(Test Bank) Essentials Of Paramedic Care Volume 1

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Chapter 1. Introduction to Prehospital Care OBJECTIVES Part 1: Introduction to Advanced Prehospital Care (begins on p. 6) After reading Part 1 of this chapter, you should be able to: 1. Describe the relationship between the paramedic and other members of the health professions. (p. 6) 2. Identify the attributes and characteristics of the paramedic. (p. 7) 3. Explain the elements of paramedic education and practice that support its stature as a profession. (p. 7) 4. Define and give examples of the expanded scope of practice for the paramedic. (p. 8) Part 2: EMS Systems (begins on p. 8) After reading Part 2 of this chapter, you should be able to: 1. Describe key historical events that influenced the national development of emergency medical services (EMS) systems. (pp. 10-12) 2. Define the following terms: EMS systems (p. 12), licensure (p. 18), certification (p. 18), profession (p. 18), professionalism (p. 24), ethics (p. 25), peer review (p. 25), medical direction (p. 14), protocols (p. 15). 3. Identify national groups that are important to the development, education, and implementation of EMS, as well as the role of provincial or territorial associations, the Paramedic Association of Canada (PAC), and the roles of various EMS standard-setting agencies. (p. 20) 4. Identify the standards (components) of an EMS system. (p. 12) 5. Differentiate among EMS provider levels: emergency medical responder, primary care paramedic, advanced care paramedic, and critical care paramedic. (p. 18) 6. Describe what is meant by "citizen involvement in the EMS system." (pp. 15-16) 7. Discuss the role of the EMS physician in providing medical direction and prehospital care as an extension of the physician, the benefits of online and offline medical direction, and the process for the development of local policies and protocols. (pp. 14-15) 8. Describe the relationship among the physician on the scene, the paramedic on the scene, and the EMS physician providing online medical direction. (pp. 14-15) 9. Describe the components of continuous quality improvement, and analyze its contribution to system improvement, continuing medical education, and research. (pp. 23-25) 10. Describe the importance, basic principles, process of evaluating and interpreting, and benefits of research. (pp. 25-26) Part 3: Roles and Responsibilities of the Paramedic (begins on p. 26) After reading Part 3 of this chapter, you should be able to: 1. Describe the attributes of a paramedic as a health-care professional. (pp. 30-34) 2. Describe the benefits of continuing education for paramedics and the importance of maintaining the paramedic licence or certification. (p. 35) 3. List the primary and additional responsibilities of paramedics. (pp. 27-30) 4. Define the role of the paramedic relative to the safety of the crew, the patient, and bystanders. (pp. 27-28) 5. Describe the role of the paramedic in health-education activities related to illness and injury prevention. (pp. 29-30) 6. Describe examples of professional behaviours in the following areas: integrity, empathy, self-motivation, appearance and personal hygiene, self-confidence, communication, time management, teamwork and diplomacy, respect, patient advocacy, and careful delivery of service. (pp. 32-34) 7. Identify the benefits of paramedics teaching in their communities. (pp. 29-30) 8. Analyze how the paramedic can benefit the health-care system by supporting primary care for patients in the prehospital setting. (pp. 28-29) 9. Describe how professionalism applies to the paramedic while on and off duty. (p. 31) Part 4: The Well-Being of the Paramedic (begins on p. 35) After reading Part 4 of this chapter, you should be able to: 1. Discuss the concept of wellness and its benefits, the components of wellness, and the role of the paramedic in promoting wellness. (p. 35) 2. Discuss how cardiovascular endurance, weight control, muscle strength, and flexibility contribute to physical fitness. (pp. 35-40) 3. Describe the impact of shift work on circadian rhythms. (p. 49) 4. Discuss the contributions that periodic risk assessments and warning sign recognition make to cancer and cardiovascular disease prevention. (p. 37) 5. Differentiate proper from improper body mechanics for lifting and moving patients in emergency and nonemergency situations. (pp. 38-40) 6. Describe the problems that a paramedic might encounter in a hostile situation and the techniques used to manage the situation. (p. 53) 7. Describe the considerations that should be given to using escorts, dealing with adverse environmental conditions, using lights and siren, proceeding through intersections, and parking at an emergency scene. (pp. 53-54) 8. Discuss the concept of "due regard for the safety of all others" while operating an emergency vehicle. (p. 54) 9. Describe the equipment available for self-protection in a variety