Phil ems system

THE PHILIPPINE EMS SYSTEM
Teodoro Javier Herbosa MD FACS FPCS FPSECP
Professor
Department of Emergency Medicine
Universiti Kebangsaan Malaysia Medical Center, KL
College of Medicine University of the Philippines, Manila

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Department of Emergency MedicineDepartment of Emergency Medicine
Objectives
Present EMS its evolution
Define selected terms used in Emergency
Medical Systems.
State the principles of the organization and
management of an Emergency Medical
Systems
Present Philippines EMS System

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Definitions
Emergency
any situation that requires immediate action.
WHO
Situation wherein
– Proposed intervention is deemed necessary
– Delay in treatment may jeopardize life or
result in disfigurement or impaired faculties

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Emergency Medicine
International Federation for Emergency Medicine, 1991
knowledge & skills required for the prevention,
diagnosis and management of acute & urgent
aspects of illness & injury
all age groups
spectrum of episodic undifferentiated physical &
behavioral disorders
encompasses pre-hospital & in-hospital
emergency medical systems

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Tel Aviv, Israel 1991

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911 Cook County EMS

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Stuuggard DRF

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Formula 1 EMS 2008, 2009, 2010Formula 1 EMS 2008, 2009, 2010

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Emergency Medicine in the Philippines
70’s-80’s ERC – Under DFM
1991 –Departmentalization of Emergency Services,
UP-PGH
1992 – Trauma Surgery Fellowship Program
April 1994 – Chairman of DEMS
1996 – Setting up of PGH Emergency Medical
Services System
1997 – Establishment of Residency Program at
DEMS, PGH
2001 – Department of EM established as
Academic unit of UP College of Medicine
EE
M
E
R
G
E
N
C
Y
C
Y
1997
U
P
-P
G
H
M
E
D
IC
IN
E

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EMS System
The total system intended to
care for a casualty from the
site of incident to definitive
care.

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EMS System includes
Triage
On-site care
Initial resuscitation and treatment
Medical transport
Definitive care or Trauma Center

““Scoop and run”Scoop and run”

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EMS System Components
Transport
Personnel
Communications System
Medical Control
Equipment and Supplies
Legislation and advocacy

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EMS System COMPONENTS
Transport - system of ambulances which may vary
from (BLS) to (MICU) or (ALS) vehicles. Also connotes
air transport either through fixed wing aircraft or rotary
wing type air transports.
Personnel - Medical First Responders (MFR),
Emergency Medical Technicians (EMT's),
Paramedics, Ambulance Nurses, & Flight Paramedics.

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EMS Transport

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Communications System
connotes the ability to relay information
about an emergency response and to
receive information or instruction as to
what further actions should be taken.

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The BystanderThe Bystander
The DispatcherThe Dispatcher
The EMS RespondersThe EMS Responders
By calling first, youBy calling first, you
join a team ofjoin a team of
Emergency ServiceEmergency Service
dispatchers anddispatchers and
responders.responders.
Each member hasEach member has
a vital role.a vital role.
Early Access

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Medical Control - use of on-line communications
with a specialized physician or through off-line
protocols of care for emergency situations. Off-
line (indirect) medical control is the responsibility
of the service medical director.
Three components of off-line medical director are:
(1) development of protocols,
(2) development of medical accountability (QA)
(3) development of ongoing education.

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Equipment and Supplies - all the necessary
tools which EMT's need
Legislation and Advocacy - stipulates the
regulation of the practice of pre-hospital and
emergency medicine in a locality. Secures the
high standards of care needed. The financial
aspects of the EMS System may also be
included.

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Regional Trauma Care System
An organized approach in the
management of acute injury utilizing
the components of an EMSS and
trauma centers or definitive care
centers, trauma specialists and other
aspects of trauma care in a locality,
province, region or country.

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COMPARATIVE DESIGNS OF
EMERGENCY RESPONSE SERVICES
USA Philippines
Funding Well Funded Scarce Funding
Infrastructure Uniform federal Not Uniform
Support
National Safety
stats. Vehicles, Exists Does not Exist
equipment's
Minimum standard Recognition Requires
care provided present recognition
Minimum guidelines Existing Not existing
for education &
training

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COMPARATIVE DESIGNS OF
EMERGENCY RESPONSE SERVICES
USA Philippines
Support Professional Minimal Voluntary
Improvements in Organizations Organizations
System Design
Cost of Med. & Heightened Lack of
Trauma Care awareness awareness
Public Health Continued Non existent
Prevention Prog. Awareness
Network for Disaster Structured Partially
Response structured
System Flexibility Existent No System

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Human Resources in the
Emergency Medical Services System
Medical First Responder
Emergency Medical Technicians
EMT - Basic
EMT - Intermediate
EMT – Paramedic
EMS Physician/Medical Director
Emergency Nurses
Emergency Physician
General Surgeon/Trauma Surgeon/Orthopedic
Surgeon/Physicians
Emergency Manager/Emergency Department
Coordinator

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EP's and EMSS
Emergency Physicians (EP's)
great help in improving the health care
during MCI’s.
help triage and institute initial management
of injured patients while the surgeons deliver
definitive care.
this specialist may be those certified in other
fields of specialization like general surgery,
orthopedics, internal medicine, or family
medicine.

