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Bartow Medical and Fire Academy Emergency Medical Responder Course Syllabus Revised: May 15, 2015 Table of Contents ***READ THIS SHORT NOTICE PRIOR TO DOING ANYTHING ELSE*** All of the contents listed as rules will have a duplicate copy within this packet. Students are required to review all rules and write their initials on the space provided. By doing so, each individual student states that they agree to follow the terms outlined by that rule. Course instructors will collect these forms and place into the student’s file for the duration of the course. Thus, the duplicate copy will remain with the student so they may reference or review rules at their leisure. Section 1 – Classroom Component I. General course information Page 5 I. Classroom Uniform Policy (Rule 1 – 0) Page 6 II. Grading Scale (Rule 1 – 1) Page 7 III. Grade Weighting (Rule 1 – 2) Page 7 IV. Withdrawal Policy (Rule 1 – 3) Page 7 V. Attendance Policy (Rule 1 – 4) Page 8 VI. Making up missed assignments (Rule 1 – 5) Page 8 VII. Exam Policies (Rule 1 – 6) Page 9 VIII. Academic Dishonesty Policy (Rule 1 – 7) Page 10 IX. Classroom Code of Conduct (Rule 1 – 8) Page 11 X. Financial Aid Statement (Rule 1 – 9) Page 13 XI. C.I.S.D. Policy (Rule 1 – 10) Page 13 XII. Program Evaluation (Rule 1 – 11) Page 13 Table of Contents Section 2 – Skills Lab/Clinical Component XIII. Clinical Prerequisite Paperwork Pages 14 – 36 (Several of these forms must be notarized. If you attend EMR orientation; a notary public will be present to assist with this matter, at NO cost. However, if you miss orientation for any reason; it is your responsibility to find someone who can provide the service and who may charge a fee) XIV. Skills & Simulation Lab Uniform Policy (Rule 2 – 0) Page 37 XV. Lab Procedures/Conduct Guidelines (Rule 2 – 1) Page 38 XVI. Uniform Policy (Rule 2 – 2) Page 40 XVII. Field Clinical Policy (Rule 2 – 3) Page 41 XVIII. Special Detail Policy (Rule 2 – 4) Page 43 XX. Policy on Injury/Illness at Clinical (Rule 2 – 6) Page 43 XXI. Clinical Misconduct Policy (Rule 2 – 7) Page 44 XXII. Student Counseling Documentation Policy (Rule 2 – 8) Page 44 XXIII. Clinical Documentation Policy (Rule 2 – 9) Page 45 XXIV. Skills Lab/Clinical Grading Policy (Rule 2 – 10) Page 46 XXV. T.E.A.M. Day (Rule 2 – 11) Page 47 XXVI. Field Clinical Evaluation Guidelines Page 49 (The tables found within these pages list the criterion by which you will be evaluated during a field clinical. In addition, it provides guidance to you and your preceptor as to how your performance should be rated.) Table of Contents Section 3 – EMR Course Completion Requirements XXVII. Completion Requirements XXVIII. Emergency Medical Responder Completion Requirements (Rule 3 – 1) Page 47 (Rule 3 – 2) Page 49 Section 4 – EMR Skills Manual XXIX. Individual Skills Sheets Page 75 Section 5 – Clinical Internship XXX. Clinical Paperwork Internship Documentation Paperwork Page 119 Section 6 – Practical Scenarios XXXI. Practical Scenarios There are 11 scenarios (including final scenario) Page 121 Basic Course Information Emergency Medical Responder (EMR Course) Course Title: Emergency Medical Responder 3 Course Number: 8417171 Course Credit: 1 Class start time: Class Times – 1224 hours (EST)-1400(EST) Classes meet in 04-048 Instructor Information Your class instructor will review the contact and availability information during the first class. Any issues pertaining to practical skills, clinical internship, scenario testing, and/or the web-based components of class should be directed to the EMR Program office located at 02-048 or by calling 863-287-3135. The Coordinators Education for the EMR program are: Kozette Hubbard (Ms. Kozy) Email: [email protected] / Cell: 863-287-3135 / Office 863-534-7400 ext. 2220 Course Materials Required textbook and workbook: Emergency: Care and Transportation of the Sick and Injured (Latest Edition) Authors: American Academy of Orthopedic Surgeons (AAOS) Online classroom address (URL): https://learn.aeseducation.com General Course Information Instructional delivery of this course employs a hybrid approach including: 1. Didactic lectures delivered during regularly scheduled classroom meetings. 2. Workbook and objective assignments, which are due at the start of regularly, scheduled classroom meetings. 3. Course related certifications delivered online via several sources. 4. Individual chapter quizzes on most regularly scheduled classroom meetings. 5. Four (4) computer based examinations. 6. Comprehensive Final Exam (computer based) this is also the Industry Certification Exam 7. T.E.A.M. Day attendance and participation. 8. Ten (10) practical scenario assessments 9. Practical skills demonstration, practice, and competency verification is obtained by visiting the practical skills lab during regularly scheduled classroom meeting hours. (Even though practical skill completion is mostly self-paced, there are several deadlines which must be met in order to receive full credit) 10. Clinical rotations at several local agencies, which take place outside of regularly scheduled classroom meetings Student Name: _________________________________________ Throughout the remainder of this syllabus: Print your initials on the blank lines to the left to acknowledge that you have read, reviewed, comprehend, and agree to be bound by the statements on the right. Classroom Uniform Policy 1-0.1______ Uniforms identify you as an EMR-Intern and are to be worn while attending all program functions; unless you are otherwise informed. The uniform policy will be strictly enforced. Failure to adhere to the uniform policy will result in a reprimand, which is the first in a series of steps to dismiss said student from class. Nothing will excuse a student from adhering to this policy. 1-0.2 ______ all students are expected to be well groomed and clean. Hair must be kept above the collar. In addition, uniforms must be kept neat and free of wrinkles while shoes should be polished as needed. 1-0.3 ______ the use of jewelry is limited to one (1) ring per hand, only. Students are not to wear any kind of jewelry above the collar during clinical rotations, regardless of gender and/or clinical site. 1-0.4 ______ there are no hats of any kind, which may be worn. 1-0.5 ______The outermost layer of clothing worn by all students must identify them as EMR Program participants. Thus, regardless of whether students decide to wear the EMR-Intern polo, EMR Program t-shirt, or an EMR Program sweatshirt, any additional layers of clothing must be worn under the EMR Program attire. 1-0.6 ______ most uniform components are available for purchase at the EMR classroom and/or any other medical uniform retailer. 1-0.7 ______ Students may NOT use any non-prescribed eyewear (i.e. sunglasses) or hats of any kind while class is in session or while participating in the skills and/or simulation labs. 1-0.8 _______ Due to the potential for injury, all types of open style footwear are prohibited in all areas of the EMS building. This includes “flip-flops”, “crocs”, and all other similar style shoes. Anyone found to be in violation of this code will be asked to leave and return once proper footwear is being worn. Any time missed from class will be counted as outlined in the Course Attendance Policy. Uniform Components 1-0.9 ______ appropriately sized Black waist belt. 1-0.10 ______ Black shoes devoid of any logos and/or any other coloring with matching black socks. 1-0.11 ______ Navy blue pants (standard as set by Fire/Rescue EMS) 1-0.12 ______ EMR-Intern polo style shirt purchased from the instructor listed above or an EMR Program t-shirt. 1-0.13 ______ Stethoscope. 1-0.14 ______ working watch. If using a traditional style watch then it must be equipped with a sweeping second hand; if using a digital watch, then it must include a display for seconds. 1-0.15 ______ EMR Program Sweatshirts if necessary (review rule 1-0.5 to determine if you will need this component) Grading Scale 1-1.0 ______ Letter grades are based on the following scale. 100% - 90% = A 90.9% - 80% = B 80.9% - 70% = C 70.9% - 60% = D (Student will be put on academic probation with 2 weeks to improve) 60.9% - 0% = F (class must be repeated) Grade Weighting 1-2.0 ______ all course work is assigned to one of the categories listed below. In addition, the overall final grade is derived based upon the weight of each category, as listed below. Workbook and Objectives: 10% Chapter Quizzes: 10% Practical Exams: 10% Final Practical Scenario: 10% Exams: 20% Comprehensive Final Exam: 20% Ride/Special Detail: 20% Withdrawal Policy 1-3.0 ______ any student who wishes to withdraw from this course without influencing their grade point average must follow Polk School Board policy as outlined in the student catalog. 1-3.1 ______ all students who fail to meet the minimum attendance as outlined in the Course are subject to dismissal from the academy. Attendance Policy (BMFA Rule 1 – 4) are subject to dismissal from the Emergency Medical Responder program. 1-3.2 ______ Students must not miss more than 20% of class time. Students must also be in class the whole period. Time is counted in 1 hour increments. Course Attendance Policy 1-4.0 ______ Students are expected to attend all class meetings. However, in the event that attending class is not possible; the responsibility to obtain any information and/or assignments, which were missed, lies solely with the student. 1-4.1 ______ Attendance is checked at the start of each of class. Any student not physically present in the classroom at that time will be marked as being absent unless they ensure the instructor is aware that they arrived late and has corrected the attendance log. 1-4.2 ______Any time missed from class, whether caused by arriving late or leaving early, will be counted in hourlong increments only. 1-4.3 ______ any student who exceeds the maximum amount of missed time allowed will be subject to withdrawal from the program. 1-4.4 ______ the maximum amount of hours, which students may miss from class, is not to exceed the equivalent of 20% of time in class 1-4.5 ______ In the event that Polk School Board officials have temporarily closed the campus affecting a normally scheduled class date the following policy will be adhered to: I. Once the campus is re-opened students are expected to arrive no later than the scheduled Start time and policies affecting tardiness will be strictly adhered to. II. If the scheduled start time is rescheduled for another day classes will be scheduled during the normal breaks as a makeup day students will be notified as to when that class will be scheduled for a “make-up day”. Policy for Making up Missed Work 1-5.0 ______ Workbooks and other take home assignments are due at the beginning of each class. Students who are late or absent will be issued a grade of ZERO (0) on the material that was due on that class date. No late work will be accepted if the students was not absent or if the absence is not excused. 1-5.1 ______ Students who arrive late may begin the quiz late, however once the last person who arrived on time completes their quiz, the late student’s quiz will be collected and graded “as is”. 1-5.2 ______ any quiz missed due to absence will receive a grade of ZERO (0). Students will make up the quiz the next class day. 1-5.3 ______ Exams not completed during their scheduled date due to student absenteeism, tardiness, or any other reasons not directly caused by Polk County School Board MUST be completed within the five (5) working days, which follow the exam’s date. 1-5.4 ______Students will have to visit the classroom after school in order to complete a different version of the exam missed. It is the student’s responsibility to familiarize themselves with the information for the exam. 1-5.5 ______ Failure to make-up an exam within five (5) working days will result in a grade of ZERO (0) on that particular exam. Module Exams/ Comprehensive Final Exam 1-6.0 ______All students are to maintain a minimum average grade of eighty percent (80%) on ALL written and/or computer based examinations. 1-6.1 ______ all students who fail to achieve a minimum of eighty percent (80%) on any three (3) written and/or computer-based exams are subject to academic probation. GPA must maintain at 2.5 or student will be dismissed from the program. 1-6.2 ______ as part of the completion requirements, all participants must complete a comprehensive final exam on the scheduled exam date of class. Students must also be in uniform to take the exam. 1-6.3 ______ the exam is composed of questions, which may be drawn from any and/or all chapters contained within the textbook in use throughout the course. Time allotted for completion will not exceed one and one half (1.5) hours. 1-6.3a ______ the afore mentioned “time allotted” begins once the class instructor advises the class to Begin the exam. Any students, who arrive tardy, may begin their exam upon arrival. However, said students will not be afforded any additional time to complete their examination. 1-6.4 ______ Attendance is mandatory on the date during which the Comprehensive Final Exam is to take place. Failure to attend class on said date will result in a grade of “zero” being issued as the Comprehensive Final Exam grade. 1-6.5 ______ In order to successfully complete the course; students must meet a minimum benchmark of eighty percent (80%) on the comprehensive final exam regardless of their overall class average. 1-6.5a ______ any student who fails to meet the minimum benchmark of eight percent (80%) on the comprehensive final exam and despite that fact, maintains an overall class average grade at or above eighty percent (80%) will afforded the opportunity to re-attempt a different version of the comprehensive final exam. 1-6.5b ______ any student who benefits from the above rule (number 1-6.4a), will be required to meet the minimum of benchmark of eighty percent (80%) on the re-attempt. In addition, if said re-attempt results exceed the minimum benchmark the “official class grade book” will not reflect a grade higher than eighty percent (80%). 1-6.5c ______ The policy outlined above is a privilege intended as a means to assist those students whose class participation and course assignment completion have demonstrated a true desire to succeed in the Emergency Medical Responder program; yet for whatever reason they do not fare well on the final exam. 1-6.5d ______ as stated above, this policy is a privilege to the student. Thus, the classroom instructor And/or the program director reserve the right to discontinue the use of this privilege at any Time and for any reason, regardless of who is affected. 1-6.6 ______ Exam and quiz questions are highly scrutinized by staff prior to deployment. In the event, that a student wishes to challenge the validity of a question deployed in an exam and/or quiz: Students are allotted five (5) Academic Calendar days from the date during which the exam and/or quiz took place to provide the lead instructor with evidence, found within the course textbook, to support the allegation. 1-6.6a ______ Regardless of whether or not there is any valid evidence presented. Once the time period Outlined in 1-6.6 expires, no change to grades will be made. Academic Dishonesty Policy 1-7.0 ______ this policy is intended to enhance Polk County School Boards academic dishonesty policy as outlined in the current student handbook. In the unlikely event that a conflict arises between the policies, the policy listed on the student handbook will supersede. 1-7.1 ______ there is no form of communication permitted amongst students while an exam, quiz, or any other type of academic assessment tool is in use. If the need to speak with an instructor should arise, students may approach the instructor unless told otherwise. However, the student must take extra care to ensure disruptions and/or distractions are, kept to a minimum. 1-7.2 ______ the following outlines the Academic Dishonesty Policy as outlined in the Polk State College student handbook: Cheating and Plagiarism Polk County School Board considers academic dishonesty an assault upon the basic integrity and value of an education. Cheating, plagiarism, and collusion in dishonest activities are serious acts that erode the educational role and tarnish the learning experience, not only for the perpetrators but for the entire community. It is expected that all students understand and subscribe to the ideal of academic integrity and that they are willing to bear individual responsibility for their work. Materials (written or otherwise) submitted to fulfill academic requirements must represent a student’s own efforts. The fundamental purpose of this rule is to emphasize that any act of academic dishonesty attempted by any student is unacceptable and shall not be tolerated. Examples of academic dishonesty include: 1. Cheating or plagiarizing on tests, projects, or assignments: Cheating is defined as the giving or taking of any information or material with the intent of wrongfully aiding oneself or another in academic work considered in the determination of a course grade. Plagiarism is defined (Black’s Law Dictionary, Revised Fourth Edition) as “the act of appropriating the literary composition of another, or parts or passages of his writings, or the ideas or language of the same, and passing them off as the product of one’s own mind.” Plagiarism includes failure to use quotation marks or other conventional markings around material quoted from any specific source without citing that source, or paraphrasing a specific passage from a specific source, or using any sequence of material or order of wording without accurately quoting and citing that source. Plagiarism further includes letting another person compose or rewrite a student’s assignment. The following items have been identified, by the faculty and students, as a partial list of examples of cheating and/or plagiarism: a. Asking for information from another student before, during, or after a test, quiz, or exam situation. b. Copying answers from another’s paper during a test, quiz, or exam situation. c. Knowingly letting someone copy from one’s paper during a test, quiz, or exam situation. d. Using sources other than what is permitted by the instructor in a test, quiz, or exam situation. e. Copying material exactly, essentially, or in part from outside sources while omitting appropriate documentation. f. Copying or falsifying a laboratory report, clinical project, or assignment without doing the required work. g. Changing answers on a returned graded test, quiz, or exam in order to get the grade revised. 2. Plagiarism in written assignments: Plagiarism also includes handing in a paper to an instructor that was purchased from a term paper service, created by another student or other individual, or downloaded from the Internet and/or presenting another person’s academic work as one’s own. Individual academic Departments may provide additional examples in writing of what does and does not constitute plagiarism, provided that such examples do not conflict with the intent of this policy. 3. Furnishing false information to any faculty member. 4. Forgery, alteration, or misuse of any document, record, or instrument of identification. Violations of the s policies pertaining to academic dishonesty may result in academic penalties and/or disciplinary action at the discretion of the professor. Academic penalties may include, but are not limited to, a failing grade for a particular assignment or a failing grade for a particular course. Students charged with violating the Academic Dishonesty portion of this rule are not permitted to withdraw from the course. Additionally, a student in violation of the Student Code of Conduct may be referred to the Dean of Student Services at the campus or center where the offense took place. Any student suspected of violating the Academic Dishonesty section of the Student Code of Conduct is subject to sanctions and provided due process as outlined in the Academic Dishonesty procedure. 1-7.3 ______ any student suspected of cheating will be subject to disciplinary action, which at minimum will result in said person receiving a grade of ZERO on the assignment underway when the alleged incident took place. In addition, the student will receive a written counseling form and a referral to speak with the EMR Program Director who will decide if the student will be subject to dismissal from the Emergency Medical Responder Program. Classroom Code of Conduct 1-8.0 ______ the responsibility to provide any materials, including text and workbooks, which are required as part of the course curriculum lies solely with the student. 1-8.1 ______ Classroom atmosphere and/or student behavior are determined according to the course instructor’s discretion. In the event that a course instructor determines a student’s conduct is inappropriate; said student will be asked to leave the classroom at once. In addition, the student will have to meet with the EMR Program Director prior to returning to class. 1-8.2 ______ any injury incurred while taking part in a related function must be reported to a Bartow Medical and Fire Academy representative promptly. 1-8.3 ______ Students are not to enter any office area unless there is a staff member present and prior authorization to enter said office has been granted. 1-8.4 ______ Smoking is NOT allowed within any of campus buildings or campus. 1-8.5 ______ the use of the phone system is strictly limited to business related staff use only. 1-8.6 ______ the use of electronic devices such as pagers, cell phones, and laptops is strictly prohibited while classes are in session (this includes skills and simulation labs). Furthermore, any electronic device in your possession must be turned off and kept out of sight. 1-8.7 ______ Failure to comply with the electronic device policy will result in the following: 1st offense will result in a ten (10) point drop in grade on any assignments due that day. 2nd offense will result in a twenty-five (25) point drop in grade on any assignment due that day. 3rd offense will result in dismissal from the Emergency Medical Responder program. *In the event an offense occurs while the students is participating in the skills or simulation lab the Above penalties will be enforced on the next scheduled quiz or exam. (An offense is described as any time the device is visible to a staff member in plain sight.) 