Download Concept of Operations, Skills and Competencies

Concept of Operations, Skills
and Competencies
Dr. Steven Lim
Consultant Emergency Physician, CGH
Deputy Chief Medical Officer
Objectives
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Understand the mission and concept of
operations
Skills and competencies of personnel
Composition of medical standby teams
Composition of ambulance transport teams
Ambulance and Medical Teams’ equipment,
supplies and drugs
Professionalism, ethics, patient privacy, safety
H1N1 Influenza pandemic threat and the
Games
Mission
• To provide effective, prompt, and
internationally recognised quality medical
care to support the AYG
Medical Support: Principal
considerations
• OCA requirements
• Limited resources and funding
• Level of medical services for the
community must not be compromised
during the AYG
Concept of operations
• Level of medical service almost equivalent
to norms (e.g. SCDF, polyclinic) in terms
of staff and stuff.
• Ambulances capable of conveying
emergency cases.
• Physicians need to be familiar with drugs
and equipment listings.
Concept of operations:
Emergencies
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Be responsive, prompt.
Stabilise and transfer – do NOT ‘stay and play’.
Avoid unnecessary delays.
Remember the Chain of Survival.
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Early access
Early CPR
Early defibrillation
Early advanced care
• Remember ABC’s and spinal immobilisation.
Scenario
• Official found collapse in hotel room.
Office hours:
• Call 995
• Games village medical center medical personnel respond with AED
and resuscitation items.
• Convey to nearest hospital immediately.
• Do not bring back to Games Village Medical Center for treatment!
Off-office hours:
• Call 995
• Night medical staff respond immediately.
• Can still convey patient to hospital if criteria for ambulance transport
team is satisfied + confident to do so.
Scenario
• VIP spectator suffers serious fall at the
stands during a competition.
• First aiders on scene responds
immediately.
• Medical team arrives and further manage
before conveying to nearest hospital.
Concept of operations: Fallback to
995
• In acute medical or surgical emergencies
when there is no doctor present, medical
personnel need to consider activation of
SCDF ambulance to augment capabilities.
Skills and Competencies: Doctor
• Registered with Singapore Medical
Council with valid practising certificate.
• BCLS and AED certified.
• ATLS and ACLS preferred but not
mandatory.
Skills and Competencies: Staff
Nurse
• Registered with Singapore Nursing Board with valid practising
certificate
• BCLS and AED certified
Able to:
• provide body immobilisation for safe transfer of trauma victim
• bag-mask-ventilate victim, assess and maintain the airway
• obtain intravenous (IV) access, administer IV medications and
perform IV infusions
• carry out emergency basic procedures to control external
hemorrhage, apply dressings, bandages, slings and splints
• obtain capillary blood glucose sample and institute treatment for
hypoglycaemia
• administer basic emergency medications including nebulisation
• appropriately use PPE and apply standard precautions to prevent
the transmission of infectious agents during patient care
Skills and Competencies:
Paramedics
Should be qualified to at least:
• Singapore Civil Defence Force (SCDF) or Singapore Armed Forces (SAF) Paramedic
Level 3;
• Higher National Institute of Technical Education Certificate (NITEC) in Paramedic and
Emergency Care
Should be:
• BCLS and AED certified
Able to:
• provide body immobilisation for safe transfer of trauma victim
• bag-mask-ventilate victim, assess and maintain the airway
• obtain intravenous (IV) access, administer IV medications and perform IV infusions
• carry out emergency basic procedures to control external hemorrhage, apply
dressings, bandages, slings and splints
• obtain capillary blood glucose sample and institute treatment for hypoglycaemia
• administer basic emergency medications including nebulisation
• appropriately use PPE and apply standard precautions to prevent the transmission of
infectious agents during patient care
Skills and Competencies: Paramedic Assistants,
Patient Care Aides, Enrolled Nurses
Should be:
• BCLS certified
• Trained in first aid
Able to:
• assist the Paramedic or Nurse in managing the patient under direction
• able to assist the Paramedic or Nurse in the use of all the equipment on board, and
familiar with all medical protocols
• independently initiate the use of an Automated External Defibrillator (AED)
• perform standard first aid
• measure and monitor the patient’s vital signs, ie. Pulse rate, blood pressure,
temperature and respiratory rate
• monitor intravenous peripheral lines of stable patients
• carry out emergency basic procedures to control external hemorrhage, apply
dressings, bandages, slings and splints
• establish contact with the receiving hospital if the need arises
• appropriately use PPE and apply standard precautions to prevent the transmission of
infectious agents during patient care
Skills and Competencies:
Ambulance Driver
• Possess a valid license to drive the ambulance
• Understand the usage of ambulance stretchers
and able to assist in evacuation of casualty
• Trained in defensive driving and be well aware
of the use of sirens and flashing lights for
conveying emergency patients to hospital
• Establish contact with the receiving hospital if
the need arises
Skills and Competencies: First
Aiders
First Tier
• Age 18 and above
• Valid certification in the Standard First Aider Course
• Valid certification in Automatic External Defibrillator
(AED)
• If not, will need training or deployment with another First
Aider who has valid certification
• Valid certification in BCLS is preferred but not mandatory
• Has experience in coverage of previous mass gathering
events (E.g. National Day Parade)
Skills and Competencies: First
Aiders
Second Tier
• Age 13 to 17+
• Valid certification in the Standard First Aider Course
• Valid certification in Automatic External Defibrillator
(AED)
• If not, will need training or deployment with another First
Aider who has valid certification
• Valid certification in BCLS is preferred but not mandatory
• Previous standby experience preferred but no
mandatory
Composition of Medical Standby
Teams
• Medical Team = 1 Dr + 2 Nurses.
