Challenges and Changes in the EMS Field

EKU Online > Challenges and Changes in the EMS Field

Modern EMS grew into what it is today in the early 1970s with a focus on cardiac and traumatic injuries. The first paramedics in America were trained to be physician extenders for heart attacks and other medical emergencies. Consequently, the area of resuscitation is something that is considered the bread and butter of EMTs and paramedics.

Heart disease, which causes heart attacks, is still the leading cause of death for Americans. In Kentucky, EMTs are allowed to use the more robust, fully featured cardiac monitor defibrillators. These are much more involved compared to the AEDs you might see in an airport or mall. Regardless of whether automated defibrillators or manual defibrillators are used, this equipment is a mainstay of the trade to address cardiac emergencies.

Emergency Treatment for Opioid Overdose

While resuscitation and cardiac emergencies were at the forefront of the profession, the opioid crisis has introduced a new challenge for the field. Many communities are still struggling with opioid and narcotic addiction issues. This issue reached its peak a couple of years ago, but still continues to be an area of concern. Unfortunately, during COVID and the mass quarantines, many communities saw a spike in overdoses.

It’s important to note in the treatment of an overdose, the use of Narcan for example, is secondary to the real issue for those patients, which is a lack of oxygenation. The reason Narcan is given is to reverse the effects of the opioid, which depresses respiration. The general public now has greater access to Narcan and tends to focus on its use. However, EMS providers are going to first pull out a bag valve mask and oxygen, and are going to start to breathe for that patient. Narcan becomes a very helpful adjunct to that oxygenation and those artificial ventilations.

Challenges for Lay People Responding to Emergencies

In addition to Narcan, the public now has greater access to tools such as AEDs. However, many people may not be prepared for how messy a situation can be when assisting with an emergency. Many times, patients in cardiac arrest experience a degradation of body systems that may include vomiting or a loss of bowel or bladder control. Additionally, the patient may have sustained injuries if they had a sudden cardiac arrest and fell or collapsed resulting in facial injuries and bleeding. Those things can be very disturbing and off-putting for lay responders.

That is part of the reason why there is still an emphasis on hands-only CPR. The American Heart Association made that recommendation about 5 years ago so lay responders would not be intimidated by some of the disturbing side effects of cardiac arrest. They can focus on doing chest compressions until professional responders arrive. These events are often traumatic for a layperson to witness and are not usually fully addressed in a CPR class. Professional responders are prepared to deal with those things and have a range of equipment that can be deployed to address multiple situations.

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About the Author

Assistant professor, David Fifer, is the coordinator of the online paramedic degree program. It is one of just a handful of baccalaureate paramedic programs in America. David also works as a paramedic for Powell County ambulance service. He deploys to disaster areas and national security events as a part-time employee of the U.S. Department of Health and Human Services National Disaster Medical System.

David is also the chair of the Kentucky Board of EMS Wilderness Medicine work group, serves on the Kentucky Board of EMS’s Education Committee, is a member of the board of directors of the Appalachian Center for Wilderness Medicine, and is the founding coordinator of the Red Star Wilderness EMS unit serving Kentucky’s Red River Gorge.

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