1-8.8 ______ All EMR program students are subject to disciplinary action if it is determined, they have in anyway participated in the distribution and/or disclosure of any pictures, videos, and/or any other form of communication deemed to display or disclose immoral, indecent, illegal, unethical or otherwise inappropriate material. If said disclosure relates to, and/or was acquired in conjunction to the students’ course of study while a part of EMR program. 1-8.8a ______All students are asked to respect the rights, privacy and dignity of all those with whom they interact as an EMR program student. All students should conduct themselves appropriately at all times. 1-8.8b ______ Any student/s who, at the sole discretion of the EMR Program Director, violates the above rule (number 1-8.11a), is/are subject to dismissal from the Emergency Medical Responder program. 1-8.9 ______ the consumption and/or possession of any alcoholic beverage and/or controlled substances, whether legal or illegal, is strictly prohibited not only on every campus, but at all clinical rotation locations as well. In addition, students must NOT be under the influence of alcohol or other controlled substances at any time during which they are representing the EMR Programs. This includes on and off campus locations. Violation of this rule will result in disciplinary action up to and including immediate dismissal from the program. 1-8.10 ______ Violations of the EMR Program Code of Conduct will result in a Student Counseling Form being generated. This form is composed of two (2) groups which are separated by the penalty which will be applied: Group one (1) offenses are serious infractions, which are associated with the potential for adverse Criminal consequences. Any group one (1) infraction will result in an immediate dismissal from the Emergency Medical Responder program. (Re-admission may not be possible) Group two (2) offenses most often relate to procedural infractions and follow a three (3) “strike” rule as Follows: First offense = Verbal Reprimand Second offense = Written Reprimand Third offense = Dismissal from the Emergency Medical Responder Program. 1-8.11 ______ Group 2 offenses signify a reprimand in steps for dismissal. You in fact may receive 1, 2 or all 3 reprimands at one time depending upon the offenses being disclosed by the EMR Program staff. 1-8.12 ______ lastly, the following persons may ask a student to leave the classroom area at any time they deemed it to be necessary: EMR Program Medical Director - Dr. Joe Nelson EMR Program Director – Kozette Hubbard EMR Program Visiting Instructors and /or Clinical Instructors Financial Aid 1-9.0 ______The Bartow Medical and Fire Academy’s objective is to assist students who would otherwise be unable to attend the medical or fire program. Any student who may wonder if there is any such assistance available to them is encouraged to visit the class instructor for more detailed information. Student Critical Incident Stress Debriefing (CISD) Assistance 1-10.0 ______EMR program staff is committed to providing a safe learning environment to all of its program participants. However, due to the nature of the line of work associated with the pre-hospital medical field, there are times when the tasks may become perilous to the stability of one’s emotional state. In keeping with our commitment to safety, students who feel they need to be debriefed following a critical incident are encouraged to contact a Program Instructor. 1-10.1 ______ Students who request this service will be treated no different from a practicing Fire Rescue/EMS crewmember. Thus, either a program employee or any Fire Rescue/EMS staff CISD personnel may debrief said student. Even though some incidents may not require a formal debriefing, anyone who feels uncomfortable or is having difficulty dealing with a particular response or tragic situation is encouraged to speak with their instructor, preceptor, or use the debriefing services that is available to them. Program Evaluation 1-11.0 ______ periodically, you may be asked to complete an anonymous evaluation of your learning experiences within the EMR Program. Your constructive criticism is welcomed and combined with other measures of success in order to assure the continuous improvement of the EMS programs. Typically, the survey will be completed using Survey monkey. Skills and High Fidelity Simulation Labs Lab Uniform Policy 2-0.1 ______ Uniforms identify you as an EMR-Intern and are to be worn while attending all program functions; unless you are otherwise informed. The uniform policy will be strictly enforced. Failure to adhere to the uniform policy will result in a reprimand, which is the first in a series of steps to dismiss said student from class. Nothing will excuse a student from adhering to this policy. 2-0.2 ______ all students are expected to be well groomed and clean. Hair must be kept above the collar. In addition, uniforms must be kept neat and free of wrinkles while shoes should be polished as needed. 2-0.3 ______ the use of jewelry is limited to one (1) ring per hand, only. Students are not to wear any kind of jewelry above the collar during clinical rotations, regardless of gender and/or clinical site. 2-0.4 ______ there are no hats of any kind, which may be worn. 2-0.5 ______ the outermost layer of clothing worn by all students must identify them as EMR Program participants. Thus, regardless of whether students decide to wear the EMR-Intern polo, EMR Program t-shirt, or an EMR Program sweatshirt, any additional layers of clothing must be worn under the EMR Program attire. 2-0.6 ______ most uniform components are available for purchase at any other medical uniform retailer. However, uniform shirts must be purchased from the program classroom. 2-0.7 ______ Students may NOT use any non-prescribed eyewear (i.e. sunglasses) or hats of any kind while class is in session or while participating in the skills and/or simulation labs. 2-0.8 _______ Due to the potential for injury, all types of open style footwear are prohibited in all areas of the EMS building. This includes “flip-flops”, “crocs”, and all other similar style shoes. Anyone found to be in violation of this code will be asked to leave and return once proper footwear is being worn. Any time missed from class will be counted as outlined in the Course Attendance Policy. Uniform Components 2-0.9 ______ appropriately sized Black waist belt. 2-0.10 ______ Black shoes devoid of any logos and/or any other coloring with matching black socks. 2-0.11 ______ Navy blue pants (standard as set by Polk County Fire/Rescue EMS) 2-0.12 ______ EMT-Intern polo style shirt purchased from the vendor listed above or an EMS Program t-shirt. 2-0.13 ______ Stethoscope. 2-0.14 ______ working watch. If using a traditional style watch then it must be equipped with a sweeping second hand; if using a digital watch, then it must include a display for seconds. 2-0.15 ______ EMS Program Sweatshirts if necessary (review rule 2-0.5 to determine if you will need this component) Skills and High Fidelity Simulation Labs Procedures and Conduct Guidelines 2-1.0 _____ generally, the EMR Skills and High Fidelity Simulations labs are open every class period and from 0630 till 1500 every day. In the event that the BHS campus is closed due to school wide closure the program will do make up time on designated make up days. 2-1.1 _____ since the schedule listed above is subject to change, students bear responsibility to verify with an EMR Program Director whether there has been any change during the current semester. 2-1.2 _____ the purpose of the EMR Program’s Skills and High Fidelity Simulation Labs is to provide ALL course participants with a place to practice the skills necessary to complete the course objectives in order to develop competency in skill performance. ALL course participants are encouraged to visit the lab facilities prior to testing in order to practice sufficiently. EMR Program instructor/preceptors are always present to assist you with any particular skill. 2-1.3 _____ Students must attend the Skills and High Fidelity Simulation labs during regular scheduled classroom time to complete several practical skills and scenarios. Failure to do so will result in a failing grade being issued for and student will not be eligible to receive a certificate of completion until he or she completes the skills and practical exams the amount of time required to complete these various tasks will vary amongst all students. Thus, the student bears all responsibility for ensuring that all course deadlines are met. 2-1.4 _____ frequently students will have to perform skills in the presence of other students. It is expected that all students maintain a professional attitude and be courteous to the student testing. 2-1.5 _____ the consumption and/or possession of any alcoholic beverage and/or controlled substances, is strictly prohibited, not only on every campus, but at all clinical rotation locations as well. In addition, students must NOT be under the influence of alcohol or other controlled substances at any time during which they are representing the EMR Program. This includes on and off campus locations. Violation of this rule will result in disciplinary action up to and including immediate dismissal from the program. 2-1.6 _____ the use of electronic devices such as pagers, cell phones, and laptops; is strictly prohibited within the EMR Skills and High Fidelity Simulation labs. Furthermore, any electronic device in your possession while inside either the lab; must be turned off and kept out of sight. In the event, that a student or group of students desires to use such devices for a study session they are instructed to speak with an instructor so that if another area is available for use, the students can be granted access. 2-1.7 _____ Failure to comply with the electronic device policy will result in the following: 1st infraction will result in a one-point (1) drop on the grading rubric used for EMR. 2nd infraction will result in a five-point (5) drop in grade on the grading rubric used for EMR. 3rd infraction will result in dismissal from EMR. *An infraction is described as; any time the device is visible to a staff member in plain sight. 2-1.8 _____ every student will receive an EMR Skills Check-off form as part of the course syllabus. This form not only outlines every skill which students are expected to develop proficiency on, but will also serves as a record of said development. Therefore, all students are advised to have this form in their possession every time they visit either of the labs. This form documents the dates of completion and the instructor initials every time a student demonstrates competency with the skill at hand. 2-1.9 _____ Instructors working in the labs when a student successfully demonstrates competency on any skill will date and initial the individual skill sheet and the skills check-off form. However, the student is responsible for ensuring that they have not only brought the appropriate paperwork to the lab, but that an instructor has signed and dated the forms as well. Failure to follow this procedure could result in a student having to repeat all the work done up to that point. 2-1.10 _____ upon entering the skills lab, all students are expected to sign-in on the EMR Lab Attendance book located just left of the entryway. In addition, to entering their own name, students must obtain and record another student’s vital signs on to this book as well. 2-1.11 _____ during the course of a semester, students may “test” on any given skill as many times as necessary to demonstrate competency. However, students will be limited to no more than two (2) testing attempts on any one skill during the same lab date on the same skill, which they have failed. In addition, students may not re-test on any skill, which was successfully completed during the same day. 2-1.12 _____ In order to record competency on all practical skills, the EMR Skills Check-off form is composed of four (4) columns; the first column identifies each particular skill while the remaining columns must be dated and initialed by either an EMR Program Instructor or an approved EMR Program Preceptor on three (3) separate occasions as outlined below: 2-1.12a _____ First or initial check-off is completed in the skills lab prior to any clinical attendance. 2-1.12b _____ Second check-off; completed during the first three (3) field clinical in a mostly discussion type scenario between the student and their assigned preceptor. 2-1.12c _____ Third or final check-off; completed once the student performs a skill on a “live” patient during clinical rotations. *Since the opportunity to perform some skills on a “live” patient may not be available, students may visit the skills lab and request to be checked-off for the third column using during a simulated scenario. 2-1.13 _____ any act of dishonesty, including but not limited to forgery, alteration, or misuse of any college document, record or instrument of identification will result in dismissal from the Emergency Medical Responder program. In addition, infractions of this rule; may, at the discretion of the EMR program director, result in a permanent ban from participation in any future Bartow Medical and Fire Academy programs course. Clinical Rotation Standard Operating Policies and Procedures Clinical Uniform Policy 2-2.0 ______ Uniforms not only identify you to the patient as an EMR-Intern, but to anyone else you may meet, as well. Additionally, the uniform presents a more professional appearance while assisting in the prevention of cross contamination by separating everyday clothes from “work” clothes. 2-2.1 ______ Uniforms are to be worn while attending all program functions; unless you are otherwise informed. The uniform policy will be strictly enforced. Failure to adhere to the uniform policy may result in your dismissal from the assigned clinical area, which will result in a reprimand and the time not counting to toward course completion. Nothing will excuse a student from adhering to this policy during clinical rotations. 2-2.2 ______ all students are expected to be well groomed and clean. Hair must be kept above the collar. In addition, uniforms must be kept neat and free of wrinkles while shoes should be polished as needed. 2-2.3 ______ the use of jewelry is limited to one (1) ring per hand, only. Students are not to wear any kind of jewelry above the collar during clinical rotations, regardless of gender and/or clinical site. 2-2.4 ______ any, and ALL tattoos must be kept covered, thus out of sight, during all hospital clinical rotations. 2-2.5 ______ there are no hats of any kind, which may be worn during any clinical; regardless of location. 2-2.6 ______ the outermost layer of clothing worn by all students must identify them as EMR Program participants. Thus, regardless of whether students decide to wear the EMR-Intern polo, EMR Program t-shirt, or an EMR Program sweatshirt, any additional layers of clothing must be worn under the EMR Program attire. 2-2.7 ______ most uniform components are available for purchase at any other medical uniform retailer. However, uniform shirts must be purchased from the Instructor in the classroom: 2-2.8 ______ appropriately sized Black waist belt. 2-2.9 ______ Black shoes devoid of any logos and/or any other coloring with matching black socks. 2-2.10 ______ Navy blue pants (standard as set by Fire/Rescue EMS) 2-2.11 ______ EMR-Intern polo style shirt purchased from the vendor listed above. DO NOT WEAR THE EMR PROGRAM T-SHIRT TO CLINICAL SITES unless it is being used as an undershirt to the EMR-Intern polo style shirt. 2-2.12 ______ one set of bandage scissors, also known as trauma shears. 2-2.13 ______ Stethoscope. 2-2.14 ______ working watch. If using a traditional style watch then it must be equipped with a sweeping second hand; if using a digital watch, then it must include a display for seconds. 2-2.14 ______ Eye Protection, which must be worn anytime you are treating a patient. 2-2.15 ______ Gloves, which must be worn during all patient contact (this item is provided to you). 2-2.16 ______ EMR Program Sweatshirts if necessary Clinical Rotation Standard Operating Policies and Procedures Field Clinical Policy 2-3.0 ______ the field clinical preceptor is not obligated to allow student riders on their assigned apparatus. The ability for students to ride is made possible by an interest the preceptor has in providing clinical experience to the student. Thus, the EMR preceptor may terminate this relationship at any time, with or without cause. 2-3.1 ______ Fire Rescue /EMS and their employees are under no obligation to provide clinical experience for students. If a student is deemed "unsafe”, said student will be removed from the program. Unsafe is defined as: A student not taking proper safety precautions that might endanger themselves or others. 2-3.2 ______ upon completing all clinical prerequisites, students will be assigned to a field clinical preceptor who they will complete their first three (3) days of field clinical rotations with. During this time, the students are expected to complete the second or middle column of the EMR Skills Check-off form. 2-3.2a ______ In the event that a student is unable to complete the second or middle column of the EMR Skills Check-off form during the initial internship (first three (3) field clinical rotations), said student will be required to return to their assigned preceptor and complete this section of the form. Any time earned during this period will not be credited towards the amount necessary for course completion. 2-3.3 ______ Once a student has completed their initial internship as well as the middle column on the EMR Skills Check-off form, he or she may ask the instructor for access to the “ride book” in order to schedule additional clinical. 2-3.4 ______ all field clinical ride times must be scheduled in advance; students must visit the instructor, during class hours only, to schedule and/or change clinical dates and/or times. *Any change to clinical schedule that is initiated by the student, must be done in person. The instructor will NOT make any changes on your behalf if your request is received via phone calls, text messaging, email, or any other means of communication (except when leaving early or arriving late). 2-3.5 ______ Field clinical rotations are scheduled on what we refer to as the “ride book”. The “ride book” is composed of an upcoming period of approximately three (3) weeks. All clinical time is available on a “first come, first served” basis. Once a student has signed up for a particular location and date, no other student may sign up for that same date and location. 2-3.6 ______ Field clinical must be a minimum of a six (3) hour period anytime between 0700 and 2100 hours (BFD) or 1500 and 2000 hours (AFD). *Any field clinical that is less than six (6) hours will result in the student receiving a reprimand and the time will not be credited towards course completion. 2-3.7 ______ Clinical rotations will not extend past 2100 hours (BFD) and 2000 hours (AFD). However, at the preceptor’s discretion, a student participating in a clinical, which is taking place, at the station may stay as late as 2200 hours. *The above restriction is not applicable if the unit on which the student is “riding” is not at the station at the time listed. However, once said unit returns to the station students must expeditiously complete their paperwork and leave the station. 2-3.8 ______ as a general courtesy, students are asked to contact preceptors by calling their duty station prior to the scheduled shift and the day of the ride time. 2-3.9 ______ Students are expected to be on time to every field clinical that they schedule. However, in the event that something precludes a student from arriving on time or attending at all, the student MUST contact instructor and preceptor prior to the start of the scheduled clinical. In addition, if a student needs to leave the clinical prior to their scheduled departure time MUST be contacted as well. 2-3.10 ______ every student must be evaluated by a minimum of three (3) field clinical preceptors. 2-3.11 ______ EMR Program students are to complete field clinical with Fire Rescue/EMS approved preceptors only. Failure to do so will result a group 2 offense reprimand and the time spent will not be credited towards course completion. 2-3.12 ______ Students who complete a field clinical on a day, which they did not previously schedule, will forfeit any time spent at that clinical location on that date. 2-3.13 ______ Students are not to operate any vehicle at any time or under any circumstance while attending a clinical rotation. *This includes any vehicle regardless of whether it is an official apparatus or a privately owned vehicle. 2-3.14 ______ Food and/or beverages are prohibited within the fire apparatus or ambulance. 2-3.15 ______ In the event that an EMR program intern is injured during a clinical, the incident and/or injury MUST be reported to a Preceptor, Dept. Administration and Instructor promptly. 2-3.16 ______ Pursuant to Chapter 64E-2.036(1a) Florida Administration Code No student shall be subject to call while participating in class, clinical or field sessions. 2-3.17 ______ Pursuant to Chapter 64E-2.036(1b) Florida Administration Code EMR interns MUST function under the direct supervision of an EMR Program/Department approved preceptor. Therefore, EMR Programs’ interns will NOT be alone during patient care and/or transport and shall not be used to meet an agency’s staffing requirements. 2-3.18 ______ Students are hereby asked to contact Instructor anytime they need an answer, which pertains to the lab and/or clinical rotations. *Failure to follow this advice could result in a reprimand. Clinical Rotation Standard Operating Policies and Procedures Special Detail Policy 2-4.0 ______ Special Details are the result of a carefully orchestrated effort by several people. Despite this fact the number of days available to complete these is very limited. As a result, with regards to special details, the attendance policy in place is strictly adhered to and listed below: 2-4.1 ______ Special Detail dates will not have less than five (5) students scheduled. 2-4.2 ______ once a student has committed to attending on a particular date, they are not to make any changes unless another student is willing to “swap” days. If there is another student willing to do the exchange, a Swap Agreement Form must be completed and turned into the EMR Program Instructor. 