• Paramedics = paired up.
• First Aiders = in teams of 2 or 4.
– For teams with 2 First Aiders only, both must
be from the first tier.
– For teams with 4 First Aiders, at least 2 of
them must fulfill criteria for first tier.
Sports Venue Medical Plan
Sports Risk
Medical
Resources
High Risk Sports
Moderate Risk Sports
Competition
Training
Warm
Up
Competition
Doctor
V
V
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V
Nurses
V
V
V
V
Paramedics
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V
V
V
First Aiders
V
Ambulances
V
Therapists
Low Risk Sports
Training
Warm
Up
Competition
Training
Warm
Up
V
V
V
V
V
V
V
V
V
V
V
V
V
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V
Physiotherapist / Athletic Therapist services will be provided centrally at the Games Village
Composition of Ambulance
Transport Medical Personnel
To-Go combinations:
– 1 Medical Team (1 Doctor, 2 Nurses) or;
– 2 Paramedics or;
– 1 Paramedic and 1 Paramedic Assistant or;
– 1 Paramedic and 1 Enrolled Nurse or;
– 2 Staff Nurses* or;
– 1 Staff Nurse and 1 Paramedic Assistant* or;
– 1 Staff Nurse and 1 Enrolled Nurse
Ambulance Equipment
A
Basic Ambulance Equipment
Qty
1
Chair-Cot Stretcher with Mattress and 3 Restraints
1
2
PVC Handheld Stretcher (Orange Canvas)
3
3
Lift-Off IV Pole 1
1
4
Linen Set comprise Blanket and Cotton Sheet
5
Pillow with Pillow Case
1
6
Paper Towel Dispenser
1
7
Biohazard Container and Sharps Disposal Box
8
Street Directory
1
9
Breakdown Sign
1
10
Fire Extinguisher
1
11
Raincoat (Single Piece)
3
12
Tool Jack with Jack and Wheel Brace
1
13
Lime-Green Safety Vest
3
14
Main Oxygen Cylinder (1500L) with Holder and Gauge
1
15
Personal Protective Equipment (N95 Mask, Cap, Gown and Goggles)
16
Kidney Dish
3 each
1 each
3 sets
1
Ambulance Equipment
B
Basic Medical Equipment (Medical Bag)
Qty
1
Digital Blood Pressure Set
1
2
Stethoscope
1
3
Thermo Scan
1 set
4
Disposable Ear Probe (20 per box)
1 box
5
Alcohol Swabs
6
Blood Glucometer
1 set
7
Incontinence Sheet
4
8
Disposable Mask with I without Face Shield
3
9
Latex Glove (Sterile)
10
Cooler Pack
2
11
Stamp Pad
1
12
I/V Normal Saline 500 ml
2
13
I/V Dextrose 10% 500 ml
1
14
I/V Admin Drip Set
2
5
2 pairs
Ambulance Equipment
B
Basic Medical Equipment (Medical Bag)
Qty
15
I/V Cannula l8G
2
16
I/V Cannula 22G
2
17
Opsite I/V/Transparent Dressing
3
18
Micropore Tape / Self Adhesive Tape
1
19
Alcohol Prep (Mediswab)
5
20
Venous Tourniquet
1
21
Polythene Bag (Medium)
3
22
Triangular Bandage
5
23
Crepe Bandage (Scm,7.5 cm,lOcm,l5cm)
2 each
24
Wound Dressing FAD Size 13, 14 and 15
2 each
25
Paramedic and Surgical Scissors
1 each
26
Medical Torch and Pen Torch
1 each
27
Latex Examination Glove (Non-Sterile)
28
Sterile Pads (L/S)
29
Sterile Gauze (per packet)
5
30
Bandage Adhesive (Finger Dressing)
5
31
Micropore Tape / Self-Adhesive Tape
1
32
MeloIin (10 x 10)
5
5 pairs each size
2 each
Ambulance Drugs
C
Drugs (Basic Drugs kept in Cooler Box)
Qty
1
Nitroglycerin 0.5 mg/tab (100/bottle)
2
Ventolin Solution (10mI/bottle)
1
3
Rectal Diazepam (5mg/tube)
1
4
Adrenaline (1 mI/ampoule)
5
5
Tab Aspirin (300 mg)
1 bottle
10 tab
Ambulance Equipment
D
Resuscitative Equipment
Qty
1
12 Lead Defibrillator (AED) with NIBP and Sp02
1
2
Portable Suction Unit with Charger
1
3
Suction Catheter Size 10,12,14 and 16
4
Portable Hand-Held Suction Unit
Adult-Child Bag Valve Mask
