS professionals are trained to follow a formal and carefully designed decision tree, more commonly referred to as a protocol or standard of care, which has been created and approved by physicians. The emphasis in emergency services is on following correct procedure quickly and accurately rather than on making in-depth diagnosis which requires much professional experience. The use of a decision tree allows EMS workers to be trained in a much shorter time than physicians, with EMT-Basic classes, for example, as short as 4-5 months. In decision theory (for example risk management), a decision tree is a graph of decisions and their possible consequences, (including resource costs and risks) used to create a plan to reach a goal. ...

National EMS standards for the US are drawn up by the U.S. Department of Transportation and modified from state to state by the state's Department of EMS (usually under its Department of Health), and further altered by Regional Medical Advisory Committees (usually in rural areas) or by other committees or even individual EMS providers. Also see emergency medical technician. In addition, the National Registry of Emergency Medical Technicians, an independent body, was created in 1970 at the recommendation of President Lyndon B. Johnson in an effort to provide a nationwide consensus on protocols and a nationally accepted certification. National Registry certification is widely accepted in some parts of the U.S., while other areas still maintain their own, separate protocols and training curricula. Many governments, both national and more local, have a Department of Health. This article is about the British one. ... An emergency medical technician (EMT) is an emergency responder trained to provide emergency medical services (EMS) to the critically ill and injured. ... Order: 36th President Vice President: Hubert H. Humphrey Term of office: November 22, 1963 – January 20, 1969 Preceded by: John F. Kennedy Succeeded by: Richard M. Nixon Date of birth: August 27, 1908 Place of birth: Gillespie County, Texas Date of death: January 22, 1973 Place of death: Johnson City...

History

The origins of EMS date back to the days of Napoleon, when the French army utilized horse drawn "ambulances" to transport the injured soldier from the battlefield. One of the first civilian EMS services can be traced back to 1869, when Dr. Edward L. Dalton at Bellevue Hospital, then known as the Free Hospital of New York, in New York City started a basic transportation service for the sick and injured. The component of care on scene began in 1928, when Julien Stanley Wise started the Roanoke Life Saving and First Aid Crew in Roanoke, Virginia, which was the first land-based rescue squad in the nation. Over the years EMS continued to evolve into much more than a "ride to the hospital." Ambulance An ambulance is a vehicle designated for the transport of sick or injured people. ... 1869 is a common year starting on Friday (link will take you to calendar). ... Midtown Manhattan, looking north from the Empire State Building, 2005 New York City (officially named the City of New York) is the most populous city in the state of New York and the entire United States. ... 1928 was a leap year starting on Sunday (link will take you to calendar). ... panoramic view of Roanoke, Virginia from 1907 Roanoke (The Star City of the South) is an independent city located in the Commonwealth of Virginia. ... A physician visiting the sick in a hospital. ...

In particular in the US state of California and in Seattle, Washington state (see Medic One), projects began to include paramedics in the EMS responses in the late 1960s. Groups in Pittsburgh, Pennsylvania and Portland, Oregon were also early pioneers in prehospital emergency medical training (see paramedic). Despite opposition from firefighters and doctors, the program eventually gained acceptance as its effectiveness became obvious. Furthermore, such programs became widely popularized around North America in the 1970s with the television series, Emergency! which in part followed the adventures of two Los Angeles County Fire Department paramedics as they responded to various types of medical emergency. James O. Page served as the series technical advisor and went on to become integral in the development and EMS in the U.S. The popularity of this series encouraged other communities to establish their own equivalent services. State nickname: The Golden State Other U.S. States Capital Sacramento Largest city Los Angeles Governor Arnold Schwarzenegger (R) Official languages English Area 410,000 km² (3rd)  - Land 404,298 km²  - Water 20,047 km² (4. ... Seattle skyline City nickname: The Emerald City Location of Seattle in King County and Washington State County King Mayor Greg Nickels (NP) Area   â€“Land   â€“Water 369. ... State nickname: The Evergreen State Other U.S. States Capital Olympia Largest city Seattle Governor Christine Gregoire (D) Official languages None Area 184,824 km² (18th)  - Land 172,587 km²  - Water 12,237 km² (6. ... Medic One can refer to the emergency medical service program (paramedics/EMTs) in King County, Washington, USA; to the approach to emergency medical service developed beginning in 1968 by Seattles Harborview Medical Center, University of Washington Medical Center, and the Seattle Fire Department; or to various other emergency medical... Nickname: The Steel City Location in Allegheny County, Pennsylvania Founded  -Incorporated 1758   County Allegheny County Mayor Tom Murphy (Dem) Area  - Total  - Water 151. ... Portland skyline. ... This article needs to be cleaned up to conform to a higher standard of quality. ... Firefighter with an axe A firefighter, sometimes still called a fireman though women have increasingly joined firefighting units, is a person who is trained and equipped to put out fires, rescue people and in some areas provide emergency medical services. ... Emergency! is an American television series which ran from January 1972 to 1977. ... This article needs to be cleaned up to conform to a higher standard of quality. ... A medical emergency is an injury or illness that poses an immediate threat to a persons health or life which requires help from a doctor or hospital. ... James O. Page, JD (August 7, 1936 - September 4, 2004), was recognized as a leading authority on emergency medical services (EMS). ...

