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Temple College EMS Professions Student Handbook Section B: Clinical Policies Advanced EMS Education Revised April 2010 EMS Professions Student Handbook Table of Contents Welcome to the Temple College EMS Professions Clinical Program! __________________ 4 Helpful Phone Numbers _____________________________________________________ 5 Clinical Rotation Requirements_________________________________________________ 6 Clinical Guidelines and Policies ________________________________________________ 8 Dress Code Policy Clinical Absence Policy _____________________________________________________10 ____ ________________________________________________11 Clinical Recordkeeping Policy _________________________________________________ 11 Documentation Summary ____________________________________________________ 12 Documents by Rotation_ ____________________________________________________ 13 Course Requirements__ ____________________________________________________ 15 EMSP 1162 (First Semester Clinical) ________________________________________ 15 EMSP 1263 (Second Semester Clinical) ______________________________________ 15 EMSP 2260 (Third Semester Clinical) _______________________________________ 16 EMSP 2460 (Fourth Semester Clinical) ______________________________________ 16 Competency Check Off Forms _________________________________________________ 17 Patient Assessment _______________________________________________ 18 IV Therapy _______________________________________________ 19 Bag Valve Mask Ventilation _______________________________________________ 20 Oral Intubation _______________________________________________ 21 IV Drug Administration _______________________________________________ 22 IM Drug Administration _______________________________________________ 23 SC Drug Administration _______________________________________________ 24 IV Continuous Infusion Drug Administration _________________________________ 25 Nebulized Drug Administration _____________________________________________ 26 12 Lead ECG Acquisition and Interpretation __________________________________ 27 Monitoring Lead Acquisition and Interpretation _______________________________ 28 Medical Director ____________________________________________________ 29 Radio Reporting _______________________________________________ 30 Written Documentation _______________________________________________ 31 Call Management (Final) _______________________________________________ 32 Clinical Documentation ____________________________________________________ 33 Global Clinical Documentation Form ________________________________________ 34 Airway Management Documentation _________________________________________ 35 ©2004-2010, Temple College Section B: Page 2 of 71 EMS Professions Student Handbook Immunization Clinic Documentation _________________________________________ 38 Toxicology (Poison Center) Documentation ___________________________________ 39 Field Internship Documentation ____________________________________________ 40 Summary of Clinical Objectives & Goals ________________________________________ 41 Global Cognitive and Psychomotor Clinical Objectives _____________________________ 42 Global Affective Objectives ___________________________________________________ 43 Statement of Learning Objectives ______________________________________________ 45 Emergency Department Objectives & Goals _____________________________________ 46 Respiratory Therapy Objectives & Goals ________________________________________ 47 Operating Room Objectives & Goals ___________________________________________ 48 Statement of Learning Objectives ______________________________________________ 50 Emergency Department Objectives & Goals _____________________________________ 51 Operating Room Objectives & Goals ___________________________________________ 52 Mobile Intensive Care Unit Objectives & Goals ___________________________________ 53 Statement of Learning Objectives ______________________________________________ 55 Coronary Care Unit Objectives & Goals_________________________________________ 56 Intensive Care Unit Objectives & Goals _________________________________________ 57 Electrophysiology/ Coronary Cath Laboratory Objectives & Goals ___________________ 58 Labor and Delivery Objectives & Goals _________________________________________ 59 Dialysis Unit Objectives & Goals ______________________________________________ 60 Immunization Clinic Objectives & Goals ________________________________________ 61 Toxicology (Poison Center) Objectives & Goals __________________________________ 62 Field Internship Objectives & Goals____________________________________________ 63 Pediatric Clinic Objectives & Goals ____________________________________________ 66 Pediatric Long Term Care Objectives & Goals ___________________________________ 68 Geriatric Long Term Care Objectives & Goals ___________________________________ 69 ED Medical Director Rotation Objectives & Goals ________________________________ 70 Field Internship Objectives____ _______________________________________________ 71 ©2004-2010, Temple College Section B: Page 3 of 71 EMS Professions Student Handbook Welcome to the Temple College EMS Professions Clinical Program! We hope you will find your clinical experiences exciting and beneficial. The following pages provide information about what your clinical rotations will include and how to get the most out of them. Preparation is the key to a successful clinical rotation. The more you know about the area and the types of patients you will be interacting with, the more you will learn from the experience. A well prepared student with a working knowledge of the vocabulary, skills, and patient issues involved with a clinical site will have a more productive interaction with the hospital staff, the patients, and the families of the patients they will be working with. Most areas are precepted by the on-duty staff of that area. Some clinical areas are more "self-directed" than others. This is especially true of areas that have a high volume of private patients such as Labor and Delivery. Preparing for the clinical rotation, being friendly and helpful, and not being shy about introducing yourself and asking what you can do to help will go a long way in "breaking the ice" in these busy areas. The opportunity to learn in these healthcare settings is a privilege afforded to us by our clinical affiliates. We are fortunate to have a number of excellent sites for our clinical rotations. Many paramedic students in Texas and around the country would love to have the opportunity to rotate through large teaching institutions like Scott & White. We encourage you to take advantage of this tremendous opportunity to learn. Clinical rotations can also be fun!! Enjoy the time you are given to learn about the practice of medicine. ©2004-2010, Temple College Section B: Page 4 of 71 EMS Professions Student Handbook Helpful Phone Numbers Clinical Coordinator Diane Quintanilla Office - (254) 298-8562 Cell - (254) 931-1498 [email protected] Chairman, EMS Professions Jeff Fritz Office - (254) 298-8563 [email protected] Faculty, EMS Professions Johnna Rister Office - (254) 298-8564 [email protected] Faculty, EMS Professions Jason Valdez Office - (254) 298-8679 [email protected] Medical Director Jeff Jarvis, MD, MS, EMT-P Office - (254) 724-1068 [email protected] ©2004-2010, Temple College Section B: Page 5 of 71 EMS Professions Student Handbook Clinical Rotation Requirements Clinical rotations are required in each semester. Rotations include departments within Scott & White Hospital and Clinic and King’s Daughter’s Clinic. Field Clinical rotations include Scott and White EMS and Williamson County EMS. All rotations are ‘competency’ based. This means that, while there are a minimum number of hours and procedures required, additional hours may be required to achieve competency. This is done on an individual basis. More information is given in the course syllabus. All clinical rotations must be completed before a semester grade will be assigned. Rotations are also required before applying for state certification testing. ALS Field Clinical Sites Scott & White EMS 2401 S. 31st Street Temple, Texas 254-724-5711 Williamson County Medic 24 150 Church Park Road Cedar Park, TX 78613 512-401-5751 Williamson County Medic 11 2801 Oakmont Round Rock, Texas 78665 512-255-0855 Williamson County Medic 31 4200 Airport Rd. Georgetown, TX 78626 512-931-2949 Williamson County Medic 12 3800 County Road 123 Round Rock, TX 78664 512-919-4211 Williamson County Medic 32 2000 Scenic Drive. Georgetown, TX 78626 512-943-3000 Williamson County Medic 13 350 Deepwood Round Rock, TX 78681 512-671-6665 Williamson County Medic 33 #5 Texas Drive Georgetown, Texas 78628 512-931-0200 Williamson County Medic 14 1991 Rawhide Drive Round Rock, TX 78681 512-244-9207 Williamson County Medic 41 2604 Northlawn Drive Taylor, Texas 76574 512-365-8526 Williamson County Medic 21 1311 Highland Drive Cedar Park, Texas 78613 512-260-1029 Williamson County Medic 42 1425 North Main Street Taylor, Texas 76574 512-365-7554 Williamson County Medic 22 1570 Cypress Creek Rd. Cedar Park, Texas 78613 512-918-9878 Williamson County Medic 43 405 Exchange Blvd. Hutto, Texas 78634 512-759-2616 Williamson County Medic 23 209 W. Willis St. Leander, TX 78641 512-259-1735 Williamson County Medic 51 16248 Great Oaks Dr. Round Rock, Texas 512-255-0100 ©2004-2010, Temple College Section B: Page 6 of 71 EMS Professions Student Handbook Hospital/Clinic Sites Scott and White Hospital 2401 S. 31st Street Temple, Texas (254) 724-5711 Kings Daughters Clinic 1905 SW H K Dodgen Loop Temple, Texas (254) 298-2400 2004-2010, Temple College Section B: Page 7 of 71 EMS Professions Student Handbook Clinical Guidelines and Policies 1. All clinical and field rotations for the Intermediate course (Paramedic first and second semesters), along with all required skills testing and competency check off forms must be completed prior to being allowed to take the EMT-Intermediate certification exam. 2. All clinical and field rotations for the Paramedic courses, along with all required skills testing and competency check off forms must be completed prior to taking the next course in the paramedic program. All rotations must be completed prior to being allowed to take the EMTParamedic certification exam. 3. Students should come to each clinical rotation ready to participate. This means they should have the appropriate equipment and relevant clinical documentation forms. They should also be rested and ready to learn. 4. Students must read and abide by the Temple College Substance Abuse Prevention Policy. This policy is published annually in the Temple College Student Handbook. 5. Students shall wear the appropriate uniform to each clinical rotation. The uniform must be clean and neat and meet the criteria expressed in the dress code. The clinical uniform will be worn to all rotations with the exception of OR where students will be issued scrubs from the department. 6. EMSP approved nametags must be worn to all clinical areas and while in a hospital rotation without exception. 7. Professional attire will be worn to and from the hospital. Jeans and T-shirts are NOT professional attire. If you are attending a rotation in which you are expected to wear scrubs, wear appropriate street attire to the rotation where you will change into your scrubs. You must change back into street attire prior to leaving. The scrubs you will be issued are property of Scott and White and must be returned. Failing to return scrubs will be considered theft and may be grounds for immediate dismissal from the program. 8. There is no smoking allowed on Scott and White Property. Students wishing to smoke must do so in their vehicle. 9. Parking during the day at Scott & White Hospital is strictly regulated. The Clinical Coordinator will provide information regarding student parking. Illegally parked cars are ticketed. 10. Tardiness to clinicals is NOT tolerated. The clinical sites work on a tight schedule and each department expects you to be in the right place at the right time. Tardiness is reported to the EMS Professions Clinical Coordinator. If you arrive late, you will be sent home. If you are sent home, you will need to reschedule the rotation. This will count as a clinical absence and will affect your grade. 11. If you are unable to attend a scheduled clinical rotation, you must notify the Clinical Coordinator not less than one hour before the time when you are required to report to the clinical site. You should notify the Clinical Coordinator as soon as possible. Do not wait till the last minute. You may leave a message on her office phone or email. If you are unable to contact the Clinical Coordinator, you must call the EMS Professions Department and leave a 2004-2010, Temple College Section B: Page 8 of 71 EMS Professions Student Handbook voice mail message. (These messages are automatically marked with a date and time by the system.) Failure to attend a scheduled clinical rotation without canceling (a “no show”) may result in dismissal from the program. 12. You will be allowed to work out lunch and/or dinner schedules for each day with the preceptor on duty or with the staff of the area in which you are working. Students must remain at the clinical rotation facility during meal breaks. During field rotations, students should plan on being away from the station during their entire shift. As, such you may not be able to return to the station to get your food. Please talk with your preceptor about the best location to store your food. Some crews may plan on purchasing food during the shift. Please discuss meal plans with your preceptor. 13. During every clinical experience, you must complete the necessary paperwork and have the preceptor sign it. Please make copies of all your clinical forms before turning them into the program. In addition, you are required to enter your clinical data into an online database. 14. If you experience any problems or conflicts at any clinical site, contact your preceptor immediately. You should also contact the EMS Professions Clinical Coordinator as soon as possible. If she is unavailable, you may contact your course instructor. 15. Please remember that what you see, hear and do during your clinical times is strictly confidential! Discussion of confidential information is grounds for immediate dismissal from the program. Federal law provides for substantial fines and the possibility of imprisonment in the federal penitentiary in cases where confidentiality of health care information is breached. 16. If a staff member is particularly helpful, please let them know personally that you appreciate his/her time and efforts. If you feel someone needs special recognition, please forward his/her name and the details of the incident to the Clinical Coordinator so a note of appreciation can be forwarded to them. 2004-2010, Temple College Section B: Page 9 of 71 EMS Professions Student Handbook Dress Code Policy Students should remember that they are representing not just themselves and the Temple College EMS Professions Department, but the entire EMS profession. An integral part of how others perceive us is through our appearance. As such, when you are representing Temple College, you should be dressed in a professional manner. Therefore, while at clinical or field rotations, students must adhere to the following dress code. 1. Students must clearly be identified as being a student with Temple College. Students are not permitted to wear clothing that represents a hospital, EMS service or fire department. Students are not permitted to wear the uniform while outside of an EMS Professions activity. 2. Pants will be EMS style uniform pants that have a side pocket on each side. The pant leg shall be hemmed and may not have drawstring style closures. The pants shall be kept neat and clean. 3. The uniform shirt shall be white and of a pleated uniform style (e.g. white with epaulettes, right and left vertical seams, and velcro pockets) and shall be kept clean, neat and ironed. A clean pure white undershirt will also be worn. 4. The uniform shirt shall have a Temple College EMS Professions Department patch affixed 1” down on the right sleeve. State certification patches should be worn 1” down on the left sleeve. 5. Shoes or boots must be low-heeled, closed toe, black and in a neat and clean condition. 6. While at an accident scene, students are expected to meet the safety standards set by ANSI 207-2006. This requires the student to bring and wear a safety vest or reflective clothing. Please ensure your vest/jacket meets the requirements set by ANSI 207-2006. 