Advanced Paramedic Standard 2008

Advanced Paramedic Education and Training Standard
Version 1- Council approved 16th June 2008

____________________________________________________________________________________________ PHECC Education and Training Standards Section G- Advanced Paramedic 1
1.
INTRODUCTIONTOPREHOSPITALEMERGENCYCARE .....................................................................4 . 1.1 1.2 1.3 1.4 1.5 GOVERNANCE,PROFESSIONALISM,ETHICSANDPHECCREGISTRATION..........................................................4 LEGALASPECTSOFPREHOSPITALEMERGENCYCARE...................................................................................5 INFORMATIONMANAGEMENTANDTHEPHECCCLINICALHANDBOOK...........................................................6 HEALTH,SAFETYANDWELFARE.............................................................................................................7 ANATOMYANDPHYSIOLOGY..................................................................................................................8
2.
PATIENTASSESSMENT...................................................................................................................12 2.1 2.2 2.3 2.4 2.5 CLINICALDECISIONMAKING.................................................................................................................12 HISTORYTAKING,DIFFERENTIALDIAGNOSISANDCLINICALIMPRESSION.........................................................13 CLINICALEXAMINATIONOFTHEABDOMEN,ANDRESPIRATORY,CARDIOVASCULARANDNEUROLOGICALSYSTEMS..14 PRIMARYSURVEY,IMMEDIATECAREANDTRANSPORTPRIORITISATION.........................................................15 SECONDARYSURVEY...........................................................................................................................16
3.
RESPIRATORYEMERGENCIES.........................................................................................................17 3.1 3.2 3.3 AIRWAYANDVENTILATORYSUPPORT.....................................................................................................17 PERSISTENTFOREIGNBODYAIRWAYOBSTRUCTION...................................................................................19 INADEQUATERESPIRATION,APNOEAANDOTHERRESPIRATORYEMERGENCIES................................................20
4.
MEDICALEMERGENCIES................................................................................................................21 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 4.9 4.10 4.11 4.12 4.13 4.14 ADVANCEDCARDIACRESPONSE............................................................................................................21 ABNORMALCARDIACCONDITIONS ........................................................................................................22 . CARDIACARRHYTHMIAS......................................................................................................................24 NEUROLOGICALDISORDERS.................................................................................................................26 ABDOMINALEMERGENCIES..................................................................................................................28 PAINMANAGEMENT ..........................................................................................................................29 . DIABETICANDENDOCRINEEMERGENCIES...............................................................................................30 ALLERGIESANDANAPHYLAXIS...............................................................................................................31 POISONING/OVERDOSEEMERGENCIES...................................................................................................32 ENVIRONMENTALEMERGENCIES...........................................................................................................33 BEHAVIOURALEMERGENCIES...............................................................................................................34 SPECIALPATIENTGROUPS....................................................................................................................35 SEPTICAEMIAANDMENINGITIS.............................................................................................................36 VIRALANDNONVIRALINFLUENZATYPEILLNESS.......................................................................................37
5.
OBSTETRICS&GYNAECOLOGY.......................................................................................................38 5.1 5.2 5.3 PREGNANCYANDPREANDPOSTDELIVERYEMERGENCIES..........................................................................38 CHILDBIRTHANDNEONATALRESUSCITATION...........................................................................................39 GYNAECOLOGICALEMERGENCIES..........................................................................................................41
6.
TRAUMA.......................................................................................................................................42 OVERVIEWOFTHEMECHANISMSANDKINEMATICSOFTRAUMA..................................................................42 HAEMORRHAGEANDHYPOVOLAEMICSHOCK..........................................................................................43 SOFTTISSUEANDMUSCULOSKELETALINJURIESINCLUDINGCRUSHINJURIES...................................................44 HEAD,BRAINANDSPINALINJURIES........................................................................................................46 BURNINJURIES..................................................................................................................................48
6.1 6.2 6.3 6.4 6.5 7.
