Emergency Medical Services - Research Paper Example

?Emergency Medical Services December 12, The use of helicopters by emergency medical service providers began in 1972; since thattime, their use has become a valuable tool for these providers who are the first responders at scenes of trauma or life threatening situations (Lemonick 5). It is estimated that in 2008 more than 400,000 patients were transported via helicopter by EMS. Though only 30% of these were transported from the original scene, the majority of EMS transports involve transfer from one facility to a different facility using one which is a higher level facility and able to provide specialized care. Cases such as these may involve patients being transported to specialized facilities which handle burn patients or facilities which have the knowledge and equipment to care for infants born prematurely and have higher level NICU’s.Either of two aircraft are employed in these transports, each having their own benefits though for the purpose of on the scene trauma transfer rotary wing helicopters are used. These helicopter are able to land on the scene and at the hospital. EMS responsibility was originally assigned to the Department of Transportation and was thought to be more of a transportation service than an actual medical service. Initially, equipment and staffing was secondary (Shah 415). It was during the 60’s that many of the newest medical technologies were being used by EMS; in 1973 arguments were made for EMS Systems Development Act. It was noted by Senator Kennedy that there was an extreme lack of quality on EMS and over 350,000 deaths annually could be prevented through the use of new technologies for cardiac patients and trauma patients (Shah 417). “EMS Services development Act of 1973 assigned the Department of Health, Education and Welfare as the guiding agency within the Federal government” (Shah 418). Today air EMS transfer are primarily regulated at different levels. Grants were approved to develop more thorough EMS coverage throughout the country, highlighting training, development, communications and education. Emphasis was placed on technology that could provide care to patients over wide spans of location’s and also in rural location lacking resources found in more urban areas. Some of this technology was aimed at better cardiac patient outcomes while air transport was considered to be necessary to transport patients out of distance of hospitals, meaning that ground units could not get them to the primary treatment facility within the crucial time period between injury or accident and treatment. With the use of helicopters in these areas care improved drastically for trauma, cardiac, and burn patients. Rural emergency services are seldom evaluated critically in research or academic settings. The goal in the care of a critically injured patient is to minimize the time between the incident and arrival at the nearest trauma center; trauma patients have always had higher incidence of mortality in rural areas (Von Recklinghausen 242). The time used to reach definitive patient treatment is crucial in the morbidity and mortality of trauma patients. Von Recklinghausen’s 2011 study sought to compare emergency services provided by ground to those provided by air through the use of helicopters. Patients transported through traditional ground methods are known to have shorter distances to travel in order to reach a level one trauma care center. Those users of EMS who require air transport are considered more critically injured at a greater chance of death and are also located further away from trauma or specialty care centers. Level 1 trauma center transport requests will come from one of two sources: ground EMS at the scene of the trauma who request ground transportation and dispatchers who request helicopter transport which is based on certain factors and EMS judgment and evaluation of the patient (Von Recklinghausen 243). Methodology used in this study was data analysis of a level 1 trauma center located in a rural area. This facility receives 1700 trauma admissions annually. Two air EMS crew are available in this area as well as several ground units. The study was completed from 2003 to 2008. Conclusions were that there are a number of differences in those patients transported by ground versus air; vital signs, chances of survival or expected outcome of the patient, and the distance between the patients and trauma level 1 center. Helicopters were used for the most critical patients, and air EMS staff have more advanced skills and are therefore requested by ground EMS evaluations in most cases who are aware of their capabilities as well as their ability to transport the patient during the period considered crucial after a traumatic injury (Von Recklinghausen 243). Air transport crews frequently have been trained in the military or are EMS responders who have completed additional training in order to be certified to become EMS providers on aircrafts. Vital signs were much worse in those patients transported by air and ICU and hospitals stays were lengthier in air transported patients. A large percentage of the air transported patients were discharged to rehabilitation facilities while those who were ground transported preferred skilled nursing facilities. This could be an indication that those patient’s transported by air had a loss of some function due to their injury which required relearning of previous abilities while those requesting skilled nursing facilities likely required monitoring and medication administration. Surprisingly, in this study the number of survivors between both groups was not significantly different. Despite the number of EMS calls per year, the number of ground EMS units does not appear to be increasing. In part this may be attributed to the services they are able to provide becoming more dynamic, advanced and diverse. Helicopter EMS services have had the most publicized and closely examined growth of all of the EMS transport methods. Individual hospitals and specialty physician’s supported publicly the use of helicopter EMS in advocating for their most critical patients. They also formed groups which were able to generate resources to implement air transport availability to and from their facility (McGinnis 357). Local governments rarely operate air EMS as they do ground EMS. Air operation authority comes from Federal Aviation Regulation with medical authority coming from regional, state and provider regulations. The fastest growing area are AMS professional crews which are combined with EMS crews to “provide physician level skills” (McGinnis et al. 360). Rotary wing ambulances are able to land at hospitals or at a trauma scene without the need for ground EMS. Air ambulances considered fixed wing are only able to land at airports are their primary use is transfer between hospitals. Air EMS are an important part of the health care delivery system and essential components of EMS services today. The NAEMSP developed a number of criteria for use in deciding EMS transport method for patients. Some factors that are considered are the patient’s location: is it accessible by ground EMS? What are the weather conditions? These play a crucial role in whether a helicopter is able to respond in an emergency safely. Is the weight of the patient along with the crew within specified safety guidelines or allowed ranges for air transport? Is there a helipad or airport near the location? Is the patient’s condition one that requires life support which is unable to be provided by ground transportation? If ground EMS is used will the area still be sufficiently covered by other EMS units availability or will the emergency require most or all of the areas ground EMS personnel, leaving the area at risk if there is an emergency? In today’s world the practice and training of EMS providers is becoming more advanced, allowing them to provide more on scene medical care. At one time cardiac patients had a much higher mortality rate despite EMS ground services due to the limitations of EMS personnel skills and abilities. EMS is constantly seeking and research methods of care to improve the outcome of emergency calls while also seeking ways in which no area is left without EMS coverage in an emergency. Works Cited McGinnis, Kevin K., et al. "Air Medical Services: Future Development As In Integrated Component Of The Emergency Medical Services (EMS) System." Prehospital Emergency Care 11.4 (2007): 353-368. CINAHL Plus with Full Text. Web. 13 Dec. 2012. Retrieved from http://ehis.ebscohost.com/eds/pdfviewer/pdfviewer?sid=f368a336-8c43-41fb-94fd-8404244b51ed%40sessionmgr11&vid=1&hid=23 Lemonick, David. "Controversies in Prehospital Care."American Journal of Clinical Medicine. 6.1 (2009): 5-15. Print. . Shah, Manish. "Public Health Then And Now. The Formation Of The Emergency Medical Services System." American Journal Of Public Health 96.3 (2006): 414-423. CINAHL Plus with Full Text. Web. 12 Dec. 2012. Retrieved from http://ehis.ebscohost.com/eds/detail?vid=5&hid=23&sid=52242a62-a9e0-4f8c-ad19-91416fb2fe61%40sessionmgr11&bdata=JnNpdGU9ZWRzLWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#db=rzh&AN=2009129449 Von Recklinghausen, Friedrich. "Comparing Rural Ground And Air Emergency Medical Services." Journal Of Trauma Nursing 18.4 (2011): 241-245. CINAHL Plus with Full Text. Web. 12 Dec. 2012. Retrieved from http://ehis.ebscohost.com/eds/pdfviewer/pdfviewer?sid=a7e46a0d-3f64-40d4-925b-d30a465cec59%40sessionmgr13&vid=1&hid=23 Read More