7. Students should wear a watch with a second hand (or digital), bring eye protection, N95 respirator, stethoscope, pen light, small note pad, pen and clinical documentation to all clinical rotations. The EMS Professions Department will only provide you with the N95 respirator. 8. Nametags shall be worn at all times. The nametag will be issued by the Temple College Admissions and Records Department. The nametag shall be worn in a manner that permits the student to be identified by full name, status, and affiliation. 9. Navy blue, black or high visibility, jackets, windbreakers, or coats may be worn in inclement weather, as long as they have been approved by EMS Professions Department Clinical Coordinator. Outerwear may not have any logos or lettering. 10. Hands, including fingernails, must be clean and neat. Garish nail polish is not acceptable. Men are allowed to wear clear nail polish only. Nails cannot extend more than ¼” beyond the fingertips. 11. Hair must be clean, neatly combed, and of a natural color. Long hair must be pulled back and, if necessary, tucked into the shirt. Long hair should not be an irritant or a potential safety hazard to the student, other health care personnel, or patients. Facial hair such as beards and sideburns must be neat, clean, well trimmed, and able to maintain a seal with an N95 respirator. 12. Excessive perfume that overwhelms patients or preceptors should not be worn. 2004-2010, Temple College Section B: Page 10 of 71 EMS Professions Student Handbook 13. No excessive jewelry should be worn. Facial jewelry may not be worn. While earrings are not considered facial jewelry, only one small stud may be worn on each ear lobe. Earrings that hang are not allowed. Students should understand that jewelry can be a significant safety and infection control hazard in the clinical setting and should plan accordingly. 14. All tattoos must be covered. Please note that any violations in the above dress code may result in the student being sent home. This would constitute a clinical absence that would need to be rescheduled according to the clinical absence policy. Violations of the Clinical Dress Code may result in disciplinary action up to and including dismissal from the program. Clinical Absence Policy Clinical attendance is critical to the success of the EMS student. Not only is this a tremendous opportunity for students to learn, it is also a direct reflection of the student’s professionalism and attitude. Absences and tardiness reflect poorly on the student as well as the EMS Professions Department and, most importantly, the EMS profession. Clinical absences will affect your clinical grade as described in the course syllabus. Additionally, it is important that you complete all of your clinical paperwork and enter the data in a timely manner. All data will be entered by the 3rd calendar day after the clinical is completed. All clinical paperwork will be due to the Clinical Coordinator by the end of the 7th calendar day after the clinical is completed. Specific clinical attendance policy information is provided to the student in the course syllabus at the beginning of each semester. Clinical Recordkeeping Policy Documentation and data entry is an integral and important part of patient care. It is also an important part of your clinical experience. As a student you are required to obtain a certain number of patient contacts and clinical experiences. The paper work and data entry allow you to see what you still need to accomplish. It is important that you complete all of your clinical paperwork and enter the data in a timely and complete manner. Clinical data must be entered in FISDAP within 3 calendar days of the rotation. Data entered after the deadline will NOT count towards meeting the required clinical contact and competencies and will need to be rescheduled. Failure to enter data on time constitutes a clinical absence. All original clinical documentation is due in the EMS Professions office within 7 calendar days of the rotation. Paperwork turned in after the deadline will NOT count towards meeting the required hours and will need to be rescheduled. Failure to turn paperwork in on time constitutes a clinical absence. Clinical paperwork and data entry will be reviewed and returned if it is incomplete or if corrections are needed. The EMSP Department office must receive all corrected paperwork within 7 days of its return. Failure to turn in corrected paperwork will also count as a clinical absence. Incomplete paperwork and/or data entry will be considered as a late submission and will constitute a clinical absence. 2004-2010, Temple College Section B: Page 11 of 71 EMS Professions Student Handbook Documentation Summary The following is a summary of the documentation requirements for each rotation. The documents in this handbook are for reference only. You will be given separate copies of each of these documents for your use. Should you need additional copies of any of these documents, you may make them yourself or contact our office. You may also download them from our web site. Document Course Requirement Summary Rotation Summary Form Student Evaluation Global Clinical Documentation Preceptor Evaluation Airway Management Documentation Toxicology Documentation EP/Coronary Cath Lab Documentation Immunization Clinic Documentation Patient Care Report (PCR) PCR Call Critique 2004-2010, Temple College Purpose Quick overview of what is needed to graduate. A ‘binder’ for your clinical paperwork. This summarizes your activities for the rotation and includes the Student Evaluation, Preceptor Evaluation and a Statement of Learning Objectives. Part of the Rotation Summary Form. Evaluates your attitude and performance during the clinical rotation. COMPLETED AND SIGNED BY THE PRECEPTOR Documentation of individual patient contacts. Used in most clinical rotations. Completed by student. NEEDS PRECEPTOR SIGNATURE. Part of the Rotation Summary form. Evaluates your preceptor. Completed by student. Documentation of procedures performed in Operating Room and Laboratory. Completed by student. NEEDS PRECEPTOR SIGNATURE. Documentation of substances discussed at Poison Control. Completed by student. NEEDS PRECEPTOR SIGNATURE. Documentation of procedures observed in electrophysiology/coronary cath lab. Completed by student. NEEDS PRECEPTOR SIGNATURE. Documentation of immunizations performed during rotation. Completed by student. NEEDS PRECEPTOR SIGNATURE. Documentation of each patient contact during field rotation, including patient refusals and no transports. Completed by student. NEEDS PRECEPTOR SIGNATURE. Evaluations of student performance on each EMS call. Completed by preceptor and student. NEEDS PRECEPTOR SIGNATURE. Section B: Page 12 of 71 EMS Professions Student Handbook Documents by Rotation This section of the handbook outlines which documents must be completed for each rotation. Emergency Department Rotation Summary Form Global Clinical Documentation (at least 3 per rotation) Operating Room Rotation Summary Form Airway Management Documentation Respiratory Therapy Rotation Summary Form Global Clinical Documentation (at least 3 per rotation) Coronary Care Unit Rotation Summary Form Global Clinical Documentation (at least 3 per rotation) Intensive Care Unit Rotation Summary Form Global Clinical Documentation (at least 3 per rotation) Labor & Delivery Rotation Summary Form Global Clinical Documentation (one for each delivery observed) Electrophysiology/Coronary Catheterization Lab Rotation Summary Form EP Lab Documentation Dialysis Unit Rotation Summary Form Global Clinical Documentation (at least 3 per rotation) Immunization Clinic Rotation Summary Form Immunization Clinic Documentation Toxicology (Poison Center) Rotation Summary Form Toxicology Documentation Pediatric ICU Rotation Summary Form Global Clinical Documentation (at least 3 per rotation) 2004-2010, Temple College Section B: Page 13 of 71 EMS Professions Student Handbook Pediatric Clinic Rotation Summary Form Global Clinical Documentation (at least 3 per rotation) Medical Director ED Rotation Rotation Summary Form Medical Director ED Competency Check Global Clinical Documentation (at least 5) Field Internship Rotation Summary Form At least one Patient Care Report per call One Patient Care Report per patient contact One Call Critique per patient contact 2004-2010, Temple College Section B: Page 14 of 71 EMS Professions Student Handbook Course Requirements These hours and requirements are subject to change. Students will be notified at the beginning of the semester if any changes occur. These hours are minimums only. Students who have not yet met the objectives may be required to complete additional rotations in order to do so. EMSP 1162 Paramedic First Semester Clinical Rotations 50 hours minimum 6 hours 2 shifts minimum (~8 hours) Hospital Competency Check Off Intubation 3 successes before check off BVM 3 successes before check off Nebulized Drug Administration 4 successes before check off Emergency Department Respiratory Care Operating Room EMSP 1263 Paramedic Second Semester Clinical Rotations 30 hours minimum 2 shifts minimum (~8 hours) 58 hours minimum (Minimum 5 ALS calls) Only required if testing for EMT-I Hospital Competency Check Off IV Therapy 4 successes before check off Patient Assessment 4 successes before check off Intubation 3 successes before check off IV Drug Administration 4 successes before check off IV Continuous Drug Administration 4 successes before check off Field Competency Check Off Patient Assessment 4 successes before check off BLS Call Management 4 successes before check off Emergency Department Operating Room Field Medical Director Patient Contacts--Complaints* Chest Pain 5 Breathing Difficulty (Adult) 4 Breathing Difficulty (Pediatric) 4 Acute Abdomen/GI Bleed 2 Vehicular Trauma 4 Non-Vehicular Trauma 4 Non-Traumatic Altered LOC/Neurologic Deficit 2 Patient Contacts--Age Groups* Children (0-12 years) 4 Adolescents (13-17 years) 4 Adults (18-60 years) 4 Older Adults (>60 years) 4 *Patient contacts by complaint and age group may be completed during either first or second semester rotations. All required contacts must be completed before the student is eligible to test for EMTIntermediate certification. 2004-2010, Temple College Section B: Page 15 of 71 EMS Professions Student Handbook EMSP 2260 Paramedic Third Semester Clinical Rotations 8 hours minimum 8 hours minimum 10 hours minimum 4 hours minimum 8 hours minimum 4 hours minimum 6 hours minimum 8 hours minimum 56 hours minimum (minimum 3 ALS calls) 16 hours minimum Hospital Competency Check Off Monitoring Lead Acquisition/Interpretation 4 successes before check off 12-Lead ECG Acquisition/Interpretation 4 successes before check off IM Drug Administration 4 successes before check off SC Drug Administration 4 successes before check off Field Competency Check Off * IV Therapy 4 successes before check off IV Drug Administration 4 successes before check off Documentation 4 successes before check off Monitoring Lead Acquisition/Interpretation 4 successes before check off 12-Lead ECG Acquisition & Interpretation 4 successes before check off Radio Reporting 4 successes before check off *May be completed during third semester if opportunities arise. MUST be completed before end of fourth semester field rotations. CCU ICU Emergency Department EP /Coronary Cath Lab Labor & Delivery Poison Center Dialysis Medical Director Field Internship Immunization Clinic EMSP 2460 Paramedic Fourth Semester Clinical Rotations 8 hours minimum 8 hours minimum 8 hours minimum 8 hours minimum 192 hours minimum (Minimum 12 ALS Runs) Hospital Competency Check Off Medical Director Evaluation/Competency Check Field Competency Check Off IV Therapy 4 successes before check off IV Drug Administration 4 successes before check off Radio Reporting 4 successes before check off Monitoring Lead Acquisition/Interpretation 4 successes before check off 12-Lead ECG Acquisition & Interpretation 4 successes before check off Documentation 4 successes before check off Patient Assessment 4 successes before check off Call Management/Field Preceptor Check Off 4 successes before check off Emergency Department Pediatric ICU Pediatric Clinic Medical Director Field Chest Pain Breathing Difficulty (Adult) Breathing Difficulty (Pediatric) Acute Abdomen Cardiac Arrest Hypoglycemia Hyperglycemia 2004-2010, Temple College Patient Contacts--Complaints 10 8 4 2 1 1 1 Section B: Page 16 of 71 EMS Professions Student Handbook Vaginal Delivery 1 Toxicologic/Poisoning 4 Acute Abdomen/GI/GU 2 Behavioral 2 Non-traumatic altered mental status/neurologic 5 deficit Vehicular Trauma 6 Non-Vehicular Trauma 6 Patient Contacts--Age Groups Newborns 3 Infants (0 to 1 years) 3 Toddlers (1 to 3 years) 3 Preschoolers (4 to 5 years) 3 School Age (6 to 12 years) 3 Adolescents (13 to 17 years) 3 Adults (18 to 60 years) 10 Older Adults (>60 years) 8 Patient contacts by complaint and age group may be completed during either third or fourth semester rotations. All required contacts must be completed before the student is eligible to test for Paramedic certification. Competency Check Off Forms This section contains copies of the forms used for competency check-offs that must be completed during clinical rotations and field internship. 2004-2010, Temple College Section B: Page 17 of 71 EMS Professions Student Handbook Competency Check Off Patient Assessment Student Name: _________________________________ Semester: ________________________ This form is provided to help assure that students have achieved competency in essential skills. Students must first demonstrate they are capable of performing the skill under the supervision of an instructor in the laboratory. They must then perform the skill, under supervision, a certain number of times on live patients in the clinical setting. They may then request that a preceptor evaluate them for competency using this form. Competency is the ability to perform this skill, in its entirety and in a clinically appropriate environment, unsupervised. The preceptor must feel comfortable with the student performing this skill alone in a clinical environment. Preparation Students must demonstrate the ability to successfully perform a patient assessment in the laboratory setting. They must then accurately assess 4 patients in the clinical setting before requesting a competency check off. Laboratory Demonstration Instructor Signature/Date This student is authorized to perform patient assessment in the clinical setting. Date Location Pt Age/Gender Chief Complaint Preceptor Signature Check Off Procedure As the preceptor, you should silently observe the student interact with the patient and perform a patient assessment. You should repeat any procedures necessary to confirm the student’s findings (e.g., breath sounds). Competence Standard The student should approach the patient, introduce him/herself, elicit a chief complaint, acquire a history of the present illness (OPQRST), a complete history (SAMPLE) and perform a physical exam as appropriate for that patient. This exam should include assessment of breath sounds. Statement of Competency I have observed this student perform this skill to the standard described above. I feel that he/she has demonstrated that he/she is competent to perform this skill unassisted in the clinical environment on live patients. Date Location Preceptor Signature 2004-2010, Temple College Pt Age/Gender Date Chief Complaint Preceptor’s Printed Name Section B: Page 18 of 71 EMS Professions Student Handbook Competency Check Off IV Therapy Student Name: _________________________________ Semester: ________________________ This form is provided to help assure that students have achieved competency in essential skills. Students must first demonstrate they are capable of performing the skill under the supervision of an instructor in the laboratory. They must then perform the skill, under supervision, a certain number of times on live patients in the clinical setting. They may then request that a preceptor evaluate them for competency using this form. Competency is the ability to perform this skill, in its entirety and in a clinically appropriate environment, unsupervised. The preceptor must feel comfortable with the student performing this skill alone in a clinical environment. Preparation Students must demonstrate the ability to obtain vascular access on a manikin once and on a live human subject 2 times in the laboratory setting. They must then successfully establish venous access 4 times in a clinical setting before requesting a competency check off. This does not include simple venipuncture. Venous access must be established with either an IV or a saline (or heparin) lock. Laboratory Demonstration Date Manikin or Human Start Instructor Signature This student is authorized to perform IV Therapy in the clinical setting. Date Clinical Location Gauge Site Fluid Pt Age/Gender Preceptor Signature Check Off Procedure As