of adverse situations, including body substance isolation steps for protection from airborne and bloodborne pathogens. (pp. 40-42, 53, 54-56) 10. Given a scenario in which equipment and supplies have been exposed to body substances, plan for the proper cleaning, disinfection, or disposal of the items. (pp. 42-43) 11. Describe the benefits and methods of smoking cessation. (p. 38) 12. Identify and describe the three phases of the stress response, factors that trigger the stress response, and causes of stress in EMS. (pp. 47-50) 13. Differentiate between normal or healthy and detrimental physiological and psychological reactions to anxiety and stress. (pp. 50- 51) 14. Describe behaviour that is a manifestation of stress in patients and those close to them and describe how that behaviour relates to paramedic stress. (pp. 50-51) 15. Identify and describe the defence mechanisms and management techniques commonly used to deal with stress, and the components of critical incident stress management (CISM) and provide examples of situations in which CISM would be beneficial to paramedics. (pp. 50, 51-52) 16. Given a scenario involving a stressful situation, formulate a strategy to help adapt to the stress. (pp. 47-52) 17. Describe the stages of the grieving process (Kubler-Ross) and the unique challenges for paramedics in dealing with themselves, adults, children, and special populations concerning their understanding or experience of death and dying. (pp. 44-47) 18. Given photos of various motor-vehicle collisions, assess scene safety and propose ways to make the scene safer. (pp. 53-54) Part 5: Illness and Injury Prevention (begins on p. 54) After reading Part 5 of this chapter, you should be able to: 1. Describe the incidence, morbidity, and mortality, and the human, environmental, and socioeconomic impact of unintentional and alleged unintentional injuries. (pp. 54-56) 2. Identify health hazards and potential crime areas within the community. (pp. 59-60) 3. Identify local, municipal, and community resources available for physical and socioeconomic crises. (pp. 56-57, 61) 4. List the general and specific environmental parameters that should be inspected to assess a patient's need for preventive information and direction. (pp. 59-60) 5. Identify the role of EMS in local, municipal, and community prevention programs. (pp. 55, 56-61) 6. Identify the injury and illness prevention programs that promote safety for all age populations. (pp. 59-62) 7. Identify patient situations in which the paramedic can intervene in a preventive manner. (pp. 59-62) 8. Document primary and secondary injury prevention data. (pp. 61-62) Part 6: Ethics in Advanced Prehospital Care (begins on p. 63) After reading Part 6 of this chapter, you should be able to: 1. Define ethics and morals and distinguish between ethical and moral decisions in emergency medical service. (pp. 63-66) 2. Identify the premise that should underlie the paramedic's ethical decisions in prehospital care. (p. 65) 3. Analyze the relationship between the law and ethics in EMS. (p. 63) 4. Compare and contrast the criteria used in allocating scarce EMS resources. (pp. 71-72) 5. Identify issues surrounding advance directives in making a prehospital resuscitation decision and describe the criteria necessary to honour an advance directive in your province or territory. (pp. 67-68) Part 7: Lifting and Moving Patients (begins on p. 74) After reading Part 7 of this chapter, you should be able to: 1. Define body mechanics. (p. 74) 2. Discuss the guidelines and safety precautions that need to be followed when lifting a patient. (pp. 74- 75) 3. Describe the power lift and the power grip. (pp. 75-76) 4. Explain how good posture and physical fitness can contribute to your well-being as an EMS provider. (pp. 77- 78) 5. Describe the indications for an emergency move. (p. 79) 6. Describe the indications for assisting in nonemergency moves. (pp. 82-84) 7. Describe additional types of emergency moves, such as the piggyback carry, one-rescuer crutch, one-rescuer cradle carry, and firefighter's drag. (pp. 81- 82) 8. Discuss the various devices associated with moving a patient in the out-of-hospital arena. (pp. 85- 87) 9. Discuss the principles of loading and securing the stretcher into, and unloading the stretcher from, an ambulance. (pp. 87-88) 10. Explain the rationale behind properly lifting and moving patients. (pp. 74-75) 11. Explain the rationale behind an emergency move. (p. 79) Figure 1-15. Keep weight close to the body as it is lifted. Figure 1-19. Proper standing position. Figure 1-25A. Grasp the patient's wrists. Figure 1-33A. Traditional wooden long backboard. INTRODUCTION Congratulations on your decision to become a paramedic. Before you begin this rewarding endeavour, it is important to understand what the job of a paramedic entails. Emergency medical services (EMS) has made significant advances over the past 30 years. Not that long ago, the ambulance was