2-4.3 ______ Students are expected to arrive on time; on their scheduled special detail day. Failure to arrive on time or failure to attend the detail altogether will result in the student being assigned to a “make-up” special detail work date and a group 2 offense reprimand will be issued. This will consist of working in the main storage room, detailing the ambulance and fire apparatus and also working in the classroom/labs area to make up the time. 2.4.4 ______ A second episode of tardiness or absence will result in an administratively withdrawal from EMR. Thus, said student would have to repeat EMR, during its next available offering. Policy on Injury or Illness Incurred During Clinical 2-6.0 ______ it is the intention of the EMR Programs to provide a safe lab and clinical environment to all program participants and visitors. However, due to the nature of the profession it is impossible for The Bartow Medical and Fire Academy or any of its staff to accept any financial liability concerning a student’s accident, injury, illness, and/or death, which is the result of clinical activities. Students are, hereby advised that during the clinical experience they (the students) may be exposed to situations, which could result in an accident, injury, illness, and/or death to the student. Thus, it is imperative that all students comply with any commands given by the preceptor immediately. Furthermore, students must follow all safety procedures instituted by the EMR program, its staff, or any of its educational partners. Lastly, students are, hereby advised that it is the student who bears all financial responsibility for treatment of any accident, injury, illness, and/or death, which occurs while the student is engaged in The Bartow Medical and Fire Academy EMR Program sanctioned activity. This includes but is not limited to needle stick injuries and disease exposure. Clinical Rotation Standard Operating Policies and Procedures Clinical Misconduct Policy 2-7.0 ______ The Bartow Medical and Fire Academies’ partnership with local agencies depends a mutual understanding of each other’s roles. However, both parties reserve the right to discontinue this partnership at any time. As a result, anytime staff from either party feels that a particular student’s actions, attitude, and/or ability as an EMR Intern may, in any way, compromise patient care and/or the safety of the team; said student shall be immediately dismissed from the clinical site. 2-7.1 ______ any student asked to leave a clinical site, and does not agree with such action may follow established grievance procedures as outlined in the most current Student Handbook. However, students who opt to begin the grievance process may not return to any clinical site and/or any EMR Program detail until the matter has been resolved. In addition, there will be no credit awarded during that period. 2-7.2 ______ lastly, the following individuals may ask a student to leave a clinical site and/or classroom, if they deem it to be necessary: EMR Program Medical Director - Dr. Joe Nelson EMR Program Director – Kozette Hubbard EMR Program Preceptors – Bartow Fire Dept. Auburndale Fire Dept. EMR Program Class and Lab Instructors ,School Board Members or Administrators. Student Counseling Documentation Policy 2-8.0 ______ Student Counseling Report: Also known as a reprimand and informational report, this form is to be used as a means to document any violations of policy as well as any tardiness and/or absenteeism. The form is composed of two (2) groups which are separated by the penalty which will be applied: 2-8.1 ______ Group one (1) infractions are serious offenses, which come along with the potential for adverse criminal consequences. Any group one (1) infraction will result in an immediate removal from the clinical site and/or campus; followed by dismissal from the Emergency Medical Responder course. *Subsequently, readmission to the EMR Program may not be an option. 2-8.2 ______ Group two (2) infractions most often relate to procedural infractions and follow a three (3) “strike” rule as follows: First infraction = Verbal Reprimand Second infraction = Written Reprimand Third infraction = Dismissal from Emergency Medical Technology, ATD program course. 2-8.3 ______ Group 2 offenses signify a reprimand in steps for dismissal. You in fact may receive 1, 2 or all-3 reprimands at one time depending upon the infraction/s disclosed. Clinical Rotation Standard Operating Policies and Procedures Clinical Documentation Policy 2-9.0 ______ Clinical Evaluation Form (Includes Field, Special Detail): This form documents clinical attendance at the various clinical internship sites in use by the EMR Program. The form is to be completed, and signed, by the clinical preceptor or instructor upon conclusion of each and every clinical. The preceptor will evaluate student performance throughout the clinical and document his or her observations accordingly on this form. 2-9.0a ______ Value System: The Clinical Evaluation Form allows preceptors to rate student performance based upon several categories. Each of these categories rates whether student performance was “Satisfactory”, “Unsatisfactory”, or “Remedial”. The instructor will then input the information from the Clinical Evaluation Form unto a computer database which assigns a numerical value to each rating as follows: Satisfactory +1, Unsatisfactory (-1), and Remedial (-2). This numerical value is collected following every clinical and averaged over the course of all clinical. Subsequently, this average is reported on both the EMR Clinical Progress Report and the EMT Terminal Clinical Evaluation Report. If this value is a negative integer; the student will have continue attending clinical until a value above zero is achieved. In the event that the deadline to complete clinical has passed, an incomplete grade will be issued and the student will be afforded an additional two (2) weeks to schedule additional field clinical in an attempt to earn a value above zero on the Terminal Clinical Evaluation Report. Failure to achieve this benchmark will result in a failing grade in EMR. 2-9.0b ______ Remedial Training: Any student who receives a REMEDIAL mark on any clinical evaluation form will be required to discontinue clinical rotations and meet with instructor. During this meeting, the instructor will make a decision as to when said student may continue clinical rotations. Typically, the issue is often resolved at this point. However, on occasion the student is asked to come back into the skills lab in order to be re-trained in those area(s) marked as remedial on the evaluation prior to continuing with clinical. 2-9.1 ______ Preceptor Evaluation Form: Completed by the student upon completion of the clinical. Students are to evaluate and rate their experience with the preceptor with whom they completed the clinical on that day (you will remain anonymous). 2-9.2 ______ Patient Care Report: PCRs or run reports are required anytime students encounter any type of patient contact. Regardless of the number of patient contacts completed previously. This rule is pursuant to State of Florida Administrative Code 64J-1.014. 2-9.3 ______ Clinical Swap Agreement Form: Used when two (2) students agree to swap their scheduled hospital clinical days. Both parties must sign the form in the presence of the instructor who will also sign it. 2-9.4 ______ Field Clinical Sign-in Form: The purpose of this form is to provide students a means to have a backup record, which documents the student’s clinical attendance. This form is not required; however, in the event that other documentation means is lost this form will serve proof of your total hours and patient contacts. Lastly, in order for this form to be valid it must have the signature of every preceptor with whom the student has completed clinical. *Responsibility to provide documentation of attendance, which fulfills the required clinical time, lies solely with the student. 2-9.5 ______ all paperwork relating to clinical completion MUST be turned into the instructor within 5 days of the date of said clinical. If you are having issues with fulfilling this requirement, contact instructor prior to the 5th day. 2-9.6 ______ Students are not to remove any confidential paperwork from their clinical locations. EMR Lab/Clinical Grading Policy 2-10.0 ______ Letter grades for EMR are determined by using a rubric composed of a point system which is dependent on several course completion benchmarks and their respective deadlines for completion. Students will earn five (5), three (3), zero (0), or up to negative six (-6) points in six (6) categories depending on when the tasks are completed. The six (6) categories are as follows: • Completion of the 1st column on the EMR Skills Check-off form and ALL clinical prerequisite paperwork (i.e. physical exam, immunizations, drug screen, background check, HIPAA) • Completion of the 2nd column on the EMR Skills Check-off form with clinical preceptor • Completion of the four (4) hour skilled nursing facility clinical • Completion of the EMR Skills Check-off Form in its entirety • Completion of all field clinical time requirements . T.E.A.M. Day Attendance 2-10.1 ______ Grading Scale: Total Points Earned Associated Letter Grade 25 – 21 A 20 – 14 B 13 – 0 C Below ZERO F (In other words, the cumulative total number of Points earned upon completion of course equals a Negative number) T.E.A.M. Day (Teaching EMS with Actual Methods) field day 2-11.0 ______ T.E.A.M. Day consists of various scenario type exercises resembling “real life” EMS events in which all EMR students MUST participate. Students will interact with each other, as well as, preceptors and instructors to apply and re-enforce their training. All student participants’ performance is evaluated as individual groups according to their respective training level during the several mock scenarios, which take place throughout day. Failure to attend T.E.A.M. Day will result in an “O” being recorded with no makeup. 2-11.1 ______ T.E.A.M. day attendance is mandatory for all EMR Program students; NO students should arrive any later than 0900 hours. However, understanding that occasionally actual real life events may disrupt plans; the following policy will be stringently adhered to during T.E.A.M. day: 2-11.1a ______ any student who arrives after 0900, but before the first scenario’s teams are announced; is subject to negative three (-3) points being included in their EMR grade rubric. 2-11.1b ______ any student who arrives after 0900, but before the second scenario’s teams are announced; is subject to negative five (-5) points being included in their EMR grade rubric. 2-11.1c ______ any student who arrives after the teams for scenario two (2) are announced; is subject to dismissal from EMR. EMR LAB Completion Requirements Field Clinical Rotation Requirement 3-1.0 ______ Complete a minimum of eighty (50) hours of field clinical rotations/Special Detail Events. However, of those fifty hours, a minimum of sixty (40) must be completed while on board a Fire Rescue/EMS vehicle and a minimum of ten (10) hours must be completed a Special Detail Event . Special Detail Clinical Requirements 3-1.1 ______ Complete a minimum of ten (10) hours of special detail rotations which are scheduled over several day at several events. Each day is composed of four hour (4) hour shifts. Practical Skill Lab Requirement 3-1.3 ______ all practical skills will be reviewed and/or performed on a minimum of three separate dates which are documented with an approved EMR instructor/preceptor on the Skills Check-Off form by Emergency Medical Responder Completion Requirements 3-2.0 ______ Obtain, maintain, and/or possess the Basic Life Support for Healthcare Provider certification, or a State of Florida approved equivalent, according to the standards set forth by the American Safety and Health Association. 3-2.1 ______ Complete a minimum of four (4) hours training on HIV / AIDS awareness and safety pursuant to: FS 401.2701(1) (a) 5c 3-2.2 ______ complete training on Sudden Infant Death Syndrome (SIDS) as pursuant to: FS 383.3362(1) & (3) 3-2.3 ______ Complete a minimum of two (2) hours training on State of Florida Trauma Score Methodologies as pursuant to: FS 401.2701(1) (a) 5b 3-2.4 ______ Achieve a minimum average exam grade of eighty percent (80%) overall. 3-2.5 ______ Achieve a minimum grade of eighty percent (80%) on the comprehensive final examination. 3-2.6 ______ Complete all the requirements for EMR Clinical with a minimum letter grade of “C”. 3-2.7 ______ Attend and participate during T.E.A.M. day as outlined on the EMR Course Syllabus. 3-2.8 ______ Achieve a minimum of an eighty percent (80%) average on the overall class grade. Field Clinical Evaluation Form Scoring Guide Be honest in your appraisal of the student’s performance. Examples for each category are described below. This is not an all-inclusive listing, but rather a list of examples provided to assist you in the evaluation process. Appearance 5-4 (Professional) In complete uniform (Dress navy blue or black pant, black belt, program shirt, watch, pen, stethoscope, black uniform shoes and socks). Student is appropriately groomed and follows socially acceptable hygiene habits, which displays professional appearance. Wears no jewelry and females have hair up. 3-2 (Non-Professional) Student is missing any of the uniform components, unshaved or unkempt. Uniform is neither clean and/or ironed. Shoes not polished. Hair not combed or requires haircut. Wearing excessive jewelry or hair down on shoulders. These students should be sent home for the shift and a Coordinator of Clinical Education should be contacted. 1 None Study Time and Self - Motivation 5-4 Student is self-motivated. Uses down time at station to study. Takes initiative to complete assignments, to improve or correct behavior, takes on or follows through on tasks without constant supervision, shows enthusiasm for learning and improvement, consistently strives for excellence. Actively engages in patient care. Punctual and completes assignments on time. 3-2 Student must be reminded or prompted to complete tasks continuously. Sleeping, talking on phone or watching TV at station instead of studying. Requires prompting to review assignments or complete paper work. Stands back and fails to involve him / her in patient management. 1 If student behavior / action continues after discussion with student to change or alter behavior, remedial is assigned. The student will be counseled and remedial training provided by program staff. Safety Precautions / Careful Delivery of Service 5-4 Reviews skills, performs complete equipment check, and follows policies and procedures. 3-2 Does not review skills, complete equipment check, or follow policies. 1 If student behavior / action continues after discussion with student to change or alter behavior, remedial is assigned. The student will be counseled and remedial training provided by program staff. Involvement with Patient / and Communications 5-4 Is involved in patient care. Does not allow personal bias to impact care, protects the patient’s privacy and confidentiality. 3-2 Places personal needs over patient needs. Fails to respect patient’s confidentiality. If student behavior / action continues after discussion with student to change or alter behavior, remedial is assigned. The student will be counseled and remedial training provided by program staff. 1 None Patient Assessment 5-4 Recognizes the need for and performs a focused or detailed assessment. Is aware of on scene trauma time limits, performs quickly and discovers all injuries. Integrates needed treatments as required. 3-2 Fails to recognize the need for or performs assessment slowly and requires prompting. Fails to recognize importance of trauma scene time limits. Performs slowly or requires prompting. Requires preceptor intervention to complete the assessment. 1 If student behavior / action or skill performance continues after discussion with student to change or alter behavior, remedial is assigned. The student will be counseled and remedial training provided by program staff BLS Treatment Decisions / Performance 5-4 Makes appropriate, timely decisions regarding BLS skills. Performs needed BLS procedures prior to ALS procedures. 3-2 Fails to recognize or is slow to recognize need for BLS skills. Performs ALS procedures prior to BLS procedures. If student behavior / action or skill performance continues after discussion with student to change or alter behavior, remedial is assigned. The student will be counseled and remedial training provided by program staff 1 None Telemetry Reports 5-4 Has knowledge of and uses correct protocol transmission of patient information. Uses appropriate tone and volume to be clearly understood. Provides coherent report. 3-2 Does not understand or recall protocol for transmission of patient information. Uses improper tone and volume to be understood. Provides poor report. 1 If student action continues after discussion with student to change or alter behavior, remedial is assigned. The student will be counseled and remedial training provided by program staff. Verbal Report to Fire/EMS 5-4 Introduces patient to Fire/EMS, uses patients name throughout, is organized and clearly and describes problem. 3-2 Fails to use patient’s name, provides disorganized and confusing report. 1 If student behavior / action or skill performance continues after discussion with student to change or alter behavior, remedial is assigned. The student will be counseled and remedial training provided by program staff. Knowledge of BLS Theory 5-4 When questioned responds with an appropriate level of knowledge and comprehension of BLS concepts. 3-2 When questioned fails to respond, responds incorrectly to questioning of BLS. If student behavior / action or skill performance continues after discussion with student to change or alter behavior, remedial is assigned. The student will be counseled and remedial training provided by program staff. 1 None Preceptor Relationship and Teamwork Diplomacy 5-4 Is polite to preceptor and other health care team members, behaves in a manner that brings credit to the profession, places the success of the team above self-interest, able to adjust to change quickly and communicates with others to resolve problems. 3-2 Rude or disrespectful to other members of the health care team, undermines the health care team, disrespects one or more health care team members, inflexible - not open to change. 1 If student behavior / action continues after discussion with student to change or alter behavior, remedial is assigned. The student will be counseled and remedial training provided by program staff. Patient Relationship 5-4 As appropriate, communicates with empathy to the patient, uses the patient=s name, speaks clearly, meets patient needs. Demonstrates a calm, compassionate demeanor. 3-2 Refuses or does not engage/communicate with patient. Fails to use patient=s name when appropriate. Does not recognize or fails to meet patient needs. 1 If student behavior / action continues after discussion with student to change or alter behavior, remedial is assigned. The student will be counseled and remedial training provided by program staff Accepts Feedback Well 5-4 Is open and receptive to critical feedback. Solicits feedback from preceptor and other team members. Accepts feedback in a non-threatening manner. 3-2 Closed minded to feedback. Reluctantly accepts feedback from preceptor, instructor and others. 