EMS Agenda for the Future

Academic: Based upon formal education; scholarly; conventional.

Academic Institution: A body or establishment instituted for an educational purpose and providing college credit or awarding degrees.

Accreditation: The granting of approval by an official review board after specific requirements have been met.

Advanced Directive: Written instructions by an individual providing directions to medical personnel in the event of critical illness with regard to the extent of resuscitative measures to be pursued.

Air Medical Transport: Emergency transport via rotor or fixed wing aircraft; may be from the scene (primary transport) or interfacility (secondary transport).

Automatic Vehicle Location: Technology or method used to track or determine a vehicle’s location or position and report the position, usually by radio, to a communications or command center. Methods include geo- positioning satellite (GPS), electronic sensed sign-posts, loran navigation, and inertial guidance computer mapped systems.

Bridging Program: An abbreviated educational program resulting in credentials that build on prior credentials in a related field; EMT certification for registered nurses.

Bystander: A citizen responder, not part of the EMS response team, on the scene of an illness or injury incident irrespective of training.

Chain of Survival: The four components of EMS response to out-of-facility cardiac arrest that are thought to effect the most optimal patient outcome. The four components include early recognition and EMS access, early CPR, rapid defibrillation, and advanced life support.

Command and Control Center: (Central Communications Center) - A place where responsibility rests for establishing communications channels and identifying the necessary equipment and facilities to permit immediate management and control of an EMS patient. This operation provides access and availability to public safety resources essential for efficient management of the immediate EMS problem.

Communication: The act of communicating. The exchange of thoughts, messages or information, as by speech, signals, writing or behavior. The art and technique of using words effectively and with grace in imparting one’s ideas. Something communicated; a message.

Communications: A means of communicating, especially: a system, such as mail, telephone, television or radio, for sending and receiving messages. A network of routes or systems for sending messages. The technology employed in transmitting messages.

Community Health Resources: Capability that may be offered within a neighborhood or community to aid in the detection, surveillance, and support of community health. This may include a municipal organization such as the fire service or EMS, department of public health, social service organization, volunteer organization, and others.

Component: An individual element, aspect, subgroup, or activity within a system. Complex systems (such as EMS) are composed of many components.

Computerized Record: Data maintained on computer for easy access, manipulation, refinement and review.

Core Content: The central elements of a professional field of study and relations involved; does not specify the course of study.

Cost-effective: Providing the maximal improved health care outcome improvement at the least cost.

Cost-effective Analysis: Analysis that determines the costs and effectiveness of an intervention or system. This includes comparing similar alternative activities to determine the relative degree to which they obtain the desired objective or outcome. The preferred alternative is the one that requires the least cost to produce a given level of effectiveness or provides the greatest effectiveness for a given level of cost.

Credentialing Agency: Organization which certifies an institution’s or individual’s authority or claim to confidence for a course of study or completion of objectives.

Curriculum: A particular course of study, often in a special field. For EMS education it has traditionally included detailed lesson plans.

Customary Charge: The amount that an individual company charges in the majority of claims for a specific item or service.

Data: Crude, isolated, nonanalyzed measures that reflect the status or degree of a measured attribute of a component or system.

Educational Affiliation: An association with a learning institution(s) (academic), the extent of which can vary greatly from recognition to integration.

Educational Objective: The outcome/goal of the teaching/training conducted; the desired knowledge to be imparted.

Effective: Capable of producing or designed to produce a particular desired effect in “real world” circumstances.

Efficacy: The effect of an intervention or series of interventions on patient outcome in a setting that is most likely to be positive (e.g., the laboratory or other “perfect” settings).

Efficiency: The effect or results achieved in relation to the effort expended (resources, money, time). It is the extent to which the resources used to provide an effective intervention or service are minimized. Thus, if two services are provided that are equally effective, but one requires the expense of fewer resources, that service is said to be more efficient.

Emergency Medical Dispatch: The function of providing prompt and accurate processing of calls, for emergency medical assistance by trained individuals, using a medically approved dispatch protocol system and functioning under medical supervision.

Emergency Medical Dispatcher (EMD): A trained public safety telecommunicator with additional training and specific emergency medical knowledge essential for the efficient management of emergency medical communications.

Emergency Medical Technician (EMT): A member of the emergency medical services team who provides out-of-facility emergency care; includes certifications of EMT-Basic, EMT-Intermediate, and EMT-Paramedic progressively advancing levels of care.

Emergency Physician: A physician specialized in the emergency care of acutely ill or injured patients.