a preceptor, you should allow the student to approach the patient, communicate his/her intentions and perform the procedure without assistance or intervention of any kind. Competence Standard The student should communicate effectively and therapeutically with the patient, prepare his/her equipment, apply a constricting band, select and prepare a site, perform the venipuncture and establish either the IV fluid or the lock. They must utilize an aseptic technique throughout. Statement of Competency I have observed this student perform this skill to the standard expressed above. I feel that he/she has demonstrated that he/she is competent to perform this skill unassisted in the clinical environment on live patients. Date Clinical Location Preceptor Signature 2004-2010, Temple College Gauge Site Date Fluid Pt Age/Gender Preceptor’s Printed Name Section B: Page 19 of 71 EMS Professions Student Handbook Competency Check Off Bag Valve Mask Ventilation Student Name: _________________________________ Semester: ________________________ This form is provided to help assure that students have achieved competency in essential skills. Students must first demonstrate they are capable of performing the skill under the supervision of an instructor in the laboratory. They must then perform the skill, under supervision, a certain number of times on live patients in the clinical setting. They may then request that a preceptor evaluate them for competency using this form. Competency is the ability to perform this skill, in its entirety and in a clinically appropriate environment, unsupervised. The preceptor must feel comfortable with the student performing this skill alone in a clinical environment. Preparation Students must demonstrate the ability to successfully establish a seal and effectively and appropriately ventilate a patient manually using a bag valve mask on a manikin in the laboratory setting. They must then successfully establish a seal and effectively and appropriately ventilate a patient manually using a bag valve mask 3 times in the clinical setting before requesting a competency check off. Laboratory Demonstration Instructor Signature/Date This student is authorized to perform BVM ventilation in the clinical setting. Date Clinical Location Pt Age/Gender Preceptor Signature Check Off Procedure As a preceptor, you should allow the student to position the patient and perform the procedure without assistance or intervention of any kind. Competence Standard The student should prepare his/her equipment, position the patient’s head in a situation-appropriate manner, form a tight seal with the device, ventilate the patient and assess the effectiveness of ventilations without assistance or prompting. Statement of Competency I have observed this student perform this skill to the standard expressed above. I feel that he/she has demonstrated that he/she is competent to perform this skill unassisted in the clinical environment on live patients. Date Clinical Location Preceptor Signature 2004-2010, Temple College Pt Age/Gender Date Preceptor’s Printed Name Section B: Page 20 of 71 EMS Professions Student Handbook Competency Check Off Oral Intubation Student Name: _________________________________ Semester: ________________________ This form is provided to help assure that students have achieved competency in essential skills. Students must first demonstrate they are capable of performing the skill under the supervision of an instructor in the laboratory. They must then perform the skill, under supervision, a certain number of times on live patients in the clinical setting. They may then request that a preceptor evaluate them for competency using this form. Competency is the ability to perform this skill, in its entirety and in a clinically appropriate environment, unsupervised. The preceptor must feel comfortable with the student performing this skill alone in a clinical environment. Preparation Students must demonstrate the ability to successfully orally intubate a manikin in the laboratory setting and successfully intubate 3 live patients before requesting a competency check off. The laboratory demonstration must be unassisted. The student may receive assistance during the preparatory intubations in the clinical setting. Laboratory Demonstration Instructor Signature/Date This student is authorized to perform intubation in the clinical setting. Date Clinical Location Blade Tube Size Pt Age/Gender Preceptor Signature Check Off Procedure As a preceptor, you should allow the student to position the patient, hyper-oxygenate as appropriate, visualize the vocal cords, insert the tube and assess tube placement without assistance or intervention of any kind. Competence Standard The student should prepare all necessary equipment, position the patient’s head in a situation-appropriate manner, hyper-oxygenate as appropriate, utilize a laryngoscope appropriately without using the teeth as a fulcrum, insert the tube in the trachea to the appropriate depth, ventilate and assess tube placement without assistance or prompting. Statement of Competency I have observed this student perform this skill to the standard expressed above. I feel that he/she has demonstrated that he/she is competent to perform this skill unassisted in the clinical environment on live patients. Date Clinical Location Preceptor Signature 2004-2010, Temple College Blade Date Tube Size Pt Age/Gender Preceptor’s Printed Name Section B: Page 21 of 71 EMS Professions Student Handbook Competency Check Off IV Drug Administration Student Name: _________________________________ Semester: ________________________ This form is provided to help assure that students have achieved competency in essential skills. Students must first demonstrate they are capable of performing the skill under the supervision of an instructor in the laboratory. They must then perform the skill, under supervision, a certain number of times on live patients in the clinical setting. They may then request that a preceptor evaluate them for competency using this form. Competency is the ability to perform this skill, in its entirety and in a clinically appropriate environment, unsupervised. The preceptor must feel comfortable with the student performing this skill alone in a clinical environment. Preparation Students must demonstrate the ability to successfully administer IV push medications to a manikin in the laboratory setting and successfully administer IV push medications 4 times in the clinical setting before requesting a competency check off. Laboratory Demonstration Instructor Signature/Date This student is authorized to give IV push medications in the clinical setting. Date Clinical Location Drug Dose Pt. Age/Gender Preceptor Signature Check Off Procedure As a preceptor, you should allow the student to approach the patient, communicate his/her intentions, and perform the procedure appropriately without assistance or intervention of any kind. Competence Standard The student should select the appropriate medication, confirm the order, dose, route, and patient, prepare the injection site and administer the appropriate amount of medication in an appropriate fashion while using aseptic technique without assistance or prompting. Statement of Competency I have observed this student perform this skill to the standard expressed above. I feel that he/she has demonstrated that he/she is competent to perform this skill unassisted in the clinical environment on live patients. Date Clinical Location Preceptor Signature 2004-2010, Temple College Drug Date Dose Pt. Age/Gender Preceptor’s Printed Name Section B: Page 22 of 71 EMS Professions Student Handbook Competency Check Off IM Drug Administration Student Name: _________________________________ Semester: ________________________ This form is provided to help assure that students have achieved competency in essential skills. Students must first demonstrate they are capable of performing the skill under the supervision of an instructor in the laboratory. They must then perform the skill, under supervision, a certain number of times on live patients in the clinical setting. They may then request that a preceptor evaluate them for competency using this form. Competency is the ability to perform this skill, in its entirety and in a clinically appropriate environment, unsupervised. The preceptor must feel comfortable with the student performing this skill alone in a clinical environment. Preparation Students must demonstrate the ability to successfully administer IM medications to a manikin and to a human subject in the laboratory setting and successfully administer IM medications 4 times in the clinical setting before requesting a competency check off. Laboratory Demonstration Date Human or Manikin Instructor Signature This student is authorized to give IM medications in the clinical setting. Date Clinical Location Drug Dose Pt. Age/Gender Preceptor Signature Check Off Procedure As a preceptor, you should allow the student to approach the patient, communicate his/her intentions, and perform the procedure appropriately without assistance or intervention of any kind. Competence Standard The student should select the appropriate medication, confirm the order, dose, route, and patient, prepare the injection site and administer the appropriate amount of medication in an appropriate fashion while using aseptic technique without assistance or prompting. Statement of Competency I have observed this student perform this skill to the standard expressed above. I feel that he/she has demonstrated that he/she is competent to perform this skill unassisted in the clinical environment on live patients. Date Clinical Location Preceptor Signature 2004-2010, Temple College Drug Date Dose Pt. Age/Gender Preceptor’s Printed Name Section B: Page 23 of 71 EMS Professions Student Handbook Competency Check Off SC Drug Administration Student Name: _________________________________ Semester: ________________________ This form is provided to help assure that students have achieved competency in essential skills. Students must first demonstrate they are capable of performing the skill under the supervision of an instructor in the laboratory. They must then perform the skill, under supervision, a certain number of times on live patients in the clinical setting. They may then request that a preceptor evaluate them for competency using this form. Competency is the ability to perform this skill, in its entirety and in a clinically appropriate environment, unsupervised. The preceptor must feel comfortable with the student performing this skill alone in a clinical environment. Preparation Students must demonstrate the ability to successfully administer SC medications to a manikin and to a human subject in the laboratory setting and successfully administer SC medications 4 times in the clinical setting before requesting a competency check off. Laboratory Demonstration Date Human or Manikin Instructor Signature This student is authorized to give SC medications in the clinical setting. Date Clinical Location Drug Dose Pt. Age/Gender Preceptor Signature Check Off Procedure As a preceptor, you should allow the student to approach the patient, communicate his/her intentions, and perform the procedure appropriately without assistance or intervention of any kind. Competence Standard The student should select the appropriate medication, confirm the order, dose, route, and patient, prepare the injection site and administer the appropriate amount of medication in an appropriate fashion while using aseptic technique without assistance or prompting. Statement of Competency I have observed this student perform this skill to the standard expressed above. I feel that he/she has demonstrated that he/she is competent to perform this skill unassisted in the clinical environment on live patients. Date Clinical Location Preceptor Signature 2004-2010, Temple College Drug Date Dose Pt. Age/Gender Preceptor’s Printed Name Section B: Page 24 of 71 EMS Professions Student Handbook Competency Check Off IV Continuous Infusion Drug Administration Student Name: _________________________________ Semester: ________________________ This form is provided to help assure that students have achieved competency in essential skills. Students must first demonstrate they are capable of performing the skill under the supervision of an instructor in the laboratory. They must then perform the skill, under supervision, a certain number of times on live patients in the clinical setting. They may then request that a preceptor evaluate them for competency using this form. Competency is the ability to perform this skill, in its entirety and in a clinically appropriate environment, unsupervised. The preceptor must feel comfortable with the student performing this skill alone in a clinical environment. Preparation Students must demonstrate the ability to successfully administer IV continuous infusion medications to a manikin in the laboratory setting and successfully administer IV push medications 4 times in the clinical setting before requesting a competency check off. Laboratory Demonstration Instructor Signature/Date This student is authorized to give IV continuous infusion medications in the clinical setting. Date Clinical Location Drug Dose Pt. Age/Gender Preceptor Signature Check Off Procedure As a preceptor, you should allow the student to approach the patient, communicate his/her intentions, and perform the procedure appropriately without assistance or intervention of any kind. Competence Standard The student should select the appropriate medication, confirm the order, dose, route, and patient, prepare the drug for administration, prepare the site and administer the appropriate amount of medication in an appropriate fashion while using aseptic technique without assistance or prompting. Statement of Competency I have observed this student perform this skill to the standard expressed above. I feel that he/she has demonstrated that he/she is competent to perform this skill unassisted in the clinical environment on live patients. Date Clinical Location Preceptor Signature 2004-2010, Temple College Drug Date Dose Pt. Age/Gender Preceptor’s Printed Name Section B: Page 25 of 71 EMS Professions Student Handbook Competency Check Off Nebulized Drug Administration Student Name: _________________________________ Semester: ________________________ This form is provided to help assure that students have achieved competency in essential skills. Students must first demonstrate they are capable of performing the skill under the supervision of an instructor in the laboratory. They must then perform the skill, under supervision, a certain number of times on live patients in the clinical setting. They may then request that a preceptor evaluate them for competency using this form. Competency is the ability to perform this skill, in its entirety and in a clinically appropriate environment, unsupervised. The preceptor must feel comfortable with the student performing this skill alone in a clinical environment. Preparation Students must demonstrate the ability to successfully administer nebulized medications in the laboratory setting and successfully administer nebulized medications 4 times in the clinical setting before requesting a competency check off. Laboratory Demonstration Instructor Signature/Date This student is authorized to give nebulized medications in the clinical setting. Date Clinical Location Drug Dose Pt. Age/Gender Preceptor Signature Check Off Procedure As a preceptor, you should allow the student to approach the patient, communicate his/her intentions, and perform the procedure appropriately without assistance or intervention of any kind. Competence Standard The student should select the appropriate medication, confirm the order, properly assemble the components of the nebulizer, prepare the medication for administration, explain the procedure to the patient, and administer the appropriate dose of medication without assistance or prompting. Statement of Competency I have observed this student perform this skill to the standard expressed above. I feel that he/she has demonstrated that he/she is competent to perform this skill unassisted in the clinical environment on live patients. Date Clinical Location Preceptor Signature 2004-2010, Temple College Drug Date Dose Pt. Age/Gender Preceptor’s Printed Name Section B: Page 26 of 71 EMS Professions Student Handbook Competency Check Off 12 Lead ECG Acquisition and Interpretation Student Name: _________________________________ Semester: ________________________ This form is provided to help assure that students have achieved competency in essential skills. Students must first demonstrate they are capable of performing the skill under the supervision of an instructor in the laboratory. They must then perform the skill, under