In a return to the military roots of EMS, the United States Army has developed the combat lifesaver program to instruct soldiers in advanced first aid and limited paramedic skills including intubation. The combat lifesaver is intended to bridge the gap between self-aid / buddy-aid and the platoon medic on the 21st century decentralized battlefield. EMS Unit treats a cardiac arrest Patient. ... The Army is the branch of the United States armed forces which has primary responsibility for land-based military operations. ... A combat lifesaver is a soldier who has received rudimentary training in advanced first aid skills. ... A Norwegian soldier (a Corporal, armed with an MP-5) A soldier is a person who has enlisted with, or has been conscripted into, the armed forces of a sovereign country and has undergone training and received equipment to defend that country or its interests. ... First aid is a series of simple, life-saving medical techniques that a non-doctor or layman can be trained to perform. ... This article needs to be cleaned up to conform to a higher standard of quality. ... Intubation being practiced on a dummy (conventional technique using a laryngoscope) In medicine, intubation is the placement of a tube into an external or internal orifice of the body. ... See also Platoon (movie) and platoon (automobile) for the concept for reducing traffic congestion. ...

Levels of Care

Two levels of care are provided by EMS systems: BLS and ALS (Basic Life Support and Advanced Life Support). BLS providers are CFRs (Certified First Responders) and EMTs, or EMT-Bs (Emergency Medical Technicians-Basic), and provide all care outlined in the EMS standard of care, except for invasive procedures and (to a certain extent) giving medications. EMTs also rarely receive training in EKG interpretation, one of the most basic ALS skills. ALS providers are principally paramedics and EMT-Intermediates (EMT-I), who are certified to perform invasive procedures and to give a wide variety of drugs. The biggest difference between EMT-I's and Paramedics is that while EMT-I's handle advanced airway management like Paramedics, they do not have as in-depth cardiac training and usually administer fewer medications. This article needs to be cleaned up to conform to a higher standard of quality. ...

In times of economic crisis and in poorer areas, much normal medical care is provided through emergency services to patients who do not have regular physicians or regular medical attention.

Prehospital Care Strategies: "Scoop and Run", "stay and play" or "play and run"?

The essential decision in prehospital care is whether the patient should be immediately taken to the hospital, or advanced care resources are taken to the patient where they lie. The "scoop and run" is best exemplified by the MEDEVAC aeromedical evacuation helicopter, where the "stay and play" is best exemplified by the French SMUR emergency mobile resuscitation unit. Airbus A310 MRT MedEvac of the German Airforce. ...

The strategy developed for prehospital care in North America is called Scoop and Run. It is based on the golden hour concept, i.e. a victim's best chance for survival is in an operating room, with the goal of having the patient in surgery within an hour of the traumatic event. This is especially true in case of internal bleeding. Thus, the minimal prehospital care is performed (ABCs, i.e. ensure airway, breathing and circulation; external bleeding control; spine immobilization; endotracheal intubation) and the victim is transported as fast as possible to a trauma center. This philosophy is aptly summarized by the following quotation from "The Rules of EMS": "Trauma is treated with diesel first." The aim in "Scoop and Run" treatment is generally to transport the patient within ten minutes of arrival; hence the birth of the phrase, "the platinum ten minutes" (in addition to the "golden hour"), now commonly used in EMT training programs. It should be noted the "Scoop and Run" is a method developed to deal with trauma, rather than strictly medical situations(e.g. cardiac or respiratory emergencies). Scoop and Run is a colloquialism for the practice of immediately transporting ill or injured medical patients to a medical facility. ... In emergency medicine the golden hour is the first sixty minutes after an accident or the onset of acute illness. ... Bleeding is the loss of blood from the body. ... Intubation being practiced on a dummy (conventional technique using a laryngoscope) In medicine, intubation is the placement of a tube into an external or internal orifice of the body. ... A trauma center is a hospital equipped to perform as a casualty receiving station for the emergency medical services by providing the best possible medical care for traumatic injuries on a 24 hour, 7 days per week, 365 days per year basis. ... In medicine, a trauma patient has suffered serious and life-threatening physical injury resulting in secondary complications such as shock, respiratory failure and death. ...