simply a vehicle that provided rapid, horizontal transportation to the hospital. Today, equipped with the latest in equipment and technology, the ambulance is truly a mobile emergency room. Today, the paramedic is a highly trained health-care professional. Emergency medical services (EMS) has made significant advances. The roles and responsibilities of the paramedic have advanced accordingly. PART 1: INTRODUCTION TO ADVANCED PREHOSPITAL CARE DESCRIPTION OF THE PROFESSION The primary task of the paramedic is to provide emergency medical care in a prehospital environment, extending the care of the emergency physician to the patient in the field. To function as a paramedic, you must have fulfilled the prescribed requirements of the appropriate licensing or credentialling body. Paramedics may only function under the direction and licence of an EMS system's medical director. Because of this, the paramedic must also be approved by the system's medical director before being permitted to practise. There are many different types of EMS system designs and operations. As a paramedic, you may work for a municipal city service, hospital, fire department, private ambulance service, police department, or other operation. Regardless of the type of service you work for, as a paramedic, you are an essential component in the continuum of care. Furthermore, paramedics often serve as a link between various health resources. Although paramedics continue to fill the well-defined and traditional role of 911 response, they also find themselves taking on a wide variety of additional responsibilities. The emerging roles and responsibilities of the paramedic include public education, health promotion, and participation in injury and illness prevention programs. Because of the need to cut costs, you may be charged with ensuring that your patient gets to the appropriate health-care facility, which may be a facility other than the hospital emergency department. Thus, the paramedic may begin to function as a facilitator of access to care as well as an individual treatment provider. You must always be an advocate for your patient and ensure that the patient receives the best possible care. Paramedics must always strive toward maintaining high-quality health care. You must always be an advocate for your patient and ensure that the patient receives the best possible care—without regard to age, gender, type of complaint, socioeconomic status, religion, or nationality. Paramedics are responsible and accountable to the system medical director, their employer, the public, and their peers. Although this may seem like a difficult standard to meet, if you always act in the best interests of the patient, you will seldom have problems. Paramedics are accountable to their medical director, their employer, the public, and peers. However, if you always act in the best interests of the patient, you will seldom have problems. PARAMEDIC CHARACTERISTICS As a paramedic, you must be a confident leader who can accept the challenge and responsibility of the position. You must have excellent judgment and be able to prioritize decisions and act quickly in the best interests of the patient. You must be able to develop a rapport with a wide variety of patients so that, for example, you can safely interview hostile patients and communicate with members of diverse cultural groups and the various ages within those groups. Overall, you must be able to function independently at an optimum level in a nonstructured, constantly changing environment. The job is never easy and is always challenging. You must be a confident leader, able to function independently at an optimum level in a nonstructured, constantly changing environment. The job is never easy and is always challenging. THE PARAMEDIC: A TRUE HEALTH PROFESSIONAL Despite its relative youth as a profession, the field of emergency medical services is now recognized as an important part of the health-care system. As a paramedic, you must never take this status for granted. Instead, you must always strive to earn your acceptance as a health-care professional. Consider the completion of your initial paramedic course to be the start of your professional education, not the end. Participate in continuing education programs. Frequently review and practise skills, especially those less frequently used. Participate in routine peer-evaluation, and assume an active role in professional and community organizations. A major step toward the recognition of EMS as a true health-care profession was the increase in the standards of education for prehospital personnel. In Canada, health care, including prehospital care, is a provincial or territorial responsibility. Each province and territory has developed its own operational models and supporting educational structures. A significant advance for paramedic education in Canada was the development of a National Occupational Competency Profile (NOCP) by the Paramedic