Chapter 6: Pre-Hospital Care
Karen Piette
Before the basic components of prehospital medicine are discussed, it is important to be familiar with medical direction used in EMS systems. Medical direction comes from qualified physicians based upon state, regional and local guidelines. These guidelines are based on current research and local needs. The ems medical director in most systems defines the clinical guidelines that advanced level providers function under. As part of medical direction, they are involved in quality review of most critical calls. They are involved in the quality improvement functions within an agency, constantly looking at ways to improve the delivery of prehospital emergency care.
First Response
First responders are those medical trained providers who will arrive prior to the Ambulance of EMS responders. These responders may be public safety personnel (police, fire or off-duty healthcare workers) or industrial responders who may respond to an industrial accident. In critical situations, these first responders may reach the patient and administer lifesaving care within minutes of the incident. This critical care has demonstrated a greater chance of survival for the patient. Most providers that fall into this group are trained at the Emergency Medical Responder (EMR) level or higher.
Disease Dissection: Coronary Artery Disease
According to the Center of Disease Control, coronary artery disease (CAD) is the most common form of heart disease. CAD is caused by atherosclerotic plaque buildup in the walls within the coronary arteries. The coronary arteries are the arteries that supply the heart with blood. Chest pain or angina is the most common symptom of CAD. Once plaque builds up, the arteries narrow causing angina to occur. Angina is a sign of a heart attack or myocardial infarction (MI), which occurs when a blood vessel supplying the heart becomes blocked, leading to death of part of the heart muscle. Different from an MI, cardiac arrest occurs when the heart stops beating and pumping blood. The damage an MI causes can lead to cardiac arrest. This condition is critical and will become fatal without appropriate intervention. During cardiac arrest, the patient requires Cardiopulmonary Resuscitation (CPR) and most likely the use of an automated external defibrillator (AED). AED’s analyze the patient’s heart rhythm and, when necessary, deliver an electrical shock to help the heart re-establish an effective rhythm. Public access defibrillator AED’s are available in many areas including schools, public buildings, and shopping malls. The goal is to provide “Zero minute” response time 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. As you begin your journey in healthcare you will undoubtedly encounter this disease. It is also important to recognize the signs of an MI and be prepared to act as future health professionals. While you