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INTRODUCTION Ambulance service is very challenging and rewarding service provided by hospital through out the country. It provides the first professional medical aids to the victims.. Through quick assessment, treatment, management, communications and transportation countless life can be saved. INTRODUCTION In real life, paramedics try to comfort little old ladies with broken hips, and they sometimes help derelicts who are dirty and smell bad. Other times they take abuse from people who are under influence of alcohol and drugs. Occasionally, they get called to exciting and dangerous emergencies that would make a good TV shows, but that doesn¶t happen every day. Modern EMS system developed to provide what is known as ³prehospital´ or ³out of hospital´ care. The purpose: - is to get trained personnel to the patient quickly as possible, and - to provide emergency care on the scene, - en route to the hospital, and - at the hospital. HISTORY No actual records are available. Ambulance was said to be introduced in the fifties. Ambulance services were more of scoop and run. Ambulance team consist of a driver and an attendant. Later a medical assistant role was inevitable HOW DID PARAMEDICS COME TO BE? In 1790s, French transported wounded soldiers so that they can be cared by physicians away from the scene. During WWI & WWII, many volunteers joined battlefield non military ambulance corps - transport service only. During conflict in Korea (1950s) and Vietnam¶s War (1960s & 1970s), medical teams produces advances in field care for trauma « MAST suit. HOW DID PARAMEDICS COME TO BE? Importance of extending hospital-quality care to sick and injured at emergency scene were recognized - of beginning care at the scene and continuing it, uninterrupted, during transport to hospital. Need to organize systems for such Emergency Pre Hospital Care and to train personnel to provide it. HOW DID PARAMEDICS COME TO BE? 30 years ago, no such things as EMT, paramedic. Today more than 50,000 EMT-paramedic in USA, Australia, Germany, Canada & U.K. Story begins in Belfast, Northern Ireland, Germany, Eastern Europe, where mobile ICU introduced in 1950s and 1960s to enable early care of critically ill and injured. HOW DID PARAMEDICS COME TO BE? Idea was simple ´ Bring the emergency room to the patient before bringing the patient to the emergency room´ & therefore saves precious minutes that could mean life and death. The idea worked and MICUs proliferate in various European countries. HOW DID PARAMEDICS COME TO BE? In USA, not feasible to staff ambulances around the clock with physicians specially trained in Emergency Care. In 1960s, no physicians specially trained in Emergency Care. Early MICUs in USA staffed with cardiologist. Very few interested in riding the ambulances. Become necessary to look for alternatives to physician staffing in MICUs. HOW DID PARAMEDICS COME TO BE? The question were asked: Can a non physician be taught the sophisticated skills of Advance Life Support! 1st Doctor to provide affirmative answer to the question was Dr. Eugene Nagel and he was considered the ³Father of Paramedics´, trained Miami fireman in Advance Emergency skills to supplement the basic first Aid the learned as part of their fire training. HOW DID PARAMEDICS COME TO BE? In addition, Dr. Nagel developed the telemetry system that enables firemen to transmit a patient¶s ECG to doctors and receive instructions from the doctor regarding measures to take. With the introduction of radio / telemetry communication, the rescuer working in the street became an extension of the doctor working in the emergency room. HOW DID PARAMEDICS COME TO BE? This idea of operating under radio command by physicians spread quickly. By 1976, US Department of Transportation issued 1st set of National Standards and Guidelines for paramedic training. By end of 1980, there were >50,000 paramedics certified in USA. EMS TODAY In 1960s, development of modern EMS system begin. In 1966, USDOT set up and upgrade quality Prehospital Emergency Care EMS TODAY The categories and standards set summarized below: Regulation and policy - must have legislation, regulations, policies and procedures. Resource management - centralised coordination of resources so that all victims of trauma or medical emergencies have equal access to EMS TODAY Resource management - basic emergency care and transport by certified personnel, in a licensed and equipped ambulance, to an appropriate facility. Human Resources and Training - at the minimum, all transporting prehospital personnel should be trained using standardized curriculum taught by qualified professional EMS TODAY Transportation - Safe, reliable ambulance transportation is a critical component. - Ground ambulances / Helicopter or airplane rapid transportation Facilities Seriously ill or injured patient must be delivered in a timely manner to the closest appropriate facility - EMS TODAY Communications - must have effective communication system: * beginning with Universal Number, * dispatched -to-ambulance, * ambulance-to-ambulance, * ambulance-to-hospital, and * hospital-to-hospital communications EMS TODAY Public Information and Education Center - EMS personnel may participate in efforts to educate the public about: * their role in the system, * their ability to access the system, * and prevention of injuries. Medical Direction - EMS physician delegate medical practice to non-physician providers (Medical Delegate Act) and must be involved in all aspects of the patient care system EMS TODAY Trauma systems - Enabling legislation must exist to develop a trauma system including : * one or more trauma center, triage, and transfer guidelines for trauma patients, * rehabilitation programs, data collection, mandatory autopsies, and * means of managing and assuring the quality of the system EMS TODAY Evaluation - Must have a program for evaluating and improving the effectiveness of the EMS system, known as Quality Improvement Program (QIP), a Quality Assurance Program (QAP), or a Total Quality Management (TQM). AMBULANCE SERVICE FLOW CHART Dial 999 via Telecoms AED Medical Asistants Alarm / Ambulance Staff Equipment Communications Ambulance Team Departs AMBULANCE SERVICE FLOW CHART VICTIMS 1ST AID Scoop & Run Enroute to Hospital AED Discharge Specialist Clinic Admission to Ward Mortuary CPR / BLS What are the future directions of the Ambulance Service Privatisation - Foundation Level (3 months) - Paramedic Level I (6 months) - Paramedic Level II (2 years) - Paramedic Level III - Post Diploma (Advance Diploma Paramedical Science (Pre Hospital Care - Australia[ Level V - 6 months])