Association of Canada in conjunction with Human Resources and Development Canada. The NOCP, introduced in March 2000, established a comprehensive framework for standardizing the fragmented paramedic educational programs across Canada. The NOCP serves as a reference point for provincial or territorial bodies seeking to facilitate the mobility of paramedics between provinces and territories. The NOCP may become the blueprint for a national registry exam. You must always strive to earn your status as a health-care professional. The National Occupational Competency Profile is the key to defining a national scope of practice for EMS in Canada. As a paramedic, you must actively participate in the design, development, evaluation, and publication of research on topics relevant to your profession. For years, paramedic practice was based on anecdotal data and tradition. EMS adapted hospital-based procedures and equipment for use in the field. Only during the 1990s did we truly begin applying the scientific method to various aspects of prehospital practice. Surprisingly, we found little or no scientific data to support many of our prehospital practices. As a result of research, many traditional EMS treatments have been abandoned or refined. Equipment is now designed specifically for the uncontrolled conditions and unique demands of the paramedic. Many questions about paramedic practice are still unanswered, and these can only be answered by sound, ongoing scientific research. Results of this research are published in journals and form part of operational quality assurance and improvement programs. Participation in research projects relevant to EMS is an important part of your profession as a paramedic. Another essential aspect of a health professional is acceptance and adherence to a code of professional ethics and etiquette. The public must feel confident that for the paramedic, the patient's and public's interests are always placed above personal, corporate, or financial interests. You must never forget that the patient is your primary concern. An essential aspect of a health professional is acceptance and adherence to a code of professional ethics and etiquette. The patient is always your primary concern. EXPANDED SCOPE OF PRACTICE Paramedics have a very bright future. New technologies and therapies bring the emergency department to the patient. Paramedics must be willing to step into these expanding roles, or persons from other health-care disciplines will fill them. Many aspects of prehospital care can give you the opportunity to work in an environment other than the typical 911-response vehicle: • Critical care transport. Paramedics manage complicated inter-hospital transports—typically from one intensive care unit to another—in specially equipped ambulances or aircraft designed to provide a higher level of care. • Primary health care. An emerging trend in health care is to keep patients with nonemergency problems out of the hospital emergency department. As a result, the EMS system is becoming involved in triaging and directing patients to the proper nonhospital facilities. In some cases, paramedics with additional skills can provide cost-effective, convenient medical care in the field or home. • Tactical EMS. Paramedics accompany specially trained law enforcement officers on such tactical operations as hostage rescue, drug raids, and similar high-risk emergencies. The tactical paramedic is a member of the operations team but is also trained to provide sophisticated, prolonged, definitive patient care. • Industrial medicine. Paramedics specially trained in occupational health are used to staff construction sites, oil rigs, and other facilities in which unique skills are required. These personnel may also serve as safety officers and inspectors. • Sports medicine. Many sports teams hire paramedics to complement their trainers. In this role, paramedics participate in pregame preparation and assume responsibility for injury prevention. They are also trained to deal with injuries specific to the sport, such as orthopedic injuries, with the goal of returning players to action as quickly and safely as possible. • Heavy urban search and rescue (HUSAR). Paramedics are an integral part of these multidisciplinary groups. HUSAR teams are groups of search, rescue, medical, and technical specialists that can rapidly assemble and deploy to disaster areas. • Other specialty teams. Other multidisciplinary teams are formed to deal with specific public safety issues. Paramedics are increasingly participating in specialized HAZMAT (hazardous materials), rescue, and emergency response groups. Paramedics are now stepping into such nontraditional roles because of their unique education and ability to think and work independently. Paramedics are now stepping into new, nontraditional roles because of their unique education and ability to think and work independently. PART 2: EMS SYSTEMS INTRODUCTION An emergency