Emergency Medical Care

Emergency Medical Care is an elite discipline, often combining Emergency Medicine with Medical Rescue. EMC forms a part of the vast Emergency Medical Services structure but extends into the Primary health care environment and the in Hospital environment. Strictly speaking they are Emergency Care Practitioners, but the use of Paramedic is acceptable. Individuals educated in this new field are specialists in caring for those in life threatening situations, and are knowledgeable in rural care with hospitals being far away.

Origins
Modern Emergency Medical Services systems developed following the 1966 publication of National Academy of Sciences paper entitled Accidental Death and Disability: The Neglected Disease of Modern Society and the work of J.F. Pantridge extending emergency cardiac care to the prehospital setting in the United Kingdom. Dr. Pantridge’s program in Northern Ireland inspired the pioneering efforts of physicians such as Eugene Nagel in Miami and Leonard Cobb in Seattle to extend emergency cardiac care to the patient’s home. As an important point of entry into the healthcare system, EMC is in a unique position to impact those patients. It is logical to assume that prehospital intervention positively affects patient outcome, but this influence is difficult to quantify. For example, early defibrillation to victims of sudden cardiac arrest, administration of nitroglycerin to patients with chest pain, and prehospital administration of fibrinolytic therapy to patients with myocardial infarction measurably saves lives. On the other hand, seemingly logical interventions such as the pneumatic anti-shock garment and endotracheal intubation in children in just over the past few years have begun studies and research that study if in fact harm is caused to the pediatric patient. More research is necessary to provide the evidence upon which EMC practices in pediatrics treatment can be based.

Short Course Training
The Emergency Medical Services has sprouted many qualifications, most being of a short course nature, where the majority of fire personnel were trained in courses of variable length and intensity, in order to render them able to care for injured persons, beyond the rescue aspect - for example NREMT, RettAss , EMA , CCA , ACP , CAP

The vast majority of operational EMC practitioners are short course trained.

University Education
Some still stagnant in the older ways find it difficult to grant the courses currently presented in Emergency Medicine the same respect as they would a course such as Occupational Therapy, Accounting, or Engineering. This is probably due to the unsophisticated, yet eager to help, reputation most Firemen, First Responders, and so called "bandage brigade" instances hold themselves to. They are often frowned upon by individuals and instances whom pride themselves with high academic attainment. Yet few would have guessed that some prehospital practitioners are more highly qualified- Bachelors, Honors, Masters, Doctorate- than they are. The most comprehensive undergraduate qualification currently available is the Bachelor in Emergency Medical Care Professional Degree, which after one may register as an Emergency Care Practitioner. Most countries have developed a tertiary level prehospital practitioner course such as:


 * Coventry University: Paramedic Science Foundation degree


 * Kingston University: Paramedic Sciences


 * Charles Sturt University: Bachelor of Clinical Practice (Paramedic)


 * Sheffield Hallam University: Diploma in Higher Education Paramedic Practice


 * Oxford Brookes University: Paramedic Emergency Care


 * The University of Northampton: Paramedic Science DipHE


 * University of Hertfordshire: Paramedic Science


 * University of Portsmouth: Foundation Degree in Paramedic Science / BSc Hons Emergency Care Practice


 * Central University of Technology: NDip Emergency Medical Care


 * Victoria University: Bachelor of Health Science (Paramedic)


 * Durban Institute of Technology: NDip Emergency Medical Care


 * Cape Peninsula University of Technology: NDip Emergency Medical


 * University of Johannesburg: Bachelor of Technology Emergency Medical Care

The various institutions have created many different programs, shifting the foci of the courses between management, medical care and rescue. Most courses have various physical requirements to meet. The reasoning behind being physically competent is to ensure the safety of the emergency care practitioner, the patient, and others on scenes. Common evaluations are phobias, medical examination, physical fitness and swimming proficiency.

Universal areas taught throughout the various programs include:High angle1.jpg


 * Emergency Medical Care Theory and Practical components
 * Foundations of Professional Practice
 * Anatomy
 * Physiology
 * Chemistry
 * Physics
 * Diagnostics
 * Primary health care
 * Pathophysiology
 * Pharmacology
 * Research Methodology
 * Management Practice
 * Educational Techniques
 * Emergency Service Administration
 * Psycho-psychiatry
 * Disaster Management
 * Various Rescue Training
 * Experiential Learning
 * A Research Elective
 * Welfare, Health and Inequalities
 * Helicopter Procedures
 * Dissertation

Many companies require that additionally, the Advanced Cardiac Life Support(ACLS), Advanced Trauma Life Support (ATLS), Pediatric Advanced Life Support (PALS) courses be completed. These courses are available to many medical practitioners, but are especially useful in adding the full emergency aspect to physician education. Thus for those who have studied emergency medical care for two to four years, it is of little value.

Rescue
Rescue is commonly accepted as a necessary skill for the paramedic. Due to the nature of work it is obvious that rescue training greatly enhances the performance of the paramedic. Even in situations where the paramedic is not an active rescuer his understanding of the rescue process creates optimal patient conditions. Although some controversy exists as it is argued that most paramedics are not in the line of work to encounter rescue scenes, it is still widely required to have rescue qualifications.

Most University programs incorporate various rescue areas as modules or subjects, even if only at introductory level.

Common rescue areas are:


 * Fire search and rescue


 * Motor vehicle rescue


 * High angle rope rescue


 * Industrial and agricultural rescue


 * Swift water rescue


 * Still water rescue


 * Aviation rescue


 * Hazardous materials rescue


 * Wilderness search and rescue


 * Confined space rescue


 * Trench rescue


 * Structural collapse rescue

Pharmacological Scope
Even though the regional scopes vary widely, there are similarities in the drugs that may be administered by emergency care practitioners. They include drugs used for Rapid sequence induction, Thrombolysis, Sedation, Analgesics, and for use in systemic conditions such as Anaphylaxis

Key Players
Every country has a body to regulate standards and practices by emergency care personnel, as well as a council or committee to lead the way in the latest advancements.


 * Australian Resuscitation Council


 * Egyptian Resuscitation Council


 * European Resuscitation Council


 * American Heart Association


 * New Zealand Resuscitation Council


 * Heart and Stroke Foundation of Canada


 * Resuscitation Council of Southern Africa

All these entities are conveniently brought together by the International Liaison Committee on Resuscitation (ILCOR). ILCOR was formed in 1992 to provide a forum for liaison between principal resuscitation organizations worldwide. The spearhead of most Emergency Medical Care programs are formed by ILCOR. Key persons from the various EMC training instances attend the ILCOR Symposia and seminars on a regular basis.