supervision, a certain number of times on live patients in the clinical setting. They may then request that a preceptor evaluate them for competency using this form. Competency is the ability to perform this skill, in its entirety and in a clinically appropriate environment, unsupervised. The preceptor must feel comfortable with the student performing this skill alone in a clinical environment. Preparation Students must successfully place leads, acquire and interpret a 12 lead ECG in the laboratory setting and on 4 patients in the clinical setting before requesting a competency check off. Laboratory Demonstration Instructor Signature/Date This student is authorized to acquire and interpret 12lead ECGs in the clinical setting. Date Clinical Location Pt Age/Gender Interpretation Preceptor Signature Check Off Procedure As a preceptor, you should allow the student to perform the procedure without assistance or intervention of any kind. Competence Standard The student should approach the patient, communicate his/her intentions in a therapeutic manner, appropriately place all leads, acquire the ECG and correctly interpret it without assistance or prompting. Statement of Competency I have observed this student perform this skill to the standard expressed above. I feel that he/she has demonstrated that he/she is competent to perform this skill unassisted in the clinical environment on live patients. Date Clinical Location Preceptor Signature 2004-2010, Temple College Pt Age/Gender Date Interpretation Preceptor’s Printed Name Section B: Page 27 of 71 EMS Professions Student Handbook Competency Check Off Monitoring Lead Acquisition and Interpretation Student Name: _________________________________ Semester: ________________________ This form is provided to help assure that students have achieved competency in essential skills. Students must first demonstrate they are capable of performing the skill under the supervision of an instructor in the laboratory. They must then perform the skill, under supervision, a certain number of times on live patients in the clinical setting. They may then request that a preceptor evaluate them for competency using this form. Competency is the ability to perform this skill, in its entirety and in a clinically appropriate environment, unsupervised. The preceptor must feel comfortable with the student performing this skill alone in a clinical environment. Preparation Students must successfully place leads, acquire and interpret a rhythm strip in a laboratory setting and on 4 patients in the clinical setting before requesting a competency check off. Laboratory Demonstration Instructor Signature/Date This student is authorized to acquire and interpret monitoring lead ECGs in the clinical setting. Date Location Pt Age/Gender Interpretation Preceptor Signature Check Off Procedure As a preceptor, you should allow the student to perform the procedure without assistance or intervention of any kind. Competence Standard The student should approach the patient, communicate his/her intentions in a therapeutic manner, appropriately place all leads, acquire the ECG and correctly interpret it without assistance or prompting. Statement of Competency I have observed this student perform this skill to the standard expressed above. I feel that he/she has demonstrated that he/she is competent to perform this skill unassisted in the clinical environment on live patients. Date Location Preceptor Signature 2004-2010, Temple College Pt Age/Gender Date Interpretation Preceptor’s Printed Name Section B: Page 28 of 71 EMS Professions Student Handbook Competency Check Off Medical Director Student Name: __________________________ Semester: ______________________________ This form is provided to help assure that our students have achieved competency in essential skills. Students must first demonstrate that they are capable of performing the skill under the supervision of an instructor in the classroom. They must then perform the skill, under supervision, a certain number of times on live patients in the clinical setting. They may then request that a preceptor evaluate them for competency using this form. Competency is the ability to perform this skill, in its entirety and in a clinically appropriate environment, unsupervised. The Medical Director must feel comfortable with them performing this skill alone in a clinical environment. Competence Standard The student should approach the patient, introduce him/herself, elicit the chief complaint, perform an appropriate assessment (history and physical exam), formulate a differential diagnosis, develop a treatment plan, appropriately perform any patient care interventions as requested by the Medical Director, document the assessment and management, and interact with patients, their families, and other health care personnel in a professional, effective fashion. Chief Complaint Differential Diagnosis Treatments Statement of Competency I have observed this student perform to the standard expressed above. Based on my observations, he/she has demonstrated to my satisfaction that he/she: 1. Possesses the ability to comprehend, apply, analyze, and evaluate information relevant to his/her role as an entry level paramedic. 2. Possess technical proficiency in the skills necessary to fulfill his/her role as an entry-level paramedic. 3. Displays the personal behaviors and attitudes consistent with professional and employer expectations for an entry-level paramedic. 4. Possesses the ability to integrate the knowledge, technical skills, and personal behaviors and attitudes required of an entry-level paramedic as needed to deliver effective prehospital and interfacility care. Medical Director’s Signature Date Medical Director’s Printed Name 2004-2010, Temple College Section B: Page 29 of 71 EMS Professions Student Handbook Competency Check Off Radio Reporting Student Name: _________________________________ Semester: ________________________ This form is provided to help assure that students have achieved competency in essential skills. Students must perform the skill, under supervision, a certain number of times in the clinical setting. They may then request that a preceptor evaluate them for competency using this form. Competency is the ability to perform this skill, in its entirety and in a clinically appropriate environment, unsupervised. The preceptor must feel comfortable with the student performing this skill alone in a clinical environment. Preparation Students must successfully perform a radio report of patient information 2 times in the laboratory setting and 4 times in the clinical setting before requesting a competency check off. Laboratory Demonstration Date Instructor Signature This student is authorized to make radio reports of patient information in the clinical setting. Date Service/Unit Pt Age/Gender Complaint Preceptor Signature Check Off Procedure As a preceptor, you should allow the student to perform a radio report of patient information to the hospital with assistance and prompting. You should monitor the report to ensure that it meets the competency standard. Competence Standard The student should give a radio report that is accurate, complete, concise, and understandable without assistance or prompting. Statement of Competency I have observed this student perform this skill to the standard expressed above. I feel that he/she has demonstrated that he/she is competent to perform this skill unassisted in the clinical environment on live patients. Date Service/Unit Preceptor Signature Pt Age/Gender Date 2004-2010, Temple College Complaint Preceptor’s Printed Name Section B: Page 30 of 71 EMS Professions Student Handbook Competency Check Off Written Documentation Student Name: _________________________________ Semester: ________________________ This form is provided to help assure that students have achieved competency in essential skills. Students must first demonstrate they are capable of performing the skill under the supervision of an instructor in the laboratory. They must then perform the skill, under supervision, a certain number of times on live patients in the clinical setting. They may then request that a preceptor evaluate them for competency using this form. Competency is the ability to perform this skill, in its entirety and in a clinically appropriate environment, unsupervised. The preceptor must feel comfortable with the student performing this skill alone in a clinical environment. Preparation Students must successfully prepare a written report documenting patient care 4 times in the clinical setting before requesting a competency check off. Date Service/Unit Pt Age/Gender Complaint Preceptor Signature Check Off Procedure As a preceptor, you should allow the student to prepare a written report documenting patient care without assistance or intervention of any kind. You should then review the report to determine whether it meets the competence standard. Competence Standard The student should prepare a written patient care record that is accurate, complete, legible, and free of extraneous information with assistance or prompting. Statement of Competency I have observed this student perform this skill to the standard expressed above. I feel that he/she has demonstrated that he/she is competent to perform this skill unassisted in the clinical environment on live patients. Date Service/Unit Preceptor Signature Pt Age/Gender Date 2004-2010, Temple College Complaint Preceptor’s Printed Name Section B: Page 31 of 71 EMS Professions Student Handbook Competency Check Off Call Management (Final) Student Name: _________________________________ Semester: ________________________ This form is provided to help assure that students have achieved competency in essential skills. Students must first demonstrate they are capable of performing the skill under the supervision of an instructor in the laboratory. They must then perform the skill, under supervision, a certain number of times on live patients in the clinical setting. They may then request that a preceptor evaluate them for competency using this form. Competency is the ability to perform this skill, in its entirety and in a clinically appropriate environment, unsupervised. The preceptor must feel comfortable with the student performing this skill alone in a clinical environment. Preparation Students must successfully run all aspects of the EMS call 5 times before requesting a competency check off. Date Service/Unit Pt Age/Gender Differential Diagnosis Preceptor Signature Check Off Procedure As a preceptor, you should allow the student to run all aspects of this call as the ‘in charge’ medic without prompting. You may assist them as you would your regular partner. Competence Standard The student should give you an appropriate scene size-up, form a correct initial impression, initiate immediate interventions, perform a situation-appropriate history and physical exam (to include breath sounds and ECG), successfully initiate any necessary interventions, correctly interpret any necessary diagnostics, appropriately manage the flow of information, effectively utilize all resources on scene, appropriately interact with all on scene providers and give appropriate radio and personal patient reports as though they were the ‘in charge’ medic. The student should be able to function at the level of a beginning paramedic in your system. Statement of Competency I have observed this student perform this skill to the standard expressed above. Based on my observations, he/she has demonstrated to my satisfaction that he/she: 1. Possesses the ability to comprehend, apply, analyze, and evaluate information relevant to his/her role as an entrylevel paramedic. 2. Possesses technical proficiency in the skills necessary to fulfill his/her role as an entry-level paramedic. 3. Displays the personal behaviors and attitudes consistent with professional and employer expectations for an entrylevel paramedic. 4. Possesses the ability to integrate the knowledge, technical skills, and personal behaviors and attitudes required of an entry-level paramedic as needed to deliver effective prehospital and interfacility care. Date Service/Unit Pt Age/Gender Preceptor Signature 2004-2010, Temple College Date Differential Diagnosis Preceptor’s Printed Name Section B: Page 32 of 71 EMS Professions Student Handbook Clinical Documentation This section contains copies of documentation forms required for each rotation. 2004-2010, Temple College Section B: Page 33 of 71 EMS Professions Student Handbook Global Clinical Documentation Form Diagnosis: _________________________________ Sex: _________ Age: _________ Pathophysiology ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ________________________________________________ Vital Signs Time B/P HR RR ECG Medication Class Dose/Route Action SOAP ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ (use back of page for additional space ) 2004-2010, Temple College Section B: Page 34 of 71 EMS Professions Student Handbook Temple College EMS Professions Date: _________________________________ Student Name: _________________________ Airway Management Documentation Age/Gender Procedure Blade/Size Tube Size Attempts/Successes Student Signature: 2004-2010, Temple College Section B: Page 35 of 71 Other Procedures Preceptor Signature EMS Professions Student Handbook Temple College Date: EMS Professions Student Name: Cardiac Catheterization/Electrophysiology Lab Documentation Age/Gender Diagnosis Student Signature: Preceptor Signature: 2004-2010, Temple College Procedure Observed _______ Section B: Page 37 of 71 EMS Professions Student Handbook Temple College Date: EMS Professions Student Name: Immunization Clinic Documentation Age/Gender Route(s) Site(s) Preceptor Signature Student Signature: 2004-2010, Temple College Section B: Page 38 of 71 EMS Professions Student Handbook Temple College Date: EMS Professions Student Name: Toxicology (Poison Center) Documentation Substance Name Route of Exposure Student Signature: Sources Mechanism Toxic Level S/S Preceptor Signature: Preceptor Name: 2004-2010, Temple College Section B: Page 39 of 71 Treatment EMS Professions Student Handbook Field Internship Documentation Students will complete the attached Patient Care Report and Call Critique for each call during their field rotations. This includes patient refusals or no transports. 2004-2010, Temple College Section B: Page 40 of 71 EMS Professions Student Handbook Summary of Clinical Objectives & Goals The following pages describe the objectives and goals for each semester in the paramedic program. Not all semesters will have objectives for each rotation. There is a core set of knowledge and skills common to all semesters. These are described in the Global Clinical Objectives. Additionally, students in each semester are responsible for demonstrating competence in the Global Affective Objectives. 2004-2010, Temple College Section B: Page 41 of 71 EMS Professions Student Handbook Global Cognitive and Psychomotor Clinical Objectives The faculty and medical director of the EMS Professions Department believe that to practice safely and effectively as an entry-level paramedic, students must demonstrate competence in the following areas: OCCUPATIONAL HEALTH AND SAFETY--Displaying safety consciousness with patients, self, other personnel, equipment; compliance with infection control principles, including appropriate use of standard precautions and aseptic technique; using proper body mechanics when handling patients and equipment; Demonstrating understanding of psychological hazards of emergency/critical care environments and of techniques for stress recognition and management. PSYCHOMOTOR SKILLS Vascular access--Demonstrating ability to safely and effectively access the venous circulation of patients from all age groups. Medication administration--Demonstrating ability to safely and effectively give medications by the intravenous push, intravenous continuous infusion, intramuscular, subcutaneous, and nebulized routes. Bag-mask ventilation--Demonstrating ability to safely and effectively ventilate unintubated patients from all age groups. Endotracheal intubation--Demonstrating ability to safely and effectively perform endotracheal intubation. ECG acquisition and interpretation--Demonstrating ability to safely and effectively acquire and interpret both a monitoring lead and 12-lead ECG. PATIENT ASSESSMENT AND MANAGEMENT--Demonstrating ability to perform a comprehensive assessment (including initial assessment, history, and physical exam), develop a differential diagnosis, formulate, and implement a treatment plan demonstrating a knowledge base and professional judgment required to care for patients from the following categories: Ages--Pediatric patients (newborns, infants, toddlers, school age); adults; geriatric patients. Pathologies--Obstetric patients; trauma patients; psychiatric patients Complaints--Chest pain; dyspnea/respiratory distress; syncope; altered mental status; abdominal complaints (abdominal pain, GI bleeding, nausea/vomiting) RECORD KEEPING/COMMUNICATIONS Written--Documenting patient information, observations, and occurrences accurately, completely, concisely, and legibly. Verbal--Communicating pertinent patient information understandably, completely, concisely, and accurately. CALL MANAGEMENT--Demonstrating ability to serve as team leader and safely and effectively direct the prehospital response to a variety of calls. 