1 If student behavior / action continues after discussion with student to change or alter behavior, remedial is assigned. The student will be counseled and remedial training provided by program staff Attitude / Behavior 5-4 (Positive) Displays a combination of all of the following components: Integrity; Empathy; Self-Motivation; Self Confidence; Communications/Teamwork, Respect for all. 3-2 (Negative) If student is counseled for any of the following: Integrity, Empathy, Self-Motivation, Self Confidence, Communications with everyone, or teamwork and respect to preceptor / patients 1 None PRECEPTOR NAME PRINTED PRECEPTOR INITIALS PRECEPTOR SIGNATURE NAME: DATE ALS UNIT CALLS TIME IN TIME OUT TOTAL TIME PRECEPTOR SIGNATURE Florida Department of Education Curriculum Framework Program Title: Program Type: Career Cluster: Emergency Medical Responder Career Preparatory Health Science Secondary – Career Preparatory Program Number 8417170 CIP Number 0317020502 Grade Level 9-12, 30, 31 Standard Length 3 credits Teacher Certification Health Science Core ANY HEALTH OCCUP G *(See DOE approved list) Secondary – Career Preparatory Emergency Medical Responder 3 REG NURSE 7 G PARAMEDIC @7 7G MED PROF 7 G EMT 7G LAW ENF @7 G CORR OFF 7G PUB SERV 7G FIRE FIGHT @7 G PRAC NURSE @7 %7%G (Must be a Registered Nurse) CTSO HOSA: Future Health Professionals SOC Codes (all applicable) 31-9099 Healthcare Support Workers, All Other 53-3011 Ambulance Drivers and Attendants, Except Emergency Medical Technicians CTE Program Resources http://www.fldoe.org/academics/career-adult-edu/career-tech-edu/programresources.stml Purpose This program offers a sequence of courses that provides coherent and rigorous content aligned with challenging academic standards and relevant technical knowledge and skills needed to prepare for further education and careers in the Health Science career cluster; provides technical skill proficiency, and includes competency-based applied learning that contributes to the academic knowledge, higher-order reasoning and problem-solving skills, work attitudes, general employability skills, technical skills, and occupation-specific skills, and knowledge of all aspects of Health Science career cluster. The content includes but is not limited to planning, management, finance, technical and production skills, underlying principles of technology, labor issues, community issues and health, safety, and environmental issues. Clinical learning experiences are an integral part of this program. This is an instructional program that prepares individuals to provide initial care to sick or injured persons or as ambulance drivers and attendants SOC 53-3011. An Emergency Medical Responder may use this training for employment. The Emergency Medical Responder is the first to arrive at the scene of an injury but does not have the primary responsibility for treating and transporting the injured person(s). Emergency Medical Responders may include law enforcement, life guard, fire services or basic life support non-licensed personnel who act as part of an organized emergency medical services team. Additional Information relevant to this Career and Technical Education (CTE) program is provided at the end of this document. Program Structure This program is a planned sequence of instruction consisting of three courses and two occupational completion points. The two credit core is required as a prerequisite for all programs and options. Secondary students completing the two required courses will not have to repeat the core in postsecondary. When the recommended sequence is followed, the structure allows students to complete at specified points for employment or remain for advanced training or cross-training. A student who completes the applicable competencies at any occupational completion point may either continue with the training program or exit as an occupational completer. The two courses in the core are: 8417100 - Health Science Anatomy and Physiology (Previously titled Health Science 1) 8417110 - Health Science Foundations (Previously titled Health Science 2) The following table illustrates the secondary program structure: OCP Course Number A Course Title Length SOC Code 31-9099 Level Graduation Requirement VO Health Science Anatomy 1 credit 3 and Physiology Health Science 31-9099 VO 8417110 1 credit 2 Foundations B Emergency Medical 53-3011 VO 8417171 1 credit 2 Responder 3 (Graduation Requirement Abbreviations- EQ= Equally Rigorous Science, PA= Practical Arts, EC= Economics, VO= Career and Technical Education) 8417100 Academic Alignment Table Academic alignment is an ongoing, collaborative effort of professional educators specializing in the fields of science, mathematics, English/language arts, and Career and Technical Education (CTE). This initiative supports CTE programs by improving student performance through the integration of academic content within CTE courses. Career and Technical Education courses that have been aligned to the Next Generation Sunshine State Standards for Science and the Florida Standards for Mathematics and English/Language Arts will show the following data: the quantity of academic standards in the CTE course; the total number of standards contained in the academic course; and the percentage of alignment to the CTE course. Courses 841710 0 841711 0 841717 1 Anatomy/ Physiology Honors Astronomy Solar/Galactic Honors Biology 1 Chemistry 1 EarthSpace Science 46/87 53% 6/80 8% 52/83 63% 7/69 10% 26/67 39% Envir onme ntal Scien ce 8/70 11% 17/87 20% 16/80 20% 32/83 39% 13/69 19% 28/67 42% 50/87 57% 28/80 35% 8/83 10% 28/69 41% 3/67 4% Integrat ed Science Marine Science 1 Honors Physica l Scienc e Physics 1 21/6 9 30% 34/82 41% 9/66 14% 29/74 39% 6/72 8% 15/70 21% 14/6 9 20% 28/82 34% 18/66 27% 31/74 42% 12/72 17% 27/70 39% 29/6 9 42% 5/82 6% 24/66 36% 9/74 12% 32/72 44% Gene tics ** Alignment pending review # Alignment attempted, but no correlation to academic course Courses 8417100 8417110 8417171 Algebra 1 21/67 31% Algebra 2 9/75 12% Geometry 18/54 33% English 1 14/46 30% English 2 14/45 31% English 3 English 4 # # 25/67 37% 15/75 20% 18/54 33% 22/46 48% 22/45 49% 25/45 56% 25/45 56% 10/67 15% 18/75 24% 8/54 15% # # 16/45 36% 16/45 36% ** Alignment pending review # Alignment attempted, but no correlation to academic course Florida Standards for Technical Subjects Florida Standards (FS) for English Language Arts and Literacy in History/Social Studies, Science, and Technical Subjects are the critical reading and writing literacy standards designed for grade 6 and above. These standards are predicated on teachers of history/social studies, science, and technical subjects using their content area expertise to help students meet the particular challenges of reading, writing, speaking, listening, and language in their respective fields. It is important to note that the 6-12 literacy standards in history/social studies, science, and technical subjects are not meant to replace content standards in those areas but rather to supplement them. This curriculum framework incorporates the grades 9-10 reading and writing literacy standards in the first two courses of this CTE program and grade 11-12 reading and writing literacy standards in the third and fourth courses of this CTE program. The standards for Mathematical Practices describe varieties of expertise that educators at all levels should seek to develop in their students. These practices rest on important “processes and proficiencies” with longstanding importance in mathematics education. This curriculum framework incorporates the appropriate mathematical practices in the first four courses of this CTE program. National Standards (NS) The student performance standards for Emergency Medical Responder were adapted and condensed from U. S. Department of Transportation Emergency Medical Services; National EMS Education Standards; Emergency Medical Responder Instructional Guidelines and American Society for Testing and Materials, Committee F-30. Administrators and instructors should refer to these materials for additional details. Common Career Technical Core – Career Ready Practices Career Ready Practices describe the career-ready skills that educators should seek to develop in their students. These practices are not exclusive to a Career Pathway, program of study, discipline or level of education. Career Ready Practices should be taught and reinforced in all career exploration and preparation programs with increasingly higher levels of complexity and expectation as a student advances through a program of study. 1. Act as a responsible and contributing citizen and employee. 2. Apply appropriate academic and technical skills. 3. Attend to personal health and financial well-being. 4. Communicate clearly, effectively and with reason. 5. Consider the environmental, social and economic impacts of decisions. 6. Demonstrate creativity and innovation. 7. Employ valid and reliable research strategies. 8. Utilize critical thinking to make sense of problems and persevere in solving them. 9. Model integrity, ethical leadership and effective management. 10. Plan education and career path aligned to personal goals. 11. Use technology to enhance productivity. 12. Work productively in teams while using cultural/global competence. Standards After successfully completing this program, the student will be able to perform the following: Standards 1-30 encompass the Health Science Core: 01.0 02.0 03.0 Methods and strategies for using Florida Standards for grades 09-10 reading in Technical Subjects for student success in Emergency Medical Responder. Methods and strategies for using Florida Standards for grades 09-10 writing in Technical Subjects for student success in Emergency Medical Responder. Methods and strategies for using Florida Standards for grades 09-10 Mathematical Practices in Technical Subjects for student success in Emergency Medical Responder. 04.0 05.0 06.0 07.0 08.0 09.0 10.0 11.0 12.0 13.0 14.0 15.0 16.0 17.0 18.0 19.0 20.0 21.0 22.0 23.0 24.0 25.0 26.0 27.0 28.0 29.0 30.0 Analyze and interpret an overview of the human body, including organization and chemical process. Apply correct medical terminology relating to body structure and function within a real-world application. Evaluate cells and tissues microscopically and macroscopically and relate their specialized functions. Analyze the integumentary system in relation to health and disease. Analyze the skeletal system in relation to health and disease. Analyze the muscular system in relation to health and disease. Analyze the nervous system in relation to health and disease. Analyze the endocrine system in relation to health and disease. Analyze the cardiovascular/circulatory system in relation to health and disease. Analyze the lymphatic and immune systems in relation to health and disease. Analyze the respiratory system in relation to health and disease. Analyze the digestive system in relation to health and disease. Analyze the urinary system in relation to health and disease. Analyze the both the male and female reproductive systems in relation to health and disease. Identify and explain factors relating to genetics and disease. Evaluate and apply the principles of disease transmission and control to real-world scenarios. Demonstrate knowledge of the healthcare delivery system and health occupations. Demonstrate the ability to communicate and use interpersonal skills effectively. Demonstrate legal and ethical responsibilities. Demonstrate an understanding of and apply wellness and disease concepts. Recognize and practice safety and security procedures. Recognize and respond to emergency situations. Recognize and practice infection control procedures. Demonstrate an understanding of information technology applications in healthcare. Demonstrate employability skills. Demonstrate knowledge of blood borne diseases, including HIV/AIDS. Apply basic math and science skills. Standards 31- 5165 encompass competencies specific to Emergency Medical Responder 3: 31.0 32.0 33.0 34.0 35.0 36.0 37.0 38.0 39.0 40.0 41.0 42.0 43.0 44.0 45.0 46.0 47.0 Methods and strategies for using Florida Standards for grades 11-12 reading in Technical Subjects for student success in Emergency Medical Responder. Methods and strategies for using Florida Standards for grades 11-12 writing in Technical Subjects for student success in Emergency Medical Responder. Methods and strategies for using Florida Standards for grades 11-12 Mathematical Practices in Technical Subjects for student success in Emergency Medical Responder. Demonstrate an understanding of the roles and responsibilities of the Emergency Medical Responder. Demonstrate an ability to communicate effectively as part of the EMS team. Demonstrate an understanding of medico legal aspects. Determine and record vital signs of a sick or injured person. Use medical identification devices. Conduct a primary assessment of problems that are a threat to life if not corrected immediately. Demonstrate BLS procedures Recognize and control bleeding. Recognize and control shock. Understand the importance of emergency medications. Demonstrate understanding of airway management, respiration and artificial ventilation. Provide secondary assessment. Identify muscular-skeletal injuries. Demonstrate proper immobilization of a Cervical/Spinal injury. 48.0 49.0 50.0 51.0 52.0 53.0 54.0 55.0 56.0 Demonstrate proper extremity immobilization as well as other immobilization for other injuries (pelvis, ribs). Provide emergency evacuation and transfer of a sick and/or injured person Identify and provide initial care for a sick and/or injured patient Identify and care for patients who are in special situations Provide triage to victims of multiple casualty incidents Recognize life-threatening situations Recognize entrapment situations Assist with emergency childbirth Identify critical incident stressors Florida Department of Education Student Performance Standards Health Science Core: The first two courses in this program are referred to as the Health Science Core and consist of the courses Health Science Anatomy & Physiology (8417100) and Health Science Foundations (8417110). These courses were previously titled Health Science 1 and Health Science 2. To ensure consistency whenever these courses are offered, the standards and benchmarks for the health science core have been placed in a separate document. You can access the course outline by visiting this link: http://www.fldoe.org/core/fileparse.php/5652/urlt/health_sci_core_secondary_1516.rtf The two credit core is required as a prerequisite for all secondary programs except for Practical Nursing and Pharmacy Technician. Secondary students completing the two required courses will not have to repeat the core in postsecondary. When the recommended sequence is followed, the structure allows students to complete at specified points for employment or remain for advanced training or cross-training. Course Title: Course Number: Course Credit: Health Science Anatomy & Physiology 8417100 1 Course Description: This course is part of the secondary Health Core consisting of an overview of the human body, both structurally and functionally with emphasis on the pathophysiology and transmission of disease. Medical terminology is an integral part of the course. You can access the course standards and benchmarks by visiting this link: http://www.fldoe.org/core/fileparse.php/5652/urlt/health_sci_core_secondary_1516.rtf Course Title: Course Number: Course Credit: Health Science Foundations 8417110 1 Course Description: This course is part of the Secondary Health Core designed to provide the student with an in depth knowledge of the health care system and associated occupations. Emphasis is placed on communication and interpersonal skills, use of technology, ethics and the development of critical thinking and problem solving skills. Students may shadow professionals throughout the course. You can access the course standards and benchmarks by visiting this link: http://www.fldoe.org/core/fileparse.php/5652/urlt/health_sci_core_secondary_1516.rtf Florida Standards Correlation to CTE Program Standard # 31.0 Methods and strategies for using Florida Standards for grades 11-12 reading in Technical Subjects for student success in Emergency Medical Responder. 31.01 Key Ideas and Details 31.01.1 Cite specific textual evidence to support analysis of science and technical texts, attending to important distinctions the author makes and to any gaps or inconsistencies in the account. LAFS.1112.RST.1.1 31.01.2 Determine the central ideas or conclusions of a text; trace the text’s explanation or depiction of a complex process, phenomenon, or concept; provide an accurate summary of the text. LAFS.1112.RST.1.2 31.01.3 Follow precisely a complex multistep procedure when carrying out experiments, taking measurements, or performing technical tasks, attending to special cases or exceptions defined in the text. LAFS.1112.RST.1.3 31.02 Craft and Structure 31.02.1 Determine the meaning of symbols key terms, and other domain-specific words and phrases as they are used in a specific scientific or technical context relevant to grades 11–12 texts and topics. LAFS.1112.RST.2.4 31.02.2 Analyze how the text structures information or ideas into categories or hierarchies, demonstrating understanding of the information or ideas. LAFS.1112.RST.2.5 31.02.3 Analyze the author’s purpose in providing an explanation, describing a procedure, or discussing an experiment in a text, identifying important issues that remain unresolved. LAFS.1112.RST.2.6 31.03 Integration of Knowledge and Ideas 31.03.1 Integrate and evaluate multiple sources of information presented in diverse formats and media (e.g. quantitative data, video, multimedia) in order to address a question or solve a problem. LAFS.1112.RST.3.7 31.03.2 Evaluate the hypotheses, data, analysis, and conclusions in a science or technical text, verifying the data when possible and corroborating or challenging conclusions with other sources of information. LAFS.1112.RST.3.8 31.03.3 Synthesize information from a range of sources (e.g., texts, experiments, simulations) into a coherent understanding of a process, 32.0 phenomenon, or concept, resolving conflicting information when possible. LAFS.1112.RST.3.9 31.04 Range of Reading and Level of Text Complexity 31.04.1 By the end of grade 11, read and comprehend literature [informational texts, history/social studies texts, science/technical texts] in the grades 11– CCR text complexity band proficiently, with scaffolding as needed at the high end of the range. 31.04.2 By the end of grade 12, read and comprehend literature [informational texts, history/social studies texts, science/technical texts] at the high end of the grades 11–CCR text complexity band independently and proficiently. LAFS.1112.RST.4.10 Methods and strategies for using Florida Standards for grades 11-12 writing in Technical Subjects for student success in Emergency Medical Responder. 32.01 Text Types and Purposes 32.01.1 Write arguments focused on discipline-specific content. LAFS.1112.WHST.1.1 32.01.2 Write informative/explanatory texts, including the narration of historical events, scientific procedures/experiments, or technical processes. LAFS.1112.WHST.1.2 32.02 Production and Distribution of Writing 32.02.1 Produce clear and coherent writing in which the development, organization, and style are appropriate to task, purpose, and audience. LAFS.1112.WHST.2.4 32.02.2 Develop and strengthen writing as needed by planning, revising, editing, rewriting, or trying a new approach, focusing on addressing what is most significant for a specific purpose and audience. LAFS.1112.WHST.2.5 32.02.3 Use technology, including the Internet, to produce, publish, and update individual or shared writing products in response to ongoing feedback, including new arguments or information. LAFS.1112.WHST.2.6 32.03 Research to Build and Present Knowledge 32.03.1 Conduct short as well as more sustained research projects to answer a question (including a selfgenerated question) or solve a problem; narrow or broaden the inquiry when appropriate; synthesize multiple sources on the subject, demonstrating understanding of the subject under investigation. LAFS.1112.WHST.3.7 33.0 32.03.2 Gather relevant information from multiple authoritative print and digital sources, using advanced searches effectively; assess the strengths and limitations of each source in terms of the specific task, purpose, and audience; integrate information into the text selectively to maintain the flow of ideas, avoiding plagiarism and overreliance on any one source and following a standard format for citation. LAFS.1112.WHST.3.8 32.03.3 Draw evidence from informational texts to support analysis, reflection, and research. LAFS.1112.WHST.3.9 32.04 Range of Writing 32.04.1 Write routinely over extended time frames (time for reflection and revision) and shorter time frames (a single sitting or a day or two) for a range of discipline-specific tasks, purposes, and audiences. LAFS.1112.WHST.4.10 Methods and strategies for using Florida Standards for grades 11-12 Mathematical Practices in Technical Subjects for student success in Emergency Medical Responder. 33.01 Make sense of problems and persevere in solving them. MAFS.K12.MP.1.1 33.02 Reason abstractly and quantitatively. MAFS.K12.MP.2.1 33.03 Construct viable arguments and critique the reasoning of others. MAFS.K12.MP.3.1 33.04 Model with mathematics. MAFS.K12.MP.4.1 33.05 Use appropriate tools strategically. MAFS.K12.MP.5.1 33.06 Attend to precision. MAFS.K12.MP.6.1 33.07 Look for and make use of structure. MAFS.K12.MP.7.1 33.08 Look for and express regularity in repeated reasoning. MAFS.K12.MP.8.1 Abbreviations: FS-M/LA = Florida Standards for Math/Language Arts NGSSS-Sci = Next Generation Sunshine State Standards for Science CTE Standards and Benchmarks 34.0 Demonstrate an understanding of the roles and responsibilities of the Emergency Medical Responder--The student will be able to: FS-M/LA NGSSS-Sci SC.912.L.17.16 SC.912.P.8.10 SC.912.P.8.11 SC.912.P.10.21 CTE Standards and Benchmarks 35.0 34.01 Describe the role of Emergency Medical Responder as a member of the EMS Team. 34.02 List and describe the responsibilities of the Emergency Medical Responder for the provision of pre-hospital emergency care within the local EMS system. 34.03 Describe principles of safely operating a ground ambulance. 34.04 Understand the guidelines of operating safety in and around a landing zone during air medical operations and transport. 34.05 Implement appropriate Joint Commission patient safety goals. 34.06 Discuss and demonstrate Hazardous Waste Operations and Emergency Response (HAZWOPER) standard, 29 CFR 1910.120 (q)(6)(i) –First Responder Awareness Level http://www.hazwopercertification.net/ Demonstrate an ability to communicate effectively as part of the EMS team--The student will be able to: 35.01 Demonstrate the proper procedure for the transfer of patient care to other EMS personnel. FS-M/LA LAFS.1112.L.1.1 LAFS.1112.L.1.2 LAFS.1112.RI.4.10 LAFS.1112.W.1.2 LAFS.1112.W.4.10 LAFS.1112.W.2.4 LAFS.1112.SL.2.4 LAFS.1112.RI.2.4 LAFS.1112.RI.3.7 LAFS.1112.RI.4.10 LAFS.1112.W.1.2 LAFS.1112.W.2.4 LAFS.11.12.W.4.10 LAFS.1112.SL.2.4 LAFS.1112.L.1.1 LAFS.1112.L.1.2 LAFS.1112.RI.2.4 LAFS1112.RI.3.7 LAFS.1112.RI.4.10 LAFS.1112.W.1.2 LAFS.1112.W.2.4 LAFS.11.12.W.4.10 LAFS.1112.SL.2.4 LAFS.1112.L.1.1 LAFS.1112.L.1.2 LAFS.1112.RI.2.4 LAFS.1112.SL.1.1 LAFS.1112.SL.1.2 LAFS.1112.L.3.4 LAFS.1112.L.3.6 LAFS.1112.RI.2.4 LAFS.1112.SL.1.1 LAFS.1112.SL.1.2 LAFS.1112.L.3.4 LAFS.1112.L.3.6 LAFS.1112.RI.2.4 LAFS.1112.SL.1.1 LAFS.1112.SL.1.2 LAFS.1112.L.3.4 LAFS.1112.L.3.6 MAFS.912.N-Q.1.3 LAFS.1112.SL.2.4 LAFS.1112.SL.2.6 LAFS.1112.L.1.1 LAFS.1112.L.3.4 LAFS.1112.L.3.6 NGSSS-Sci SC.912.P.12.1 SC.912.P.12.3 SC.912.P.12.5 CTE Standards and Benchmarks 35.02 Describe information regarding a patient's condition and treatment that need to be communicated. 35.03 35.04 35.05 36.0 37.0 38.0 39.0 Communicate the Emergency Medical Responder’s observations and actions to whomever patient care is transferred. Describe and apply the principles of communicating with patients in a manner that achieves a positive relationship. Recognize simple medical prefixes, suffixes and combining words. Demonstrate an understanding of medico legal aspects–The student will be able to: 36.01 Describe and demonstrate an understanding of the medico legal aspects of an Emergency Medical Responder’s provision of emergency medical care in the jurisdiction having authority, including, but not limited to, duty to act, standard of care, consent to care, forcible restraint, abandonment, documentation and any applicable Good Samaritan Laws. FS-M/LA LAFS.1112.L.1.1 LAFS.1112.L.3.4 LAFS.1112.L.3.6 LAFS.1112.L.1.1 LAFS.1112.L.3.4 LAFS.1112.L.3.6 LAFS.1112.L.1.1 LAFS.1112.L.3.4 LAFS.1112.L.3.6 LAFS.1112.L.1.1 LAFS.1112.L.3.4 LAFS.1112.L.3.6 SC.912.L.16.10 LAFS.1112.RI.4.10 LAFS.1112.W.1.2 LAFS.1112.W.2.4 LAFS.11.12.W.4.10 LAFS.1112.SL.2.4 LAFS.1112.L.1.1 LAFS.1112.L.1.2 LAFS.1112.L.3.4 LAFS.1112.L.3.6 36.02 Practice within medico legal standards. Determine and record vital signs of a sick or injured person– The student will be able to: 37.01 Determine and record skin color, temperature and moistness. 37.02 Demonstrate ability to accurately measure and record vital signs including manual blood pressure. Use medical identification devices–The student will be able to: 38.01 Identify the most commonly used medical identification devices. 38.02 Apply the information contained on or in the medical identification devices to patient assessment and patient care procedures. Conduct a primary assessment of problems that are a threat to life if not corrected immediately–The student will be able to: 39.01 Determine and record the level of consciousness of the injured person. 