|
Emergency medical services also known as Emergency Medical Ambulance Service or Emergency Medical Ambulance Rescue Service(abbreviated to the initialism EMS,EMAS,EMARS or SAMU in some countries) are a type of emergency service dedicated to providing out-of-hospital acute medical care, transport to definitive care, and other medical transport to patients with illnesses and injuries which prevent the patient from transporting themselves.〔(【引用サイトリンク】publisher=NHTSA )〕 Emergency medical services may also be locally known as a paramedic service, a first aid squad,〔(【引用サイトリンク】title=Long Hill Township First Aid Squad )〕 emergency squad,〔(【引用サイトリンク】title=Hennepin County Emergency Squad )〕 rescue squad,〔(【引用サイトリンク】url=http://www.sprescuesquad.com/ )〕 ambulance squad,〔(【引用サイトリンク】url=http://www.angelfire.com/nj2/nas/ )〕 ambulance service,〔(【引用サイトリンク】title=Scottish Ambulance Service )〕 ambulance corps,〔(【引用サイトリンク】url=http://members.aol.com/oreilly7/vvac/ )〕 or life squad.〔(【引用サイトリンク】title=Sardinia Life Squad )〕 The goal of most emergency medical services is to either provide treatment to those in need of urgent medical care, with the goal of satisfactorily treating the presenting conditions, or arranging for timely removal of the patient to the next point of definitive care. This is most likely an emergency department at a hospital. The term emergency medical service evolved to reflect a change from a simple system of ambulances providing only transportation, to a system in which preliminary medical care is given on scene and during transport. In some developing regions, the term is not used, or may be used inaccurately, since the service in question does not provide treatment to the patients, but only the provision of transport to the point of care. In most places in the world, the EMS is summoned by members of the public (or other emergency services, businesses, or authorities) via an emergency telephone number which puts them in contact with a control facility, which will then dispatch a suitable resource to deal with the situation.〔(【引用サイトリンク】title=EU document on European adoption of 112 emergency number )〕 In some parts of the world, the emergency medical service also encompasses the role of moving patients from one medical facility to an alternative one; usually to facilitate the provision of a higher level or more specialized field of care but also to transfer patients from a specialized facility to a local hospital or nursing home when they no longer require the services of that specialized hospital, such as following successful cardiac catheterization due to a heart attack. In such services, the EMS is not summoned by members of the public but by clinical professionals (e.g. physicians or nurses) in the referring facility. Specialized hospitals that provide higher levels of care may include services such as neonatal intensive care (NICU),〔(【引用サイトリンク】title=Crouse-Irving NICU )〕 pediatric intensive care (PICU), state regional burn centres,〔(【引用サイトリンク】title=Strong Memorial Burn Center )〕 specialized care for spinal injury and/or neurosurgery,〔(【引用サイトリンク】title=Avera Neurosciences Institute )〕 regional stroke centers,〔(【引用サイトリンク】title= NYS DOH Regional Stroke Centers )〕 specialized cardiac care〔(【引用サイトリンク】title=Cath Labs )〕〔(【引用サイトリンク】title=NHS Heart Hospital )〕 (Cardiac catheterization),〔(【引用サイトリンク】title=AHA Cath Lab Definition )〕 and specialized/regional trauma care.〔(【引用サイトリンク】title=Maryland Shock Trauma )〕 In some jurisdictions, EMS units may handle technical rescue operations such as extrication, water rescue, and search and rescue.〔(【引用サイトリンク】url=http://www.colonie.org/ems/#anchor45252 )〕 Training and qualification levels for members and employees of emergency medical services vary widely throughout the world. In some systems, members may be present who are qualified only to drive the ambulance, with no medical training.〔 In contrast, most systems have personnel who retain at least basic first aid certifications, such as Basic Life Support (BLS). Additionally many EMS systems are staffed with Advanced Life Support (ALS) personnel, including paramedics, nurses, or, less commonly, physicians. ==History== (詳細はNew Testament contains the parable of the Good Samaritan, where a man who was beaten is cared for by a Samaritan. Luke 10:34 (NIV) - "He went to him and bandaged his wounds, pouring on oil and wine. Then he put the man on his own donkey, took him to an inn and took care of him." Also during the Middle Ages, the Knights Hospitaller were known for rendering assistance to wounded soldiers in the battlefield.〔(【引用サイトリンク】title=Knights Hspitaller's )〕 The first use of the ambulance as a specialized vehicle, in battle came about with the ''ambulances volantes'' designed by Dominique Jean Larrey (1766–1842), Napoleon Bonaparte's chief surgeon. Larrey was present at the battle of Spires, between the French and Prussians, and was distressed by the fact that wounded soldiers were not picked up by the numerous ambulances (which Napoleon required to be stationed two and half miles back from the scene of battle) until after hostilities had ceased, and set about developing a new ambulance system.〔〔 Having decided against using the Norman system of horse litters, he settled on two- or four-wheeled horse-drawn wagons, which were used to transport fallen soldiers from the (active) battlefield ''after'' they had received early treatment in the field.〔 Larrey's projects for 'flying ambulances' were first approved by the Committee of Public Safety in 1794. Larrey subsequently entered Napoleon's service during the Italian campaigns in 1796, where his ambulances were used for the first time at Udine, Padua and Milan, and he adapted his ambulances to the conditions, even developing a litter which could be carried by a camel for a campaign in Egypt.〔 In civilian ambulances, a major advance was made (which in future years would come to shape policy on hospitals and ambulances) with the introduction of a transport carriage for cholera patients in London during 1832.〔(【引用サイトリンク】title=Cholera carriages )〕 The statement on the carriage, as printed in ''The Times'', said "The curative process commences the instant the patient is put in to the carriage; time is saved which can be given to the care of the patient; the patient may be driven to the hospital so speedily that the hospitals may be less numerous and located at greater distances from each other".