![]() Dispatch and regional call centers, local EMS agencies, and hospitals will undertake contingency measures utilizing their emergency operations plans and medically approved protocols to implement surge medical capabilities ( DOT, 2007 NHTSA, 2007a). This emergency health care system will be stressed to its limits during a mass casualty incident. This continuum of conventional care is provided through a coordinated and integrated emergency health care system with well-trained and well-equipped personnel at dispatch centers, ambulance agencies, hospitals, and specialty care centers (trauma, burn, pediatrics) using standardized protocols and guidelines approved by medical directors ( HRSA, 2006 NHTSA, 2012). Routinely, the need for emergency care is determined by trained personnel who receive such a call and dispatch appropriate air and ground ambulances and other EMS responders to triage, treat, and transport the patient(s) to the appropriate health care facility, where definitive care is ultimately provided. Prehospital care is an essential part of the continuum of emergency health care that is frequently initiated by a 911 call to a dispatch center. ROLES AND RESPONSIBILITIES OF EMERGENCY MEDICAL SERVICES The content of this chapter should be used in conjunction with other chapters of this report that provide detailed guidance on specific CSC topics (e.g., related to legal issues, ethical considerations, palliative care, mental health, hospital care, and out-of-hospital and alternate care systems) that may be referenced only briefly as planning or implementation considerations in this chapter or the two accompanying templates. Two templates provide core functions for EMS systems in CSC planning and for EMS systems and EMS personnel in the implementation of CSC plans. This chapter outlines the roles and responsibilities of state EMS in CSC planning and implementation in the overall context of a CSC response system, as well as operational considerations entailed in carrying out those roles and responsibilities. Their farther involvement at all levels of CSC planning and implementation should be a goal. EMS agencies and personnel may already be engaged in such planning at the local level through their regional EMS/trauma advisory councils or health care coalitions ( HHS, 2009 NASEMSO, 2011a NHTSA, 2000). These licensed/certified personnel (emergency medical dispatchers, emergency medical responders, emergency medical technicians, and paramedics) may be the first to apply crisis standards of care (CSC), and are integral partners in local and state 1 efforts related to the development and implementation of coordinated and integrated CSC plans (NHTSA, 2012). EMS personnel often are the first to recognize the nature of a disaster and can immediately evaluate the situation and determine the need for resources, including medical resources. Prehospital care is provided by emergency medical services (EMS) responders, who are the initial health care providers at the scene of disaster.
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