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 important way.
The first crucial step in the cardiac chain of survival is recognizing cardiac arrest and activating the emergency response system (Schlesinger, 2024). Recognizing the signs of MI, such as angina, weakness, faintness, pain or discomfort in one or both shoulders or arms, and shortness of breath, is critical for timely medical intervention. Although these are common symptoms of MI, others, such as nausea, lightheadedness, and cold sweats, may also be signs of an impending cardiac arrest. Symptoms may present differently between genders as well. In any case, once symptoms are identified, 911 should be called immediately. Early intervention results in more favorable outcomes for the patient.
Basic Life Support Ambulance
Ambulances are typically staffed by emergency medical technicians (EMTs), paramedics, or a combination of both. Basic life support ambulances provide emergency and scheduled transportation for the sick and injured, as well as for those who require transportation and cannot be transported by other means.
Advanced Life Support Care
Advanced life support care is provided by paramedics and, in some areas, by advanced emergency medical technicians (AEMTs). Paramedics, the highest level of prehospital care providers, along with AEMTs, deliver advanced life support to patients who have suffered medical or trauma-related injuries. These providers perform advanced assessments and treatments that include medication administration, airway management, and cardiac rhythm interpretation.
Emergency Department
The emergency department is the primary destination for patients who require ongoing care. Every hospital has an emergency department, staffed by specially trained physicians, midlevel providers (PAs and NPs), respiratory therapists, and nurses. These departments are tasked with providing the care needed to treat and stabilize patients. If further care is required, patients are either admitted to the hospital or transferred to a larger facility with more specialized services. In some areas, free-standing emergency departments, usually affiliated with a hospital, are common, and some EMS agencies may transport patients to these facilities.
Trauma Center
Trauma centers are hospitals designated to provide care and stabilization for patients who have experienced serious traumatic events. In Washington state, trauma centers are classified into five levels, with Level 1 being the highest. A Level 1 trauma center is typically located in a large academic teaching hospital and is prepared 24/7 to receive the most critically injured and complex trauma patients (American Trauma Society, 2019). These centers have trauma surgeons on-site, along with operating rooms and surgical staff ready at a moment’s notice. They also provide ongoing care in intensive care units and offer rehabilitative services.
Level 2 trauma centers provide most of the same care as Level 1 centers, but may not have access to certain specialized subspecialty care. Levels 3, 4, and 5 trauma centers are more commonly found in rural and suburban areas. Level 3 centers provide initial care and stabilization for critical trauma patients before transferring them to a higher-level trauma center for continued care. Like Level 1 and 2 centers, Level 3 centers have 24-hour emergency medicine physicians on hand. Level 4 and 5 centers typically offer more basic emergency services, including evaluation, stabilization, and diagnostic testing, and provide advanced trauma life support before transferring patients to higher-level trauma centers.
Tertiary Care Center
Tertiary care centers are specialized hospitals that provide care to specific groups of patients. Examples include burn centers, pediatric hospitals, and neonatal intensive care centers. Most tertiary care centers are part of, or affiliated with, large academic teaching hospitals.
Attributions
- Figure 6.2: image released under the Pexels License
- Figure 6.3: image released under the Pexels License
- Figure 6.4: MarkhamStouffvilleHospital23.jpg by Raysonho is released under CC0
A physician who is responsible for all aspects of patient care for an EMS system.
Abbreviated CAD.
Chest pain or discomfort caused by insufficient oxygen supply to the heart muscle, typically due to narrowed or blocked coronary arteries.
Abbreviated as MI and also known as a heart attack. A serious medical condition where there is a sudden blockage of blood flow to a portion of the heart muscle, leading to tissue damage or death.
Sudden loss of cardiac activity due to an irregular rhythm.
Commonly abbreviated as AED. A portable electronic device that can diagnose cardiac arrhythmias and is able to treat them through defibrillation to re-establish a normal rhythm.
Abbreviated as EMT. A healthcare professional who provides prehospital emergency medical care and transportation for critical and emergent patients.
An allied health professional whose primary focus is to provide advanced emergency medical care for critical and emergent patients.
Hospitals that are designated as being able to deliver the care and stabilization to patients who have experienced a serious trauma related event.