PAEDIATRICEMERGENCIES............................................................................................................49 7.1 7.2 7.3 PAEDIATRICGENERAL.........................................................................................................................49 PAEDIATRICMEDICAL .........................................................................................................................50 . PAEDIATRICTRAUMA..........................................................................................................................52

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____________________________________________________________________________________________ PHECC Education and Training Standards Section G- Advanced Paramedic
8.PREHOSPITALEMERGENCYCAREOPERATIONS..................................................................................53 8.1 9. MAJORINCIDENTMEDICALMANAGEMENTANDSUPPORT........................................................................53
PROFESSIONALDEVELOPMENT......................................................................................................54 9.1 9.2 9.3 9.4 9.5 9.6 9.7 9.8 COMMUNICATION.............................................................................................................................54 MANAGEPERSONALWORKPRIORITIESANDPROFESSIONALDEVELOPMENT....................................................54 WORKEFFECTIVELYWITHOTHERS.........................................................................................................54 MENTORSHIP....................................................................................................................................54 LEADANDPARTICIPATEINWORKTEAMS ................................................................................................54 . CLINICALQUALITYIMPROVEMENT.........................................................................................................56 CHANGEMANAGEMENT......................................................................................................................58 EXPERIENTIALLEARNINGANDREFLECTIVEPRACTICE..................................................................................60
10.CLINICALPROCEDURES.....................................................................................................................62 10.1 10.2 10.3 PHARMACOLOGY...............................................................................................................................62 INFECTIONPREVENTIONANDCONTROL..................................................................................................64 MEDICATIONADMINISTRATION............................................................................................................65
The standard for the Advanced Paramedic builds substantially on the knowledge and competencies of an experienced Paramedic, therefore this standard does not repeat but frequently refers to the relevant units of the 2007 Education and Training Standard- Paramedic level.
1.
INTRODUCTION TO PRE-HOSPITAL EMERGENCY CARE
1.1 Governance, Professionalism, Ethics and PHECC registration Objectives Refer also to the relevant units of the 2007 Education and Training Standard- Paramedic level and the PHECC Code of Professional Conduct and Ethics Knowledge Objectives Demonstrate adequate working knowledge and comprehension of: 1.1.1 1.1.2 1.1.3 1.1.4 1.1.5 1.1.6 Self-regulation as a professional and as a profession Legislation underpinning the ability and licensing of practitioners on the PHECC Register The concepts of good governance The mechanism and maintenance of PHECC registration The PHECC Code of Professional Conduct and Ethics The nature of professionalism and the commitment to continuing professional development (CPD) and lifelong learning and the concepts of professionalism outlined therein The principles of ethical clinical practice Clinical indemnity as it relates to the Advanced Paramedic The difference between an ethical and a moral decision The appropriate action the Advanced Paramedic should take when faced with the situation that another Advanced Paramedic or a Doctor on scene orders a course of action, which may be detrimental to the care of the patient The appropriate action the Advanced Paramedic should take when faced with the situation that a Doctor on scene orders a course of action that would not under normal conditions be part of the Advanced Paramedics scope of practice
1.1.7 1.1.8 1.1.9 1.1.10
1.1.11
Attitudinal Objectives Demonstrate ability to: 1.1.12 1.1.13 1.1.14 1.1.15 Accept and uphold the professional responsibilities of an Advanced Paramedic in accordance with the standards of the PHECC Register Limit practice to that within the Advanced Paramedic responsibilities outlined by the PHECC CPGs Advocate for the resuscitation of patients who may be potential organ donors Strive to apply the highest standards of professionalism
Skills Objectives Demonstrate ability to: 1.1.16 1.1.17 1.1.18 1.1.19 Apply the principles of good governance to practice Work in a patient-centred way applying the principles of ethical clinical practice Apply the principles contained with the PHECC codes and standards Work seamlessly with other healthcare and emergency professionals
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1.