EMS Personnel: Paid or volunteer individuals who are qualified, by satisfying formalized existing requirements, to provide some aspect of care or service within the EMS system.

EMS Physician: A physician with specialized knowledge and skills in the area of emergency medical service, including clinical car and systems management; a physician who specializes in emergency medical services system management, in which the provision of direct patient care is only one component.

EMS Protocol: Written medical instructions or algorithms authorized by an EMS medical director to be used by personnel in the field without the necessity of on-line ore real-time consultation with the physician or nurse providing medical direction.

EMS System: Any specific arrangement of emergency medical personnel, equipment, and supplies designed to function in a coordinated fashion. May be local, regional, state, or national.

Enabling EMS Legislation: Law that grants authority to specific entities to undertake activity related to the provision or establishment of an EMS system. Generally, enabling legislation represents a legislature’s delegation of authority to a state agency to regulate some or all aspects of an EMS delivery system. This may include technical support, funding, or regulation.

Episodic Care: An acute, relatively brief, intervention representing a segment of continuous health care experience.

Expanded Role/Expanded Scope: Increased dimensions of the services, activities, or care provided by EMS.

Federal Communications: A board of five commissioners appointed by the president Commission (FCC): Under the Communications Act of 1934 to formulate rules and regulations and to authorize use of radio communications. The FCC regulates all communications in the United States by radio or wireline, including television, telephone, radio, facsimile, and cable systems, and maintains communications in accordance with applicable treaties and agreements to which the United States is a party.

First Responder: The initial level of care within an EMS system as defined by the EMS Education and Practice Blueprint, as opposed to a bystander.

Health Care Delivery System: A specific arrangement for providing preventive, remedial, and therapeutic services; may be local, regional, or national.

Health Care Facility: A site at which dedicated space is available for the delivery of health care. This may include physicians’ offices and urgent care centers, as well as hospitals and other medical facilities.

Health Care Provider Network: Conglomerate of both community and hospital resources participating in a common contractual agreement to provide all health care needs to individual members of society.

Information: A combination of data, usually from multiple sources, used to derive meaningful conclusions about a system (health resources, costs, utilization of health services, outcomes and populations, etc.). Information cannot be developed without crude data. However, data must be transformed into information to allow decision making that improves a given system.

Informed Consent: Voluntary consent by a given subject, or by a person responsible for a subject, for participation in an investigation, treatment program, medical procedure, etc., after being informed of the purpose, methods, procedures, benefits, and potential risks. Awareness of risk is necessary for any subject to make an informed choice.

Infrastructure: The basic facilities, equipment, services, and installations needed for functioning; the substructure, components, or underlying foundation of a community or system.

Injury Control: A systematic approach to preventing and mitigating the effects of all injuries.

Injury Prevention: Activities to keep injuries from ever occurring (primary), or reducing further injury once it has occurred through acute care (secondary) and rehabilitation (tertiary).

Legislation: Lawmaking: the procedure of legislating; law or laws made by such a procedure.

Licensing: The act of granting an entity permission to do something which the entity could not legally do absent such permission. Licensing is generally viewed by legislative bodies as a regulatory effort to protect the public from potential harm. In the health care delivery system, an individual who is licensed tends to enjoy a certain amount of autonomy in delivering health care services. Conversely, the licensed individual must satisfy certain initial proficiency criteria and may be required to satisfy ongoing requirements which assure certain minimum levels of expertise. A license is generally considered a privilege and not a right.

Linkage: Connected; combining crude data from various sources to provide information that can be analyzed. This analyzed information allows meaningful inferences to be made about various aspects of a system. (An example would be linking EMS dispatch records, out-of-hospital patient care records, and hospital discharge data.)

Medicaid: A federal program, administered by the states, designed to provide health care coverage to the indigent. Established by Title XIX of the Social Security Act.

Medical Direction: The provision of management, supervision, and guidance for all aspects of EMS to assure its quality of care.

Medical Director: The physician who has the ultimate responsibility and authority to provide management, supervision, and guidance for all aspects of EMS in an effort to assure its quality of care (may be on a local, regional, state, and national level).

Medical Facility: A stationary structure with the purpose of providing health care services (e.g., hospital, emergency department, physician office, and others).

Medical Oversight: The ultimate responsibility and authority for the medical actions of an EMS system.

Medicare: A federal program designed to provide health care coverage to individuals 65 and over. Established on July 30, 1965, by Title XVIII of the Social Security Act.

Network: A formal system linking multiple sites or units.