2004-2010, Temple College Section B: Page 42 of 71 EMS Professions Student Handbook Global Affective Objectives The faculty and medical director of the EMS Professions Department feel strongly that a student’s attitude and appearance reflect upon not just that student, but the faculty, medical director, other students and the entire EMS profession. We also feel that these attributes can be defined and evaluated. Therefore, students will be evaluated on the following objectives for affective competence at each of their clinical rotations. Objectives Students will demonstrate competence in each of the following categories of professional behavior: 1. INTEGRITY--Examples of professional behavior include, but are not limited to: Consistent honesty; being able to be trusted with the property of others; being able to be trusted with confidential information; complete and accurate documentation of patient care and learning activities. 2. EMPATHY--Examples of professional behavior include, but are not limited to: Showing compassion for others; responding appropriately to the emotional response of patients and family members; demonstrating respect for others; demonstrating a calm, compassionate, and helpful demeanor toward those in need; being supportive and reassuring to others. 3. SELF-MOTIVATION--Examples of professional behavior include, but are not limited to: Taking initiative to complete assignments; taking initiative to correct and/or improve behavior; taking on and following through on tasks without constant supervision; showing enthusiasm for learning and improvement; consistently striving for excellence in all aspects of patient care and professional activities; accepting constructive feedback in a positive manner; taking advantage of learning opportunities. 4. APPEARANCE AND PERSONAL HYGIENE--Examples of professional behavior include, but are not limited to: Complying with clinical dress code requirements, including wearing a uniform that is neat, clean, and well-maintained; practicing good personal hygiene and grooming. 5. SELF-CONFIDENCE--Examples of professional behavior include, but are not limited to: Demonstrating the ability to trust personal judgment; demonstrating awareness of strengths and limitations; exercising good judgment. 6. COMMUNICATIONS--Examples of professional behavior include, but are not limited to: Speaking clearly; writing legibly; listening actively; adjusting communications strategies to various situations. 7. TIME MANAGEMENT--Examples of professional behavior include, but are not limited to: Being consistently punctual; Completing tasks and assignments on time. 8. TEAMWORK AND DIPLOMACY--Examples of professional behavior include, but are not limited to: Placing the success of the team above self-interest; not undermining the team; helping and supporting other team members; showing respect for all team members; remaining flexible and open to change; communicating with others to resolve problems. 9. RESPECT--Examples of professional behavior include, but are not limited to: Being polite to others; not using derogatory or demeaning terms; behaving in a manner that brings credit to the profession. 10. PATIENT ADVOCACY--Examples of professional behavior include, but are not limited to: Not allowing personal bias or feelings to interfere with patient care; placing the needs of patients above self-interest; protecting and respecting patient confidentiality and dignity. 11. CAREFUL DELIVERY OF SERVICE--Examples of professional behavior include, but are not limited to: Developing and maintaining mastery of professional knowledge and skills; performing complete equipment checks; demonstrating careful and safe vehicle operations; Following policies, procedures, and protocols; following orders and instructions. 2004-2010, Temple College Section B: Page 43 of 71 EMS Professions Student Handbook Objectives and Goals EMSP 1162 Paramedic First Semester Clinical 2004-2010, Temple College Section B: Page 44 of 71 EMS Professions Student Handbook Statement of Learning Objectives EMSP 1162--Paramedic First Semester Clinical Students enrolled in EMSP 1162 also will be concurrently enrolled in the following courses: EMSP 1438 (Introduction to Advanced Practice), EMSP 1356 (Patient Assessment and Airway Management), and EMSP 2348 (Emergency Pharmacology) They will be studying the following topics during this semester: Roles & responsibilities of advanced EMS Personnel Legal and ethical aspects of advanced prehospital care Injury control and prevention General principles of pathophysiology Advanced patient assessment Advanced airway management Foundations of pharmacology Drug calculations IV Therapy and drug administration techniques They will demonstrate laboratory proficiency in the following skills during this semester: All EMT-Basic skills Airway management: Oral intubation Nasal intubation Esophageal Airways Surgical Airways NG tubes IV therapy Intraosseous vascular access Chest decompression Medication Administration: IV bolus and infusion SQ ET IM Paramedic first semester clinical rotations focus on development demonstration of proficiency in technical skills in the clinical setting and on beginning to develop competence in patient assessment and management. 2004-2010, Temple College Section B: Page 45 of 71 EMS Professions Student Handbook Emergency Department Objectives & Goals EMSP 1162 – Paramedic First Semester Clinical In addition to the Global Clinical Objectives, certain clinical experiences are best suited to the attainment of specific knowledge and skills. In this context, Goals are defined as competencies that the faculty and medical director feel would benefit the student if presented with the opportunity to experience them. Objectives, on the other hand, are competencies that the student will be expected to obtain. Purpose The purpose of this rotation is to prepare students to assess and manage patients at the level of an EMTIntermediate as well as to continue their accumulation of patient care experience and knowledge of EMS and its role in the health care system. Objectives At a minimum, students in paramedic first semester clinical rotations will be expected to accomplish the following objectives during each ED rotation: Perform at least 3 patient assessments, including recent and past medical history and physical exam. The assessment should include taking and recording vital signs and a review of all systems (neurological, cardiovascular, pulmonary, gastrointestinal, genitourinary.) Document at least 3 patient assessments to include the pathophysiology of the diagnosis, mechanism of action of any medications given and a SOAP style report. Interact with patients and their families. Observe behavioral reactions to injury/illness. Operate oxygen administration equipment and give oxygen as many times as possible. Administer medications as many times as possible. Record the mechanism of action, dosage, route of administration and indications for any medications given. Establish IV access as many times as possible. Draw and prepare blood samples for laboratory studies as many times as possible. Goals It is the goal of paramedic first semester emergency department rotations is to expose students to as many patient assessment/management experiences as possible. These experiences may include, but are not limited to: Insertion of nasogastric tubes. Administration of medications via infusion pump. Administration of RSI protocol medications followed by intubation. Performing nasal intubation. Exposure and assistance with other procedures not commonly performed in the prehospital environment such as: Placement of central venous lines Placement of arterial lines Endoscopic procedures Neurological assessments Hemodynamic monitoring Urinary catheterization Assisting in cases of cardiac arrest as directed. (Note: first semester students do not perform electrical arrhythmia therapy.) 2004-2010, Temple College Section B: Page 46 of 71 EMS Professions Student Handbook Respiratory Therapy Objectives & Goals EMSP 1162--Paramedic First Semester Clinical In addition to the Global Clinical Objectives, certain clinical experiences are best suited to the attainment of specific knowledge and skills. In this context, Goals are defined as competencies that the program faculty and medical director feel would benefit the student if presented with the opportunity to experience them. Objectives, on the other hand, are competencies that the student will be expected to obtain. Purpose The purpose of this rotation is to give students access to a large number of patients with respiratory diseases. Students are expected to take advantage of this opportunity to focus on development of assessment skills for respiratory patients as well as to continue their accumulation of patient care experience and knowledge of EMS and its role in the health care system. Objectives At a minimum, students in paramedic first semester clinical rotations will be expected to accomplish the following objectives during each Respiratory Care rotation: Listen to and identify chest sounds to include rales, rhonchi, wheezes and diminished breath sounds on every patient assessed. Document at least 3 patient assessments to include the pathophysiology of the diagnosis, mechanism of action of any medications given, and a SOAP style report. Goals It is the goal of paramedic first semester Respiratory Care rotations to expose students to as many patient assessment and management experiences as possible. These may include, but are not limited to: Operate oxygen delivery equipment and give oxygen. Observe and assist with chest percussion. Observe and assist with the monitoring and care of patients on of mechanical ventilators. Discuss with the preceptor types of ventilator systems in use on patients, including: mode, control settings, use of PEEP and CPAP, and appropriate responses to alarms. Observe and assist with routine maintenance care of patients with tracheostomies. Observe and assist with acquisition of arterial blood gas samples. Observe lab values with special attention to PO2, PCO2, and pH values. Observe and discuss with preceptor use of pulse oximeters Observe and discuss with preceptor use of end tidal CO2 monitors. Observe and discuss with preceptor use of peak flow measurement in patient assessment and management. Correlate lab values with patient condition and treatment plans. Administer medications via small volume nebulizer. Observe and assist with the use of pharmacologic agents used in the care of respiratory disease. Perform sterile endotracheal suctioning to include auscultation of breath sounds before and after procedure. Observe signs, symptoms, and care of patients with common respiratory diseases found in the prehospital setting, including: emphysema, chronic bronchitis, asthma, cardiogenic pulmonary edema, noncardiogenic edema, pneumonia/pneumonitis. 2004-2010, Temple College Section B: Page 47 of 71 EMS Professions Student Handbook Operating Room Objectives & Goals EMSP 1162--Paramedic First Semester Clinical In addition to the Global Clinical Objectives, certain clinical experiences are best suited to the attainment of specific knowledge and skills. In this context, Goals are defined as competencies that the program faculty and medical director feel would benefit the student if presented with the opportunity to experience them. Objectives, on the other hand, are competencies that the student will be expected to obtain. Purpose The purpose of this rotation is to give students an opportunity to practice airway management procedures, especially bag valve mask ventilation and endotracheal intubation. Objectives At a minimum, students in first semester paramedic clinical rotations will be expected to accomplish the following objectives during each OR rotation: Appropriately manage the patient’s airway before, during and after anesthesia to include: Proper positioning of the head and shoulders Formation of an effective seal with a bag valve mask Effective ventilation with a manual ventilation device and mask Effective intubation of all ages and conditions of patients. Appropriate assessment of tube placement Effective ventilation with a manual ventilation device and ET tube. Goals It is the goal of first semester paramedic clinical rotations in the operating room is to expose students to as many patient assessment and management situations as possible. These may include, but are not limited to: Administration of medications to facilitate endotracheal intubation. Monitoring patients, including blood pressure, pulse, respirations, level of consciousness, arterial oxygen saturation, and end-tidal carbon dioxide detection Operating oxygen administration equipment and giving oxygen Assisting in operation of mechanical ventilation equipment Preparing and giving medications as directed by preceptor Observing effects of medications given. NOTE: While students will be exposed to surgical procedures during this rotation and have the opportunity to learn about those procedures, the primary purpose of this rotation is airway management. Students should concentrate their time on mastering these tasks. 2004-2010, Temple College Section B: Page 48 of 71 EMS Professions Student Handbook Objectives and Goals EMSP 1263 Paramedic Second Semester Clinical 2004-2010, Temple College Section B: Page 49 of 71 EMS Professions Student Handbook Statement of Learning Objectives EMSP 1263--Paramedic Second Semester Clinical Students enrolled in EMSP 1263 also will be concurrently enrolled in EMSP 1355 (Trauma Management) and EMSP 2544 (Cardiology). They will have completed EMSP 1438 (Introduction to Advanced Practice), EMSP 1356 (Patient Assessment and Airway Management), EMSP 2348 (Emergency Pharmacology), and EMSP 1162 (Paramedic First Semester Clinical). They will be studying the following topics during this semester: Trauma care systems Kinematics Pathophysiology, assessment, and management of hypovolemic shock Pathophysiology, assessment, and management of soft tissue trauma, burns, head trauma; trauma to the face, eyes, and cervical soft tissues; spinal and spinal cord trauma; thoracic trauma; abdominal trauma; genitourinary trauma; musculoskeletal trauma Pathophysiology, assessment, and management of cardiovascular disease, including coronary artery disease, angina pectoris, acute myocardial infarction, congestive heart failure and cardiogenic shock, peripheral vascular disease, and hypertension Acquisition and interpretation of monitoring lead and 12-lead electrocardiograms. Pathophysiology, evaluation, and management of patients with cardiac arrhythmias. Before beginning this semester they will have demonstrated laboratory proficiency in the following skills: All EMT-Basic skills Airway management: Oral intubation Nasal intubation Esophageal Airways Surgical Airways NG tubes IV therapy Intraosseous vascular access Chest decompression Medication Administration: IV bolus and continuous infusion SQ ET IM They will demonstrate laboratory proficiency in the following skills during this semester: Defibrillation Cardioversion External cardiac pacing Monitoring lead acquisition and interpretation 12-lead ECG acquisition and interpretation Assessment and management of trauma patients Assessment and management of cardiac patients to include ACLS standard algorithms 2004-2010, Temple College Section B: Page 50 of 71 EMS Professions Student Handbook Emergency Department Objectives & Goals EMSP 1263 – Paramedic Second Semester Clinical In addition to the Global Clinical Objectives, certain clinical experiences are best suited to the attainment of specific knowledge and skills. In this context, Goals are defined as competencies that the faculty and medical director feel would benefit the student if presented with the opportunity to experience them. Objectives, on the other hand, are competencies that the student will be expected to attain. Purpose The purpose of this rotation is to prepare students to assess and manage patients at the level of a paramedic as well as to continue their accumulation of patient care experience and knowledge of EMS and its role in the health care system. Objectives At a minimum, students in paramedic second semester clinical rotations will be expected to accomplish the following objectives during each Emergency Department rotation: Perform at least 3 patient assessments, including recent and past medical history and physical exam. The assessment should include taking and recording vital signs and a review of all systems (neurological, cardiovascular, pulmonary, gastrointestinal, genitourinary.) Document at least 3 patient assessments to include the pathophysiology of the diagnosis, mechanism of action of any medications given and a SOAP style report. Interact with patients and their families. Observe behavioral reactions to injury/illness. Operate oxygen administration equipment and give oxygen as many times as possible. Administer medications as many times as possible. Record the mechanism of action, dosage, route of administration and indications for any medications given. Establish IV access as many times as possible. Draw and prepare blood samples for laboratory studies as many times as possible. Goals It is the goal of paramedic second semester emergency department rotations is to expose students to as many patient assessment/management experiences as possible with an emphasis on developing proficiency in performing the technical skills taught during the first and second semesters. These experiences may include, but are not limited to: Insertion of nasogastric tubes. Administration of medications via infusion pump. Administration of RSI protocol medications followed by intubation. Nasal intubation. Exposure and assistance with other procedures not commonly performed in the prehospital environment such as: Placement of central venous lines Placement of arterial lines Endoscopic procedures Neurological assessments Hemodynamic monitoring Urinary catheterization Assisting in cases of cardiac arrest as directed. (Note: second semester students may perform electrical arrhythmia therapy if they have demonstrated laboratory proficiency in these techniques.) 