medical services (EMS) system is a comprehensive network of personnel, equipment, and resources established to deliver aid and emergency medical care to the community. An EMS system comprises both prehospital and in-hospital components. The prehospital component includes: • Members of the community who are trained in first aid and cardiopulmonary resuscitation (CPR) • A communications system that allows public access to emergency services dispatch and allows EMS providers to communicate with one another • EMS providers, including paramedics • Fire/rescue and hazardous-materials services • Public utilities, such as power and gas companies • Resource centres, such as regional poison control centres • Medical control The in-hospital component includes: • Emergency nurses • Emergency physicians • Ancillary services, such as radiology and respiratory therapy • Specialty physicians, such as trauma surgeons and cardiologists • Rehabilitation services A typical request for EMS begins with citizen activation when someone contacts a 911 dispatch centre. EMS dispatch collects essential information and sends out the closest appropriately staffed and equipped unit. In many EMS systems, the dispatcher also provides prearrival instructions to the caller. The first EMS provider at the scene may be a police officer, firefighter, lifeguard, teacher, or other community member who has been trained as an emergency medical responder (EMR). The EMR's role is to stabilize the patient until more advanced personnel arrive. The next EMS provider likely to arrive depends on the type of EMS system. In most areas, the dispatcher will send either a basic life support (BLS) or an advanced life support (ALS) ambulance. Other EMS systems use a tiered response, sending multiple levels of emergency care personnel to the same incident. In still other areas, ALS personnel respond to every incident, regardless of the level of care needed. Once care has been initiated, EMS providers must quickly decide on the medical facility to which the patient should be transported, based on the type of care needed, transport time, and local protocols. Where specialty centres have been designated (such as pediatric, trauma, and burn centres), it may be necessary to transport the patient to a facility other than the closest hospital. At the receiving medical facility, an emergency nurse or physician assumes responsibility, and the patient is assigned a priority of care. If needed, a surgeon or other specialist will be summoned. HISTORY OF EMS ANCIENT TIMES Emergency medicine has a very long history. Emergency medicine may be traced back to biblical times, when it was recorded that a "good Samaritan" provided care to a wounded traveller by the side of a road. In fact, about 4000 to 5000 years ago, Sumerians inscribed clay tablets with some of the earliest medical records. Similar to EMS protocols today, the tablets provided step-by-step instructions for care based on the patient's description of symptoms, as well as instructions on how to create and administer medications. The most striking difference between these first "protocols" and EMS today is the absence of a secondary assessment (physical exam). In 1862, the Egyptologist Edwin Smith purchased a papyrus scroll dating to about 1500 B.C.E. It contained 48 medical case histories with data arranged in head-to-toe order and in order of severity, an arrangement very similar to today's patient assessment. One section, the "Book of Wounds," explains the treatment of such injuries as fractures and dislocations. At about the same time, King Hammurabi of Babylon created a code of laws known today as the "Code of Hammurabi." A section of the code regulated medical fees and penalties based on the social class of the patient. For example, if a surgeon operated successfully on a commoner, he would be paid only half of what his fee would be if he had operated on a rich man. If a surgeon caused the death of a rich man, the surgeon's hand would be cut off, but if a slave died under his care, he only had to replace the slave. THE NINETEENTH CENTURY During the Napoleonic Wars of the early nineteenth century, one of Napoleon's chief surgeons, Jean Larrey, formed the ambulance volante, or "flying ambulance," which focused efforts on providing emergency surgery as close to the battlefield as possible. Though the ambulance volante was little more than a covered horse-drawn cart, Larrey is credited with the development of the first prehospital system that used triage and transport. Between 1861 and 1865, during the American Civil War, a nurse named Clara Barton coordinated care for the sick and injured. Defying army leaders, she persisted in going to the front, where wounded men suffered and often died from lack of the simplest medical attention. She organized the triage and transport of injured soldiers to improvised hospitals in nearby houses, barns, and churches away from the battlefield. The first civilian