39.02 Assess for an inadequate airway, inadequate respiration's, inadequate circulation and profuse bleeding. NGSSS-Sci SC.912.L.14.39 SC.912.L.14.40 SC.912.P.12.12 LAFS.1112.L.3.4 LAFS.1112.L.3.6 LAFS.1112.SL.1.2 LAFS.1112.SL.2.4 LAFS.1112.L.3.4 LAFS.1112.L.3.6 MAFS.912.N-Q.1.1 MAFS.912.N-Q.1.3 LAFS.1112.L.3.6 LAFS.1112.L.3.6 LAFS.1112.SL.1.2 SC.912.L.14.25 LAFS.1112.SL.1.2 LAFS.1112.SL.2.4 LAFS.1112.SL.2.6 LAFS.1112.SL.1.2 LAFS.1112.SL.2.4 LAFS.1112.SL.2.6 CTE Standards and Benchmarks 39.03 Recognize when immediate correction is necessary. 40.0 41.0 39.04 Assess patient and determine if the patient has a life threatening condition. 39.05 Use spinal precautions as appropriate Demonstrate BLS procedures–The student will be able to: 40.01 Establish and maintain an open airway using both manual and mechanical airway techniques. 40.02 Restore breathing and circulation by means of cardiopulmonary resuscitation (CPR). 40.03 Demonstrate proficiency in the use of an automated external defibrillator (AED). 41.02 41.03 41.04 43.0 Identify items that can be used to control external bleeding and minimize the contamination of open wounds. Apply pressure dressings that will control bleeding and minimize the contamination of open wounds. Identify the likelihood of internal bleeding through observations of signs, symptoms and mechanisms of injury. Care for a patient who exhibits the signs and symptoms of internal bleeding. Recognize and control shock–The student will be able to: 42.01 Recognize the likelihood that shock may occur or be present on the basis of patient assessment and observation of a mechanism of injury. 42.02 Provide anti-shock measures as a part of routine patient care. Understand the importance of emergency medications–The student will be able to: 43.01 Understand the advantages, disadvantages and techniques of self and peer administration of an intramuscular injection by Auto injector. NGSSS-Sci SC.912.L.14.36 SC.912.L.14.37 SC.912.P.10.15 LAFS.1112.SL.1.2 LAFS.1112.SL.2.4 LAFS.1112.SL.2.6 LAFS.1112.SL.1.2 LAFS.1112.SL.2.4 LAFS.1112.SL.2.6 LAFS.1112.SL.1.2 LAFS.1112.SL.2.4 LAFS.1112.SL.2.6 Recognize and control bleeding–The student will be able to: 41.01 42.0 FS-M/LA LAFS.1112.SL.1.2 LAFS.1112.SL.2.4 LAFS.1112.SL.2.6 LAFS.1112.SL.1.2 LAFS.1112.SL.2.4 LAFS.1112.SL.2.6 LAFS.1112.SL.1.2 LAFS.1112.SL.2.4 LAFS.1112.SL.2.6 SC.912.L.14.34 SC.912.L.14.40 LAFS.1112.SL.1.2 LAFS.1112.SL.2.4 LAFS.1112.SL.2.6 LAFS.1112.SL.1.2 LAFS.1112.SL.2.4 LAFS.1112.SL.2.6 LAFS.1112.SL.1.2 LAFS.1112.SL.2.4 LAFS.1112.SL.2.6 LAFS.1112.SL1.2 LAFS.1112.SL.2.4 LAFS.1112.SL.2.6 SC.912.P.10.15 LAFS.1112.SL.1.2 LAFS.1112.SL.2.4 LAFS.1112.SL.2.6 LAFS.1112.SL.1.2 LAFS.1112.SL.2.4 LAFS.1112.SL.2.6 SC.912.L.14.44 LAFS.1112.SL.1.2 LAFS.1112.SL.2.4 LAFS.1112.SL.2.6 LAFS.1112.RI.1.1 LAFS.1112.RI.3.7 CTE Standards and Benchmarks 43.02 Describe the names, effects, Indications, routes of administration and dosages for specific medications (I.E Chemical Antidote Auto injector Devices). 44.0 Demonstrate understanding of airway management, respiration and artificial ventilation–The student will be able to: 44.01 Apply knowledge of Anatomy and Physiology to airway management procedures (I.E. Oxygenation and perfusion) 44.02 Understand the pathophysiology of respiratory dysfunction. 44.03 Use available mechanical devices to assure the maintenance of an open airway and assist ventilation (i.e. pocket mask, Bag-valve mask, Sellick’s maneuver) Demonstrate proficiency in supplemental oxygen therapy including portable oxygen cylinder and oxygen delivery devices. Describe and demonstrate airway management utilizing of upper airway suctioning. 44.04 44.05 45.0 Provide secondary assessment–The student will be able to: 45.01 Conduct a methodical head-to-toe physical examination to discover conditions not found during the primary assessment. 45.02 Interview the sick or injured person to obtain facts relevant to the person's condition. 45.03 46.0 46.02 Identify the various types of muscular-skeletal injuries. Immobilize and otherwise care for suspected fractures, dislocations, sprains and strains with available supplies and equipment, including commercially available and improvised devices. Demonstrate proper immobilization of an Cervical/Spinal injury–The student will be able to: NGSSS-Sci SC.912.L.14.43 LAFS.1112.SL.1.2 LAFS.1112.SL.2.4 LAFS.1112.SL.2.6 LAFS.1112.RI.3.7 LAFS.1112.SL.1.2 LAFS.1112.SL.2.4 LAFS.1112.SL.2.6 LAFS.1112.RI.3.7 LAFS.1112.SL.1.2 LAFS.1112.SL.2.4 LAFS.1112.SL.2.6 LAFS.1112.RI.3.7 LAFS.1112.SL.1.2 LAFS.1112.SL.2.4 LAFS.1112.SL.2.6 LAFS.1112.SL.1.2 LAFS.1112.SL.2.4 LAFS.1112.SL.2.6 SC.912.N.1.1 LAFS.1112.SL.1.2 LAFS.1112.SL.2.4 LAFS.1112.SL.2.6 LAFS.1112.SL.1.2 LAFS.1112.SL.2.4 LAFS.1112.SL.2.6 LAFS.1112.SL.1.3 LAFS.1112.SL.1.2 LAFS.1112.SL.2.4 LAFS.1112.SL.2.6 LAFS.1112.SL.1.3 Identify muscular-skeletal injuries–The student will be able to: 46.01 47.0 Interview co-workers, witnesses, family members, or other individuals to obtain facts relevant to the person's condition. FS-M/LA LAFS.1112.SL.1.2 LAFS.1112.SL.2.4 LAFS.1112.SL.2.6 MAFS.912.N-Q.1.3 SC.912.L.14.12 SC.912.L.14.25 SC.912.L.14.28 SC.912.P.12.3 LAFS.1112.SL.1.2 LAFS.1112.SL.2.4 LAFS.1112.SL.2.6 LAFS.1112.L.3.6 LAFS.1112.SL.1.2 LAFS.1112.SL.2.4 LAFS.1112.SL.2.6 SC.912.L.14.13 SC.912.L.14.14 CTE Standards and Benchmarks 48.0 49.0 47.01 Identify need for spinal immobilization 47.02 Maintain in-line immobilization of cervical spine 47.03 Place proper fitting rigid extrication-type cervical collar 47.04 Place patient in supine position on full length spine board 47.05 Secure patient to immobilization device Demonstrate proper extremity immobilization as well as other immobilization for other injuries (pelvis, ribs)–The student will be able to: 48.01 Identify need for extremity immobilization 48.02 Assesses motor, sensory, and distal circulation in extremities 48.03 Place proper fitting splint on extremity 48.04 Reassesses motor, sensory, and distal circulation in extremities Provide emergency evacuation and transfer of a sick and/or injured person–The student will be able to: 49.01 Describe situations when a person should be evacuated or transferred. 49.02 Use the most appropriate assist, drag or carry (alone or with a partner) to move a sick or injured person from a dangerous location to a safe place. FS-M/LA NGSSS-Sci SC.912.L.14.25 SC.912.L.14.28 LAFS.1112.SL.1.2 LAFS.1112.SL.2.4 LAFS.1112.SL.2.6 LAFS.1112.RI.3.7 LAFS.1112.SL.1.2 LAFS.1112.SL.2.4 LAFS.1112.SL.2.6 LAFS.1112.SL.1.2 LAFS.1112.SL.2.4 LAFS.1112.SL.2.6 LAFS.1112.SL.1.2 LAFS.1112.SL.2.4 LAFS.1112.SL.2.6 LAFS.1112.SL.1.2 LAFS.1112.SL.2.4 LAFS.1112.SL.2.6 SC.912.L.14.12 SC.912.L.14.13 SC.912.L.14.14 LAFS.1112.SL.1.2 LAFS.1112.SL.2.4 LAFS.1112.SL.2.6 LAFS.1112.RI.3.7 LAFS.1112.SL.1.2 LAFS.1112.SL.2.4 LAFS.1112.SL.2.6 LAFS.1112.RI.3.7 LAFS.1112.SL.1.2 LAFS.1112.SL.2.4 LAFS.1112.SL.2.6 LAFS.1112.SL.1.2 LAFS.1112.SL.2.4 LAFS.1112.SL.2.6 LAFS.1112.RI.3.7 SC.912.N.1.1 LAFS.1112.SL.1.2 LAFS.1112.SL.2.4 LAFS.1112.SL.2.6 LAFS.1112.RI.3.7 LAFS.1112.RI.4.10 LAFS.1112.W.1.2 LAFS.1112.W.2.4 LAFS.11.12.W.4.10 LAFS.1112.L.1.1 LAFS.1112.L.1.2 LAFS.1112.SL1.2 LAFS.1112.SL.2.4 LAFS.1112.SL.2.6 CTE Standards and Benchmarks 49.03 Maintain safety precautions during evacuation and transfer. 50.0 FS-M/LA LAFS.1112.SL1.2 LAFS.1112.SL.2.4 LAFS.1112.SL.2.6 Identify and provide initial care for a sick and/or injured patient–The student will be able to: 50.01 Identify and care for patients with non-traumatic chest pain, utilizing patient assessment. 50.02 Identify and care for patients experiencing respiratory distress, utilizing patient assessment. 50.03 Identify and care for patients experiencing a diabetic emergency, utilizing patient assessment. 50.04 Identify and care for a patient who is experiencing a seizure, utilizing patient assessment. 50.05 Identify and care for a patient who has ingested, inhaled, absorbed or been injected with a poisonous substance. 50.06 Identify and care for a patient who is in an altered state of consciousness, utilizing patient assessment. 50.07 Identify and care for a patient who is experiencing a stroke, utilizing patient assessment. 50.08 Identify and care for a patient who has a foreign body in the eye, utilizing patient assessment. 50.09 Identify and care for a patient with thermal, chemical, or electrical burns, determining the NGSSS-Sci SC.912.L.14.2 SC.912.L.14.6 SC.912.L.14.21 SC.912.L.14.24 SC.912.L.14.29 SC.912.L.14.30 SC.912.L.14.32 SC.912.L.14.38 SC.912.L.14.39 SC.912.L.14.44 SC.912.L.14.46 SC.912.L.14.49 SC.912.L.14.50 SC.912.L.14.51 LAFS.1112.SL.1.2 LAFS.1112.SL.2.4 LAFS.1112.SL.2.6 LAFS.1112.RI.3.7 LAFS.1112.SL.1.2 LAFS.1112.SL.2.4 LAFS.1112.SL.2.6 LAFS.1112.RI.3.7 LAFS.1112.SL.1.2 LAFS.1112.SL.2.4 LAFS.1112.SL.2.6 LAFS.1112.RI.3.7 LAFS.1112.SL.1.2 LAFS.1112.SL.2.4 LAFS.1112.SL.2.6 LAFS.1112.RI.3.7 LAFS.1112.SL.1.2 LAFS.1112.SL.2.4 LAFS.1112.SL.2.6 LAFS.1112.RI.3.7 LAFS.1112.SL.1.2 LAFS.1112.SL.2.4 LAFS.1112.SL.2.6 LAFS.1112.RI.3.7 LAFS.1112.SL.1.2 LAFS.1112.SL.2.4 LAFS.1112.SL.2.6 LAFS.1112.RI.3.7 LAFS.1112.SL.1.2 LAFS.1112.SL.2.4 LAFS.1112.SL.2.6 LAFS.1112.RI.3.7 LAFS.1112.SL.1.2 LAFS.1112.SL.2.4 CTE Standards and Benchmarks severity including degree, body surface area, type, and location. 50.10 Identify and care for a patient suffering from an environmental emergency including heat cramps, heat exhaustion, heat stroke, and frostbite, utilizing patient assessment. 51.0 Identify and care for patients who are in special situations– The student will be able to: 51.01 Identify patients who have special needs. 52.0 51.02 Care for injured/ill children. 51.03 Care for the injured/ill elderly. 51.04 Care for the injured/ill physically disabled. 51.05 Care for the injured/ill developmentally disabled. Provide triage to victims of multiple casualty incidents–The student will be able to: 52.01 Categorize the victims of multiple casualty incidents according to the severity of injury or illness on the basis of patient assessments. LAFS.1112.SL.1.2 LAFS.1112.SL.2.4 LAFS.1112.SL.2.6 LAFS.1112.RI.3.7 LAFS.1112.SL.1.2 LAFS.1112.SL.2.4 LAFS.1112.SL.2.6 LAFS.1112.SL.1.2 LAFS.1112.SL.2.4 LAFS.1112.SL.2.6 LAFS.1112.SL.1.2 LAFS.1112.SL.2.4 LAFS.1112.SL.2.6 LAFS.1112.SL.1.2 LAFS.1112.SL.2.4 LAFS.1112.SL.2.6 LAFS.1112.RI.3.7 LAFS.1112.SL.1.1 LAFS.1112.SL.1.3 LAFS.1112.SL.2.4 52.02 53.0 Use triage tags or other identification devices available locally to indicate priorities for pre-hospital emergency care and transportation to medical facilities. 52.03 Work as a member of a team to perform triage at locations of multiple casualty incidents. 52.04 Work as a member of a team to perform patient assessments at locations of multiple casualty incidents. 52.05 Work as a member of a team to carry out patient care procedures at the locations of multiple casualty incidents. 52.06 Demonstrate knowledge of the operating procedures during a terrorist event or during a natural or manmade disaster. Recognize life-threatening situations–The student will be able to: 53.01 Take steps to minimize the chance of injury or death to all involved when confronted with a potentially life-threatening situation on the basis of an assessment of a scene. FS-M/LA LAFS.1112.SL.2.6 LAFS.1112.RI.3.7 LAFS.1112.SL.1.2 LAFS.1112.SL.2.4 LAFS.1112.SL.2.6 LAFS.1112.RI.3.7 LAFS.11.12.L.3.6 LAFS.1112.SL.1.1 LAFS.1112.SL.1.3 LAFS.1112.SL.1.1 LAFS.1112.SL.1.3 LAFS.1112.SL.1.1 LAFS.1112.RI.3.7 LAFS.1112.SL.1.2 NGSSS-Sci CTE Standards and Benchmarks 54.0 Recognize entrapment situations–The student will be able to: 54.01 Identify accident-related hazards and undertake hazard control measures consistent with the capabilities of the Emergency Medical Responder and available equipment. 54.02 Use available equipment safely to gain access to persons who are entrapped. 54.03 Use available equipment safely to disentangle persons from mechanisms of entrapment. 55.0 Assist with emergency childbirth–The student will be able to: 55.01 56.0 Evaluate a mother to determine whether delivery is imminent. 55.02 Assist with a normal delivery. 55.03 Care for the mother and baby. 55.04 Identify abnormal childbirth situations and care for the mother and baby within the Emergency Medical Responder’s capabilities. Identify critical incident stressors–The student will be able to: 56.01 56.02 56.03 Identify stressors which may affect the performance of an Emergency Medical Responder. Identify stressors which may affect the behavior of a sick or injured person. Carry out procedures to minimize critical incident stress. FS-M/LA NGSSS-Sci SC.912.P.10.3 LAFS.1112.SL.1.2 LAFS.1112.SL.1.2 LAFS.1112.SL.1.2 SC.912.L.14.33 SC.912.L.14.41 LAFS.1112.SL.1.2 LAFS.1112.SL.1.2 SC.912.L.14.52 SC.912.L.16.8 LAFS.1112.SL.1.2 LAFS.1112.SL.1.2 BHS EMR PROGRAM BLS Skills Manual BHS Emergency Medical Responder Basic Life Support Skills Check-Off Sheet Completion Date: Physical Exam Date: Student Name: Class Period: Must be completed before attempting Stretcher Lifting Skill Name Completion of CPR Course 1. Universal Precautions 2. Pulses 3. Respirations 4. Blood Pressure (Auscultation / Palpation) 5. Oxygen Tank Preparation 6. Oxygen Administration - Infant / Child / Adult 7. Airway Adjunct (NPA / OPA) 8. Bag - Valve - Mask Ventilation (positive pressure ventilation) 9. Suctioning Techniques 10. Patient Assessment 11. Bleeding Control / Tourniquet 12. Dressing and Bandage 13. Rigid Splint 14. Impaled Object 15. Helmet Removal 16. C-Collar Application with Long Spine Board – Standing Patient 17. C-Collar Application with Long Spine Board – Supine / Prone Patient 18. Automated External Defibrillator Lab Preceptor Field Basic Life Support Skills Check-Off Sheet Skill Name 19. Pulse Oximetry 20. Stretcher Lifting Techniques (Must have Physical Exam before attempting) 21. Kendrick Extrication Device 22. Scoop Stretcher 23. Sling & Swathe 24. Air Splint 25. Combo-Tube (PTL) 26. Nebulizer / Updraft Set-Up 27. Sager Splint 28. Amputated Parts 29. EKG Set-Up 30. 12 Lead EKG 31. Intubation Set-Up 32. Medication Set-Up 33. IV Set-Up 34. Epinephrine Auto-Injector 35. Blood Glucose Set-Up 36. Burns 37. Impending Childbirth 38) Radio Transmissions Lab Preceptor Field 1. Universal Precautions (BSI / Standard Precautions) Pass _______ Retry _______ Fail _______ Student Name: ______________________________ Date: ______________________________ A) Purpose: 1. ALL patients are considered infectious. 2. Universal precautions protect the patient from the caregiver while simultaneously protecting the caregiver from the patient. B) Equipment Needed: 1. 2. 3. Gown Gloves Mask – Discuss what you would perform. **Do not place the mask in the lab on your face. ** 4. Eye protection (Goggles) C) Procedure: 1. Student will properly don the gloves, gown, mask, and goggles. 2. Student will properly doff the gloves, gown, mask, and goggles following the sequence below: i. Eye protection (goggles) is removed first. Taking care not to contaminate the eyes. ii. Mask is removed without contaminating the mouth or nose. iii. Pull the gown away from body and invert it. So as the contaminated aspect is kept away from the caregiver. 3. Gloves are removed last. Student will demonstrate how to invert the gloves to contain any contaminants on the inside of the inverted gloves. **Proper removal of gloves is important to minimize the spread of pathogens** 4. Contaminated trash is placed in a red biohazard bag, which must be sealed. Sealed red biohazard bags are then placed in an approved container for disposal. 5. Contaminated (non-disposable) linen is placed within a water soluble bag and sealed. Subsequently, the water soluble bag is placed in a contaminated linen container. 6. Student will demonstrate proper hand washing techniques and state that this is to be done after every patient contact because hand washing is the single most important way to prevent the spread of infections. i. First, use a paper towel to turn on the water and discard the paper towel. ii. Use another paper towel to dispense soap into your free hand and dispose of this paper towel. iii. Thoroughly wash hands for approximately 30 seconds; then rinse. iv. Use another paper towel to shut the water off and dispose paper towel. v. Lastly, use another paper towel to dry hands and once complete, dispose of paper towel appropriately. Comments: Student Signature: 2. Pulse (Time limit: 1 minute) Pass _______ Retry _______ Fail _______ Student Name: ______________________________ Date: ______________________________ A) Purpose: 1. Determine the heart rate. 2. Determine the heart rhythm. 3. Determine the heart force. B) Equipment Needed: 1. Watch C) Procedure: 1. Standard precautions (BSI) 2. Use pads of fingers to feel for pulse at the following known pulse point locations rapidly. i. Radial pulse point – located on the thumb side of the wrist. ii. Brachial pulse point – located under the medial side of the biceps or on the medial aspect of the anterior elbow. iii. Carotid pulse point – located in the groves of the neck found medial to both sides of the thyroid cartilage. iv. Apical pulse point – auscultate over the left nipple using a stethoscope. v. Femoral pulse point – located in the anterior groove of the thigh and groin area. vi. Posterior Tibia pulse point – located on the medial side of the ankles. vii. Dorsalis Pedi’s pulse point – located on the anterior foot between the big toe and the next toe. 3. Count the pulse rate for either 1 minute; or 30 seconds multiply by 2; or 15 seconds multiply by 4. 4. Note the following characteristics of the pulse: i. Rate – normal adult resting rate 60 – 100 beats per minute; below 60 = slow; above 100 = fast. ii. Rhythm –regular or irregular. iii. Force – strong (bounding) or weak (thready). 5. Records or charts accurately. Example: 68, weak/irregular 6. Pulse related terminology: i. Brady – slow; Cardia – heart / Bradycardia = slow heart rate. Less than 60 beats per minute. ii. Tachy – fast; Cardia – heart / Tachycardia = fast heart rate. Greater than 100 beats per minute. Comments: Student Signature: 3. Respirations (Time limit: 1 minute) Student Name: ______________________________ Date: ______________________________ A) Purpose: Pass _______ Retry _______ Fail _______ 1. Determine the breathing rate. 2. Determine the breathing rhythm. 3. Determine the breathing depth. 4. Determine the breathing effort. B) Equipment needed: 1. Watch C) Procedure: 1. Standard precautions (BSI). 2. Student does not allow the patient to realize that his/her respirations are being assessed or counted. 3. Count the respiration rate for either 1 minute; or 30 seconds multiply by 2; or 15 seconds multiply by 4. 4. Note the following characteristics of the breathing pattern: i. Rate – normal adult resting rate 12 – 20 breaths per minute; below 12 = slow; above 20 = fast. ii. Rhythm –regular or irregular. iii. Depth – normal, shallow, or deep. iv. Effort – labored or non-labored. 5. Records or charts accurately. Example: 24, irregular, shallow, labored 6. Breathing related terminology: i. A – without; Pnea – breathing / Apnea – absent breathing. ii. Dys – difficulty; Pnea – breathing / Dyspnea – difficulty breathing. Comments: Student Signature: 4. Blood Pressure (Auscultation and Palpation) Pass _______ Retry _______ Fail _______ Student Name: ______________________________ A) Purpose: 1. Systolic – Determines the pressure exerted upon the walls of the body’s arteries while the heart is contracting (depolarization). 2. Diastolic – Determines the pressure exerted upon the walls of the body’s arteries while the heart is at rest (repolarization). B) Equipment Needed: 1. Stethoscope 2. Sphygmomanometer (Blood Pressure Cuff) C) Procedure: 1. Auscultation and Palpation i. Standard Precautions (BSI) ii. Explain what you are about to do to the patient. *Example: Sir/Mam I am going to place a blood pressure cuff around your arm in order to obtain you blood pressure* iii. Ask the patient if he or she has had a mastectomy (breast removed) and/or if they have fistula (dialysis shunt). iv. If they have had a mastectomy or fistula, inquire as to which side (left or right) it is on and take the blood pressure on the opposite side’s arm. v. If the mastectomy and/or fistula is bilateral (on both sides) then use a leg. vi. Place the blood pressure cuff on the selected extremity. vii. Select an appropriate size cuff (i.e. infant/child/adult). viii. The B/P cuff should fit snugly around the upper arm and should remain level with the pt.’s heart. ix. Palpate for the brachial pulse and place the cuff’s bladder over this artery by aligning the markings on the cuff with the artery. 2. Auscultation only x. Place the stethoscope’s earpieces into ears. xi. Place the stethoscope’s diaphragm over the brachial pulse site. xii. Begin inflating the cuff while listening for Korotkoff sounds (i.e. thumping sounds heard when taking B/P) xiii. Once the Korotkoff sounds fade away, inflate sphygmomanometer another 20 mm/Hg. xiv. Slowly deflate the sphygmomanometer while paying close attention to the meter’s numerical values. xv. Note the numerical value when the Korotkoff sounds return. This is the patient’s systolic pressure. xvi. Continue slowly deflating the sphygmomanometer. xvii. Note the numerical value when the Korotkoff sounds once again fade away. This is the diastolic pressure. xviii. Document the patient’s blood pressure as Systolic/Diastolic. Example: 120/70 **Pay attention to the fact that a manual sphygmomanometer does not have any odd numbers** 3. Palpation only i. Palpation method is used a second or back-up way of obtaining a blood pressure when auscultation is not possible due to ambient noises or hypotension (low blood pressure). ii. Student should state, “The palpation method provides an approximate reading, which is not as accurate as that of auscultation because only a systolic pressure may be obtained”. iii. Palpate either the brachial or radial pulse point. iv. Inflate the sphygmomanometer approximately 20 mmHg above the point at which the pulse is no longer palpable. v. Slowly deflate the sphygmomanometer and note the numerical value at which the pulse returns. This is the systolic pressure. vi. Document the systolic pressure as follows: Example 120/P *Note that it is not possible to obtain a diastolic pressure value when using the palpation method.* Comments: Student Signature: 5. Oxygen Tank Preparation Pass _______ Retry _______ Fail _______ Student Name: ______________________________ Date: ______________________________ A) Purpose: 1. Identify various oxygen tank sizes. 