〔 This tenet of ambulances providing instant care, allowing hospitals to be spaced further apart, displays itself in modern emergency medical planning. The first known hospital-based ambulance service operated out of Commercial Hospital, Cincinnati, Ohio (now the Cincinnati General) by 1865.〔 This was soon followed by other services, notably the New York service provided out of Bellevue Hospital which started in 1869 with ambulances carrying medical equipment, such as splints, a stomach pump, morphine, and brandy, reflecting contemporary medicine. In June 1887 the St John Ambulance Brigade was established to provide first aid and ambulance services at public events in London.〔(【引用サイトリンク】title=St John Ambulance in the Industrial Revolution )〕 It was modelled on a military-style command and discipline structure. The earliest emergency medical service was reportedly the rescue society founded by Jaromir V. Mundy, Count J. N. Wilczek, and Eduard Lamezan-Salins in Vienna after the disastrous fire at the Vienna Ring Theater in 1881. Named the "Vienna Voluntary Rescue Society," it served as a model for similar societies worldwide. Also in the late 19th century, the automobile was being developed, and in addition to horse-drawn models, early 20th century ambulances were powered by steam, gasoline, and electricity, reflecting the competing automotive technologies then in existence. However, the first motorized ambulance was brought into service in the last year of the 19th century, with the Michael Reese Hospital, Chicago, taking delivery of the first automobile ambulance, donated by 500 prominent local businessmen, in February 1899.〔 This was followed in 1900 by New York City, who extolled its virtues of greater speed, more safety for the patient, faster stopping and a smoother ride. These first two automobile ambulances were electrically powered with 2 hp motors on the rear axle.〔 American historians claim that the world's first component of civilian pre-hospital care on scene began in 1928, when "Julien Stanley Wise started the Roanoke Life Saving and First Aid Crew in Roanoke, Virginia, which was the first land-based rescue squad in the nation." Canadian historians dispute this with the city of Toronto claiming "The first formal training for ambulance attendants was conducted in 1892." During World War One, further advances were made in providing care before and during transport – traction splints were introduced during World War I, and were found to have a positive effect on the morbidity and mortality of patients with leg fractures.〔(【引用サイトリンク】format=PDF )〕 Two-way radios became available shortly after World War I, enabling for more efficient radio dispatch of ambulances in some areas. Shortly before World War II, then, a modern ambulance carried advanced medical equipment, was staffed by a physician, and was dispatched by radio. In many locations, however, ambulances were hearses - the only available vehicle that could carry a recumbent patient - and were thus frequently run by funeral homes. These vehicles, which could serve either purpose, were known as combination cars.〔Kuehl, Alexander E. (Ed.). ''Prehospital Systems and Medical Oversight'', 3rd edition. ''National Association of EMS Physicians''. 2002. @ ch. 1.〕〔("Miller-Meteor History" ). Miller-Meteor. n.d. Retrieved 23 February 2007.〕 Prior to World War II, hospitals provided ambulance service in many large cities. With the severe manpower shortages imposed by the war effort, it became difficult for many hospitals to maintain their ambulance operations. City governments in many cases turned ambulance services over to the police or fire department. No laws required minimal training for ambulance personnel and no training programs existed beyond basic first aid. In many fire departments, assignment to ambulance duty became an unofficial form of punishment. Advances in the 1960s, especially the development of CPR and defibrillation as the standard form of care for out-of-hospital cardiac arrest, along with new pharmaceuticals, led to changes in the tasks of the ambulances. In Belfast, Northern Ireland the first experimental mobile coronary care ambulance successfully resuscitated patients using these technologies. One well-known report in the USA during that time was ''Accidental Death and Disability: The Neglected Disease of Modern Society''. This report is commonly known as The White Paper.〔(【引用サイトリンク】title=Accidental Death and Disability: The Neglected Disease of Modern Society )〕 These studies, along with the White Paper report, placed pressure on governments to improve emergency care in general, including the care provided by ambulance services. In the USA prior to the 1970s, ambulance service was largely unregulated. While some areas ambulances were staffed by advanced first-aid-level responders, in other areas, it was common for the local undertaker, having the only transport in town in which one could lie down, to operate both the local furniture store (where he would make coffins as a sideline) and the local ambulance service. The government reports resulted in the creation of standards in ambulance construction concerning the internal height of the patient care area (to allow for an attendant to continue to care for the patient during transport), and the equipment (and thus weight) that an ambulance had to carry, and several other factors. In 1971 a progress report was published at the annual meeting, by the then president of American Association of Trauma, Sawnie R. Gaston M.D. Dr. Gaston reported the study was a "superb white paper" that "jolted and wakened the entire structure of organized medicine. This report is created as a "prime mover" and made the "single greatest contribution of its kind to the improvement of emergency medical services". Since this time a concerted effort has been undertaken to improve emergency medical care in the pre-hospital setting. Such advancements included Dr. R Adams Cowley creating the country's first statewide EMS program, in Maryland. 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「Emergency medical services」の詳細全文を読む スポンサード リンク
|