2004-2010, Temple College Section B: Page 51 of 71 EMS Professions Student Handbook Operating Room Objectives & Goals EMSP 1263--Paramedic Second Semester Clinical In addition to the Global Clinical Objectives, certain clinical experiences are best suited to the attainment of specific knowledge and skills. In this context, Goals are defined as competencies that the program faculty and medical director feel would benefit the student if presented with the opportunity to experience them. Objectives, on the other hand, are competencies that the student will be expected to obtain. Purpose The purpose of this rotation is to give students an opportunity to practice airway management procedures, especially bag valve mask ventilation and endotracheal intubation. Objectives At a minimum, students in second semester paramedic clinical rotations will be expected to accomplish the following objectives during each OR rotation: Appropriately manage the patient’s airway before, during and after anesthesia to include: Proper positioning of the head and shoulders Formation of an effective seal with a bag valve mask Effective ventilation with a manual ventilation device and mask Effective intubation of all ages and conditions of patients Appropriate assessment of tube placement Effective ventilation with a manual ventilation device and ET tube. Goals It is the goal of second semester paramedic clinical rotations in the operating room is to expose students to as many patient assessment and management situations as possible. These may include, but are not limited to: Administration of RSI protocol medications. Monitoring patients, including blood pressure, pulse, respirations, level of consciousness, arterial oxygen saturation, and end-tidal carbon dioxide detection Operating oxygen administration equipment and giving oxygen Assisting in operation of mechanical ventilation equipment Preparing and giving medications as directed by preceptor Observing effects of medications given. NOTE: While students will be exposed to surgical procedures during this rotation and have the opportunity to learn about those procedures, the primary purpose of this rotation is airway management. Students should concentrate their time on mastering these tasks. 2004-2010, Temple College Section B: Page 52 of 71 EMS Professions Student Handbook Mobile Intensive Care Unit Objectives & Goals EMSP 1263 – Paramedic Second Semester Clinical In addition to the Global Clinical Objectives, certain clinical experiences are best suited to the attainment of specific knowledge and skills. In this context, Goals are defined as competencies that the program faculty and medical director feel would benefit the student if presented with the opportunity to experience them. Objectives, on the other hand, are competencies that the student will be expected to attain. Purpose The purpose of this rotation is to give students an opportunity to gain experience with the assessment and management of patients in the out-of-hospital setting. They are also to gain experience with the EMS system and its role in the health care system. During this semester, students should focus on patient assessment and performance of specific skills taught to date. Objectives At a minimum, students in paramedic second semester clinical rotations will be expected to accomplish the following objectives during each field rotation: Evaluate equipment readiness (unit ‘check-out’). Participation in all station daily duties. Complete documentation on all patient contacts to include a SOAP style report. Discuss with preceptor and observe standard procedures for EMS operations and call management. When the opportunity arises, the student in paramedic second semester clinical rotations is expected to focus on the: Integration as a team member with the crew. Performance of appropriate patient assessments. Performing vascular access and blood draws. Initiation of appropriate advanced airway management procedures. Initiation of appropriate skills as directed by crew, including medication administration by all routes. Goals The goal of second semester paramedic clinical rotations on the mobile intensive care unit is to develop the knowledge and skills necessary for the student to function as an entry-level member of an EMS system at the EMT-Intermediate level. When possible, this should include providing the student with the opportunity to perform call management at the EMT-Intermediate level. 2004-2010, Temple College Section B: Page 53 of 71 EMS Professions Student Handbook Objectives and Goals EMSP 2260 Paramedic Third Semester Clinical 2004-2010, Temple College Section B: Page 54 of 71 EMS Professions Student Handbook Statement of Learning Objectives EMSP 2260--Paramedic Third Semester Clinical Students enrolled in EMSP 2260 will be concurrently enrolled in EMSP 2430 (Special Populations) and EMSP 2434 (Medical Emergencies). They will have completed EMSP 1438 (Introduction to Advanced Practice), EMSP 1356 (Patient Assessment and Airway Management), EMSP 2348 (Emergency Pharmacology), EMSP 1162 (First Semester Clinical), EMSP 1355 (Trauma Management), EMSP 2544 (Cardiology), and EMSP 1263 (Second Semester Clinical) During this semester they will be studying the assessment, management and pathophysiology of: Medical emergencies, including patients with respiratory, neurologic, endocrine, gastroenterologic, urologic, hematologic, infectious, toxicologic, allergic, and environmental problems. Obstetric and gynecologic problems Pediatric patients Geriatric patients Patients with behavioral and psychiatric disorders Patients with special needs, including technology-dependent patients Before beginning this semester they will have demonstrated competence in the following skills: All EMT-Basic skills Airway management: Oral intubation Nasal intubation Esophageal Airways Surgical Airways NG tubes IV therapy Intraosseous vascular access Chest decompression Medication Administration: IV bolus and infusion SQ ET IM Assessment and management of trauma patients ECG monitoring lead acquisition and interpretation 12-lead ECG acquisition and interpretation Defibrillation Cardioversion External cardiac pacing Assessment and management of cardiac patients to include ACLS standard algorithms Throughout this semester they will participate in patient assessment and management simulations in which they will be expected to demonstrate continuing competence in all skills taught during previous semesters. During third and fourth semester clinical rotations the focus will shift from developing and demonstrating competence in specific clinical skills to refining the student's ability to perform assessments, define a differential diagnosis, develop a treatment plan, and integrate previously learned knowledge and skills into the execution of that plan. 2004-2010, Temple College Section B: Page 55 of 71 EMS Professions Student Handbook Coronary Care Unit Objectives & Goals EMSP 2260 – Paramedic Third Semester Clinical In addition to the Global Clinical Objectives, certain clinical experiences are best suited to the attainment of specific knowledge and skills. In this context, Goals are defined as competencies that the program faculty and medical director feel would benefit the student if presented with the opportunity to experience them. Objectives, on the other hand, are competencies that the student will be expected to attain. Purpose The purpose of this rotation is to expose students to a variety of critically ill patients suffering from cardiovascular disease and allow them to practice their assessment skills. Although students may perform technical skills as requested, they should focus on each patient’s diagnosis, key assessment findings and treatment plans. Objectives At a minimum, students in third semester paramedic clinical rotations in the CCU will be expected to accomplish the following objectives during each rotation: 1. Perform at least 3 patient assessments including recent and past medical history and physical examination. The assessment should include taking and recording vitalsigns, a review of all systems (neuro, cardiovascular, pulmonary, gastrointestinal, and genitourinary), and noting all IV, tubes, drains, and invasive hemodynamic monitoring. 2. Document at least 3 patient assessments to include the pathophysiology of the diagnosis, mechanism of action of any medications given and a SOAP style report. 3. Prepare and administer medications as directed by preceptor. 4. Observe effects of pharmacological agents administered. 5. Identify therapeutic action, use, and major side effects of patient medications. 6. Evaluate and interpret ECGs, especially 12 lead ECGs. 7. Observe complications of acute myocardial infarction. Goals It is the goal of the paramedic third semester clinical rotations in the CCU to expose students to as many experiences as possible. This may include but is not limited to: 1. Reviewing all charts, including patient's chart, diagnosis, treatment, progress notes, and nurse's notes. 2. Operating oxygen administration equipment and giving oxygen. 3. Performing peripheral IV insertion. 4. After observation and instruction, drawing blood samples via venipuncture or exiting IV lines 5. Inserting orogastric or nasogastric tubes 6. Assisting in ambulating patients from bed to chair, lifting and turning patients, and with activities of daily living. 7. Assisting in cases of cardiac arrest as directed, including performing CPR, managing the airway, assisting with endotracheal intubation, and electrical arrhythmia therapy. 8. Evaluating results of laboratory tests, and correlating results with patient management. 9. Reviewing operation of mechanical ventilator equipment, noting various settings. 10. Maintaining airway in unconscious patients using manipulation and positioning, oropharyngeal airways, and suctioning. 11. Performing aseptic endotracheal suctioning. 12. Observing and assisting in setting up and maintaining IV infusion pumps. 13. Exposure to critical care diagnostic procedures. 14. Exposure to long term treatment plans and care of patients with complex cardiovascular disease. 15. Treatment modalities not normally utilized in prehospital medicine. 2004-2010, Temple College Section B: Page 56 of 71 EMS Professions Student Handbook Intensive Care Unit Objectives & Goals EMSP 2260 – Paramedic Third Semester Clinical In addition to the Global Clinical Objectives, certain clinical experiences are best suited to the attainment of specific knowledge and skills. In this context, Goals are defined as competencies that the program faculty and medical director feel would benefit the student if presented with the opportunity to experience them. Objectives, on the other hand, are competencies that the student will be expected to attain. Purpose The purpose of this rotation is to expose students to a variety of critically ill and injured patients and allow them to practice their assessment skills. Although students may perform technical skills as requested, they should focus on each patient’s diagnosis, key assessment findings, and treatment plans. Objectives At a minimum, students in third semester paramedic clinical rotations in the ICU will be expected to accomplish the following objectives during each rotation: Perform at least 3 patient assessments including recent and past medical history and physical examination. The assessment should include taking and recording vital signs, a review of all systems (neuro, cardiovascular, pulmonary, gastrointestinal, and genitourinary), and noting all IV, tubes, drains, and invasive hemodynamic monitoring. Document at least 3 patient assessments to include the pathophysiology of the diagnosis, mechanism of action of any medications given and a SOAP style report. Prepare and administer medications as directed by preceptor. Observe effects of pharmacological agents administered. Identify therapeutic action, use, and major side effects of patient medications. Evaluate and interpret ECGs, especially 12 lead ECGs. Observe complications of complex multiple system injury or illness, including ARDS, renal failure, hepatic failure, DIC, and multiple organ systems failure. Goals It is the goal of paramedic third semester clinical rotations in the ICU to expose students to as many experiences as possible. This may include but is not limited to: Reviewing all charts, including patient's chart, diagnosis, treatment, progress notes, and nurse's notes. Operating oxygen administration equipment and giving oxygen. Performing peripheral IV insertion. After observation and instruction, drawing blood samples via venipuncture or exiting IV lines Inserting orogastric or nasogastric tubes Assisting in ambulating patients from bed to chair, lifting and turning patients, and with activities of daily living. Assisting in cases of cardiac arrest as directed, including performing CPR, managing the airway, assisting with endotracheal intubation, and electrical arrhythmia therapy. Evaluating results of laboratory tests, and correlating results with patient management. Reviewing operation of mechanical ventilator equipment, noting various settings. Maintaining airway in unconscious patients using manipulation and positioning, oropharyngeal airways, and suctioning. Performing aseptic endotracheal suctioning. Observing and assisting in setting up and maintaining IV infusion pumps. Exposure to critical care diagnostic procedures. 14. Exposure to long term treatment plans and care of patients with multiple organ system failure. 15. Treatment modalities not normally utilized in prehospital medicine. 2004-2010, Temple College Section B: Page 57 of 71 EMS Professions Student Handbook Electrophysiology/ Coronary Cath Laboratory Objectives & Goals EMSP 2260 – Paramedic Third Semester Clinical In addition to the Global Clinical Objectives, certain clinical experiences are best suited to the attainment of specific knowledge and skills. In this context, Goals are defined as competencies that the program faculty and medical director feel would benefit the student if presented with the opportunity to experience them. Objectives, on the other hand, are competencies that the student will be expected to attain. Purpose The purpose of the paramedic third semester clinical rotation in the Electrophysiology/Coronary Catheterization Laboratory is to give the student an opportunity to expand his/her knowledge and understanding of the mechanisms that produce cardiac arrhythmias, the clinical effects of arrhythmias, and procedures for managing arrhythmias. Objectives At a minimum, students are expected to accomplish the following objectives during the third semester paramedic clinical rotation in the Electrophysiology/Coronary Catheterization Laboratory: 1. Observe electrophysiology studies and procedures. 2. Observe cardiac catheterization and interventional cardiology procedures 3. Interpret ECGs. 4. Discuss with preceptor mechanisms producing arrhythmias. 