2. Correctly identify when oxygen tanks need to be changed and how this change should take place. B) Equipment Needed: 1. Oxygen tank/s 2. Oxygen tank key 3. Oxygen flow regulator C) Procedure: 1. Correctly identify “D”, “E”, and “R” or “M” sized cylinders (tanks) i. “D” tanks are small and used with portable oxygen devices. ii. “E” tanks are medium sized and used with oxygen-powered devices such as a “Thumper”. iii. “R” and/or “M” tanks are large and used to provide oxygen supply to wall oxygen outlets mounted on an ambulance. 2. Check the tank’s pressure by opening the tank valve and looking at the cylinder pressure gauge located on the oxygen regulator. This gauge provides a numerical value representing pounds per square inch (psi). 3. If the tank’s pressure is below 500 psi, it will need to be changed. 4. Close the tank valve and open the flow valve to relieve pressure within the oxygen regulator. 5. Retrieve a full oxygen tank. i. Check the oxygen tank’s tag or seal to ensure the tank is full. 6. Remove the tape/seal, which protects the tank’s outlet. Be sure to save the new “O” ring. 7. Remove the regulator from the empty tank and remove the old “O” ring from the regulator 8. Placed the new “O” ring on the regulator 9. Crack open the tank valve to blow any dust away from tank outlet 10. Attach the regulator onto the full tank and securely tighten in place 11. Open the tank valve and check for air leaks. If necessary, retighten the regulator 12. Check the cylinder pressure gauge to ensure there is more than 500 psi contained within 13. Close the tank valve and open the flow valve to relieve pressure from the regulator 14. Store the tank in a secure area until it needs to be used. Comments: Student Signature: 6. Oxygen Administration - Infant / Child / Adult PASS RETRY ______ FAIL _____ Student Name: _____________________ Date: _________________ A. Equipment Needed 1. Oxygen Supply 2. Oxygen Delivery Device B. Procedure 1. Body substance isolation. 2. Explain need to patient 3. Open main valve on Oxygen tank, check for leaks and tank pressure. 4. Attached appropriate oxygen delivery device to the oxygen tank. 5. Set appropriate oxygen flow for the device used for an infant / child / adult. a. Nasal Cannula flow rate is 1-6 L/min which = 24-44% O2. b. Face Mask flow rate is 6-10 L/min which = 35-60% O2. c. Non-Rebreather Mask flow rate is >15L/min = 90-100% O2. Make sure reservoir bag is fully inflated prior to application. d. Venturi Mask flow rate and percentage of oxygen administration vary with carburetor type used. The use of this device is usually in hospital settings, for Chronic Obstructive Pulmonary Disease (COPD) patients. 6. Place oxygen delivery device on patient's face explaining to the patient the procedure. 7. Connect humidifier to O2 tank and connect O2 line to humidifier. 8. Secure tanks during transport. 9. If removal of oxygen device is needed: a. Remove device from patient. b. Close main valve and then bleed flow meter. Comments: _____________________________________________________________________________ Student Signature: ________________________________________________ 7. Airway Adjunct (Skill Time Limit = 1 minutes) PASS RETRY ______ FAIL _____ Student Name: _____________________ Date: _________________ Nasopharyngeal Airway (NPA) A. Purpose 1. Is an airway adjunct that is used to keep the tongue from obstructing the airway in a semi-conscious infant, child or adult with a gag reflex who can't maintain their own airway. B. Equipment Needed 1. Nasopharyngeal Airway 2. Lubrication Jelly C. Contraindication 1. Signs and symptoms of basal skull fracture (Battle sign, Raccoon eyes, cerebrospinal fluid/blood from ears) D. Procedure 1. Body substance isolation. 2. Choose the proper size airway. a. Choose largest diameter that will easily fit into nostril, length is determined by measuring the distance between the nasal septum and the base of the earlobe. b. Choose the proper size diameter by looking at the size of the patients nostril or little finger 3. Lubricate with K-Y jelly. 4. Insert the airway bevel edge toward the septum into the patient's right nostril. 5. If resistance or blockage is NOT met inside the nostril, continue to advance the airway until the flange of the airway rests on the nose. 6. If resistance is met, remove the airway and attempt insertion in the left nostril. Oropharyngeal Airway (OPA) A. Purpose 1. The OPA is an airway adjunct that is used to keep the tongue from obstructing the airway in an unconscious infant, child, or adult who has no gag reflex. B. Indications 1. Unconscious patient without a gag reflex. a. May be accomplished by assessing either: Inner thigh pinch (Should not respond), flicker patients eye lash (Should not respond) C. Procedure 1. Body substance isolation 2. Select the correct size OPA by measuring from the corner of the mouth to the angle of the jaw or ear lobe. 3. Open the teeth using a cross finger technique. 4. Insert OPA with tip towards roof of mouth then rotate 180 degrees until flange rest on teeth/lips. (Do not rotate in infant, use tongue depressor to assist in insertion) 5. Remove the OPA if patient starts to gag. 6. Rotate in opposite direction of insertion or pull out of the mouth down toward the chest. Comments: Student Signature: ________________________________________________ . 8. Bag-Valve-Mask Ventilation (BVM) - Infant / Child / Adult PASS RETRY ______ FAIL _____ Student Name: _____________________ Date: _________________ A. Purpose 1. The Bag Valve Mask (BVM) is a device to provide artificial ventilations to patients who are not adequately breathing on their own. Student will demonstrate the BVM use for infant / child and adult. B. Equipment Needed 1. Bag-Valve Mask (BVM) 2. Oxygen 3. Airway Adjunct (NPA / OPA) C. Procedure 1. Through patient’s mouth 1. Body substance isolation. 2. Position yourself at the patient’s head. 3. Student should state if available "This should be a two person procedure". 4. Opens airway - (Demonstrates head tilt - chin lift, jaw thrust and modified jaw thrust) 5. Demonstrates proper insertion of airway adjunct. 6. Select appropriate size mask for an infant / child / adult. 7. Apply BVM holding mask firmly in place with C/E -Clamp method while maintaining head tilt chin lift, jaw thrust or modified jaw thrust. 8. Ventilate the patient on room air assessing for adequate chest rise at a rate of adult 10-12 breaths / min and for child / infant 12 -20 breaths / min. Allow bag to refill. 9..After the patient has been ventilated on room air connect oxygen delivery system at >15 L/Min. DO NOT INTERRUPT VENTILATIONS FOR MORE THAN 20 SECONDS!!!!! 10. Resume ventilation assessing for adequate chest rise at a rate of adult 10-12 breaths / min and for child / infant 12 -20 breaths / min. 2. Through patient’s stoma 1. Body substance isolation. 2. Position yourself at the patient’s head. 3. Student should state if available "This should be a two person procedure". 4. Select appropriate size mask for an infant / child 5. Apply BVM holding mask firmly in place over stoma. 6. Cover patients mouth and nose with hand. 7. Ventilate the patient on room air assessing for adequate chest rise at a rate of adult 10-12 breaths / min and for child / infant 12 -20 breaths / min. Allow bag to refill. 8. After the patient has been ventilated on room air connect oxygen delivery system at >15 L/Min. DO NOT INTERRUPT VENTILATIONS FOR MORE THAN 20 SECONDS!!!!! 9. Resume ventilation assessing for adequate chest rise at a rate of adult 10-12 breaths / min and for child / infant 12 -20 breaths / min. Comments: _____________________________________________________________________________ Student Signature: ________________________________________________ 9. Suctioning Techniques (Skill Time Limit = 1min) PASS RETRY ______ FAIL _____ Student Name: _____________________ Date: _________________ A. Purpose 1. To remove oral secretions from the oral cavity of infants, children, and adults. B. Equipment Needed 1. Universal Precautions 2. Suction Catheter ( Yankeer or French tip ) 3. Suction Device 4. Irrigation Fluid C. Procedure – oral and nasal suctioning 1. Body substance isolation. 2. Student rolls pt to side and uses manual methods for opening the mouth and removal of secretions until suction device can be set up. 3. Assemble appropriate size catheter to suction unit and turn unit on. a. French tip catheter is used when flexibility and smaller size is needed for remove emesis from nasopharynx or oropharynx. b. Yankeer (Tonsil Tip) is used when large volume of emesis is in need of removal from the oropharynx. 4. Measure the insertion distance of the catheter by measuring Yankeer (from the corner of the mouth to the angle of the jaw), French tip (from septum to earlobe). 5. Insert suction catheter into the mouth or nose to the measured depth. 6. Put finger over T-port to create suction and remove catheter tip. ONLY SUCTION DURING WITHDRAWAL OF CATHETER FOR NO LONGER THAN 15 SECONDS. 7. The minimum vacuum for wall mounted suction device in the ambulance should be 300 mm / Hg. D. Procedure – suctioning with intubated patient. 1. Body substance isolation. 2. Procedure should be done as sterile as possible. 3. Pre-oxygenate the patient before and after the procedure. 4. Lubricant the distal tip of the catheter with a water soluble gel, gentle inserting until you feel resistance. 5. Apply suction for 10 seconds while extracting the suction catheter. a. You may have to inject 3-5 ml of sterile water down the ETT to help loosen thick secretions. 6. Re-oxygenate the patient, repeating if necessary. Comments: _____________________________________________________________________________ Student Signature: ___________________________________ 10.Patient Assessment (Skill Time Limit = 7 min) PASS RETRY Name (please print your full name legibly): SCENE SIZE UP Determines the scene is safe / Determines the mechanism of injury/nature of illness Take Standard precautions / Determines the number of patients / Requests additional help if necessary PRIMARY ASSESSMENT Verbalizes general impression of the patient / holds c-spine if trauma suspected Determines the level of consciousness (A.V.P.U.) Airway Verify airway patency or manually open airway as needed Rate/Rhythm/Depth/Effort Initiate appropriate oxygen therapy Ensure adequate ventilations Assess pulse – compare carotid and radial pulses Assess skin color, temperature, and condition Control any major bleeding found Breathing Circulation Perform a rapid scan Determine priority of patient care and transport HISTORY TAKING Investigates the Chief Complaint (history of present illness) S A M P L E Signs/Symptoms Allergies Medications Past Medical History Last Oral Intake Events leading to the current issue (Onset, Provokes, Quality, Radiates, Severity, Time) (Prescribed/OTC) (Time of day) SECONDARY ASSESSMENT Base line vitals: (Vital signs MUST be obtained from the high-fidelity simulator) Pulse: Respirations: Rate / Rhythm / Force Rate / Rhythm / Depth / Effort Blood Pressure: Palpated or Auscultation Full-body scan and focused assessment– (Focused assessment – based on chief complaint) Inspect and palpate the scalp and ear (2) Assess the eyes and pupil reaction (2) Head Assess the face including the oral and nasal areas (2) Inspect and palpate the neck (2) Check for JVD (Jugular Vein Distention) (1) Neck Check for Tracheal Deviation (1) Inspect the chest (1) Palpate the chest (1) Chest Auscultate bilateral lung sounds (2) Assess all four quadrants of the abdomen (2) Assess the pelvis (pelvic push) (2) Abdomen/Pelvis Verbalize genitalia/perineum areas are assessed as needed (2) Inspect and palpate all extremities (1) Extremities Assess distal pulses and motor/sensory function in all extremities (1) Assess posterior thorax (2) Back Assess lumbar region (2) REASSESSMENT Repeats Primary Assessment Reassess Vital Signs Reassess the Chief Complaint Recheck Interventions Identify and treat Changes in the Patient’s Condition Reassess patient FAIL 11. Bleeding Control PASS RETRY FAIL____ Student Name: _____________________ Date: _________________ A. Purpose 1. To control external bleeding and/or hemorrhage on infant, child and adult patients. B. Equipment Needed 1. Sterile dressing 2. Roller gauze 3. Cravat (Triangular Bandage) 4. Pen, stick or other straight object available at scene. 5. Padding material (4X4, ABD, or Multi-trauma dressing) C. Initial Procedure (verbalized) 7. Body Substance Isolation. 8. Expose the entire wound (cut clothing away). 9. Apply direct pressure with your gloved fingertip or hand over the top of a sterile dressing. 10. Hold uninterrupted pressure for at least 5 minutes 11. Elevate a bleeding extremity by as little as 6" while applying direct pressure a. Never elevate an open fracture to control bleeding. (Fractures can be elevated after splinting / Splinting helps control bleeding). 12. Select proper sized sterile dressing. 13. Open sterile dressing package, maintaining sterility, and places on wound site. 14. Unroll the gauze around the wound site advancing the wrap from below the wound to above the wound 15. Secure bandage material in place by applying a knot over the wound site to give it extra pressure. If the bleeding is not controlled using the steps above, then proceed with the steps outlined below: D. Procedure to apply Tourniquet (to be done on manikin) 1. Remember once a tourniquet is applied it must not be removed. 2. Student lists items not suitable for use as a TK. a. Wire, Cord or other narrow material that will cut into the body. 3. Place as close to injury as possible. 4. Pad over artery. 5. Tighten until bleeding is controlled. 6. Tape or tie tightening device. 7. Attach notation to patient forehead TK and the time tourniquet was applied. 8. Notify ED staff upon arrival at hospital. If applying a tourniquet is not possible because the wound is too far proximal, continue to apply direct pressure until arrival at the hospital. Comments: _____________________________________________________________________________ Student Signature: ________________________________________________ 12. Dressing and Bandaging PASS RETRY ______ FAIL _____ Student Name: _____________________ Date: _________________ A. Purpose 1. To control bleeding (crushing injury, abrasion, laceration) of an infant, child or adult patient. 2. Protect from further contamination. B. Equipment Needed 1. Universal precautions 2. Dressing Material / Gauze Roll 3. Tape C. Pressure Dressing 1. Body Substance Isolation / Expose entire wound. 2. Select proper sized sterile dressing. 3. Open sterile dressing package, maintaining sterility, and places on wound site. 4. Unroll the gauze around the wound site advancing the wrap from below the wound to above the wound. 5. Secure bandage material in place by applying a knot over the wound site to give it extra pressure. D. Spiral Turns - (tapered extremity injuries) 1. Body Substance Isolation / Expose entire wound site. 2. Select proper sized sterile dressing, maintaining sterility, and places on wound site. 3. Anchor below the wound site and secures with several circular turns. 4. Open spiral up the length of the limb to the first joint. 5. Return to the wrist or ankle with a closed spiral, securing the bandage in place with adhesive tape or ties off. E. Figure-eight Turns - (joint injuries/ allows for motion of joint) 1. Body Substance Isolation / Expose entire wound site. 2. Select proper sized sterile dressing package, maintaining sterility and places on wound site. 3. Anchor above the wrist and secures with two circular turns. 4. Complete figure-of-eight bandage of wrist with "X" on palm, securing the bandage in place with adhesive tape or tie off. F. Recurrent Head Bandage 1. Body Substance Isolation / Expose entire wound site. 2. Select proper sized dressing package, maintaining sterility, and places on wound site. 3. Use kling and drape across the head from one side of the head to the other side until the entire head is covered. 4. Anchor bandage by making circular turns around head leaving ears exposed. 5. Secure bandage with adhesive tape or tie off. Comments: _____________________________________________________________________________ Student Signature: ________________________________________________ 13. Rigid Splint PASS RETRY ______ FAIL _____ Student Name: _____________________ Date: _________________ A. Purpose 1. To immobilize an injured extremity of an infant, child, or adult patient that is suspected of being fractured to prevent the occurrence of any further damage. B. Equipment Needed 1. 2-Rigid Splints 2. Kling or Cravats 3. Bandaging Material C. Procedure 1. Body Substance Isolation 2. Expose extremity 3. Cover any open wound with sterile dressing and stop bleeding. 4. Check for (PMS) pulse, motor, sensory distal to the fracture site. 5. Manually stabilize extremity. 6. If circulation is absent, make one attempt to align the extremity to improve circulation. 7. Apply two well-padded board splints extending beyond the joint above and below the injured area. a. Upper extremities - one on the anterior and posterior sides b. Lower extremities - one on the medial and lateral sides c. Joint Injuries - immobilize bone above and below the joint in the position found 8. Secure the splint in place with cravats or wraps entire leg in roller gauze. 9. Make sure hand and foot are immobilized in the position of function 10. Check (PMS) pulse, motor, sensory after splinting. Comments: _____________________________________________________________________________ Student Signature: ________________________________________________ 14. Impaled Object (eye / body) PASS RETRY FAIL____ Student Name: _____________________ Date: _________________ A. Purpose 1. To secure and stabilize objects that has been impaled into the body to prevent movement that would cause further harm. B. Equipment Needed 1. Bulky Dressing 2. Tape 3. Bandages (Use the ACE Bandages in place of kling) C. Procedure 1. Body Substance Isolation 2. Cut away clothing from area. 3. Control bleeding using direct pressure, being sure not to remove or move the object unless object is impaled in the cheek and is obstructing the airway. 4. Stabilize the object using bulky dressing. 5. With an impaled object to eye; a. Place kling on each side of the object b. Place cup over object to prevent any inward motion of the object and from being struck. c. Wrap kling (ACE bandage) around the patients head and cup and secure d. Cover uninjured eye to prevent motion. 6. With an impaled object to chest; a. Place kling on each side of the object to stabilize. b. Secure the dressing using tape. Comments: _____________________________________________________________________________ Student Signature: ________________________________________________ 15. Helmet Removal PASS RETRY ______ FAIL _____ Student Name: _____________________ Date: _________________ A. Purpose 1. To remove a helmet (football, bicycle, motorcycle etc): a. That does not immobilize the patient’s head within. b. When you cannot securely immobilize the helmet to the long spine board. c. The helmet prevents airway care. d. The helmet prevents assessment of anticipated injuries. e. There are, or you anticipate airway or breathing problems. f. Helmet removal will not cause further injury. D. Procedure 1. Body Substance Isolation 2. EMR #1 stabilizes patient’s neck in neutral position. 3. EMR #2 checks the pt's neurological status including sensation and motor function. a. Have the patient squeeze your fingers, and wiggle their toes. If they are successful in doing so, they are neurological intact. 4. EMR #2 unfastens or cuts away chin strap 5. EMR #2 immobilizes the head by sliding their hands under the helmet and placing them along the sides of the head, supporting the occiput, or place one hand on the jaw and the other on the occiput. 6. EMR #1 relinquishes c-spine to EMR #2. 7. EMR #1 grasps the helmet and spreads it slightly to clear the ears by pulling laterally just below and anterior to the ear enclosure. 8. EMR #1 then rotates the helmet to clear the chin, counter rotates it to clear the occiput, and then rotates it to clear the nose and brow ridge. 9. After removal apply the proper sized c-collar. NOTE: if removing football helmet you must also remove the shoulder pads. Comments: _____________________________________________________________________________ Student Signature: ________________________________________________ 16. LSB - Standing Patient (Skill Time Limit = 5 min) Student Name: _____________________ PASS RETRY ______ FAIL _____ Date: _________________ A. Purpose 1. To maintain correct alignment of the spinal column. B. Equipment Needed 1. Cervical Collar 2. Long Spine board (LSB) 3. Cervical Immobilization Device (CID) 4. 3 - 9 ft Straps 5. Padding Skill must be completed on a live patient C. Procedure 1. Body Substance Isolation 2. EMR #1 stabilizes patient’s neck in neutral position. 3. EMR #2 removes helmet if appropriate while EMR #1 maintains manual immobilization 4. EMR #2 checks the pt's neurological status including sensation and motor function. a. Have the patient squeeze your fingers, and wiggle their toes. If they are successful in doing so, they are neurological intact. 5. EMR #2 measures the patient from the shoulder to an imaginary line even with the patient”s chin. 6. EMR #2 then selects the appropriate size collar by comparing the distance from the bottom edge of the plastic to the black measuring pin. 7. EMR #2 Exposes, inspects and palpates the neck. 8. EMR #2 applies C-Collar a. EMR #2 positions self in front of patient. b. EMR #2 then slides the front of the collar beneath the patient's chin using the left hand. c. EMR #2 then gently pulls the collar around the back of the neck using the right hand. d. EMR #2 then fastens the Velcro tabs together with a scissor motion. 9. EMR #2 Inspects the patient”s back and directs another EMR to slide a backboard behind the pt. 10. EMT R1 directs two other EMRs to stand beside the pt and place one hand under the pt's arm and grasp the LSB. Their other arms should hold the patient's arms securely to his body. 11. EMR #1 directs the two EMRs to lower the pt to the ground. 12. EMR #2 secures the patient's chest and pelvis to the LSB using separate straps that cris-cross the chest and pelvis. 13. EMR #2 secures the patient's feet to the LSB. 14. EMR #2 secures the patient's head to the LSB using the CID. 15. EMRT #1 releases manual stabilization of the patients head. 16. Pad any voids around straps or board. 