ambulance service in North America was formed about the same time (1865) in Cincinnati, Ohio. Four years later, in 1869, the New York City Health Department Ambulance Service began operating out of Bellevue Hospital. The ambulances of both services were specially designed horse-drawn carts, which were staffed with physician interns from the various hospital wards. THE TWENTIETH CENTURY The high mortality rate of soldiers during World War I was associated with an average evacuation time of 18 hours. As a result, in World War II, a system was created in which battlefield ambulance corps transported wounded soldiers from the front lines to the echelons (levels) of care. However, many of the echelons were so far from the battlefield and each other that there were huge delays in patient care. In many cases, it was often days from the injury itself to definitive surgery. During the Korean and Vietnam conflicts, great advances in the patient care delivery system were made. The wounded soldier was treated on the battlefield when the injury occurred and evacuated by helicopter to a field hospital to receive definitive surgery. In Vietnam, in many cases, this occurred within 10 to 20 minutes. Once stabilized and able to be moved (generally within 24 to 48 hours), the patient would be flown by jet to Clark Air Force Base in the Philippines for further treatment. The decreased time before definitive care and the advances in medical procedures significantly reduced mortality rates. Throughout history, significant advances in trauma care occurred during wartime. However, until the late 1960s, few areas in North America provided adequate civilian prehospital emergency care. Medical care began in the hospital emergency department. Rescue techniques were crude, ambulance attendants poorly educated, and equipment minimal. Police, fire, and EMS personnel had no radio communication. Proper medical direction was not available, and the only interaction between physicians and EMS personnel was at the receiving facility. EARLY EMS In the late 1960s, ambulance services were provided by a wide variety of municipal services, fire- and police-based services, hospitals, private operators, funeral homes, and volunteers. As demands for additional services and increased training grew, early EMS systems with formal training, communications, and medical direction began to develop across Canada. In many areas, fragmented operations were amalgamated into municipal, regional, or even provincial or territorial services. In the late 1960s, many provinces and territories were creating basic emergency medical technician (EMT) programs, often following the American models and curriculum. By the 1970s, Calgary and some communities in Ontario had early advanced life support (ALS) programs. ALS was soon available in parts of Quebec, Toronto, and in British Columbia through the newly formed B.C. Ambulance Service. However, many of these initiatives continued to exist only at municipal, regional, or provincial or territorial levels, and there was little coordination of these emerging prehospital systems at a national level. In the United States, EMS was pushed by several federal initiatives. In 1966, the National Academy of Sciences, National Resource Council published "Accidental Death and Disability: The Neglected Disease of Modern Society." This White Paper spelled out deficiencies in prehospital emergency care. It suggested guidelines for the development of EMS systems, the training of prehospital emergency medical providers, and the upgrading of ambulances and their equipment. This publication set off a series of federal and private initiatives including the National Highways Safety Act, the establishment of the U.S. Department of Transportation (DOT), and funding for a variety of EMS projects and systems. In 1969, the Emergency Medical Technician-Ambulance program was made public. The first American paramedic curriculum followed in 1977. Canadian EMS has remained a provincial or territorial responsibility. Each province and territory developed its own systems and educational programs built on its unique historical and operational needs. Most have a mix of basic, intermediate, and ALS programs, often based on the American DOT curriculum. However, in adapting to local operations, these programs have become difficult to compare. Through the 1980s and 1990s, some provinces and territories retained EMT and EMT-paramedic designations, while others developed their own models. British Columbia trained three levels of emergency medical assistants (EMA), while Ontario created the emergency medical care assistant (EMCA) designation. In 1988, in the United States, the National Highway Traffic Safety Administration (NHTSA) established the Statewide EMS Technical Assessment Program. It defines elements necessary to all EMS systems. Although these elements have not been formally adopted by Canadian EMS, they are often referred to by Canadian