La. Admin. Code tit. 48 § I-11521

Current through Register Vol. 50, No. 9, September 20, 2024

Section I-11521 - Emergency Medical Services A. Definition/Description

1. Title 40 of the Louisiana Revised Statutes established the Emergency Medical Services program within the Louisiana Department of Health & Human Resources. The department was granted the authority to adopt rules and regulations pertaining to Emergency medical Services in Louisiana and to responsibility for coordinating the planning and implementation of the statewide Emergency Medical Services systems.

2. Emergency Medical Services (EMS) are services utilized in responding to a perceived need for immediate medical care to prevent death or aggravation of physiological or psychological illness or injury. The purpose of EMS is to respond to and care for people who have experienced a medical emergency, including care at the scene of the emergency, during transportation to a medical facility, and in the hospital emergency department or specialty care center.

3. For an EMS system to respond effectively, each element of the integrated system must be in place, so that assistance is summoned when needed and patients are transferred smoothly along the chain of emergency medical care. An EMS system should include an organized method for detecting, reporting, providing initial care, sorting or triage, transporting, caring for patients en route, giving acute definitive care to and providing linkage to continued care and rehabilitation for acutely ill or injured patients.

4. Although the development of multi-institutional systems for coordination or consolidation of health services such as EMS is a national health priority, there have been problems in successful community planning. Some of the obstacles have been the lack of clear federal guidelines, lack of coordination between agencies with program responsibilities, and lack of uniformity and reliability of data to indicate need for improvement.

5. The specific health status and environmental characteristics of the state or service area impact the development of an EMS system. An individual's residential and occupational settings greatly affect his degree of risk, of becoming an emergency victim, and of coming into contact with an emergency situation. Local occupational settings such as industrial or offshore workplaces carry high risk of life-threatening events and risk of medical attention not being readily available. In rural communities residents are separated from each other and from medical assistance by long distances. Low population density creates unique needs; sparsely populated areas have higher rates of traffic fatalities, and most emergency conditions are complicated by the increased response time to emergencies. In these areas there is a greater need for CPR programs due to high response time of emergency medical personnel and low utilization or lack of medical facilities and personnel. Population groups such as the poor and ethnic minorities are also at a higher risk for emergencies than the general population, as a result of poor health and inadequate economic access to medical care.

6. Heart disease is the leading cause of death in Louisiana. The majority of heart-related deaths are due to acute myocardial infarction, with death usually occurring before the patient reaches a hospital. It has been estimated that 10% of deaths attributable to heart disease and 15% of deaths attributable to accidents could be prevented if proper medical treratment were initiated at the scene of the incident and continued en route to a medical facility. Thus, the intent of an EMS system is to decrease current death and disability rates.

7. Elements of an EMS System

a. The key to saving emergency patients from unnecessary death, disability, and complications from injury involves careful evaluation of the patient's condition, followed by a stablization of the patient at the scene, with an expeditious and careful trip to a medical facility. The following emergency patient's needs can be met through an effective EMS system:

i. discovery and notification of accident/illness;

ii. pre-hospital emergency care;

iii. transportation to designated facility;

iv. initial care in appropriate critical care unit; v. secondary definitive care.

b. An EMS system should provide arrangement of personnel, facilities, and equipment for effective and coordinated delivery of emergency health care services in an appropriate geographical area. An ideal system should have well-developed plans for efficiently and effectively moving patients through the various parts of the system. The component parts of an EMS system are as follows:

i. Manpower-An EMS system shall include an adequate number of health professionals, allied health professionals, and other health personnel, including ambulance personnel, with appropriate training and experience. This means sufficient personnel to provide services on a 24-hour basis within the service area of the system. There are 4,000 Emergency Medical Technicians in Louisiana.

ii. Trained Personnel-An EMS system shall provide for its personnel appropriate training and continuing education programs which are coordinated with other programs in the system's service area.

iii. Communications-An EMS system shall join the personnel, facilities, and equipment of the system by a central communications systems.

iv. Transportation-An EMS system shall include an adequate number of necessary ground, air, and other transportation facilities to meet the individual characteristics of the service area.

v. Facilities-An EMS system shall include an adequate number of easily accessible emergency medical services facilities which are collectively capable of providing services on a continuing basis, have appropriate standards relating to capacity, location, personnel, and equipment, and which are coordinated with other health care facilities of the system.

vi. Critical Care Units-An EMS system shall provide access (including appropriate transportation) to specialized critical medical care units in the system's service area or neighboring areas if necessary.

vii. Use of Public Safety Agencies-An EMS system shall provide for the effective utilization of personnel, facilities, and equipment of each public safety agency providing emergency services in the system's service area.

viii. Consumer Participation-An EMS system shall be organized in a manner that provides persons who reside in the service area, and who have no professional training or financial interest in health care, with an opportunity to participate in policymaking for the system.

ix. Accessibility to Care-An EMS system shall provide, without prior inquiry as to ability to pay, necessary emergency medical services to all patients requiring such services.

x. Transfer of Patients-An EMS system shall provide for transfer of patients to facilities and programs which offer such follow-up care and rehabilitation as is necessary to effect the maximum recovery of the patient.

xi. Standard Medical Record Keeping-An EMS system shall provide for a standardized patient record keeping system, covering treatment of the patient from initial entry into the system through discharge, and consistent with ensuing patient records used in follow-up care and rehabilitation of the patient.

xii. Consumer Information and Education-An EMS system shall provide programs of public information and education which disseminate information regarding appropriate methods of medical self-help and first-aid.

xiii. Independent Review and Evaluation-An EMS system shall provide for periodic, comprehensive, and independent review and evaluation of the extent and quality of the emergency health care services provided in the system's service area.

xiv. Disaster Linkage-An EMS system shall have a plan to assure that the system will be capable of providing emergency medical services in the system's service area during mass casualties, natural disasters, or national emergencies.

xv. Mutual Aid Agreements-An EMS system shall provide for appropriate arrangements with EMS systems in neighboring areas for the provision of services on a reciprocal basis, where access to such services would be more appropriate and effective in terms of the services available, time, and distance.