5. Discuss with preceptor mechanisms producing myocardial ischemia/infarction. 6. Correlate arrhythmias observed with clinical effects. 7. Correlate coronary artery pathology with ECG changes. Goals Perform patient care procedures as directed by preceptor, including: Airway management Oxygenation and ventilation Vascular access Medication administration Electrical arrhythmia therapy 2004-2010, Temple College Section B: Page 58 of 71 EMS Professions Student Handbook Labor and Delivery Objectives & Goals EMSP 2260 – Paramedic Third Semester Clinical In addition to the Global Clinical Objectives, certain clinical experiences are best suited to the attainment of specific knowledge and skills. In this context, Goals are defined as competencies that the program faculty and medical director feel would benefit the student if presented with the opportunity to experience them. Objectives, on the other hand, are competencies that the student will be expected to attain. Purpose The purpose of this rotation is to give students an opportunity to observe and assist with normal and abnormal deliveries as well as practice assessing the pregnant patient and newborn infant. Objectives At a minimum, students are expected to accomplish the following objectives during the third semester paramedic clinical rotation in the Labor and Delivery Unit: Assess pregnant patients to include determining gravidity and parity, estimating length of gestation by measuring fundal height, determining EDC, identifying stage of labor, measuring contraction frequency and length, and recognizing imminent delivery. Document at least 3 patient assessments to include the pathophysiology of the diagnosis, mechanism of action of any medications given and a SOAP style report. Identification of the three stages of labor Observe and assist with normal vaginal deliveries. Evaluation of neonate by determination of APGAR score. Observe and assist with routine care of newborn including evaluation of airway and ventilation, suctioning, oxygen administration, clamping/cutting umbilical cord, and temperature control. Inspect placenta. Inspect umbilical cord and attempt to identify artery and veins. Goals It is the goal of paramedic third semester clinical rotations on the Labor and Delivery Unit to expose students to as many experiences as possible. These may include but are not limited to: Observe and assist with abnormal deliveries including breech delivery, prolapsed cord, shoulder dystocia, and limb presentation. Observe, assist in, and review management of patients with pregnancy induced hypertension, placenta previa, placental abruption, fetal distress, ruptured/leaking amniotic membranes, premature labor, and precipitous delivery. Observe delivery via cesarean section. Observe and assist with evaluation of dilation and effacement. Observe administration of epidural or subdural anesthesia. Performance of fundal massage after delivery. Observe and assist with medication administration including magnesium sulfate and pitocin. Observe assessment and management of postpartum complications including perineal injury, retained placenta, and prolapsed cord. Observe and assist with neonatal resuscitation. Observe and assist with management of meconium aspiration. 2004-2010, Temple College Section B: Page 59 of 71 EMS Professions Student Handbook Dialysis Unit Objectives & Goals EMSP 2260 – Paramedic Third Semester Clinical In addition to the Global Clinical Objectives, certain clinical experiences are best suited to the attainment of specific knowledge and skills. In this context, Goals are defined as competencies that the program faculty and medical director feel would benefit the student if presented with the opportunity to experience them. Objectives, on the other hand, are competencies that the student will be expected to attain. Purpose The purpose of this rotation is to give paramedic students experience in the assessment and management of patients with renal failure who are being treated with hemodialysis. Objectives At a minimum, students will be expected to accomplish the following objectives during the third semester paramedic clinical rotation in the Dialysis Unit: Perform at least 3 assessments of patients receiving dialysis. Document at least 3 patient assessments to include the pathophysiology of the diagnosis, mechanism of action of any medications given and a SOAP style report. Reviewing all charts, including patient's chart, diagnosis, treatment, progress notes, and nurse's notes. Observe types of hemodialysis access sites and discuss with preceptor advantages, disadvantages, and prehospital care considerations with each type. Assess dialysis access sites for patency and signs of infection. Discuss with preceptor methods for and limitations of using hemodialysis access sites for vascular access in lifethreatening situations. Goals It is the goal of paramedic third semester clinical rotations on the Dialysis Unit to expose students to as many experiences as possible. These may include but are not limited to: Observing and assisting in the management of patients suffering from complications of hemodialysis, including: disequilibrium syndrome, angina, air embolism, hypovolemia and hypotension, hyperthermia, hemolysis, hyperglycemia, hypernatremia, and cardiac arrhythmias. 2004-2010, Temple College Section B: Page 60 of 71 EMS Professions Student Handbook Immunization Clinic Objectives & Goals EMSP 2260 – Paramedic Third Semester Clinical In addition to the Global Clinical Objectives, certain clinical experiences are best suited to the attainment of specific knowledge and skills. In this context, Goals are defined as competencies that the program faculty and medical director feel would benefit the student if presented with the opportunity to experience them. Objectives, on the other hand, are competencies that the student will be expected to attain. Purpose The purpose of this rotation is to: Give paramedic students experience in performing intramuscular and subcutaneous injections, particularly on pediatric patients. Give paramedic students the opportunity to observe how healthy pediatric patients interact with their parents and with health care providers. Expose paramedic students to an expanded concept of the role of EMS professionals in the health care system. Objectives At a minimum, students are expected to accomplish the following objectives during the third semester paramedic clinical rotation in the Immunization Clinic: Demonstrate proper technique for administration of medications by the subcutaneous and intramuscular routes. Demonstrate proper techniques for infection control. Demonstrate proper technique for disposal of used syringes and needles. Demonstrate techniques for properly restraining infants and children. Observe interactions between patients, family members, and health care practitioners. Goals It is the goal of paramedic third semester clinical rotations in the Immunization Clinic is to expose students to as many experiences as possible. These may include but is not limited to: Setting up clinic supplies, including emergency drugs and standing orders. Identifying appropriate for age vaccine(s) needed. Verifying client identify. Verifying signature and relationship of consenting adult. Screening for contraindications and possible risks prior to vaccine administration. Documenting any deferred vaccinations. Performing and documenting post-vaccinating counseling. Assisting in management of untoward reactions to vaccines. 2004-2010, Temple College Section B: Page 61 of 71 EMS Professions Student Handbook Toxicology (Poison Center) Objectives & Goals EMSP 2260 – Paramedic Third Semester Clinical In addition to the Global Clinical Objectives, certain clinical experiences are best suited to the attainment of specific knowledge and skills. In this context, Goals are defined as competencies that the program faculty and medical director feel would benefit the student if presented with the opportunity to experience them. Objectives, on the other hand, are competencies that the student will be expected to attain. Purpose The purpose of this rotation is to give students an understanding of the function and role of the Poison Center network as well as an exposure to a wide variety of patients with toxicological emergencies. Objectives At a minimum, students will be expected to accomplish the following objectives during the third semester paramedic clinical rotation in the Poison Control Center: Accurately describe the substance involved in each call to poison control to include the following: Name and alternate names if applicable Toxicologic or pharmacologic class Common sources for the substance Mechanism of action Toxic level Signs and Symptoms of overdose or exposure Treatment Discuss, at a minimum, the items from number 1 for a representative substance from 5 or more of the following: caustics petroleum distillates analgesics (salicylates, acetaminophen, NSAIDS, opiates) cyclic antidepressants drugs of abuse decongestants, antihistamines carbon monoxide and other gases mushrooms and food poisoning common indoor and outdoor plants alcohols (ethanol, isopropyl, methanol, ethylene glycol) household cleaning products, cosmetics pesticides Observe the day-to-day operation of the poison control center. Use toxicology references to identify substances and suggest treatment plans based on scenarios given by preceptor. Assist the poison specialist with duties as requested. Goal It is the goal of the paramedic third semester clinical rotation in the Poison Control Center is to expose students to as many experiences as possible. This may include but is not limited to using a computer database to research the effects of toxins. 2004-2010, Temple College Section B: Page 62 of 71 EMS Professions Student Handbook Field Internship Objectives & Goals EMSP 2260 – Paramedic Third Semester Clinical In addition to the Global Clinical Objectives, certain clinical experiences are best suited to the attainment of specific knowledge and skills. In this context, Goals are defined as competencies that the program faculty and medical director feel would benefit the student if presented with the opportunity to experience them. Objectives, on the other hand, are competencies that the student will be expected to obtain. Purpose The purpose of this rotation is to give students an opportunity to gain experience with the assessment and management of patients in the out-of-hospital setting. They are also to gain experience with the EMS system and its role in the health care system. During this semester, students should focus on ‘running’ the patient interaction and directing the patient care aspects of the call. Third semester Field Internship rotations will be spent on a mobile intensive care unit with an assigned preceptor. These rotations will begin the process of taking the student from functioning as an observer, to serving as a member of the EMS team, to performing as team leader and directing the crew in its response to a variety of calls. The student will continue the Field Internship during the fourth semester with the same preceptor. Objectives At a minimum, students in the paramedic third semester clinical will be expected to accomplish the following objectives during each field rotation: Evaluate equipment readiness (unit ‘check-out’). Participation in all station daily duties. Complete documentation on all patient contacts to include a SOAP style report. When the opportunity arises, the student in the paramedic third semester clinical is expected to focus on the following: 1) Integration as a team member with the crew 2) Performing appropriate patient assessments. 3) Developing a differential diagnosis. 4) Developing and implementing a treatment plan. 5) Initiation of IV access and blood draws. 6) Acquisition and interpretation of ECG rhythm strips. 7) Acquisition and interpretation of 12 Lead ECGS or ‘multi-lead’ ECG. 8) Administration of medications. 9) Initiation of appropriate advanced airway management procedures. 2004-2010, Temple College Section B: Page 63 of 71 EMS Professions Student Handbook Objectives and Goals EMSP 2460 Paramedic Fourth Semester Clinical 2004-2010, Temple College Section B: Page 64 of 71 EMS Professions Student Handbook Statement of Learning Objectives EMSP 2460: Paramedic Fourth Semester Clinical Students enrolled in EMSP 2460 will be concurrently enrolled in EMSP 2338 (EMS Operations), EMSP 2143 (Assessment Based Management), EMS) 2135 (Advanced Cardiac Life Support), EMSP 1147 (Pediatric Advanced Life Support), and EMSP 1149 (Prehospital Trauma Life Support). They will have completed EMSP 1438 (Introduction to Advanced Practice), EMSP 1356 (Patient Assessment and Airway Management), EMSP 2348 (Emergency Pharmacology), EMSP 1162 (First Semester Clinical), EMSP 1355 (Trauma Management), EMSP 2544 (Cardiology), EMSP 1263 (Second Semester Clinical), EMSP 2430 (Special Populations), EMSP 2434 (Medical Emergencies), and EMSP 2260 (Third Semester Clinical). During this semester they will be studying of non-clinical operational topics such as rescue, HAZMAT operations, crime scene operations, and incident command. They also will be completing ACLS, PHTLS, and PALS and will be participating in a series of advanced patient management simulations. Before beginning this semester they will have demonstrated competence in the following skills: All EMT-Basic skills Airway management: Oral intubation Nasal intubation Esophageal Airways Surgical Airways NG tubes IV therapy Intraosseous vascular access Chest decompression Medication Administration: IV bolus and continuous infusion SQ ET IM Assessment and management of trauma patients ECG monitoring lead acquisition and interpretation 12-lead ECG acquisition and interpretation Defibrillation Cardioversion External cardiac pacing Assessment and management of cardiac patients to include ACLS standard algorithms Assessment and management of patients with medical emergencies or from special patient populations Throughout this semester students will participate in patient management simulations in which they will be expected to demonstrate continuing competence in all skills taught during previous semesters. During fourth semester clinical rotations the focus will continue to be on refining the student's ability to perform assessments, define a differential diagnosis, develop a treatment plan, and integrate previously learned knowledge and skills into the execution of that plan. Most fourth semester clinical rotations will be spent on a mobile intensive care unit with an assigned preceptor. These rotations will focus on taking the student from functioning as an observer, to serving as a member of the EMS team, to performing as team leader and directing the crew in its response to a variety of calls. 2004-2010, Temple College Section B: Page 65 of 71 EMS Professions Student Handbook Pediatric Clinic Objectives & Goals EMSP 2260 – Paramedic Fourth Semester Clinical In addition to the Global Clinical Objectives, certain clinical experiences are best suited to the attainment of specific knowledge and skills. In this context, Goals are defined as competencies that the program faculty and medical director feel would benefit the student if presented with the opportunity to experience them. Objectives, on the other hand, are competencies that the student will be expected to attain. Purpose The purpose of this rotation is to give students an opportunity to assess pediatric patients under the supervision of a staff pediatrician, physician assistant, or pediatric nurse practitioner. Objectives Students will be precepted by a staff pediatrician, physician assistant, or pediatric nurse practitioner. They will be expected to: 1. Accompany the preceptor on all patient contacts and reports 2. Observe and assist assessment and management of each patient 3. Discuss each patient’s condition with the preceptor and document the following: a). Pathophysiology b). Common signs and symptoms c). Common treatment plans d). Prognosis 4. Document each patient contact using SOAP method to include: a). Age and sex b). Presenting problem or chief complaint c). Past Medical History d). Assessment findings e). Treatment plan 5. Complete documentation on each patient to include the name, class, mechanism of action, dose, and administration route of each medication being administered. Goals It is the goal of the paramedic fourth semester clinical rotations in the pediatric clinic is to expose students to as many experiences as possible involving assessment of common injuries and illnesses in children. 