Bledsoe v1 ch03_lecture

Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved.

Bryan E. BledsoeRichard A. Cherry Robert S. Porter

Paramedic Care: Principles & PracticeVolume 1, 5e

Chapter 3Roles and Responsibilities of the Paramedic



Standard• Preparatory (EMS Systems)



Competency• Integrates comprehensive knowledge of EMS

systems, the safety and well-being of the paramedic, and medical–legal and ethical issues, which is intended to improve the health of EMS personnel, patients, and the community.



Introduction• Strong knowledge of pathophysiology and current

medical technology

• Maintain professional attitude while making medical and ethical decisions.

• Provide emotional support to patients and their families.



Primary Responsibilities• Preparation

– Ongoing Training Aerobics Exercises Stretching Understand biomechanics of lifting Effects of stress; ways to alleviate it




– Inspection and maintenance of emergency vehicle and equipment

– Restocking medications; checking expiration dates– Local EMS protocols, policies, procedures




– Communications system hardware and software– Local geography– Support agencies



Figure 3-1 A paramedic provides emergency care to ill and injured patients—at the scene and in the ambulance.



Primary Responsibilities• Response

– Personal safety number one priority– Always follow basic safety precautions en route to

incident. Wear seat belt. Obey posted speed limits. Monitor road for potential hazards.




– Correct location of incident– Appropriate equipment en route– Request additional personnel or services.– Anticipate high-risk situations based on dispatch

information and experience.




– Multiple patients– Motor vehicle collisions– Hazardous materials– Rescue situations– Violent individuals– Use of weapon– Knowledge of previous violence



Primary Responsibilities• Scene Size-Up

– Primary concern safety of crew, patient, and bystanders

– Identify all potential hazards.– Never enter unsafe scene until hazards have been

dealt with.– Any scene has potential to deteriorate.



Figure 3-2 Always assess the scene for potential hazards as you approach.(© Ed Effron)



Primary Responsibilities• Scene Size-Up

– Determine number of patients.– Determine mechanism of injury (MOI) or nature of the

illness (NOI).



Primary Responsibilities• Patient Assessment—Primary

– General impression of appearance – Assess responsiveness.– Assess airway, breathing, circulation.– Treat life threats immediately.– Decide whether to continue assessment on scene or

transport.



Primary Responsibilities• Patient Assessment—Primary

– Take patient's medical history.– Continuously monitor patient.– Provide additional emergency care needed.



Figure 3-3 During the primary assessment of your patient, you will look for and immediately treat any life-threatening conditions.



Primary Responsibilities• Recognition of Illness or Injury

– First aspect of patient prioritization – Patient priority based on urgency for transport.



Primary Responsibilities• Patient Management

– Follow protocols or treatment guidelines.– Ensure use of proper equipment and availability of

adequate personnel.– Medical direction:

Instructions on how to proceed with emergency care Permission to perform certain procedures Alternatives to standard care



Primary Responsibilities• Appropriate Disposition

– Patient taken to appropriate facility by appropriate mechanism of transport

– Mode of transportation; time and distance key factors– Know resources available.– Follow all local protocols.




– Selecting appropriate receiving facility for patient is your responsibility.

– Know which medical facilities in your area offer appropriate services.

– Receiving facilities categorized based on level of care they can provide.




– Level I facility: regional resource trauma center; tertiary care facility for trauma care system; university-based teaching hospitals.

– Level II trauma center: hospital expected to provide initial definitive trauma care, regardless of severity of injury.




– Level III trauma center: serves communities that do not have immediate access to Level I or II institution.

– Level IV trauma facilities: provide advanced trauma life support before patient transfer in remote areas where no higher level of care is available.




– Designated trauma centers offer unique services: burn, pediatric, psychiatric, perinatal, cardiac, spinal, poison centers.

– When in doubt, contact on-line medical direction for advice and support.




– In some areas, paramedics provide primary care and then transport.