8. Communications

a. Development of an effective system of communication is essential to an EMS operation, since time is a critical factor and delay is costly. A regionalized emergency communications system should exist, linking all phases of the emergency system, including dispatchers, emergency vehicles, hospitals, and physicians. There should be a rapid, easy, universal method of telephone entry into the system (such as "911") which is easy to remember and to dial. Currently, two-thirds of Louisiana has access to the "911" number, and within five years, the number will be in use statewide.

b. Communications plays a key role during several phases of the EMS system's cycle, including notification, dispatch, transportation of resources, and transportation of patients to facilities. The success of the EMS system depends on the effectiveness of the communications system.

c. The essentials of a central communications center are that (1) all requests for system response are directed to the center; (2) all system resource response is directed from the center; and (3) all system liason with other public safety and emergency response systems is coordinated from the center. The primary functions of an EMS communications system are:

i. To provide a method of access for the public so that calls for emergency medical help can be quickly and easily placed.

ii. To provide a method that allows an ambulance to be dispatches to the scene of an emergency in response to a call for assistance.

iii. To provide a method that allows direct communication between the physician or nurse in the hospital and personnel at the scene of the emergency.

(a). Hospital-to-ambulance communication permits emergency medical personnel at the scene of an emergency to notify the hospital in advance of their arrival, giving the hospital time to prepare. With the use of paramedics providing advanced life support, hospital-ambulance communication assumes greater importance. Paramedics provide sophisticated treatment at the scene of an emergency, such as administering medications, requiring direct contact with a physician. Each of the seven regions in Louisiana's EMS program will have ambulance-hospital communications capabilities within two years; currently, three-fourths of the facilities have this capability.

9. Transportation

a. Emergency transportation of the sick and injured is one of the most critical areas of the EMS system. Transportation provides a connecting link between the EMS system components. It is the primary purpose of the ground or air transportation to transport qualified personnel and equipment to the scene, to initiate immediate care to the ill or injured, and then to transport the victim to the most appropriate medical facility.

b. All phases and modes of emergency transportation should be coordinated in order that response times are minimized, while high quality pre-hospital patient care is maintained. Ambulance service areas should be established and clearly defined to ensure that the closest, most appropriate units are dispatched to a call, that dispatchers can quickly determine which unit serves an area and who provides back-up services, and that response time goals can be met. Factors which should be considered in defining service area size of units include:

i. response time goals-what is the farthest the unit can travel within that goal 90 percent of the time?;

ii. population distribution and call load estimates;

iii. population characteristics which may alter call load estimates (for example, a concentration of elderly residents could increase the frequency of calls from an area);

iv. topographic features and road conditions which may affect response times;

v. special features such as heavy industry, recreational areas, etc. which could affect frequency and type of call;

vi. traditional service area patterns where appropriate.

c. The placement of emergency medical vehicles involves both basic and advanced life support, frequency from several ambulance providers, often from non-ambulance providers, and often from non-ambulance emergency vehicles from other public safety agencies such as fire departments. If centers around the concept of response time:, which varies between urban and rural communities and between types of emergencies. Response time, the elapsed time from the receipt of a call for service to the arrival of that service, is used to measure the availability of emergency medical care. National guidelines indicate that maximum ambulance response times to 95 percent of the population should be 10 minutes in urban and 30 minutes in rural areas.

10. Regionalization/Accessibility

a. An EMS system must design a rational sequence of comprehensive program activities on a regional basis if the needs of all potential emergency patients are to be properly anticipated and adequately met. A regional EMS system is described geographically be existing natural patient care flow patterns. It must be large enough in size and population so that definitive care can be made available to most general emergency and critical patients. Where sophisticated medical resources are not available within the region, arrangements must be formalized for providing these patients care services in an adjoining region. When possible, EMS regions should coincide with existing service area boundaries. Critical patient origin and distribution patterns are the essential issues in defining the regional boundaries.

b. There are seven EMS regions in Louisiana: Southeast, Southwest, Northeast, Northwest, Acadiana, Greater New Orleans, and Capital/Central.

11. Critical Care

a. One of the major goals of an EMS program is the development of a network of care for critical patients. The critical care concept is based on the premise that a critically ill or injured person should get to the facility, that can provide the medical care most appropriate to his condition. Ideally, critical patients who are suffering from a life-threatening condition should be transported to those hospitals which have the intense concentration of resources necessary to care for those patients. Also, caring for critical patients at a small number of hospitals allows those hospitals to further develop their expertise in providing for the critical patient. There are several types of specialty centers for critical care patients: trauma, burn, spinal injuries, cardiac, poison, perinatal, and behavioral emergencies. (Refer to Chapter X, Louisiana Medical Inventory, Hospital Special Services.)

B. Resource Goals

1. Emergency medical transportation services should be available to 95 percent of the urban population within 10 minutes, on a 24-hour basis.

2. Emergency medical transportation services should be available to 95 percent of the non-urban population within 30 minutes, on a 24-hour basis.

La. Admin. Code tit. 48, § I-11521

Promulgated by the Department of Health and Human Resources, Office of Management and Finance, LR 13:246 (April 1987).

AUTHORITY NOTE: Promulgated in accordance with P.L. 93-641 as amended by P.L. 96-79, and R. S. 36:256(b).