EMS AND DISASTER MEDICINE■ Public utility model: Allows a local government to contract all their calls
to a privatecompany that provides basic life support (BLS) and/or advanced
life support (ALS); the government oversees and regulates performance
■ Third service model: A separate municipal department owns, operates,
and staffs ambulances
■ Fire station–based model: Public fire department provides all EMS
services
■ Combined public/private model: eg, fire department provides first response
with transportation to hospital provided by private ambulance service
All models provide first responders, but the response after that varies:
■ Single-tier system: ProvidesonlyBLSorALS (including EMT-I and EMT-P)
response
■ Multitiered system: Provides a mixed BLS/ALS response
■ Is becoming less common
COMPONENTS OF AN EMS SYSTEMThe Emergency Medical Service Act of 1973 identified 15 essential compo-
nents of an EMS system. (See Table 20.2. Shaded entries are discussed in this
chapter.)
Training
Multiple levels of EMS training and credentialing exist (see Table 20.3).
■ First responders (FR)
■ Firefighters, police officers, community EMS responders: First to arrive
on scene
■ Are trained in CPR, BLS, and basic trauma care
■ Emergency medical technician basic (EMT-B)
■ The lowest EMT level
■ Can perform BLS, automated external defibrillation (AED), basic
assessments, and assist in medication administration
■ Emergency medical technician intermediate (EMT-I)
■ Addition of IV access, endotracheal intubation, and manual defibrillation
■ Emergency medical technician paramedic (EMT-P)
■ The most advanced EMT level
■ Can perform advanced airway procedures, needle decompression of
chest, ECG interpretation, external pacing, and advanced drug therapy
Communication
After activating the system via 911, goal is to get BLS to scene in 4 minutes
and ALS in 8 minutes. An enhanced 911system displays the caller’s tele-
phone number and address.
The emergency medical dispatcher must
■ Take and triage call
■ Alert appropriate unit
■ Address location
■ Assist victim until arrival
Communication must also be available between hospital and field or dispatch
center via designated radio frequencies.
In a multitiered EMS system
the level of response (BLS or
ALS) depends on the nature of
the call.In a single-tier EMS system
only one level of response (eg,
BLS) is provided for every call.EMT-B providers can assist in
medication administration
and provide BLS, AED, and
basic care.EMT-P providers can perform
advanced drug therapy, ECG
interpretation, external pacing,
surgical airway, and needle
decompression of chest.