The stay and play strategy was designed in France with the SMUR (Service Mobile d'Urgence de Réanimation, emergency mobile resuscitation unit) and SAMU (Service d'Aide Médicale d'Urgence), as it was noted that an unacceptable number of patients were dying during transport. The French thus developed a strategy based on maximum care before transportation. Prehospital medical care is provided by a medical doctor MD, a nurse and an ambulance technician, with almost all the equipment and drugs that can be found in an emergency department. The priority here is the stabilization of the patient prior to transport, including intravenous drip to raise the blood pressure (one of the causes of death during transportation is the drop in pressure, which decreases perfusion of the brain and heart; see shock). Categories: Stub | Emergency services | Prehospital care ... A brazilian ambulance with a SAMU marking SAMU (Service dAide Médicale dUrgence, Emergency Medical Assistance Service) is the French hospital based emergency medical service. ... A doctorate is an academic degree of the highest level. ... A nurse comforting a patient A nurse is a health care professional, who is engaged in the practice of nursing. ... The emergency room is the American English term for a room, or group of rooms, within a hospital that is designed for the treatment of urgent and medical emergencies. ... An intravenous drip in a hospital Intravenous therapy or IV therapy is the administration of liquid substances directly into a vein. ... In medicine, shock (hypoperfusion) is a life-threatening medical emergency characterized by inability of the body to supply enough oxygen to meet tissue requirements. ...

In case of a severe myocardial infarction (or heart attack), all care is performed onsite (including the possibility of thrombolysis), and the victim is transported only if the heart starts again or the patient is declared dead. Defibrilation is performed by a firefighter rescue team with an automated external defibrillator if they arrive before the medical team. Note that this example is one of the only "real" stay and play approaches performed in France; in most cases, the treatment by the physician is fast and the patient is transported to the hospital within the golden hour. A myocardial infarction occurs when an atherosclerotic plaque slowly builds up in the inner lining of a coronary artery and then suddenly ruptures, totally occluding the artery and preventing blood flow downstream. ... Firefighter in full turn out gear with a pickhead axe. ... A semi-automatic external defibrillator An automated external defibrillator (AED) is a portable electronic device that diagnoses and treats cardiac arrest by reestablishing an effective heart rhythm. ...

Both strategies have their advantages and drawbacks.

The confrontation of these two opposite strategies has led recently to a new concept: the play and run. The time that cannot be reduced (e.g. while extracting a victim trapped in a car) is used to perform medical care. The treatment aim is no longer to recover a "normal" blood pressure, but a minimal blood pressure, using not only intravenous drip but also vasocompressing drugs and antishock pants (to compress the legs and push the blood into the rest of the body). The aim is to reduce the risk of death due to transportation trauma while respecting the golden hour. The difficulty with play and run lies in the difficulty of getting a good IV stick in a moving vehicle and controlling the volume of IV fluids given to the patient. Too little fluid will cause inadequate circulation and heart failure, while too much fluid will cause excessive loss of oxygen-bearing blood.

Organization and Funding

In the USA

EMS in the US is delivered through various models. These include;

• Public EMS
  • Third Service stand alone
  • Third Service hospital based
  • Fire Service fully integrated and cross trained
  • Fire Service based, non-integrated(includes volunteer fire services)
  • Police service based, includes Sheriff's Offices (Police and Fire Services being the first two emergency services)
• Private EMS
  • large national companies
  • Regional companies
  • Small local "mom and pop" companies, and
  • Funeral homes in some places, once the largest providers.

Funding and manpower models include:

• Volunteer Public, non-billing, subsidized by property or sales taxes
• Volunteer Public, calls billed, partially subsidized through property or sales taxes
• Full time paid Private Enterprise, calls billed, partially subsidized through property or sales taxes
• Full time paid Private Enterprise, calls billed, no subsidy
• Full time paid Public Utility Model, calls billed, usually no subsidy

EMS in the USA was once largely provided by volunteers. But due to the increasing intensity of training, EMS is becoming more of a paid profession. Even agencies that were once strictly volunteer have begun supplementing their ranks with compensated members in order to keep up with booming call volumes. As of 2004, the largest "Private Enterprise" provider of contract EMS services in North America is AMR or American Medical Response, a subsidiary of Laidlaw International, Inc., a North American corporation also the major provider of contract school bus service, intercity passenger route and charter bus service, contract paratransit and public transit services in the United States and Canada. 2004 is a leap year starting on Thursday of the Gregorian calendar. ... American Medical Response, Inc. ... One of Laidlaws 40,000 yellow school buses Laidlaw, currently organized as Laidlaw International, Inc. ... A new 1973 Wayne Lifeguard school bus won in national contest for safety ideas is presented to winning driver from Goochland County Public Schools by Wayne dealer Jeff Davis at Virginia State Capitol A school bus is a specially built, painted and equipped bus used to transport students to and...