1.2 Legal aspects of pre-hospital emergency care Objectives Refer also to the relevant units of the 2007 Education and Training Standard- Paramedic level
Knowledge Objectives Demonstrate adequate working knowledge and comprehension of: 1.2.1 1.2.2 1.2.3 1.2.4 1.2.5 1.2.6 1.2.7 1.2.8 1.2.9 1.2.10 1.2.11 1.2.12 1.2.13 1.2.14 1.2.15 1.2.16 1.2.17 1.2.18 1.2.19 The concepts of trespass to the person and assault The tort of negligence Valid, explicit and implicit consent The three types of evidence The four sources of legal rules in Ireland The Irish court system The role of the Coroners court The differences between evidence and hearsay The role of an expert witness The concept of Duty of Care The potential conflict between professional standards and the law The basic assessment of patient capacity/ competence The issues around pre-hospital consent The issues surrounding patient refusal The legal status of DNR or DNAR and advance directives in Ireland The issues around managing minors Writing reports or statements, appropriate content, difference between objective and subjective statements The process of detention of mental health patients The legislation underpinning controlled drugs
Attitudinal Objectives Demonstrate ability to: 1.2.20 Accept and uphold the legal responsibilities of an Advanced Paramedic in accordance with the standards of the PHECC Register
Skills Objectives Demonstrate ability to:
1.2.21 1.2.22
Prepare a statement from a simulated case in a manner that meets legislative requirements Demonstrate how to check the relevant sections of an involuntary admission form for a mental health patient
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1.3 Information management and the PHECC Clinical Handbook Objectives Refer also to the relevant units of the 2007 Education and Training Standard- Paramedic level Knowledge Objectives Demonstrate adequate working knowledge and comprehension of: 1.3.1 1.3.2 1.3.3 1.3.4 1.3.5 1.3.6 The benefits of clinical record keeping in pre- hospital emergency care How to maintain the security and confidentiality of clinical and other services files while facilitating access as appropriate The importance of accurate, timely legible and attributable patient clinical records The role of such records in clinical audit and research and the importance of these in improving patient care The PHECC Clinical Handbook (PHECC CPGs, Formulary and similar) The implications of the Data Protection Acts and Freedom of Information Acts on patient records
Attitudinal Objectives Demonstrate ability to: 1.3.7 1.3.8 Apply PHECC guidance regarding information management reliably Use knowledge to support others so that they are competent to fulfil workplace requirements
1.3.9 1.3.10 1.3.11 1.3.12 1.3.13 1.3.14
1.3.15 1.3.16
Use CPGs as a guide for pre-hospital emergency care practice Complete a PHECC PCR for a given patient scenario in a timely and relevant manner in accordance with organisational requirements Evaluate a PCR for accuracy and efficacy Collect, record, process and organise information including from PCRs, accurately using business equipment/ technology as appropriate Maintain an established records system to ensure its integrity Communicate with other team members, colleagues and fellow professionals effectively and constructively regarding information management Access data from the Reporting Module via the PHECC website Prepare an individual care management report based on individual skills and medication provided within a given time period
1.
1.4 Health, Safety and Welfare Objectives Refer also to the relevant units of the 2007 Education and Training Standard- Paramedic level Knowledge Objectives Demonstrate adequate working knowledge and comprehension of: 1.4.1 1.4.2 1.4.3 1.4.4 1.4.5 1.4.6 1.4.7 1.4.8 1.4.9 The function of an organisations Safety Statement The difference between hazard, risk and controls How a hazard, risk and control assessment is carried out The risk control hierarchy The benefits of an occupational health and safety programme in the workplace The term contributory negligence The differences between a near miss and an incident The benefits of incident and near miss reporting Risk reduction approaches related to Advanced Paramedic practice
Attitudinal Objectives Demonstrate ability to: 1.4.10 1.4.11 Help develop and promote a workplace safety culture Openly report risks and errors
1.4.12 1.4.13 1.4.14
Conduct a basic hazard, risk and control assessment of a workplace Analyse relevant workplaces in order to identify, assess and control risks Analyse relevant workplaces/ data in order to evaluate the effectiveness of a health and safety programme
1.
