Module 7: EMS Operations and Professional Issues

Section 1: Incident Command System (ICS)

1.1 Role of EMS in ICS

• Definition: ICS is a standardized approach to the command, control, and coordination of emergency response

• EMS Responsibilities in ICS:

  • Provide triage, treatment, and transport for patients

  • Communicate effectively with other teams (fire, law enforcement)

  • Operate under the Medical Branch Director or Incident Commander

1.2 ICS Structure

• Key Positions:

  • Incident Commander (IC): Overall authority

  • Operations Section Chief: Manages tactical operations

  • Medical Branch Director: Supervises EMS operations

  • Triage, Treatment, and Transport Officers: Focus on patient care

1.3 Integration into ICS

• Follow chain of command.

• Use standard terminology for clarity (ex, "10-33" for medical emergency)

• Ensure resource requests go through the proper channels

Section 2: Scene Management

2.1 Securing the Scene

• Scene Safety:

  • Identify hazards: Environmental (fires, spills), situational (weapons, violence)

  • Use PPE appropriate to the scene (ex., gloves, helmets, reflective vests)

• Perimeter Control:

  • Work with law enforcement to establish a safe working area

2.2 Triage and Mass Casualty Incidents (MCI)

• Triage Methods:

  • START Triage (Simple Triage and Rapid Treatment):

    • Assess breathing, circulation, and mental status

    • Assign color-coded tags:

      • Red: Immediate (life-threatening injuries)

      • Yellow: Delayed (serious but not life-threatening)

      • Green: Minor (walking wounded)

      • Black: Deceased or non-salvageable

• MCI Best Practices:

  • Establish triage, treatment, and transport zones

Section 3: Documentation and Communication

3.1 Patient Care Reports (PCRs)

• Purpose:

  • Legal record of care provided

  • Communication tool for receiving facilities

• Essential Components:

  • Patient demographics

  • Chief complaint and history of present illness

  • Vitals, interventions, and outcomes

3.2 Effective Communication

• Radio Communication:

  • Use clear, concise language. Avoid unnecessary jargon

  • Example: "OA101 en-route to a two-vehicle collision, three patients, ETA 5 minutes."

• Handoff Reports:

  • Use the SBAR format:

    • Situation: Chief complaint

    • Background: Relevant medical history

    • Assessment: Findings and interventions

    • Recommendation: Specific needs (ex, trauma team activation)

Section 4: Legal, Ethical, and Professional Responsibilities

4.1 Legal Considerations

• Scope of Practice:

  • Know state and local guidelines for EMS interventions

  • Example: Paramedics may administer medications, while EMTs cannot

• Consent:

  • Expressed: Patient directly agrees to care

  • Implied: Assumed for unconscious/incapacitated patients

  • Minors: Require parental consent unless life-threatening

• Documentation:

  • Accurate, timely, and complete reports protect against legal liability

4.2 Ethics in EMS

• Principles:

  • Beneficence: Act in the patient’s best interest

  • Non-maleficence: Do no harm

  • Autonomy: Respect the patient’s choices

  • Justice: Provide equitable care to all

Section 5: Case Studies

Case Study 1: MCI at a Train Derailment

• Scenario: 20 patients at the scene. Hazards include spilled fuel and overturned cars

• Actions:

  • Ensure scene safety and establish a command post

  • Use START triage to prioritize patients

  • Coordinate with fire and law enforcement for resource allocation

Case Study 2: Refusal of Care

• Scenario: 65-year-old male with chest pain refuses transport

• Actions:

  • Explain risks of refusing care

  • Document the refusal with a witness signature

  • Provide the patient with instructions to call 911 if symptoms worsen