Noninvasive Monitoring: Measurement/scanning accomplished without penetrating the viscera or superficial tissues.

On-line Medical Direction: The moment-to-moment contemporaneous medical supervision/guidance of EMS personnel in the field, provided by a physician or other specialty qualified health professional (e.g., mobile intensive care nurse), via radio transmission, telephone, or on the scene.

Out-of-facility EMS: Remote from a medical facility. In the case of EMS it pertains to those components of the emergency health delivery system that occur outside of the traditional medical settings (e.g., prehospital care, transportation, and others).

Outcome: The short, intermediate, or long-term consequence or visible result of treatment, particularly as it pertains to a patient’s return to societal function.

Perceived Emergent Need: A medical condition for which a prudent layperson possessing an average knowledge of health care believes there is a necessity of rapid medical treatment.

Personnel Configuration: Specific way of staffing or organizing members of the work force.

Pilot Project: A systematic planned undertaking which serves as an experimental model for others to follow.

Preparedness Based Payment: Reimbursing EMS agencies for the cost of being prepared to respond to an emergency.

Prevailing Charge: The amount that falls within the range of charges most frequently billed in the locality for a particular service.

Protocol: The plan for a course of medical treatment; the current standard of medical practice.

Provider: An individual within an EMS system with a specific credential(s) that defines a specific level of competency (i.e., first responder, EMT-Basic, EMT-Intermediate, EMT-Paramedic, or other).

Public Education: Activities aimed at educating the general public concerning EMS and health related issues.

Public Health: The science of providing protection and promotion of community health through organized community effort.

Public Safety Answering Point (PSAP): A facility equipped and staffed to receive and control 9-1-1 emergency telephone calls.

Public Safety Telecommunicator: An individual trained to communicate remotely with persons seeking emergency assistance, and with agencies and individuals providing such assistance.

Real-time Patient Data: Current patient information provided by a field technician at the patient location to a physician or health care facility at a remote site, potentially for the purpose of assisting the physician to make a better informed decision on patient treatment and/or transport.

Reciprocity: The ability for a license or certificate to be mutually interchangeable between jurisdictions.

Regional EMS System: A systematic approach to the delivery of Emergency Medical Services defined by distinct geographic boundaries that may or may not cross state boundaries.

Regulation: Either a rule or a statute which prescribes the management, governance, or operating parameters for a given group; tends to be a function of administrative agencies to which a legislative body has delegated authority to promulgate rules/regulations to “regulate” a given industry or profession. Most regulations are intended to protect the public health, safety and welfare.

Reimbursement: To compensate; to repay.

Research: The study of questions and hypotheses using the scientific method.

Safe Communities: An integrated injury control system-incorporating prevention, acute care, and rehabilitation-to understand and solve injury problems, and identify new partners to help develop and implement solutions.

Scope of Practice: Defined parameters of various duties or services which may be provided by an individual with specific credentials. Whether regulated by a rule, statute, or court decision, it tends to represent the limits of what services an individual may perform.

Stabilizing Care: The medical attention needed to achieve physical equilibrium in a person.

State-of-the-art: The highest use of technology or technique known at the time.

Statute: An act of legislative body which has been adopted pursuant to constitutional authority, by certain means and in such form that it becomes a law governing conduct or actions.

Subscription Program: A prepayment program; a prepayment made to secure future events; a prepayment made to secure a reduced ambulance bill either through assignment or discount. Must be actuarially sound.

System Preparedness: Efforts necessary to ensure the readiness to provide a specific standard of care.

Systems Analysis: The research discipline that evaluated efficacy, effectiveness, and efficiency based upon all relevant components that contribute to a system. This entails the examination of various elements of a system to ascertain whether the proposed solution to a problem will fit into the system and, in turn, effect an overall improvement in the system.

Telephone Aid: Ad-libbed telephone instructions provided by either trained or untrained dispatchers, differing from “dispatch life support” pre-arrival instructions in that the instructions provided to the caller are based on the dispatcher’s knowledge or previous training in a procedure or treatment without following a scripted pre-arrival instruction protocol. They are not medically pre-approved since they do not exist in written form.

Telephone Treatment Protocol: Specific treatment strategy designed in a conversational script format that direct the EMD step-by-step in giving critical pre-arrival instructions such as CPR, Heimlich maneuver, mouth-to-mouth breathing, and childbirth instruction.

Third Party Payor: Insurance; an entity which is responsible to pay for services even though it is not directly involved in the transaction.