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Airway Devices
oxygen tanks
non-rebreather masks
nasal cannula
oropharyngeal airway devices of different sizes
nasopharyngeal airway devices
Intubation equipment like laryngoscopes
endotracheal tubes
LMA's (laryngeal mask airway)
tracheostomy instruments
tracheostomy tubes and suction machines
Cervical immobilization devices

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Management of Hypovolemic Shock
Devices for hemorrhage control
Surgical gauze packs
Elastic and rolled bandages
IV access, IV cannulas of different sizes, central
lines, cutdown sets, intra-osseous infusion needles
Crystalloids & colloids for fluid replacement
Access to blood bank facilities or blood retrieval
Traction splints for long bone fractures

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Defibrillation
Automated external defibrillators (AED's)
– Manual defibrillators
Personnel trained in ACLS
Biphasic defibrillators
Cardiac monitors w/ AED's incorporated
into one machine

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Critical Care Monitoring
Critical monitoring devices should include
pulse oximetry
non-invasive blood pressure readings,
heart rate and cardiac rhythm
Point of care testing devices like arterial
blood gas determinations (ABG) and
electrolytes are useful.
End Tidal carbon dioxide tension (ETCO2)

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Characteristics of the EMSS
Triage, Stabilize, Prioritize, Refer,
Observe
ABCs
Limited resources
– Time
– Information
– Space
Technology dependent
Cutting-edge medicine

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Unique Characteristics of
Prehospital Care
Not necessary to arrive at diagnosis
Does not follow sequence of SOAP
– Assess  Action  Reassess  Action
Always thinks of worst-case scenario
– Chest pain is MI!
SAMPLE history
Don’t believe everything you hear!

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Patient Transport
Star of Life
Type I – cab & chassis
Type II – van-type, modified height
Type III – larger with walk-through passage
BLS or ALS/ICU

1902 American Era
Used blueprint of Johns Hopkins University
(JHU)—the best US medical school
Philippine Medical School 1905
Philippine General Hospital 1907
University of the Philippines College of
Medicine 1908
Sept 1, 1910, state-of-the-art public teaching
hospital, the Philippine General Hospital

Philippine General Hospital
1910

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Philippine EMS System
Components
Transport (family van conversions)
Personnel (EMT-B)
Communications System (117)
Medical Control (EP's)
Equipment and Supplies
Legislation and advocacy (EMT law
SB3458)

Modern EMS units in the
Philippines
PNRC
Subic Naval Base
ERUF
AAP
PCSO
DOH STOPDEATH
UPPGH
Makati Rescue
Lifeline Arrows
BFP
FC Fire brigade
PAGCOR EMS
Bacolod Amity EMS
Davao 911
Marikina Rescue
Many others

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SAREX NAIA

Philippine Society
of EMT's
PSEMT
Affiliate of the Philippine Society
of Emergency Care Physicians
PSECP
Australasian Registry of EMT's
AREMT

Life Support Training
International
is a Philippine Training Industry leader in all
levels of instructions in pre-hospital emergency
care. It carries the standard of the Philippines
Society of Emergency Medical Technicians,
member expanded council of resuscitation of
the Philippine Heart Association, the
International Liaison committee on
resuscitation and the country regional affiliate
of Australasia Registry of Emergency Medical
Technicians.
http://apcaregivers.com/trainings.htm

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Directions in EMS
EMT Law
Research & Documentation
SimulationTraining
– BLS, ACLS, ATLS/BEST
– Emergency Nursing
– Emergency Medical
Technicians

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Directions in EMSS
Pre-Hospital & ED reimbursement
Emergency Public Health Information
Dissemination
EMS Systems Design
Patient Safety
Quality Assurance
Decreasing Errors in EM
Technology

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The Future is Uncertain
“Everything that can be invented have been
invented.”
Charles Duell Commissioner US Office of Patents 1899
“Who the hell wants to hear actors talk?”
Harry M. Warner Warner Brothers 1921
“There is no reason for any individual to have a
computer in their home.”
Kieth Olsen, President,
Chairman and Founder Digital Equipment Corp. 1977
(filed for bankcruptcy 1991)

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Questions ?Questions ?

Phil ems system

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