Fire Service in the US is rated through ISO classes and fire insurance rates (casualty insurance) are based on those classes, EMS does not receive ratings, nor are there corresponding monetary savings in health or life insurance policies. On the contrary it may be financially advantages for a person to die rather than accumulate large medical bills in rehabilitation. (depending on the size or existence of a life insurance policy) This relegates EMS funding to an emotional plea for funds during difficult financial times. ISO has many meanings: Iso is the stem of the Latin transliteration of the Greek word ίσος (ísos, meaning equal). The iso- prefix in English derives from this and means equality or similarity. ...

Each State in the USA has control over its EMS, and so more levels of certification may exist. First Responder comes under Basic level, and is the level most fire fighters hold in Tennessee and Virginia. States may also attach add ons to an existing certification. In Tennessee, Most basic level providers are Basic-IV, which simply means they can start IV lines in addition to their Basic level of certification. Other examples such as Intermediate 85 and Intermediate 99 exist, as well as Critical Care Paramedic. Each state decides what it needs based on manpower and money and alters the U.S. Governments recommendations accordingly.

Challenges of the future

In the United States, fire service-based EMS may face funding crises due to rapid increases in EMS calls in a department still devoted to and funded primarily for fire suppression. Compounding these financial difficulties are third party payers such as Medicare which view EMS as a transportion service and not a medical care service. Much of the public has been aware of EMS's medical capabilities since the early 1970s but many third party payers still seem clueless after over 30 years of EMS successes, and a great number of private EMS providers are happy to fill the lucrative niche of non-emergency transport, perhaps adding to this impression. Medicare is a program of health insurance for the elderly and disabled in the USA. It was first passed on July 30, 1965 as amendments to Social Security legislation. ...

Many feel, however, that this state of affairs is bound to change as new technologies continue to spur a drop in the number of fires annually. Already, most firefighters are required to have basic medical training, and many, as noted above, are fully cross-trained as EMTs or even paramedics. In New York City, for example, FDNY firefighters are all trained at least to the CFR level, and many others are EMTs. Furthermore, the focus on homeland security since the September 11, 2001 terrorist attacks has aided in the integration of what many municipalities still regard as their fire departments' 'bastard son.' Midtown Manhattan, looking north from the Empire State Building, 2005 New York City (officially named the City of New York) is the most populous city in the United States, and is at the center of international finance, politics, music, and culture. ... The New York City Fire Department (FDNY) has the responsibility of protecting the New York Citys five boroughs from fires and fire hazards, as well as preventing and responding to accidents and disasters (such as The Station nightclub fire in nearby Rhode Island, or the trampling deaths at an... Military personnel have started to guard transportation facilities such as Penn Station as part of homeland security efforts. ... The September 11, 2001 attacks were a series of coordinated attacks carried out in the United States on Tuesday, September 11, 2001. ...

In France, most of the medical emergency services are already carried out by firefighters.

The future of EMS

The future development of an artificial blood substitute that will carry oxygen will greatly enhance the provision of emergency medical services, as natural blood is rarely available for field transfusions outside military medicine due to scarcity and fragility.

An interim life-saving technique being pioneered by the US military is the use of blood clotting powders such as QuikClot which make it easier to stop previously uncontrollable bleeding from major wounds.

Pioneering advances in telemedicine, including the use of videocameras, now make it possible for advanced medical direction and advice to be supplied to emergency medical technicians, military medics, and nurses or other community health care providers in remote or isolated areas or even aboard cruise ships. One future possibility is the use of robotics to permit a surgeon thousands of miles away to provide life-saving surgery from the comfort of their own office, without requiring emergency travel or exposing themselves to hazards. Telemedicine is composed of the Greek word τελε (tele) meaning far, and medicine. ... Medical Direction, or Online Medical Direction, allows a Paramedic to contact a physician from the field via radio or other means to obtain instructions on further care of a patient. ...

See also

• trauma center
• battlefield medicine
• first aid
• ambulance
• paramedic
• Emergency medical technician

A trauma center is a hospital equipped to perform as a casualty receiving station for the emergency medical services by providing the best possible medical care for traumatic injuries on a 24 hour, 7 days per week, 365 days per year basis. ... An illustration showing a variety of wounds from the Feldbuch der Wundarznei (Field manual for the treatment of wounds) by Hans von Gersdorff, (1517). ... First aid is a series of simple, life-saving medical techniques that a non-doctor or layman can be trained to perform. ... Ambulance An ambulance is a vehicle designated for the transport of sick or injured people. ... This article needs to be cleaned up to conform to a higher standard of quality. ... An emergency medical technician (EMT) is an emergency responder trained to provide emergency medical services (EMS) to the critically ill and injured. ...

External links

• System of Emergency Medical Assistance in France