1.5 Anatomy and physiology Objectives Refer also to the relevant units of the 2007 Education and Training Standard- Paramedic level
Knowledge Objectives Demonstrate adequate working knowledge and comprehension of: Fluids and electrolytes 1.5.1 1.5.2 1.5.3 1.5.4 1.5.5 1.5.6 1.5.7 1.5.8 1.5.9 1.5.10 1.5.11 1.5.12 Why electrolytes are important body constituents The importance of buffers in the maintenance of body pH Homeostasis The function of the pH scale Why different body fluids have varying pH values The difference between isotonic, hypotonic and hypertonic The difference between acidosis and alkalosis The basic chemical nature of sugars, protein, lipids, nucleotides and enzymes The difference between the processes of osmosis and diffusion How molecules move within and between body compartments The difference between intra- and extra-cellular fluid Why homeostatic control of intra- and extra-cellular fluids is vital to body function
The cells, tissues and organisation of life 1.5.13 1.5.14 1.5.15 1.5.16 1.5.17 How substances are transported across cell membranes The difference between the structures of epithelial, connective, muscle and nervous tissue How different types of tissues regenerate The structure and function of mucous, serous and synovial membranes The structure and functions of endocrine and exocrine glands
The respiratory system 1.5.18 1.5.19 1.5.20 1.5.21 1.5.22 1.5.23 1.5.24 1.5.25 The outline of the physiology of respiration The difference between external and internal respiration The nervous and chemical mechanism that regulate respiration including the hypoxic drive and the role of CO2 The pulmonary and systemic gaseous exchange How respiration affects the pH of certain body fluids The partial pressures in relation to the respiratory gases The physiological variables affecting respiration The function of smooth muscle in the pulmonary system
The cardiovascular system 1.5.26 1.5.27 1.5.28 1.5.29 1.5.30 1.5.31 1.5.32 1.5.33 1.5.34 1.5.35 1.5.36 1.5.37 1.5.38 1.5.39 1.5.40 1.5.41 1.5.42 1.5.43 The structure and functions of arteries, veins and capillaries The relationship between the different types of blood vessels The difference between vasodilatation and vasoconstriction of blood vessels The mechanism by which the exchange of gases occurs in internal respiration The mechanism by which nutrients, water and waste occurs The circulation of blood to the pelvis and lower limbs The physiology of heart sounds The factors affecting cardiac output The main control mechanism for the regulation of blood pressure The electrical conducting system of the heart The relationship of the electrical activity of the conduction system to the cardiac cycle The properties of cardiac cells The role of sodium and potassium in cardiac muscle contraction The phases of cardiac potential The effect that circulating catecholamine have on the heart Typical venous pathways in the hand and arm Main arterial circulation Mechanism for venous blood flow
The musculoskeletal system 1.5.44 1.5.45 1.5.46 1.5.47 1.5.48 1.5.49 1.5.50 1.5.51 1.5.52 The functions of the main muscles in the face and neck, back, abdominal wall and pelvic floor The relationship of the function of muscles in the limbs to movement The relationship of the structure of each type of bone to their functions The relationship of the structure of the vertebral column with movement and other functions The characteristics of the bones of the appendicular skeleton The relationship of the characteristics of the types of joints with their functions The difference between the functions of muscles, ligaments and tendons The importance of the growth plate to bone development The neuromuscular junction
The digestive system 1.5.53 1.5.54 How peristalsis occurs The functions of the liver, pancreas and gallbladder
The blood 1.5.55 1.5.56 1.5.57 1.5.58 1.5.59 The structure, function and formation of erythrocytes, leucocytes and thrombocytes The function of the constituent parts of plasma The relationship between intracellular and extra-cellular fluids and their effects on haemostasis How coagulation is controlled How the clotting process controls blood loss
The skin 1.5.60 1.5.61 1.5.62 1.5.63 The functions of the skin The difference between primary and secondary healing The layers of the skin, dermis, epidermis, superficial facia, deep facia How blood vessels in the skin respond to heat, cold and to the stress response
The nervous system 1.5.64 1.5.65 1.5.66 1.5.67 1.5.68 1.5.69 1.5.70 1.5.71 1.5.72 1.5.73 The physiology of nerve impulse transmission including the role of neurotransmitters The difference between the functions of sensory and motor nerves How pain is perceived and the rational for referred pain The relationship between the structures of the meninges to its functions The composition cerebrospinal fluid (CSF) in the brain The difference between the functions of white and grey matter The origins of the 31 pairs of spinal nerves The areas innervated by the 8 cervical nerves The functions of the 12 cranial nerves The difference between the sympathetic and parasympathetic nervous system, comparing the structures and neurotransmitters of the 2 divisions
The urinary system 1.5.74 1.5.75 1.5.76 1.5.77 1.5.78 The structure of a nephron The processes involved in the formation of urine How body water and electrolyte balance is maintained The role of kidneys in blood pressure control The storage and passage of urine
The female reproductive system and labour 1.5.79 1.5.80 1.5.81 1.5.82 1.5.83 1.5.84 The main structures comprising the external genitalia The location, structure and function of the uterus How the placenta develops and list its functions The location, structure and function of the umbilical cord The pregnancy induced changes in maternal physiology Foetal circulation and the physiological changes that occur at birth
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The endocrine system 1.5.85 The actions of the hormone aldosterone on the renin-angiotensinaldosterone system in maintaining the water and electrolyte balance in the body. The functions of the hormones adrenaline and noradrenaline and outline their relationship to the sympathetic nervous system The actions of insulin and glucagon
1.5.86 1.5.87
Skills Objectives Demonstrate ability to: 1.5.88 Apply anatomy and physiology knowledge to Advanced Paramedic practice
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2.