2004-2010, Temple College Section B: Page 66 of 71 EMS Professions Student Handbook Pediatric ICU Objectives & Goals EMSP 2460 – Paramedic Fourth Semester Clinical In addition to the Global Clinical Objectives, certain clinical experiences are best suited to the attainment of specific knowledge and skills. In this context, Goals are defined as competencies that the program faculty and medical director feel would benefit the student if presented with the opportunity to experience them. Objectives, on the other hand, are competencies that the student will be expected to attain. Purpose The purpose of this rotation is to give students exposure to a wide variety of critically ill and injured children and provide opportunities to assess these patients and to review and discuss their treatment plans. Although students may perform technical skills as requested, they should focus on each patient’s diagnosis, key assessment findings, and treatment plans. Objectives At a minimum, students in fourth semester paramedic clinical rotations will be expected to accomplish the following objectives during the Pediatric ICU rotation: Perform at least 3 patient assessments, including recent and past medical history and physical examination. The assessment should include a rapid initial evaluation of respiratory effort, heart rate, and status of hydration and perfusion; taking and recording of vital signs; a review of all systems (neuro, cardiovascular, pulmonary, gastrointestinal, genitourinary; and noting of all IV, tubes, drains, and hemodynamic monitoring. Review all records, including patient's chart, diagnosis, treatment, and nurses notes. Document each patient assessment using the SOAP method to include age and gender, presenting problem or chief complaint, past medical history, assessment findings, treatment plan, and a description of each medication being administered which includes name, class, mechanism of action, dose, and route of administration. Observe age-specific reactions to injury/illness and responses to health care personnel. Observe age-specific parent-child interactions. Demonstrate appropriate age-specific approaches to elicit and keep child's cooperation. Goals It is the goal of the paramedic fourth semester clinical rotation in the pediatric ICU to expose students to as many experiences as possible involving critically ill or injured children. These may include but are not limited to: Assess and manage pediatric patients with common illnesses found in the critical care setting, including acute asthma, meningitis, croup, epiglottis, bronchiolitis, and sepsis. After observation and instruction, draw blood samples via venipuncture or existing IV lines Demonstrate knowledge of equipment, procedures, and sites for vascular access in children Perform peripheral IV insertion. Prepare and administer medications as directed Observe effects of medications administered. Insert nasogastric and orogastric tubes. Acquire and interpret ECG rhythms Assist in ambulating patients from bed to chair, lifting and turning patients, and with activities of daily living. Assist in cases of cardiac arrest as directed including performing CPR, managing airway, assisting with endotracheal intubation, and defibrillation. Operate oxygen delivery equipment and give oxygen Review mechanical ventilation equipment, noting various settings. Maintain airway in unconscious patients using positioning, oral airways, and suctioning. Perform aseptic endotracheal or orotracheal suctioning Observe and assist in set-up and maintenance of IV infusion pumps. 2004-2010, Temple College Section B: Page 67 of 71 EMS Professions Student Handbook Pediatric Long Term Care Objectives & Goals EMSP 2460 – Paramedic Fourth Semester Clinical In addition to the Global Clinical Objectives, certain clinical experiences are best suited to the attainment of specific knowledge and skills. In this context, Goals are defined as competencies that the program faculty and medical director feel would benefit the student if presented with the opportunity to experience them. Objectives, on the other hand, are competencies that the student will be expected to attain. Purpose The purpose of this rotation is to give students exposure to a wide variety of children with special health care needs, including technology-dependent patients, and provide opportunities to assess these patients, review and discuss their treatment plans, and discuss procedures for modifying field assessment and management techniques when caring for these patients. Objectives At a minimum, students in fourth semester paramedic clinical rotations will be expected to accomplish the following objectives during the Pediatric Long Term Care rotation: Perform at least 3 patient assessments, including recent and past medical history and physical examination. The assessment should include a rapid initial evaluation of respiratory effort, heart rate, and status of hydration and perfusion; taking and recording of vital signs; a review of all systems (neuro, cardiovascular, pulmonary, gastrointestinal, genitourinary; and noting of all special care devices. Review all records, including patient's chart, diagnosis, treatment, and nurses notes. Document each patient assessment using the SOAP method to include age and gender, presenting problem or chief complaint, past medical history, assessment findings, treatment plan, and a description of each medication being administered which includes name, class, mechanism of action, dose, and route of administration. As available, observe and assist in the care of patients with tracheostomy tubes, central venous lines, gastrostomy tubes or gastric feeding tubes, or ventriculoperitoneal shunts. Discuss with preceptor common problems with devices used in the care of children with special health care needs and procedures for managing these problems. Observe patient reactions to injury/illness and responses to health care personnel. Observe parent-child interactions. Demonstrate appropriate approaches to elicit and keep child's cooperation. 2004-2010, Temple College Section B: Page 68 of 71 EMS Professions Student Handbook Geriatric Long Term Care Objectives & Goals EMSP 2460 – Paramedic Fourth Semester Clinical In addition to the Global Clinical Objectives, certain clinical experiences are best suited to the attainment of specific knowledge and skills. In this context, Goals are defined as competencies that the program faculty and medical director feel would benefit the student if presented with the opportunity to experience them. Objectives, on the other hand, are competencies that the student will be expected to attain. Purpose The purpose of this rotation is to give students exposure to a wide variety of geriatric patients in a longterm care setting and to provide opportunities to assess these patients, review and discuss their treatment plans, and discuss procedures for modifying field assessment and management techniques when caring for the elderly. Objectives At a minimum, students in fourth semester paramedic clinical rotations will be expected to accomplish the following objectives during the Geriatric Long Term Care rotation: Perform at least 3 patient assessments, including recent and past medical history and physical examination. The assessment should include taking and recording of vital signs and review of all systems (neuro, cardiovascular, pulmonary, gastrointestinal, genitourinary). Review all records, including patient's chart, diagnosis, treatment, and nurses notes. Document each patient assessment using the SOAP method to include age and gender, presenting problem or chief complaint, past medical history, assessment findings, treatment plan, and a description of each medication being administered which includes name, class, mechanism of action, dose, and route of administration. Observe patient reactions to injury/illness and responses to health care personnel. Demonstrate appropriate approaches to elicit and keep patient cooperation. Goals It is the goal of the paramedic fourth semester clinical rotation in a long-term care facility to expose students to as many experiences as possible involving geriatric patients. These may include but are not limited to: Observing alterations in physical examination findings resulting from effects of aging or prolonged immobility, including pressure (decubitus) ulcers, osteoarthritis/degenerative joint disease, osteoporosis/pathological fractures, contractures, Alzheimer's Disease, Parkinson's Disease, chronic CHF, longstanding COPD, diabetic complications, disorders of hydration, previous cerebrovascular accident. 2004-2010, Temple College Section B: Page 69 of 71 EMS Professions Student Handbook ED Medical Director Rotation Objectives & Goals EMSP 2460 – Paramedic Fourth Semester Clinical In addition to the Global Clinical Objectives, certain clinical experiences are best suited to the attainment of specific knowledge and skills. In this context, Goals are defined as competencies that the program faculty and medical director feel would benefit the student if presented with the opportunity to experience them. Objectives, on the other hand, are competencies that the student will be expected to obtain. Purpose The purpose of this rotation is to give students an opportunity to "fine-tune" the cognitive, psychomotor, and affective competencies they have developed by spending a shift working in the Emergency Department under direct supervision of the EMS Professions Department's Medical Director. This rotation also gives the Medical Director and opportunity to perform a final assessment of the student’s achievement of the program goals and objectives in the clinical environment. Objectives At a minimum, students in fourth semester paramedic clinical rotations will be expected to accomplish the following objectives during the Emergency Department Medical Director rotation: Under the direct supervision of the EMSP Department's Medical Director, perform at least 5 patient assessments, including recent and past medical history and a physical examination. The assessment should include taking and recording of vital signs and a review of all systems (neurological, cardiovascular, pulmonary, gastrointestinal, and genitourinary.) Formulate a differential diagnosis based on the information obtained from the history and physical exam in a timely manner and report this differential diagnosis to the Medical Director with appropriate justifications for each problem included. Develop a treatment plan based on findings of the history and physical exam and describe it to the Medical Director with appropriate justifications for all interventions. Appropriately perform any patient care interventions as requested by the Medical Director. Interact with patients, their families, and other health care personnel in a professional, effective fashion. Document the assessment and management of all patients to include the pathophysiology of the diagnosis; the mechanism of action, indications, dosage, and route of administration for any medications given, and a SOAP style report. Goals It is the goal of the paramedic fourth semester clinical rotation in the Emergency Department to expose students to as many experiences as possible under the direct supervision and guidance of the EMSP Department's Medical Director. These may include, but is not limited to: Insertion of nasogastric tubes. Administration of medications via infusion pump. Administration of RSI protocol medications followed by intubation. Performing nasal intubation. Interpretation of 12 lead ECG with a focus on infarct recognition and localization. Exposure and assistance with other procedures not commonly performed in the prehospital environment such as: a) Placement of central venous lines b) Placement of arterial lines c) Endoscopic procedures d) Neurological assessments e) Hemodynamic monitoring f) Urinary catheterization Interpretation of lab values and their correlation with patient presentations. 2004-2010, Temple College Section B: Page 70 of 71 EMS Professions Student Handbook Field Internship Objectives EMSP 2261 – Paramedic Fourth Semester Clinical In addition to the Global Clinical Objectives, certain clinical experiences are best suited to the attainment of specific knowledge and skills. In this context, Goals are defined as competencies that the program faculty and medical director feel would benefit the student if presented with the opportunity to experience them. Objectives, on the other hand, are competencies that the student will be expected to attain. Purpose The purpose of this rotation is to allow students to act as the ‘in charge’ medic. They are expected to be able to ‘run’ the call at the same level of competence as an entry-level paramedic. In addition to the appropriate interaction, assessment and management of all patients, the student should focus this semester on the overall integration of everything they have learned as well as ‘scene management’ This rotation will serve as a summative or ‘capstone’ evaluation of their achievement of the objectives and goals of the program. At the completion of this semester, the student should be able to function as an entry-level paramedic. Objectives At a minimum, students in fourth semester paramedic clinical rotations will be expected to accomplish the following objectives during the Field Internship 1. Participate in precall planning enroute to calls based on dispatch information, to include discussion of: potential differential diagnoses potential treatment plans identification of each team member’s role in the call identification of specific equipment needed on the call 2. Perform a scene size-up and respond appropriately to any noted hazards 3. Perform an initial assessment to identify life-threatening injuries or illness 4. Initiate interventions necessary to correct or treat any problems found in the initial assessment 5. Take a thorough history of the patient’s current and past medical conditions based on the SAMPLE and OPQRST format when appropriate. 6. Perform a Detailed Physical (“head to toe”) Exam, when appropriate, in a logical, organized fashion based upon the DCAP-BTLS-TIC format 7. Formulate a differential diagnosis based on the information obtained from the history and physical exam in a timely manner and relay this differential to the preceptor. 8. Develop a treatment plan based on findings of the history and physical exam and discuss it with the preceptor. 9. Implement the treatment plan, to include: Institution of appropriate standing orders/protocols using appropriate skill technique. Institution of therapy in an appropriate sequence and location based on the situation. a) Perform all assessment and interventions in a timely manner based on patient needs. 10. Deliver a concise and accurate radio or phone report to the receiving facility to include the following when appropriate: (Report to be done in 30-45 seconds) Service and Unit Number MEDIC designation Age of patient Gender of Patient Mechanism of Injury/Chief Complaint/Pertinent Past Medical History Vital Signs (if appropriate for situation) Treatment rendered and effect of treatment on patient’s condition Changes in patient condition Suggest a treatment plan or request orders where appropriate Confirmation of all orders received ETA to facility 2004-2010, Temple College Section B: Page 71 of 71 EMS Professions 11. 12. 13. 14. 15. Student Handbook Deliver a concise and accurate oral report to receiving facility’s designated personnel upon arrival at the facility, to include the following: Patient Name, Age Mechanism of Injury/Chief Complaint/Pertinent Past Medical History Assessment findings Treatment rendered and any effects of treatment on patient condition Any changes in patient condition during your care Initial and current vital signs where appropriate Write a concise and accurate written report of the call based on the SOAP format. Demonstrate effective Call Management skills, to include the following: Communicate calmly and professionally with the patient, patient’s family, friends and/or bystanders to ascertain pertinent information regarding the patient and inform them of procedures and plans Communicate calmly and professionally with appropriate support agencies (to include preceptor crew) to ascertain pertinent information regarding the patient and maintain effective interagency relations Effectively utilize resources to facilitate an organized, timely and smoothly run call. Demonstrate flexibility in call management to be able to change as the call or patient condition changes or progresses. Participate fully in all aspects of the call to include the above objectives and: Establishing initial contact with the patient Performing interventions Participate fully in post call critique to include the following: Discussion of assessment and history findings Discussion of differential diagnosis and treatment plan Identification and discussion of what was done well Identification and discussion of what could have been done better 2004-2010, Temple College Section B: Page 72 of 71
