Emergency Medical Services Overview

Emergency Medical Services in Charlottesville is a joint effort between the local rescue squads, fire departments, Thomas Jefferson EMS Council and UVA Hospital. The rescue squads are responsible for staffing, providing training in pre-hospital emergency medical service, administering a quality assurance program, supervising the provision of pre-arrival instructions, and coordinating data collection. By OVirginia Office of EMS Regulations, each agency must have a physician operational medical director (OMD) to oversee their service.

Overall policies for system planning, rules enforcement, mutual-aid planning and disaster planning for emergency medical services is established by the Thomas Jefferson EMS Council.

The Thomas Jefferson Emergency Medical Services Council coordinates the pre-hospital components of these services in the region.

Basic ambulance service is provided by Basic Life Support Units (BLS) and are staffed by Emergency Medical Technicians - Basic (EMT-B). The basic life support units are dispatched on non-life threatening calls such as, automobile accidents, minor injuries or illness and uncomplicated childbirth. The personnel who staff these units are trained to the level of Emergency Medical Technician - Basic. This 121-hour course is taught by local EMT instructors either through the rescue squads or the local community college. The course consists of lecture and practical work that covers splinting, cardiopulmonary resuscitation and basic first aid. The successful EMT-B must pass both a written and practical exam and must re-certify every four years.

The next higher level of service is the Advanced Life Support Units. These units are staffed by Emergency Medical Technicians - (Enhanced, Intermediate or Paramedic), are state certified and undergo additional training lasting up to one year. They are required to attend continuing education programs and are re-certified on a biennial basis. Besides the skills learned in the EMT-B classes, they can start intravenous infusions, administer medications, interpret electrocardiograms, defibrillate a patient's heart, perform emergency cardioversion and external pacing of the heart, endotracheal intubation and chest decompression. Currently, each rescue squad staffs at least one medic unit around the clock, additional units can be staffed up as needed.

What is Considered an Emergency?

A medical emergency is an unforeseen injury or illness (physiological or psychological) requiring immediate medical care. The individual may be in danger of loss of life or health impairment, or may be incapacitated or helpless as a result of a physical or mental condition.

Emergency incidents are classified according to the level of care required to treat the patient. Basic Life Support (non-critical care) is the first level of care provided by the fire and rescue service. It is normally provided by an individual who is trained and certified at the Emergency Medical Technician-Basic level and involves pre-hospital emergency medical care and management of illness or injury including patient assessment, airway and bleeding control, administration of cardiopulmonary resuscitation, splinting, and the administration of oxygen. For basic life support calls, the closest emergency ambulance (rescue level) is dispatched. At a minimum, all firefighter/rescuers are trained and certified to the Emergency Medical Technician-Basic level.

Advanced Life Support (critical care) is more advanced pre-hospital and basic care of serious illness or injury provided by EMT-Enhanced technicians, EMT-Intermediates or EMT-Paramedics. This medical care includes administration of emergency drugs, electrical defibrillation, intravenous fluids, and advanced airway management techniques. On advanced life support calls, the closest emergency vehicle (fire engine) and a unit specifically equipped to handle advanced life support calls are usually sent.

Some of the incidents which indicate the need for advanced life support include heart attack, trouble breathing, unconscious person, chest pain, drowning, electrocution, asthma, allergic reaction, automobile accident with trapped persons, serious burns, gunshot or stab wounds, second or greater alarm fires where medical emergencies may result, structure fires with report of individuals trapped, motorcycle accidents, bicyclist struck, and diabetic reactions.

Fast Response Needed

Time is one of the most important factors relating to patient outcome in emergency situations. In general, irreversible brain damage from an acute heart attack starts within four to six minutes of when the heart stops pumping and the patient stops breathing. Getting help to the patient within this timeframe is critical and requires structuring the medical emergency care system to respond quickly.

In a study of out-of-hospital cardiac arrests, it was found that when victims were not resuscitated before arrival at the hospital, long-term survival was unlikely. Patients' records indicate that the only characteristic associated with improved outcome was a resuscitation time of less than 15 minutes. This reinforces the importance of quick response times and the application of life support, including CPR to ensure oxygen to the brain and early defibrillation to reestablish heart rhythm.

In most cases, the recognition that medical assistance is needed occurs almost immediately. For example, witnesses to automobile accidents, industrial accidents or home accidents typically know to call 911 as quickly as possible. In some medical emergencies, however, such as an individual experiencing chest pain, the individual may not recognize the seriousness of the experience and may delay seeking help. Delays also occur when individuals are not familiar with the area or the phone numbers used to call for help.

Even before emergency medical staff arrives, the patient may already be receiving assistance from trained citizens. In years past, a sick or injured person usually did not receive help until an ambulance arrived. Now, with better public education and CPR training, citizen bystanders may initiate treatment, especially in life threatening situations such as cardiac arrests. Also, 911 call-takers provide emergency medical instructions by telephone on a regular basis to individuals who are willing to provide help. It is important that this type of care is available as it may take time for emergency medical staff to arrive.

Once the emergency crew arrives, they assess the patient and begin appropriate treatment. Patients are assigned a status that reflects the severity and urgency for treatment of the illness or injury.

Patients are transported to the closest, most appropriate hospital capable of treating their condition.

On trauma incidents twenty minutes or more from the local Trauma Center, the dispatcher may request a Medevac helicopter. The Incident Commander may also request a Medevac if it will provide the most timely means of transport to a Trauma Center or Specialty Referral Center.

To give you an idea of what innovations have taken place over the years that decrease the time it takes a patient to receive appropriate medical care, reference this chart which shows each segment of an emergency:

Emergency Time Intervals & Advances in Timely Care

Discovery Time (the time it takes for an emergency be reported to the dispatching facility)cellular telephones, On-Star tracking system in equipped General Motors cars
Dispatch Time (the time it takes for the emergency to be dispatched to the appropriate agencies)Enhanced 911, computerized dispatching systems
Response Time (the time it takes for the emergency unit to leave the station and arrive at the scene)Opticom traffic light capture system, street classes/tests
Scene Time (the time it takes for the EMT's to properly access, evaluate, treat and package the patient for transport)citizen CPR, pre-arrival instructions by the dispatching center, hydraulic extrication tools, EMT-B program
Transport Time (the time it takes for the patient to be transported to the nearest appropriate care medical facility)helicopter transport (Pegasus), 12-lead EKG

Recent Improvements

Automated External Defibrillators
Starting in 1995, many local fire departments initiated use of automated external defibrillators on first response vehicles. Using matching state funds, these defibrillators were purchased and strategically placed on units throughout the region. The goal is to equip Basic Life Support units and first response vehicles in every station with these devices. Like the Medic-Engine concept, this program provides for different types of units to deliver immediate care for certain types of critical emergency medical service incidents.

12-Lead EKG
During 1998, the University of Virginia hospital initiated a trial program by having CARS medic units equipped with a 12-lead EKG machine. These EKG machines enable the paramedics to perform a diagnostic quality ECG while on the scene with the patient. This ability allows the hospital to prepare for a heart attack patient who may require thrombolytic (clot buster) medication. This pre-hospital assessment will shorten the time that the patient spends in the emergency department preparing for this life saving procedure.

Medic Engines
In 1999, the Charlottesville Fire Department started carrying a defibrillator machine and cardiac drug box to enable personnel who were EMT-I's and paramedics to initiate life-saving care before the arrival of the rescue squad medic unit. This was further enhanced in 2002 when Albemarle County Fire & Rescue started hiring and staffing their fire apparatus with EMT-Paramedics as minimum manning.

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