– Treat and release: paramedics on scene, assess patient, provide emergency care, do not transport.



Primary Responsibilities• Patient Transfer

– When in doubt about patient's stability for duration of transport, or capabilities of receiving facility, contact medical direction.

– Hand-off: before removing patient from hospital, request verbal report from primary care provider.



Primary Responsibilities• Patient Transfer

– First priority during transport is patient.– All documents provided by sending facility turned over

to receiving care provider along with copy of run report.



Primary Responsibilities• Documentation

– Patient care report completed in entirety as soon as emergency care completed.

– Notes taken copied into report– Importance of accurate and complete documentation

cannot be overemphasized.– Record only observations, not opinions.



Primary Responsibilities• Returning to Service

– Clean and decontaminate unit.– Properly discard disposable materials.– Restock supplies; replace and stow away equipment.– Refuel unit.– Review call with crew members.– Check for signs of critical incident stress; assist anyone

who needs help.



Figure 3-4 A paramedic’s responsibility does not end with providing patient care. Documentation, restocking, and cleaning of the ambulance and emergency equipment are equally important.



Additional Responsibilities• Training civilians in CPR

• EMS demonstrations and seminars

• Teaching first aid classes

• Organizing prevention programs

• Professional development activities



Additional Responsibilities• Administration

– Station duties– Record keeping and reporting– Special projects– Developing interagency relationships



Additional Responsibilities• Community Involvement

– Help public learn how to: Recognize emergency Provide basic first aid measures Properly access EMS system

– Successful effort can save lives. – Illness and injury risk surveys



Additional Responsibilities• Support for Primary Care

– Promote wellness and prevent illness and injury.– Reduce cost of services by decreasing burden on

system.– Patient always receives appropriate emergency care

based on need, not cost.



Additional Responsibilities• Citizen Involvement in EMS

– Helps give insiders an outside, objective view of quality improvement; problem resolution.

– Members of community used in development, evaluation, regulation of EMS system.



Additional Responsibilities• Personal and Professional Development

– Responsibility to continue personal and professional development

– As volume of calls decreases, training correspondingly increases.

– Review previously learned materials; receive new information.



Professionalism• Paramedic member of health care professions

• Periodic recertification with specified amount of continuing education time

• Promote quality patient care.

• Set and strive for highest standards.

• Earn respect and confidence of team members and public.



Professionalism• Professional Ethics

– Ethics: rules or standards that govern conduct of members of a particular group or profession.

– Ethics are not laws; they are standards for honorable behavior.

– Conformity to ethical standards expected.



Professionalism• Professional Ethics

– Guiding principles for professional EMT service: 1948: World Medical Association adopted "Oath of Geneva." 1978: National Association of Emergency Medical Technicians

adopted "EMT Code of Ethics."



Professionalism• Professional Attitudes

– Establish excellence as goal– Never be complacent about performance– Practice skills– Take refresher courses– Set high standards



Professionalism• Professional Attitudes

– Critically review performance; seek ways to improve.– Check all equipment prior to emergency response.– Act in professional manner both on and off duty.



Professionalism• Professional Attributes

– Leadership– Integrity– Empathy– Self-motivation– Professional appearance and hygiene– Self-confidence



Figure 3-7 As leader of the EMS team, the paramedic must interact with patients, bystanders, and other rescue personnel in a professional and efficient manner.



Professionalism• Professional Attributes

– Communication skills– Time-management skills– Diplomacy and teamwork– Respect– Patient advocacy– Careful delivery of service



Professionalism• Continuing Education

– Maintaining certification responsibility of paramedic– Develop further knowledge and skills– Keep up with emergency health care delivery system.



Summary• To become a paramedic, you must be willing to be

a leader in prehospital emergency medical care.

• Responsibilities: on-call emergency duties; off-duty preparation.

• Be prepared to respond.



Summary• Most time as paramedic will be spent preparing

yourself to do job properly—not providing emergency care.

• The best paramedics are those who make a commitment to excellence.