EMS systems. Briefly, the essential elements are: • Regulation and policy. Each state (province or territory) must have laws, regulations, policies, and procedures that govern its EMS system. It also is required to provide leadership to local jurisdictions. • Resources management. Each state (province or territory) must have central control of EMS resources so that all patients have equal access to acceptable emergency care. • Human resources and training. A standardized EMS curriculum should be taught by qualified instructors, and all personnel who transport patients in the prehospital setting should be adequately trained. • Transport. Patients must be safely and reliably transported by ground or air ambulance. • Facilities. Every seriously ill or injured patient must be delivered in a timely manner to an appropriate medical facility. • Communications. A system for public access to the EMS system must be in place. Communication among dispatchers, the ambulance crew, and medical control and hospital personnel must also be possible. • Trauma systems. Each state (province or territory) should develop a system of specialized care for trauma patients, including one or more trauma centres and rehabilitation programs. It also must develop systems for assigning and transporting patients to those facilities. • Public information and education. EMS personnel should participate in programs designed to educate the public. The programs are to focus on the prevention of injuries and how to properly access the EMS system. • Medical direction. Each EMS system must have a physician as its medical director. This physician delegates medical practice to nonphysician caregivers and oversees all aspects of patient care. • Evaluation. Each state (province or territory) must have a quality improvement (QI) system in place for continuing evaluation and upgrading of its EMS system. Many EMS providers fail to realize that each component of the EMS system has gone through many stages of development. In spite of the advances of more than 40 years, startling differences in the quality of prehospital care exist across Canada. TODAY'S EMS SYSTEMS Though EMS systems across the country and the world vary, certain elements are essential to ensure the best possible patient care. In Canada, there is no one method of provision of prehospital care. EMS systems in Canada vary across provinces and territories and even across cities and towns. TYPES OF EMS SERVICES The provision of EMS is a provincial or territorial responsibility. The following list describes some of the models that have developed in Canada. Note that the following services are given only as examples and that EMS systems change over time. Canadian EMS services may be provided by the following types of agencies: • Provincial or territorial service • Municipal service • Fire-based service • Hospital-based service • Private operator • Volunteer service Content Review: 1988 NHTSA: 10 System Elements • Regulation and policy • Resources management • Human resources and training • Transport • Facilities • Communications • Trauma systems • Public information and education • Medical direction • Evaluation Provincial or Territorial Service EMS is often regulated through provincial or territorial agencies but delivered through a variety of agencies. In British Columbia, B.C. Ambulance Service was created in 1974 to serve as the sole provider of EMS in B.C. Municipal, Upper Tier, and Regional Municipality Services In many provinces and territories, provision of EMS is delegated to the municipality. Cities, such as Calgary and Winnipeg, maintain EMS departments separate from other emergency services (fire and police) within the municipal structure. In Ontario, the province sets EMS standards, but service may be delivered through municipal or provincial organizations. Fire-Based Service EMS is provided within a fire department structure in municipalities, such as Fort McMurray and Lethbridge in Alberta, or Riverview in New Brunswick. Fire-based EMS may operate independently but under the administrative structure of the department. In a dual-trained model, members may rotate between firefighting and EMS duties. Hospital-Based Service Hospital-based EMS services can be found in Fredericton and Saint John in New Brunswick or St. John's in Newfoundland and Labrador. This type of service allows paramedics to maintain close relationships with nurses and physicians. In some models, paramedics may also assume duties within the hospital. Private Operator Some systems contract EMS services to a private operator. Performance clauses establish expectations for such things as levels of service, response times, and so on. Volunteer Services Some small towns, rural areas, and isolated communities maintain EMS services through a volunteer network. These members often take training on their own time and at their own expense and receive little compensation for their service to the community.