National EMS Core Content

Introduction

The National EMS Core Content uses the Model of Clinical Practice of Emergency Medicine as the template. This will further align the out-of-hospital community with the medical community. With out-of-hospital providers using the same terminology and definitions as other allied health care partners, this may lead to enhanced patient care and facilitate EMS 's professional acceptance.

The Model of Clinical Practice of Emergency Medicine Listing of Conditions and Components, as well as its matrix, was used as a basis for developing the National EMS Core Content . The appropriateness for inclusion of each item in the Core Content was considered individually. Definitions of patient acuity and tasks were developed consistent with out-of-hospital practice.

The following principles guided the decision-making process:

• Criticality relates to patient presentation and not to the degree of emphasis that must be placed on the topic during instruction;
  
  
• A differential diagnosis needs to be developed in sufficient depth to allow the EMS provider to determine what treatment might be harmful;
  
  
• EMS education is in the form of building blocks to allow the EMS provider to integrate knowledge to care for the patient appropriately.

As with the Model of the Clinical Practice of Emergency Medicine , the National EMS Core Content is not just a list of knowledge, skills, and tasks; it describes what EMS providers must know and how they practice. The EMS providers must master, at their level of licensure, the Listing of Conditions and Components, and must learn skills and procedures unique to their practice. Then, when assessing a patient, the EMS provider must use their knowledge, skills, and procedures commensurate with the level of patient criticality.

Components of National EMS Core Content

Listing of Conditions and Components

The universal body of knowledge one must possess to practice emergency medical services. The National EMS Core Content used the listing of the Model of Clinical Practice of Emergency Medicine as a starting point. (See Appendix 2)

Patient Acuity Definitions

Definitions of acuity are fundamental to determining the sequence of events in which the EMS provider tasks are carried out. These definitions are consistent with those in the Model of Practice of Emergency Medicine. (See Appendix 3)

Out-of-Hospital/EMS Task Definitions/Elements

This list defines all processes used by the EMS personnel in delivering care to the patient in the out-of-hospital environment. (See Appendix 4)

Matrix of Out-of-Hospital/EMS Task Definitions/Elements

The matrix provides a listing of EMS tasks and a corresponding level of acuity (critical, emergent, or lower priority). The patient acuity is fundamental to determining the sequence of performing the tasks. The dynamic matrix defines the complex set of interactions that describes the process of delivery of patient care in the out-of-hospital environment – i.e., the EMS personnel modify the patient interactions based on the patient acuity. (See Appendix 5)

Procedures and Skills Integral to the Practice of EMS

This listing of procedures and skills recognizes the unique characteristics of out-of-hospital practice and provides additional clarity to the Scope of Practice and National EMS Education Standards Task Forces. (See Appendix 6)

Other Components of the Practice of EMS

This listing of other practice components helps to further elucidate the practice of emergency medical services and to provide guidance to remaining components of the EMS Education Agenda for the Future . (See Appendix 7)

All the components of the Core Content together define the entire domain of EMS knowledge and skills for out-of-hospital providers based on the interaction of patient complaints, presenting signs and symptoms, and potential patient criticality. It recognizes the need for delineation of the procedures, skills, and other components of the practice of EMS . The National EMS Core Content provides the domain from which the National EMS Scope of Practice Model is derived.

Special Note Concerning Pediatric, Geriatric, and Other Special Population Patients:

The National EMS Core Content focuses on the domain of practice for the care of ALL patients. It does not separately address the unique knowledge, skills, and attitudes necessary to care for special patient populations, such as children, elders, cardiac, trauma, and technology-assisted patients. However, the entire EMS Education Agenda for the Future: A Systems Approach ultimately must assure that the EMS education system adequately prepares EMS professionals to care for each of these distinct patient populations. Specifically, this will necessitate the inclusion of additional information in both the National EMS Scope of Practice Model and the National EMS Education Standards pertaining to which EMS professional levels are best prepared to manage each of these populations in the out-of-hospital setting. The vigilance of the authors of the National EMS Scope of Practice Model and of the National EMS Education Standards toward the needs of those special populations will be paramount to assure the continuation of the tremendous strides in EMS education during the past 20 years.

For example, in addressing the needs of pediatric patients, the National EMS Scope of Practice Model may specify which of the conditions and components delineated in the National EMS Core Content affect infants and children, and which provider levels are best suited to care for them. Likewise, in addressing the needs of pediatric patients, the National EMS Education Standards would specify how etiology, presentation, and treatment in pediatric patients may vary from adult patients, emphasizing disparities in pediatric and adult assessment, based upon anatomic, physiologic, developmental, and behavioral differences. Thus, the National EMS Education Standards would likely include both specific knowledge about pediatric respiratory conditions such as croup, laryngeal foreign body, epiglottitis, bacterial tracheitis, bronchiolitis, and tracheal foreign body – in addition to asthma and pneumonia which occur in adult and pediatric populations alike; and an assessment-based approach to their management – stressing symptomatic relief of respiratory distress and failure, rather than treatment of specific diagnoses. They may also incorporate specific skills, such as intraosseous infusion, that are used rarely in adults, and could de-emphasize certain others, such as endotracheal intubation, that have been demonstrated to possess limited utility in the pediatric population. A similar approach would be used for conditions and components affecting other special populations, extending the range of the National EMS Core Content to patients of all ages and all health needs.