PATIENT ASSESSMENT
2.1 Clinical decision making Objectives Refer also to the relevant units of the 2007 Education and Training Standard- Paramedic level Knowledge Objectives Demonstrate adequate working knowledge and comprehension of: 2.1.1 2.1.2 2.1.3 2.1.4 2.1.5 2.1.6 2.1.7 2.1.8 2.1.9 2.1.10 2.1.11 2.1.12 2.1.13 The benefits of using a clinical problem solving model The factors that may influence clinical judgement Forming a clinical impression The strengths and weaknesses of CPGs in decision making Preparation of strategies for effective clinical decision making under pressure The fundamental elements of critical thinking The importance of post intervention reassessment How effective assessment is critical to clinical decision making How Advanced Paramedics attitudes affect assessment and decision making How uncooperative patients affect assessment and decision making The principles of medical direction/ advice The different strategies of medical direction/ advice The principles underpinning treat and discharge decisions
Attitudinal Objectives Demonstrate ability to: 2.1.14 2.1.15 Uphold clinical decisions made based on best practice and anticipate incidents when exceptions may arise Advocate and practice the process of complete patient assessment on all patients
Skills Objectives Demonstrate ability to: 2.1.16 2.1.17 2.1.18 2.1.19 2.1.20 2.1.21 Develop and implement appropriate care management plans for given scenarios Practice effective clinical decision making during clinical practice Practice implementing effective care management plans including evaluation for patients during clinical practice Implement treat and discharge procedures for patients as per PHECC CPGs Apply strategies to prevent patient labelling and tunnel vision Apply strategies to reduce scene distractions
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2.
PATIENT ASSESSMENT
2.2 History taking, differential diagnosis and clinical impression Objectives Refer also to the relevant units of the 2007 Education and Training Standard- Paramedic level
Knowledge Objectives Demonstrate adequate working knowledge and comprehension of: 2.2.1 2.2.2 2.2.3 2.2.4 2.2.5 2.2.6 2.2.7 2.2.8 2.2.9 The purposes of obtaining a detailed medical history The techniques of history taking The importance of open ended questions and the role of closed questions How the skills of communication are employed to facilitate, clarify and interpret a patients medical history Breaking bad news The difference between the past medical and presenting medical history and outline how they often interrelate How a medical history can be gathered concurrently with patient assessment The concepts of differential diagnosis and clinical impression The methods and main terms used in recording medical examinations
Attitudinal Objectives Demonstrate ability to: 2.2.10 2.2.11 2.2.12 Advocate and practice the process of complete history taking on all patients Strive to develop empathetic and therapeutic trusting relationships with patients Value the requirements for confidentiality when obtaining a medical history
Skills Objectives Demonstrate ability to: 2.2.13 2.2.14 2.2.15 Obtain a detailed medical history pertaining to the patients presenting illness/ injury using interviewing skills and techniques Obtain information regarding the patients past medical history How to form a clinical impression and consider differential diagnosis
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2.
PATIENT ASSESSMENT
2.3 Clinical examination of the abdomen, and respiratory, cardiovascular and neurological systems Objectives Refer also to the relevant units of the 2007 Education and Training Standard- Paramedic level
Knowledge Objectives Demonstrate adequate working knowledge and comprehension of: 2.3.1 2.3.2 The techniques of general and focussed clinical examination Advanced Paramedic level examination techniques of the abdomen and respiratory, cardiovascular, neurological systems; including a Face, Arm, Speech and Time (FAST) assessment The implications of typical abnormal findings in each of these systems
2.3.3
Attitudinal Objectives Demonstrate ability to: 2.3.4 Deal sensitively and respectfully with examination of patients recognising the need to keep patients dignity wherever possible
Skills Objectives Demonstrate ability to: 2.3.5 2.3.6 2.3.7 2.3.8 Make some general physical assessments of the patient from nearby/ during approach Focus the clinical examination based upon the presentation and history, as well as the clinical impression Examine the respiratory system using inspection, auscultation, palpation and percussion of the patient generally, the chest and the neck Examine the cardiovascular system using palpation of pulses, capillary refill, examination of the jugular venous pressure, taking a BP, auscultation of the heart Examine the neurological system checking limb sensation and power, and basic cranial nerve functions including those relating to raised intracranial pressure and FAST assessment as appropriate Examine the abdomen to include examination of the abdominal aorta, examination for tenderness, rigidity or rebound tenderness, and auscultation for bowel sounds
2.3.9
2.3.10
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2.