17. Rechecks the neurological status of the patient including sensation, and motor responses. DO NOT WALK OR TRANSFER EQUIPMENT ACROSS PATIENT - AUTOMATIC FAILURE Comments: _____________________________________________________________________________ Student Signature: ________________________________________________ 17. LSB - Supine / Prone Patient (Skill Time Limit = 5 min) Student Name: _____________________ PASS RETRY ______ FAIL _____ Date: _________________ A. Purpose 1. To maintain correct alignment of the spinal column. B. Equipment Needed 1. Cervical Collar 2. Long Spine board (LSB) 3. Cervical Immobilization Device (CID) 4. 3 - 9 ft Straps 5. Padding Skill must be completed on a live patient C. Procedure 1. Body Substance Isolation 2. EMR #1 stabilizes patient’s neck in neutral position. 3. EMR #2 removes helmet if appropriate while EMR #1 maintains manual immobilization 4. EMR #1 places head in neutral in-line position and manually immobilizes the head during the entire procedure. a. Demonstrates opening the airway via jaw thrust and / or modified jaw thrust for suspected spinal cord injury. 5. EMR #2 checks the pt's neurological status including sensation and motor function. a. Have the patient squeeze your fingers, and wiggle their toes. If they are successful in doing so, they are neurological intact. 6. EMR #2 measures the patient from the shoulder to an imaginary line even with the patient’s chin. 7. EMR #2 then selects the appropriate size collar by comparing the distance from the bottom edge of the plastic to the black measuring pin. 8. EMR #2 Exposes, inspects and palpates the neck. 9. EMR #2 applies C-Collar a. EMR #2 positions self in front of patient. b. EMR #2 then slides the front of the collar beneath the patient's chin using the left hand. c. EMR #2 then gently pulls the collar around the back of the neck using the right hand. d. EMR #2 then fastens the Velcro tabs together with a scissor motion. 10. EMR #2 places the spine board next to the patient with the bottom of the board at knee level 11. EMR #1 directs and coordinates preferably two other EMR’s in rolling the pt onto the side closest to the person doing the roll. 12. EMR #2 inspects patients back then slides the board under the patient. 13. EMR #1 directs the roll back onto the patient’s back then the patient is moved up and onto the board as a unit. 14. EMR #2 secures the patient's chest and pelvis to the LSB using separate straps that criss-cross the chest and pelvis. 15. EMR #2 secures the patient's feet to the LSB. 16. EMR #2 secures the patient's head to the LSB using the CID. 17.EMR #1 releases manual stabilization of the patients head. 18.Pad voids around straps and board. 19.Rechecks the neurological status of the patient including sensation and motor responses. DO NOT WALK OR TRANSFER EQUIPMENT ACROSS PATIENT - AUTOMATIC FAILURE Comments: _____________________________________________________________________________ Student Signature: ________________________________________________ 18. AED (Automatic External Defibrillator) PASS RETRY FAIL_____ Student Name: _____________________ Date: ________________ A. Purpose 1. To deliver electrical therapy to a patient that is in Ventricular Fibrillation or pulseless Ventricular Tachycardia. B. Equipment 1. Automated External Defibrillator (AED) 2. BVM with OPA. 3. Oxygen C. Caution 1. Ensure patient is dry 2. Do not place de-fib pads over a pace maker. ( place to the side of the pace maker) 3. Remove any patches (i.e.: NTG) before placement of de-fib pads. D. Procedure 1. Body Substance Isolation 2. Checks for responsiveness and scans chest for breathing. 3. Activate “911" emergency response and call for AED. 4. Check for a pulse (Adult - Carotid, Infant- Brachial) 5. Delivers 30 compressions (student must perform) 6. Give two breaths with the use of an Airway Adjunct, BVM and oxygen. (student must perform) 7. Continues CPR 30:2 until AED arrives 8. As soon as the AED arrives; (a) Turn AED on (b) Select proper AED pads. (c) Attach AED pads to patient correctly (attach negative defibrillator pad just below the right clavicle and attach positive defib pad just below the patient’s left nipple) (d) Ensure leads are making good connection and no one is touching or moving the patient. (e) Connect Pads to AED (f) If necessary, press analyze; otherwise listen for device to advise it is analyzing. (g) If shock IS advised, reconfirm everyone is clear of the patient then press discharge button. Immediately after shock is delivered, resume CPR beginning with chest compressions. If shock is NOT advised, resume CPR beginning with chest compressions. 7. After approximately 2 minutes of CPR (5 cycles 30:2) or upon AED audio prompt, reanalyze and/or reassess the patient. (If shock is advised; repeat step 8(g). If shock is NOT advised, check for a pulse. (Adult - Carotid, InfantBrachial) If there is not a pulse (Adult - Carotid, Infant- Brachial), resume CPR. Otherwise, proceed accordingly). Comments: _____________________________________________________________________________ Student Signature: ________________________________________________ 19. Pulse Oximetry PASS RETRY ______ FAIL _____ Student Name: _____________________ Date: _________________ A. Purpose 1. To measure oxygen saturation in the peripheral tissues. The pulse oximeter functions by measuring the transmission of red and infrared light through an arterial bed, such as those present in a finger, toe or earlobe. 2. To possibly detect problems with oxygenation before assessments of blood pressure, pulse and respirations would detect a problem. B. Procedure 1. Place the non-invasive sensor on the patient’s finger, toe, or ear lobe. 2. Turn pulse oximetry on. C. Awareness 1. Be cautious in using the pulse oximeter in patients with anemia and hypovolemia. The reading may be misleading. 2. May give false positive reading in patients with carbon monoxide poisonings, high intensity light, and certain hemoglobin abnormalities. Interpretation of Oximetry 100 - 95 % 94 - 91 % 90 - 86 % 85 % or less Normal Mild Hypoxia Moderate Hypoxia Severe Hypoxia ** THIS IS A DEVICE USED AS A SIXTH VITAL SIGN. IT DOES NOT REPLACE OTHER ASSESSMENT OR MONITORING SKILLS. TREAT THE PATIENT NOT THE PULSE OXIMETRY. Comments: _____________________________________________________________________________ Student Signature: ________________________________________________ 20. Stretcher lifting PASS RETRY ______ FAIL _____ Student Name: _____________________ Date: _________________ A. Purpose 1. To safely lift patient on a stretcher in and out of ambulance. 2. To safely move patient from scene to transport unit. B. Procedure (STUDENT MUST PERFORM SKILL AT THE HEAD/CARRIAGE AND FOOT OF STRETCHER) 1. Ensure patient is strapped onto stretcher. 2. Unlock stretcher from harness. 3. Pull stretcher out of ambulance safely. 4. Place patient in shock position and back to supine. 5. Place patient in fowlers position and back to supine. 6. Lower stretcher safely to lowest setting. 7. Raise stretcher safely to highest setting. 8. Demonstrate how to make stretcher smaller to get around corners and put back to normal position. 9. Lift stretcher into ambulance safely and lock into harness. Comments: _____________________________________________________________________________ Student Signature: ________________________________________________ 21. Kendrix Extrication Device (KED) (Skill Time Limit = 5 min) PASS RETRY ______ FAIL _____ Student Name: _____________________ Date: _________________ A. Purpose 1. To immobilize the spinal column when used in conjunction with a stiff neck extrication collar on a semi-fowler or seated patient. B. Equipment Needed 1. KED (with head straps) 2. Stiff Neck Extrication Collar 3. Spine Board 4. 3- 9 ft Straps 5. Padding Skill must be completed on a live patient C. Procedure 1. Body Substance Isolation 2. EMR #1 places head in neutral in-line position and maintains manual immobilization of the head. 3. EMR #2 performs a neuro assessment including sensation and motor function. 4. EMR #2 Exposes, inspects and palpates the neck. 5. EMR #2 applies C-collar and KED. a. Choose appropriate size C-collar and applies to pt. b. Inspect and palpate back. c. Slide KED behind the pt making sure it is snug under the armpit. d. Secure the middle strap around the chest. e. Secure the bottom strap around the chest. f. Secure the leg straps by going under legs then up through the groin area then attaching it to the buckle on the same side. g. Secure the head strap applying padding where needed to maintain the neck in neutral position. h. Secure the top strap around the chest. i. Make sure all straps are snug. 6. Remove pt as a unit onto spine board while maintaining pt's legs in a sitting position. 7. Remove leg straps and allow pt to move to supine position. Time Stops and student must state steps 7-11 8. Secure body to board with straps. 9. Secure head to board with CID and straps or tape. 10. Pad the voids around straps and board. 11. EMR #1 can release manual C-spine. 12. EMR #2 performs a neuro assessment including sensation and motor function. Comments: _____________________________________________________________________________ Student Signature: ________________________________________________ 22. Scoop Stretcher (Skill Time Limit = 5 min) PASS RETRY ______ FAIL _____ Student Name: _____________________ Date: _________________ A. Purpose 1. To allow the user to safely pick up pt's who might have hip fractures or other similar injuries. The advantage of this stretcher is that it can be broken apart and placed around the pt without having to move the pt very much. THIS IS NOT TO BE USED IN SPINAL INJURY PATIENTS AS A MEANS OF MOVEMENT OR SPINAL STABILIZATION. B. Equipment Needed 1. Scoop Stretcher 2. 3- 9 ft Straps Skill must be completed on a live patient C. Procedure 1. Body Substance Isolation 2. Separates both halves of the stretcher by depressing the head and foot latches, then applying outward pressure. 3. Place half of stretcher on one side of the patient and the other half on the other side of the patient, with the scoop blades toward the patient's body. NEVER MOVE EQUIPMENT OVER THE PATIENT. 4. Measuring against the uninjured side, adjust the length of the Scoop to fit the pt. 5. Place half the stretcher under the patient by having an assistant gently rolls the patient toward the uninjured side. 6. Slide the other half under the patient without rolling the patient towards the injured side. 7. Connect upper and lower latch. 8. Secure the patient’s chest and pelvis to the scoop stretcher using separate straps that crisscross the chest and pelvis. 9. Secure the patient’s feet with strap. DO NOT WALK OR TRANSFER EQUIPMENT ACROSS PATIENT - AUTOMATIC FAILURE Comments: _____________________________________________________________________________ Student Signature: ________________________________________________ 23. Sling and Swathe PASS RETRY ______ FAIL ____ Student Name: _____________________ Date: _________________ A. Purpose 1. To splint clavicle and humerus injuries. B. Equipment Needed 1. 2 - triangular bandages 2. Safety Pins (optional) C. Procedure 1. Body Substance Isolation 2. Check the (PMS) pulse, motor, sensory. 3. Fold forearm of injured side across chest, slightly elevated toward opposite shoulder. 4. Place triangular bandage between the arm and the trunk with the point toward the elbow. 5. Bring the bottom of the triangular bandage over the outer part of the arm and tie a knot to the side of the neck. 6. Pin or tie the pointed end to form cup for elbow. 7. Keep fingers exposed to check circulation. 8. Wrap wide cravat or roller gauze around injured arm and body as swathe to pull shoulder back and secure injured arm to body. Tie knot on uninjured mid-axillary side of body. 9. Recheck the (PMS) pulse, motor, sensory. 10. Transport in a sitting position. Comments: _____________________________________________________________________________ Student Signature: ________________________________________________ 24. Air Splint PASS RETRY ______ FAIL _____ Student Name: _____________________ Date: _________________ A. Purpose 1. To immobilize an injured extremity that is suspected of being fractured to prevent further damage. B. Equipment Needed 1. Air Splint 2. Cravats C. Procedure 1. Body Substance Isolation 2. EMR #2 Manually supports the extremity. 3. EMR #1 Check for (PMS) pulse, motor, sensory and removes any jewelry on injured extremity. 4. EMR #1 Select correct size air splint to immobilize the joint above and below the fracture. 5. EMR #1 gathers air splint on his arm, so that the bottom edge of splint is above his wrist. 6. With that hand, EMT #1 grasps hand of affected extremity. 7. While tension is maintained, EMT #1 slides the splint into position making sure the finger tips are kept behind the red line on the splint. 8. EMR #2 zips the splint closed and inflates the splint by mouth to the point where the thumb makes a slight dent when pressed against the splint. 9. Monitor pressure of splint when pt is moved from cold to hot environment. Comments: _____________________________________________________________________________ Student Signature: ________________________________________________ 25. Combi-Tube (PTL) (Skill Time Limit = 3min) PASS RETRY ______ FAIL _____ Student Name: _____________________ Date: _________________ A. Purpose 1. To secure the airway in an unconscious patient without a gag reflex. B. Equipment 1. Combi-Tube ( PTL) 2. 140 ml and 20 ml syringes 3. Water soluble lubrication 4. Stethoscope 5. Ambu-bag and Oxygen Supply 6. Suction 7. Airway adjunct (NPA / OPA) C. Contraindications 1. Esophageal disease. ( seen in alcoholics with spider vein nose ) 2. Ingestion of caustic substances. ( burns going down it will burn coming up / break down the tube) 3. Pt less than 14 years old. 4. Patient with a gag reflex 5. Less than 5ft tall. D. Procedure 1. Body Substance Isolation 2. Make sure the patient is being ventilated with and Airway adjunct, B.V.M., and Oxygen at > 15 LPM 3. Begin hyperventilation of patient. 4. Checks / prepares airway device 5. Lubricates the distal tip of the device. 6. Stop ventilations. 7. Removes airway adjunct. 8. Extends the patient’s head. 9. Inserts the combitube between ventilations by lifting the tongue and lower jaw upward with one hand. 10. If the tube doesn’t advance easily to where the patient’s teeth are between the black lines, then withdraw and reinsert. 11. Inflate the blue pilot balloon leading to the pharyngeal cuff with 100 ml of air. Disconnect 140ml syringe 12. Inflate the white pilot balloon leading to the distal cuff with approximately 15 ml of air. Disconnect 20ml syringe 13. Begin ventilation through the longer blue connecting tube 14. Confirm combi-tube placement by auscultating over epigastrium, bilateral lung sounds and visualize chest rise and fall. a. If tube is confirmed continue ventilations. NOTE: (Under this usage the second clear connecting tube may be used for the removal of gastric fluids with a suction catheter.) b. If tube is not confirmed then immediately begin ventilating through clear tube and repeat step 14. 15. Ventilate at a rate of adult 10-12 breaths / min. **NOTE: DO NOT TAPE CLEAR TUBE DOWN** Comments: _____________________________________________________________________________ Student Signature: ________________________________________________ 26. Nebulizer / Updraft Set-Up PASS RETRY ______ FAIL _____ Student Name: _____________________ Date: _________________ A. Procedure 1. To administer a unit dose of medication to a patient who is having bronchospasms associated with bronchitis / emphysema or asthma. B. Indications 1. To deliver appropriate updraft medication to the patient exhibiting bronchospasms. 2. Preparing for the updraft procedure. C. The student correctly identifies the components. 1. Check Equipment: 2. One nebulizer set-up (mouth piece, T-piece) 3. One oxygen supply tubing. 4. One Albuterol 2.5 mg / Atrovent (Ipratropium Bromide) 0.5 mg of medication 5. Unhumidified oxygen with a flow meter set at 6 - 8 liters / minute. A minimum of 700p.s.i. is needed in a D cylinder. D. Procedure for administration: 1. Assemble oxygen supply tubing to the nebulizer. 2. Add the medication to the nebulizing chamber. 3. Connect the top of the nebulizing chamber. 4. Connect the T piece to the top of the nebulizing chamber. 5. Connect the mouth piece to the T piece. 6. Connect the oxygen supply tubing to the oxygen flow meter. 7. Set the flow meter to 6 - 8 liters / minute and watch for the medication to mist. 8. Give the nebulizer to the patient and have them breathe the medication. 9. If the patient is unable to hold the nebulizer, remove the mouth piece from the T piece. Take a simple mask and remove the oxygen tubing and connecting piece from the mask. Insert the T piece into the mask. Apply the mask to the patient. 10. Listen to lung sounds to assess if the medication is working. 11. Monitor heart rate continuously, blood pressure and respiratory status (rate and exchange) frequently during administration. Comments: _____________________________________________________________________________ Student Signature: ________________________________________________ 27. Sager Splint PASS RETRY FAIL_____ Student Name: _____________________ Date: _________________ A. Purpose 1. To immobilize an injured leg that is suspected of having one or bi lateral mid-shaft femur fracture(s). 2. Contraindicated is tib/fib fracture on same leg B. Equipment Needed 1. Traction Splint 2. Ankle Harness 3. Elastic cravats 4. Figure eight strap 5. Spine board / Straps Skill must be completed on a live patient C. Procedure 1. Body Substance Isolation 2. Remove the clothing on the affected leg. 3. Controls any hemorrhage. 4. Check (PMS) pulse, motor, sensory 5. Position the sager splint between the patients legs 6. Rest the Perineal Cushion against the ischial tuberosity (on the side of the injury) 7. Apply the thigh strap around the upper thigh of the fractured limb. 8. Extend the inner shaft until the crossbar rests adjacent to the patient’s heal. 9. Place the ankle harness just above the ankle. 10. Attach ankle harness to sager splint 11. Grasp the padded shaft with one hand and the traction handle with the other. 12. Pull the inner shaft until the desired amount of traction is recorded on traction scale. 10 % of patient’s body weight per fracture to a MAXIMUM of 15 lbs per leg. a. (170 lbs. patient-15 pounds one leg and 30 pounds two legs.) 13. Secure elastic leg cravats and figure eight strap. 14. Recheck (PMS) pulse, motor, sensory. 15. Student verbalizes to place patient onto Long Spine Board Comments: _____________________________________________________________________________ Student Signature: ________________________________________________ 28. Amputated Parts PASS RETRY FAIL_____ Student Name: _____________________ Date: _________________ A. Procedure: 1. Attempt to remove any gross contaminants from the amputated part by irrigating with sterile saline solution or gently cleansing with sterile saline solution on a sterile sponge. **Do not attempt a thorough cleansing of the amputated part. ** 2. Place a few moistened sterile 4 x 4's into a waterproof container. 3. Place the amputated part wrapped with the moist 4 x 4s into a waterproof container. 4. Place the sealed container into iced water or place activated cold packs around the container. 5. Transport the amputated part with the patient but out of the patient's sight. Comments: _____________________________________________________________________________ Student Signature: ________________________________________________ 29. EKG Monitoring Set-up PASS RETRY FAIL_____ Student Name: _____________________ Date: _________________ A. Procedure 1. Open pouch and remove electrodes immediately prior to use. The end of bulk pouches should be folded over and electrodes should be used within 30 days of opening. 2. Hold the electrode firmly with both hands. Attach electrode wire to electrode patches. Peel electrode from carrier and discard carrier in appropriate waste receptacle. a. Shave excessive hair if necessary at electrode site b. For oily skin, cleanse with alcohol pad and let dry completely before applying electrode. 3. Apply electrode to skin and gently press down around outer edge of electrode in a circular motion to assure firm attachment to the skin. a. Place the white electrode to patient’s right arm b. Place the black electrode to patient’s left arm c. Place the red electrode to the patient’s left leg. d. Place the green electrode to patient’s right leg. 4. Attach the cable to the monitor and turn the machine on. 5. Be aware that electrical appliances, florescent lights, and poor conduction can cause interference in the monitor printout. 6. Students must demonstrate the following tasks: a. Switch between displayed leads b. Check energy level of batteries, use wall charger, change batteries c. Attach CO2, B/P cuff, 3-lead cable, Defib pads and paddles d. Print EKG strip, event summary, trend summary e. Change EKG paper B. Cautions 1. Electrodes should not be used if the gel is dried out or in a liquid state. 2. If the electrode site is not dry prior to application, trapped solvents can cause skin irritation and loss of adhesion. 3. Rapid removal of electrode from a patient may cause skin damage. If the electrode is difficult to remove use alcohol to moisten the adhesive. 4. Under occasional circumstances, alteration of the skin pigmentation may occur after electrode removal. Comments: _____________________________________________________________________________ Student Signature: ________________________________________________ 30. 12 Lead EKG Student Name: _____________________ PASS RETRY ______ FAIL _____ Date: _________________ A. Purpose 1. To assist the paramedic in early recognition of acute Myocardial infarction.. B. Equipment Needed 1. 12 lead capable cardiac monitor 2. Electrodes 3. Razor C. Complications 1. Excessive hair 2. Diaphoresis 3. Breast Tissue 4. Obese patients D. Procedure 1. Body substance isolation. 2. Ensure proper limb lead placement 3. Place V-leads (1) V1 – 4th intercostals space, right parastrenal (2) V2 – 4th intercostals space, left parastrenal (3) V4– 5th intercostals space, midclavicular (4) V3 – between V2 and V4 (5) V5 – level = V4, anterior Axiliary Line (6) V6 - level = V4, anterior Midaxillary Line Comments: _____________________________________________________________________________ Student Signature: ________________________________________________ 31. Intubation Set-Up PASS RETRY FAIL _____ Student Name: ________________________________ Date: ___________________ A. Equipment Needed 1. Universal Precautions 2. Correct Size Endotracheal (ET) Tube. 3. Stylet (Used as a guide wire for the ET tube) 4. 