1 each
1
1 set
5
Reservoir Bag
1
6
Test Lung
1
7
Mask Size 3 and 5
1 each
8
Airway Guerdal Size 2, 3, 4 and 5
2 each
9
LMA Sizes 3 and 4
2 each
Ventilator Resuscitator Set with Oxygen Cylinder and Bag
1 set
10
Nebu Mask, Non-Rebreather with Reservoir Bag and Nasal Prong
2 each
11
Spare 02 Filled Cylinder
1
12
Syringe 3ml
2
13
Needles Size 21G and 23G
2 each
Ambulance Equipment
E
Basic Trauma Equipment
Qty
1
Scoop Stretcher c/w 3 Restraints
1
2
KED
1
3
Head Immobiliser
1
4
Aluminium Long Back Board
1
5
Cervical Collars (Adjustable)
2
6
Cervical Collars (Paediatric Size)
1
7
Frac Immobiliser Set (3, 4 and 5 Straps)
8
SAM Splint
2
9
Burn Dressing (60cm x 80cm)
2
1 each
Standby Personnel Equipment
A
B
Oral Drugs
Qty
Tab Paracetamol 500 mg
20 tabs
Cap Mefenamic 250 mg (Ponstan)
20 caps
Tab Chlorpheniramine 4 mg
20 tabs
Drugs External Application
Normal Saline Eye Drops
Antiseptic Cream
Qty
1 vial
2 tubes
Chlorehexidine 1 in 2000
10 Sachets
Sterile water for irrigation
2 bottles
Standby Personnel Equipment
C
Dressing
Qty
1.
Transparent adhesive dressing 6 cm x 7 cm
5 pcs
2.
Alcohol swabs
20 pcs
3.
Iodine packets
10 pcs
4.
Adhesive gauze dressing size - small
3
- medium
3
- large
3
5.
Elastoplast
10 strips
6.
Surgical tape 1”
1 roll
7.
Steri-strips 1/4”
1 pkt
1/2”
1 pkt
8.
Sterile swab applicators
2 pkts
9.
Field dressing
2 pkts
10
Crepe bandages 2”
2 rolls
3”
2 rolls
4”
2 rolls
6”
2 rolls
Standby Personnel Equipment
D
Miscellaneous
Qty
1.
Digital thermometer (oral)
1
2.
Thermometer sleeves
10
3.
Pen torch with size AA batteries
2
4.
Tourniquet
1
5.
Medicine cups
2
6.
Plastic spoons
3
8.
BP set
1
9.
Stethoscope
1
10.
Scissors
1 pair
11.
Disposable gloves size Small
5 pairs
Medium
5 pairs
Large
5 pairs
12.
Wooden spatula (sterile)
10 pcs
Medical Team (Doctor’s)
Equipment
A
1.
Airway Management
Laryngoscope handle
Qty
1
Blades size
2.
- 2
1
- 3
1
Batteries size C 1.5 V
2
Guedal airways :
- 2
1
- 3
1
3.
Adult ETT Intoducer
1
4.
Spencer Wells artery forceps
2 pairs
5.
Mcgills forceps
1 pair
6.
Wooden tongue depressor (sterile)
4 nos
7.
Mouth gag
1
Medical Team (Doctor’s)
Equipment
8.
Endotracheal tubes sizes - 5
1
- 6
1
-7
1
- 7.5
2
- 8
2
- 8.5
1
9.
Surgical lubricant
1 tube
10.
10 ml syringe
11.
Scissors
1 pair
12.
Gauze, sterile
2 pkts
13.
Mini trachy
1 set
2
Medical Team (Doctor’s)
Equipment
B Doctor’s Emergency Drugs
14. One plastic bag containing the following: -
Qty
Injection Atropine 0.6mg
5 amps
Injection Adrenaline 1 mg
5 amps
Injection Midazolam 15 mg
2 amps
Water for Injection 20 mls
10 amps
Needles and Syringes 10cc
10
Quality Care
• Be professional.
• Comply to the provisions of the Ethical
Code.
• Appropriate attire and grooming.
• Respect patient privacy at all times.
• Direct media questions to operations
center.
• Think Safety.
Consent/ Therapy
• General consent taken by SAYGOC
• Parent and Guardian
• Emergency situations
• Prescription are to be made by doctors only
(NOC foreign doctors with temporary registration
included).
• Exception being those who are trained to use
certain drugs during their routine course of work
(e.g. paramedics giving IV adrenaline for cardiac
arrest cases).
H1N1 elevated pandemic threat
• Mode of operations may change
depending on DORSCON level.
• 993 Special ambulance service
• 1800-333-9999 Influenza A (H1N1-2009)
hotline
• www.crisis.gov.sg/flu
THANK YOU