PATIENT ASSESSMENT
2.4 Primary survey, immediate care and transport prioritisation Objectives Refer also to the relevant units of the 2007 Education and Training Standard- Paramedic level
Knowledge Objectives Demonstrate adequate working knowledge and comprehension of: 2.4.1 2.4.2 2.4.3 The purpose of a primary survey The components of a primary survey The types of immediately life-threatening problem which can be found during the primary survey and how to treat them for both medical and trauma patients The differences between a primary survey for a medical and a trauma patient Categorise a patient using Clinical Status Decision and its impact on time/ transport criticality How advanced care and transport requirements of the patient may be prioritised based on the results of the primary survey The appropriateness of on scene care management versus rapid transport to definitive care The reasons for reconsideration concerning the mechanism of injury
2.4.4 2.4.5 2.4.6 2.4.7 2.4.8
Attitudinal Objectives Demonstrate ability to: 2.4.9 2.4.10 Advocate and practice the process of completing a primary survey on all patients Understand the contribution of on scene care and medication management to morbidity / comfort
2.4.11 2.4.12 2.4.13
Carry out a primary survey on a medical and trauma patient Continuous assessment, analysis and prioritising the patients immediate and definitive needs based on the findings of the primary survey Treat the needs found following the relevant PHECC CPGs
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2.
PATIENT ASSESSMENT
2.5 Secondary survey Objectives Refer also to the relevant units of the 2007 Education and Training Standard- Paramedic level Knowledge Objectives Demonstrate adequate working knowledge and comprehension of: 2.5.1 2.5.2 2.5.3 2.5.4 2.5.5 2.5.6 2.5.7 2.5.8 The purpose of a secondary survey The components of a secondary survey Categorise a patient using medical early warning system (MEWS) How advanced care and transport requirements of the patient may be prioritised or revised based on the results of the secondary survey How the finding of the secondary survey contribute to establishing presenting problems and forming a clinical impression The differences between the physical exam for the trauma and the medical patient Rapid Physical Exam System- based assessments of the respiratory, cardiovascular, neurological, gastrointestinal, locomotor and genito-urinary systems as appropriate to Advanced Paramedic practice
Attitudinal Objectives Demonstrate ability to: 2.5.9 2.5.10 2.5.11 Advocate and practice the process of completing a secondary survey on all patients; time permitting Understand the limitation of the pre-hospital physical examination Value the importance of continuous assessment
2.5.12 2.5.13 2.5.14 2.5.15
Carry out a secondary survey on a medical and a trauma patient Carry out a Rapid Physical Exam Continuously assess, analyse and prioritise the patients immediate and definitive needs based on the findings of the secondary survey Treat the needs found following the relevant PHECC CPGs
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3.
RESPIRATORY EMERGENCIES
3.1 Airway and ventilatory support Objectives Refer also to the relevant units of the 2007 Education and Training Standard- Paramedic level
Knowledge Objectives Demonstrate adequate working knowledge and comprehension of: 3.1.1 3.1.2 3.1.3 3.1.4 3.1.5 3.1.6 3.1.7 3.1.8 3.1.9 3.1.10 3.1.11 The measurement of oxygen and carbon dioxide in the blood The pre-hospital emergency assessment findings and evaluation of respiratory function The gag reflex Tracheostomies, stoma and the tracheostomy tube The management of an occluded stoma or tracheostomy tube with mucous The risk of infection to pre-hospital emergency care practitioners associated with ventilation Rigid and soft suction catheters and the conditions when each should be used The purpose of upper airway suctioning and describe the procedure The purpose and procedure for tracheobronchial suctioning in the intubated patient The concept of the airway management ladder The indications, contraindications, benefits, limitations, complications, equipment and procedure of endotrachael intubation, Laryngeal mask airway/ laryngeal tube (LMA/LT) insertion and use of any other PHECC CPG approved advanced airway devices Gastric distention and the factors that precipitate its occurrence The methods to confirm correct placement of an endotrachael tube (ETT) The methods for securing an endotrachael tube The indications, contraindications, procedure and complications for extubation The special considerations in airway management and ventilation for patients with facial injuries
3.1.12 3.1.13 3.1.14 3.1.15 3.1.16
Attitudinal Objectives Demonstrate ability to: 3.1.17 3.1.18 Advocate for the patient who requires airway and ventilatory support Use advanced airway skills appropriately
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Skills Objectives Demonstrate ability to: 3.1.19 3.1.20 3.1.21 3.1.22 3.1.23 Insert and secure an ETT, an LMA/LT and any other advanced airway devices as per PHECC CPGs confirming correct placement Use end-tidal CO2 detection - Colour metric & capnography Manage an occluded stoma or tracheostomy tube with mucous Perform ETT tracheobronchial suctioning in the intubated patient Remove an advanced airway
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3.
