Core Topics to Review for EMS and Public Health Preparedness
Focus your review on understanding trauma system protocols, Mobile Integrated Healthcare scope, NHTSA assessment standards, and the distinction between public health core functions—these are the areas where your pre- and post-test errors clustered most heavily.
1. Trauma Patient Destination Decisions
Always transport multisystem trauma patients to designated trauma centers rather than closer community hospitals, even if it means traveling farther. 1
- Multisystem trauma includes patients with multiple long bone fractures, especially when combined with altered mental status—this is NOT a "simple emergency" 1
- Trauma centers (Level I or Level II) provide definitive care, not just stabilization, which significantly reduces mortality 1
- Mortality is 20% lower at Level I trauma centers compared to large non-trauma hospitals for severely injured patients (10.4% vs 13.8%) 1
- Undertriage (sending trauma patients to non-trauma centers) carries high risk of death or substantial morbidity; systems target 0-5% undertriage rates 1
- The Transportation standard focuses on safe vehicle transfer, NOT destination selection—destination protocols fall under the Trauma Systems standard 1
Common Pitfall:
Do not confuse proximity with appropriateness. The extra 2 miles to a trauma center is clinically justified for multisystem trauma patients. 1
2. NHTSA Technical Assistance Program Assessment Standards
Medical Direction is one of the 10 core standards, while 911 emergency phone numbers fall under the Communications standard. 1
The 10 Standards (memorize these):
- Regulation and Policy: State laws/regulations governing EMS, including minimum staffing requirements (e.g., EMT + Paramedic) 1
- Resource Management: Equal access to EMS across all localities 1
- Human Resources and Training: Minimum EMT-level certification for all ambulance personnel 1
- Transportation: Safe, reliable ground/air transport—focuses on vehicle safety, NOT destination 1
- Facilities: Timely delivery to appropriate medical facilities 1
- Communications: Public access systems and dispatcher-to-hospital communication 1
- Public Information and Education: Injury prevention and proper EMS access education 1
- Medical Direction: Physician oversight of clinical care and delegation of medical practices 1
- Trauma Systems: Specialized trauma care facilities and patient assignment/transport protocols 1
- Evaluation: Quality improvement and system upgrades 1
Key Distinction:
Regulation and Policy governs staffing requirements, while Medical Direction provides clinical oversight. 1
3. Advanced EMT (AEMT) Scope of Practice
AEMTs perform all EMT skills PLUS advanced airway devices, IV/IO access, blood glucose monitoring, AND administration of select medications—not just airway management. 1
- AEMTs can initiate intravenous and intraosseous infusions 1
- AEMTs can administer a select number of medications beyond basic EMT scope 1
- Chest decompression typically requires paramedic-level training, not AEMT 1
4. Mobile Integrated Healthcare (MIH) vs. Community Paramedicine
MIH includes telephone advice to 911 callers (call routing/nurse lines) in addition to in-person community paramedicine services. 1
MIH Services Include:
- Providing advice to 911 callers via telephone instead of dispatching resources 1
- Increasing access to care in underserved/rural areas 1
- Managing high-volume healthcare users and chronic disease conditions 1
- Preventative care and post-discharge follow-up visits 1
- Patient education significantly increases EMS value in the healthcare system 1
Key Distinction:
Call routing (transferring low-acuity 911 calls to nurse lines) is an example of MIH, not a separate category. MIH represents the broader shift from emergency-only response to comprehensive patient-centered care. 1
5. Public Health Core Functions: Assessment vs. Assurance
Assurance evaluates the effectiveness, accessibility, and quality of health services—Assessment collects and analyzes community health data. 1
The Three Core Functions:
Assessment:
- Monitor health status to identify community problems 1
- Diagnose and investigate health problems 1
- Systematic collection, assembly, and analysis of health information 1
Policy Development:
Assurance:
- Evaluate effectiveness, accessibility, and quality of health services 1
- Enforce health protection laws 1
- Link people to needed health services 1
- Ensure competent public health workforce 1
Memory Aid:
Assessment = data collection; Assurance = quality evaluation. 1
6. Enhanced 911 Systems
Phase II Enhanced 911 provides latitude and longitude of the caller (accurate within 50-300 meters), while Phase I only provides cell tower location. 1
- Basic 911: Transmits all calls to PSAP regardless of subscription 1
- Phase I E-911: Provides phone number and cell tower/base station location 1
- Phase II E-911: Provides caller's latitude and longitude coordinates 1
7. Public Health Achievements and EMS Impact
Motor vehicle safety translates into fewer EMS patients more directly than vaccination programs, as trauma constitutes a larger proportion of EMS calls. 1
- While vaccinations are a major public health achievement, motor vehicle safety has more immediate impact on EMS call volume 1
- Reduction in coronary heart disease and stroke also significantly reduces EMS patient volume 1
- Trauma systems and vehicle safety directly affect the types of emergencies EMS responds to 1
8. Health Department Functions
Vehicle rescue training is NOT a health department function—it falls under EMS operational training. 1
Health Department Functions Include:
- Injury surveillance (tracking and analyzing injury patterns) 1
- Disease monitoring and outbreak investigation 1
- Health education and promotion 1
- Policy development for public health 1
9. Transport-Related Risks
Ambulance vehicle crashes pose the greatest risk during patient transport, not patient handling injuries. 1
- Vehicle crashes during transport represent a significant, preventable risk 1
- While patient movement risks exist, they are more controllable than crash risk 1
- EMS providers have direct control over safe driving practices but less control over external crash factors 1
- Transporting to the wrong hospital is suboptimal but not the most grievous error 1
Risk Mitigation:
Preparation and management are crucial steps with direct impact on patient prognosis during transport. 1
10. Study Strategies for Pre/Post-Test Improvement
Formulation of questions followed by small group discussion significantly improves understanding and retention across all achievement levels. 2
- Creating your own questions on topics forces deeper engagement with material 2
- Small group discussion is particularly effective for low and medium achievers 2
- High achievers gain more from question formulation than discussion 2
- Learning gains are retained after 15 days 2
Application to Your Review:
Create practice questions on the 10 NHTSA standards, MIH services, and trauma triage criteria, then discuss answers with peers or review them systematically. 2