10cc Syringe - Inflate balloon for ET tube 5. Laryngoscope ( Miller blade is straight / Macintosh is curved blade) 6. ET Holder 7. End-tidal CO2 detector 8. Stethoscope (confirm placement) 9. Ambu-Bag with Oxygen 10. Suction device B. Procedure 1. The student should successfully be able to identify the equipment and set it up for intubation. a. Attach laryngoscope handle and blade b. Insert stylet into ET tube to the Murphy’s Eye. c. After checking bulb leave syringe attached. Comments: _____________________________________________________________________________ Student Signature: ________________________________________________ 32. Medication Set-Up PASS RETRY FAIL_____ Student Name: _____________________ Date: _________________ A. Equipment Needed 1. Appropriate medicine B. Procedure 1. Set out the appropriate medication when told to do so by the paramedic. 2. Check for expiration date of medication. 3. Open the box containing the medication. 4. Inspect for damage container or cloudy solution. 5. Assemble a prefilled syringe in an upright position. a. Do not tighten to the point where the medication is running out. Comments: _____________________________________________________________________________ Student Signature: ________________________________________________ 33. IV Set-Up PASS RETRY FAIL_____ Student Name: _____________________ Date: _________________ A. Equipment Needed 1. Gloves 2. IV Solution 3. Administration Set (60 or 15 gtt set ) 4. Tourniquet 5. Alcohol Prep 6. Gauze 7. 1 inch Tape (2 pieces approx 6 inches long) 8. 2 inch Tape (2 pieces approx 6 inches long) 9. IV Needles 10. Blood Tube of each color 11. Vacutainer Holder 12. Vacutainer Leur Adaptor B. Indications 1. Fluid Replacement 2. Access Route For Medications C. Procedure 1. Select correct type of IV solution requested by the paramedic. a. Inspect expiration date. b. Inspect for cloudy fluid. c. Inspect for leaks. d. Inspect for correct solution. 2. Select correct type of IV administration set requested by the paramedic. a. Macro Setup = 15gtt/ml - used for replace fluids b. Micro Setup = 60gtt/ml - used as medication access line only. Not for fluid replacement 3. Remove IV bag from packaging and remove rubber cap. 4. Remove administration set from packaging and remove plastic cap from end maintaining sterility and insert into IV bag. 5. Pinch Tubing and squeeze drip chamber to fill 1/2 full. 6. Release tubing and open stopcock and flush air out of line. 7. Hang bag from IV pole and turn stopcock off and replace cap maintaining sterility. 8. Set up needle, tape, gauze, gloves, and tourniquet for easy access by medic. Comments: _____________________________________________________________________________ Student Signature: ________________________________________________ 34. Epinephrine Auto-Injector PASS RETRY FAIL____ Student Name: _____________________ Date: _________________ A. Purpose 1. To automatically administer a unit dose of epinephrine to a patient who is having an anaphylactic reaction. B. Equipment 1. Epi Pen auto-injector (contains 0.3 mg of epinephrine) 2. Epi Pen Jr. auto-injector(contains 0.15 mg of epinephrine) C. Indications 1. A patient who appears to be in anaphylactic reaction including difficulty breathing, hypotension, urticaria (hives) or signs of anaphylactic shock (B/P < 90). D. Procedure 1. Body Substance Isolation 2. Assess the patient and initiate appropriate oxygen therapy if available 3. Contact medical control for authorization of usage. 4. Obtain the patient’s auto-injector. 5. Assure the injector is prescribed for the patient. 6. Check the expiration date of the medication. 7. Check for cloudiness or discoloration of the medication. 8. Remove clothing if possible from the thigh. 9. Clean the site with antiseptic swab. 10. Remove the safety cap from the injector. 11. Push the black tip of the injector firmly against the thigh and hold for a minimum of 10 seconds. 12. Massage in injection area for 10 seconds. 13. Discard the auto-injector in a sharps container. 14. Continue with patient assessment and transport the patient. Comments: _____________________________________________________________________________ Student Signature: ________________________________________________ 35. Blood Glucose Set-Up PASS RETRY FAIL_____ Student Name: _____________________ Date: _________________ A. Purpose 1. To field test a patient’s blood-sugar level. B. The student correctly identifies the components. 1. Glucometer 2. Dextrostix 3. Lancet 4. Alcohol prep 5. 4x4's 6. Band-Aid ** Note: Be sure you familiarize yourself with the type of glucometer your agency is using ** (Paid Fire Dept or EMS Staff Performs Procedure) C. Procedure 1. Body Substance Isolation 2. Explain procedure to patient. 3. Using an alcohol prep, cleanse the patients finger that is to be pricked ( usually index or ring finger ) 4. Place Dextrostix in glucometer 5. Using a lancet, pierce the finger for blood return. ** Note: If patient has poor circulation or the finger is cold you may have to milk the finger to enable You to get the drop of blood required to test glucose. 6. Place lancet in sharp container 7. Place a drop of blood on the dextrose strip. 8. Wipe patient’s finger with 4x4. 9. Place band-aid on finger 10. Place 4x4 in bio-hazard bag 11. If reading is below 65 mg / dl (or what your local protocol states) with an altered level of consciousness the patient is symptomatic for the administration of Dextrose 50%. No glucose checks shall be done from a venipuncture needle. Comments: _____________________________________________________________________________ Student Signature: ________________________________________________ 36. Burns Student Name: _____________________ PASS RETRY FAIL____ Date: _________________ A. Equipment Needed 1. Universal Precautions 2. Sterile Burn Sheets 3. Irrigation Fluid B. Procedure 1. Body Substance Isolation 2. Perform patient assessment ruling out any airway, breathing, circulation, life threatening complications. a. Any complication of airway, breathing circulation will be rapid transport to trauma center or burn unit. 3. Remove clothing around the burn area, cut around clothing that is stuck to the skin. 4. The student should be able to categorize a burn a. First degree: red areas of skin (like a sunburn). b. Second degree: blistering of skin c. Third degree : charring of skin / white waxy 5. The student should be able to estimate the Total Body Surface Area burned using the rule of nines. a. Adult: head - 9%, chest/abdomen - 18%, back - 18%, legs - 18% each, genitalia -1%, arms - 9% each i. Second and third degree burns to > than 15% of the TBSA is considered a trauma alert b. Child: head -12%, chest / abdomen - 18%, back -18%, legs - 16.5% each, genitalia -1%, arms - 9% each i. Second and third degree burns to > than 10% of the TBSA is considered a trauma alert c. Infant: head -18%, chest / abdomen - 18%, back -18%, legs - 13.5% or 14% each, genitalia -1%, arms - 9% each i Second and third degree burns to > than 10% of the TBSA is considered a trauma alert 6. If burning agent is a powder then brush as much of the powder off before attempting to irrigate. 7. If area is < 10% then cool the area with sterile saline and wrap with moist sterile dressing until area is no longer burning the patient. 8. If area is > 10% then wrap the area with sterile burn sheets and transport the patient. 9. Complication of Burns: a. Infections b. Temperature Control (the inability to control the body temperature due to the loss of skin being burned away) c. Hypothermia from too much irrigation of the burn with saline. Comments: _____________________________________________________________________________ Student Signature: ________________________________________________ 37. Impending Childbirth (Skill Time Limit = 5 min) PASS RETRY FAIL____ Student Name: _____________________ Date: _________________ A. Purpose 1. To deliver and care for a newborn and the mother. B. Equipment Needed 1. Universal Precautions 2. OB Kit 3. O2 Supply C. Procedure (Time Begins) 1. Body Substance Isolation 2. Confirm impending childbirth. a. Question the pt. i. Determine the GPA of the patient: Gravida@ : this is the number of times she has been pregnant. Para@ : this is the number of live children she has had. Abortions@ : this is the number of miscarriages or aborted pregnancies the patient has had. ii. Has your water broken? iii. Have you had prenatal care? iv. Have you had any complications with the pregnancy? v. Is there more than one baby? 3. Time the Duration of the contraction (from the beginning of the contraction to the end of the contraction). 4. Time the Interval of the contractions (from the beginning of one contraction to the beginning of the next contraction). 5. Examine the perineum for crowning. 6. No pelvic exams to be performed 7. Oxygen by nasal cannula at 6 LPM. 8. Prepare the patient for delivery. a. Place the patient in semi-fowler. b. Place a sheet under the patient and elevate patient’s buttocks to help delivery of newborn. c. Drape the patient. d. Calm the patient. 9. Delivery of infant. a. As the crowning occurs, place your hands on the infants head to prevent explosive birth. b. As the head emerges check the neck for the umbilical cord. If the cord is present gently slip the cord over the head or if it is to tight clamp and cut the cord before further delivery of the infant. c. With the head out aspirate the infant's mouth then nose before the chest is delivered. d. Gently lower the head down to allow the top shoulder to deliver then lift the head to allow delivery of the bottom shoulder. 10. Care of infant. a. Dry the infant by vigorously rubbing. b. Discard wet towel and place dry towel around baby c. Check for crying and breathing Look, listen, and feel. d. Perform APGAR score within the first minute then repeat after 5 minutes. 0 pts 1pts 2 pts Appearance Blue Body pink / Extremity blue Fully Pink Pulse Absent <100 >100 Grimace None Some Motion Vigorous Cry Activity Flaccid Some Flexion Active Respirations Absent Slow Irregular Strong Cry e. Place the first clamp on the umbilical cord approx 7 inches from the infant. f. Place the second clamp on the umbilical cord approx 10 inches from the infant. g. Cut the cord. If bleeding is present from cord ends place another clamp behind the first clamp. h. If heart rate is < 60 then begin CPR. If heart rate is 60-80 assist ventilations. If no increase is noted then begin CPR. If heart rate is 80-100 then assist ventilations. If heart rate is 100 or greater then give blow by O2 at 5 LPM via supply tubing 2 inch away from infants mouth to deliver 80%. 11. Care of the mother a. Massage the fundus of the uterus to control bleeding and facilitate a more rapid delivery of the placenta. b. Have mother nurse baby if she wants to. c. Dress the perineum if torn. d. Apply a sanitary napkin. e. (Time Ends) 12. Student will demonstrate appropriate APGAR score of scenario given. 13. Childbirth Complications (All childbirth complications are rapid transport to the hospital. a. Breech Birth (Feet First presentation) i. After the shoulder are delivered and the infants face is in a downward position then elevate the legs and trunk of the infant to facilitate delivery of the head. ii. Head should deliver in 30 seconds if NOT then place two sterile gloved finger in the vagina to locate the infants mouth. iii. Push vaginal wall away from infant’s mouth to form airway. iv. Apply gentile pressure to the fundus. If head does NOT deliver in 2 minutes, keep your fingers in place to maintain the airway. b. Prolapsed Cord: Elevate mother’s hips to knee chest position, explaining to mother not to push. If cord is not pulsating place sterile gloved hand into vagina and gently exert counter-pressure until the cord begins to pulsate again. Once cord is determined to be pulsating cover exposed cord with moist dressing and keep warm. Comments: _____________________________________________________________________________ Student Signature: ________________________________________________ Bartow Medical and Fire Academy EMR Course 15 16 SY 94 | P a g e Bartow Medical and Fire Academy EMR Course 15 16 SY Bartow Medical and Fire Academy EMR Field Evaluation Report First Name: Date: Last Name: Time In: Instructor: Hubbard Preceptor: Number of Response with Trauma: Time Out: Total Time: Number of Response without Medical: BFD / PCFD Total Number of Patients Evaluated: Disposition EYE OPENING Transport VERBAL RESPONSE NPU nd: (C/C): C/C: (SX): PE): 4 Oriented 5 3 Confused 4 2 95 | P a g e Inappropriate 3 Words Bartow Medical and Fire Academy EMR Course 15 16 SY To Scene Age: Sex: 96 | P a g e Response Information Emergency Race: Kg: 1 Garbled 2 None 1 Non-emergency Cat: Red / Yellow / Green / Trauma Alert Bartow Medical and Fire Academy EMR Course 15 16 SY TIME TIME P R TREATMENT BP / / / / / / DOSE RHYTHM SaO 2 ROUTE LOC SKIN PUPILS RESPONSE Reassessment / Narrative: Preceptor Comments: Date_________ Student_____________________________________ 97 | P a g e Precepter Initials__________ Bartow Medical and Fire Academy EMR Course 15 16 SY Date_________ Student_____________________________________ 98 | P a g e Precepter Initials__________ Bartow Medical and Fire Academy EMR Course 15 16 SY Bartow Medical and Fire Academy EMR Field Evaluation Report First Name: Date: Last Name: Time In: Instructor: Hubbard Preceptor: Time Out: Number of Response with Trauma: Total Time: Number of Response without Medical: BFD / PCFD Total Number of Patients Evaluated: Psychomotor / Affective Evaluation 1-remedial 2-poor 3-needs improvement 4-working at level 5-working above level Appearance Study Time Use / Self Motivation Safety Precautions Involvement with Patient and Communication History of Chief Complaint Patient Assessment BLS Treatment Decisions / Skill Performance Radio Reports Verbal Reports To EMS Report Writing Knowledge of BLS Theory Preceptor Relationship / Teamwork Patient Relationships Accepts Feedback Well Attitude / Behavior 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 Preceptor Comments:_______________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ _________________________ __________________________ Student Signature Preceptor Signature 99 | P a g e Bartow Medical and Fire Academy EMR Course 15 16 SY 100 | P a g e Bartow Medical and Fire Academy EMR Course 15 16 SY Practical Exam Scenarios SCENE SIZE UP Determines the scene is safe / Determines the mechanism of injury/nature of illness Take Standard precautions / Determines the number of patients / Requests additional help if necessary Verbalizes general impression of the patient / holds c-spine if trauma suspected Determines the level of consciousness (A.V.P.U.) Airway - Verify airway patency or manually open airway as needed Breathing - Rate/Rhythm/Depth/Effort / Initiate appropriate oxygen therapy / Ensure adequate ventilations Circulation - Assess pulse – compare carotid and radial pulses / Assess skin color, temperature, and condition Control any major bleeding found Perform a rapid scan Determine priority of patient care and transport Investigates the Chief Complaint (history of present illness) S A M P L Signs/Sympt Allergies Medications Past Medical Last Oral Intake oms (Prescribed/ History (Time of day) (Onset, OTC) Provokes, Quality, Radiates, Severity, Time) Pulse: Rate / Rhythm / Respirations: Rate / Blood Pressure: Palpated or Force Rhythm / Depth / Auscultation Effort Head Inspect and palpate the scalp and ear Assess the eyes and pupil reaction Assess the face including the oral and nasal areas Neck Inspect and palpate the neck Check for JVD (Jugular Vein Distention)Tracheal Deviation Chest Inspect the chest /Palpate the chest Auscultate bilateral lung sounds Abdomen/Pelvis Assess all four quadrants of the abdomen Assess the pelvis (pelvic push) Verbalize genitalia/perineum areas are assessed as needed Extremities Inspect and palpate all extremities Assess distal pulses and motor/sensory function in all extremities Back Assess posterior thorax Assess lumbar region Repeats Primary Assessment 101 | P a g e Bartow Medical and Fire Academy EMR Course 15 16 SY Reassess Vital Signs : (Vital signs MUST be obtained from the high-fidelity simulator) Pulse: Rate / Rhythm / Force Reassess the Chief Complaint Recheck Interventions Identify and treat Changes in the Patient’s Condition Reassess patient 1.EMR Open Abdominal / Open Chest Patient Assessment Exam (EMR FINAL) TREATMENT: Open Abdominal / Open Chest Patient Student treated chest wound with occlusive dressing Student treated abdominal wound with moist sterile dressing and occlusive dressing. 2. EMR Chest pain / Nitro / ASA Patient Assessment Exam TREATMENT: Chest pain / Nitro / ASA Evaluates the patient and ensures that he or she is having chest pain Position Patient Properly Call ALS back up Confirm patient has prescribed NTG tablets or spray and Aspirin Makes sure patient has not had any erectile dysfunction medication (i.e. Cialis, Viagra, etc…) Contacts medical control and obtains medical direction for Aspirin and Nitro NOTE: They DO NOT receive credit for #4, 5, or 7 if they failed to obtain info prior to Med Control Ensure that the patient’s Systolic B/P is over 100mm/hg and that he or she has not taken more than 3 doses of nitro prior to rescuer arrival Assures that the patient is alert and that the following are checked: right patient, right medication, right dosage, right route, expiration date Gives patient one dose .3-.4mg SL nitro and 162-324mg ASA PO Asks the patient to lift tongue and either place tablet under or sprays under the tongue (the patient should medicate themselves). Records administration time, medication dose and any change in patient’s status or pain (results) 3.EMR (Adult/Child) Respiratory / Meter Dose Inhaler Patient Assessment Exam 1. Patient must exhibit signs and symptoms of a respiratory emergency with past medical history 2. Calls ALS back up 3. Inhaler is prescribed for this patient 4. Obtain medical direction 5. Assures: right patient, right medication, right dosage, right route, pt is alert and can use the inhaler 6. Checks the medication’s expiration date 7. Allow patient to use inhaler 8. Evaluates the patient for changes 9. Reassess the patients lung sounds 102 | P a g e Bartow Medical and Fire Academy EMR Course 15 16 SY 4.EMR Behavioral Emergency / Overdose / Charcoal Patient Assessment Exam TREATMENT: Behavioral Emergency / Overdose / Charcoal Patient History: Description of the episode / Onset / Duration / Associated symptoms / Evidence of trauma? Interventions / Seizures / Fever Oral Glucose: 1. Evaluates the patient and insures patient has altered LOC and history of diabetes 2. Calls ALS back up 3. Performs glucose check if possible 4. Obtains medical direction 5. Assures: right patient, right medication, right dose, right route, pt is conscious and able to swallow 6. Checks expiration date 7. Administers glucose between cheek and gums 8. Evaluates for changes in mental status 5.EMR (Adult/Child) Allergic Reaction / Epi pen Patient Assessment Exam TREATMENT: Allergic Reaction / Epi pen Patient History: 1. History of allergies? 2. What were you exposed to? 3. How were you exposed? 4. Effects? 5. Progression? 6. Interventions? Epi-Pen: 1. Identifies that patient exhibits signs of severe allergic reaction, including either respiratory distress or shock 2. Calls ALS back up 3. Identifies that the auto-injector is prescribed to this patient by a physician 4. Obtain medical direction 5. Identifies dose for adult (0.3mg) and child (0.15mg) 6. Inspects injector for date and clarity of fluid 7. Cleans injection site with alcohol swab if time permits 8. Place the tip of the injection against the thigh 9. Press and hold the injector against the thigh for 10 seconds 10. Record time, dose site, and response 6.EMR Heat Environmental / OB Patient Assessment Exam TREATMENT: Environmental / OB Patient History OB patient: Checks pt :Gravida, Para, Abortions / Prenatal care / How many babies (twins)? How long have you been pregnant / Pain or contractions? / Pain or discharge? Do you feel the need to push? / Last menstrual period? / Due date? / Has water broken? History Environmental 1. Source? 2. Environment? 3. Duration? 4. Loss of consciousness? 5. Effects general or local? 103 | P a g e Bartow Medical and Fire Academy EMR Course 15 16 SY 7.EMR Drowning (infant) Patient Assessment Exam TREATMENT: Drowning (infant) Patient Assessment Exam 1. If patient is apneic use air adjunct and BVM / Follow AHA guidelines 2. Follow treatment and assessment standards for injury / illness of patient 8.EMR Environmental Cold (child) Patient Assessment Exam TREATMENT: EMT Environmental Cold (child) Patient History Environmental 1. Source? 2. Environment? 3. Duration? 4. Loss of consciousness? 5. Effects general or local? Treatment cold: 1. Remove patient from environment 2. Rewarm patient 9.EMR Head-Spinal Trauma Patient Assessment Exam TREATMENT: Head-Spinal Trauma Patient Assessment Exam 1. Apples cervical collar a. Checks neurological status b. Measures for proper size collar c. Exposes, inspects and palpates the patient’s neck d. Applies the collar e. Check neurological status f. Verbalizes placement to a long spine board. 2. Applies ridged splint a. Expose extremity and cover any open wounds with sterile dressing b. Checks for PMS c. Manually stabilize extremity d. Apply splint / secure with cravets e. Mobilized in position of fraction f. Checks PMS 10.Final Practical EMR Cardiac Arrest /AED / Combi -Tube Patient Assessment Exam TREATMENT: Cardiac Arrest /AED / Combi -Tube Patient Follow AHA guidelines for CPR and AED use 1. CPR per AHA - 5 2. AED use per AHA - 5 Combi-Tube 1. Checks and prepares Combi Tube, lubricates the distal end of the device 2. Extends head and inserts the Combi tube until teeth are between the black lines 3. Inflates blue balloon with 100ml of air 4. Inflates white balloon with 15ml of air 5. Ventilates through blue tube(if negative epigastric and adequate chest rise continue ventilating, if positive epigastric and no chest rise began ventilating through clear tube) 6. Confirm tracheal ventilation – auscultate lungs (4 fields) and epigastric region 104 | P a g e Bartow Medical and Fire Academy EMR Course 15 16 SY 105 | P a g e Bartow Medical and Fire Academy EMR Course 15 16 SY 106 | P a g e