6.2 The Basic Components of Prehospital Medicine
Karen Piette, MHS, CMA
Before discussing the basic components of prehospital medicine, it is important to understand medical direction in EMS systems. Medical direction is provided by qualified physicians who base their decisions on state, regional, and local guidelines. These guidelines are based on current research and local needs. In most systems, the EMS medical director defines the clinical guidelines under which advanced-level providers function. As part of their role, medical directors are involved in reviewing critical calls for quality assurance. They also play a key role in the agency’s quality improvement efforts, continually seeking ways to enhance the delivery of prehospital emergency care.
First Response
First responders are medically trained providers who arrive at the scene before EMS responders. These responders may include public safety officers (police, fire, or off-duty healthcare workers) or industrial responders at the site of an industrial accident. In critical situations, first responders can provide life-saving care within minutes of the incident, significantly improving the patient’s chances of survival. Most individuals in this group are trained at the emergency medical responder (EMR) level or higher.
Disease Dissection: Coronary Artery Disease
According to the Centers for Disease Control and Prevention (CDC, 2021), coronary artery disease (CAD) is the most common form of heart disease. CAD is caused by atherosclerotic plaque that builds up in the walls of the coronary arteries, which supply the heart with blood. Chest pain, or angina, is the most common symptom of CAD. As plaque accumulates, the arteries narrow, triggering angina. Angina can be a sign of a heart attack or myocardial infarction (MI), which occurs when a blood vessel supplying the heart becomes blocked, leading to the death of part of the heart muscle.
Unlike MI, cardiac arrest occurs when the heart stops beating and pumping blood. The damage MI causes can lead to cardiac arrest, which is critical and will become fatal without appropriate intervention. During cardiac arrest, the patient requires cardiopulmonary resuscitation (CPR) and, in most cases, use of an automated external defibrillator (AED). AEDs analyze the heart’s rhythm and, if necessary, deliver an electrical shock to help the heart reestablish an effective rhythm. Public access AEDs are available in many places, including schools, public buildings, and shopping malls, with the goal of providing “zero-minute” response times to cardiac arrest victims.
As a future health professional, it is important to know that heart disease is the leading cause of death in the United States. During your healthcare journey, you will undoubtedly encounter this disease. It is also important to recognize the signs of MI and be prepared to act. While you may not be trained to provide first responder-level care in medical crises, you can still assist in a vitally i