3.2 Persistent foreign body airway obstruction Objectives Refer also to the relevant units of the 2007 Education and Training Standard- Paramedic level
Knowledge Objectives Demonstrate adequate working knowledge and comprehension of: 3.2.1 3.2.2 3.2.3 3.2.4 The causes of upper airways obstruction Complete airway obstruction The implications of partial airway obstruction with good and poor air exchange The pre-hospital emergency care assessment findings and *care management of the patient with partial airway obstruction and complete airway obstruction The visual landmarks for direct laryngoscopy Laryngoscopy to remove a foreign body airway obstruction The indications for performing a needle cricothyrotomy The equipment required when performing a needle cricothyrotomy
3.2.5 3.2.6 3.2.7 3.2.8
Attitudinal Objectives Demonstrate ability to: 3.2.9 Empathise with the relatives or bystanders who witness a patient with airway obstruction understanding the acuteness of the condition
Skills Objectives Demonstrate ability to: 3.2.10 Perform a rapid pre-hospital emergency assessment and *care management of the patient with partial airway obstruction and complete airway obstruction Perform laryngoscopy Retrieve foreign bodies from the upper airway using laryngoscopy and forceps or suction Perform endotracheal intubation where removal of foreign body obstruction is not possible with forceps Perform needle cricothyrotomy Perform the pre-hospital emergency assessment and *care management of the patient with all the conditions listed above
3.2.11 3.2.12 3.2.13 3.2.14 3.2.15
*Care management includes the administration of approved medication(s) as per the PHECC CPGs
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3.
3.3 Inadequate respiration, apnoea and other respiratory emergencies Objectives Refer also to the relevant units of the 2007 Education and Training Standard- Paramedic level Knowledge Objectives Demonstrate adequate working knowledge and comprehension of: 3.3.1 The aetiology and pathophysiology of each of the following conditions Chronic obstructive airway disease Asthma Broncholitis Pneumonia Pulmonary embolism Pulmonary oedema Simple and Tension pneumothoraces Respiratory arrest Inhalation injury Haemothoraces Inadequate respiratory depth and rate associated with narcotic overdose, allergic reactions, Stroke and traumatic brain injury The pre-hospital emergency assessment findings and *care management of the patient with the conditions listed above The differences between hypoxia and hypoxemia The time/ transport critical features of respiratory conditions The indication, equipment and procedure for needle thoracocentesis The indication, equipment and procedure for continuous positive airway pressure (CPAP) therapy
3.3.2 3.3.3 3.3.4 3.3.5 3.3.6 3.3.7
Attitudinal Objectives Demonstrate ability to: 3.3.8 3.3.9 3.3.10 Understand the sense of urgency for assessment and care management in the patient with inadequate respiration Advocate for the patient who requires airway and ventilatory support Empathise with the patient who has a respiratory emergency
Skills Objectives Demonstrate ability to: Perform the pre-hospital emergency assessment and *care management of the patient with all the conditions listed above 3.3.12 Demonstrate CPAP therapy *Care management includes the administration of approved medication(s) as per the PHECC CPGs
3.3.11
4.
MEDICAL EMERGENCIES
4.1 Advanced cardiac response Objectives Refer also to the relevant units of the 2007 Education and Training Standard- Paramedic level Knowledge Objectives Demonstrate adequate working knowledge and comprehension of: 4.1.1 4.1.2 4.1.3 4.1.4 4.1.5 4.1.6 The principles behind the latest International Liaison Committee on Resuscitation guidelines The prime importance of excellent chest compressions in all cardiopulmonary resuscitation (CPR) Understand why minimal or no interruption to CPR is critical to outcomes The prime importance of quick and safe defibrillation for ventricular fibrillation (VF)/ pulseless ventricular tachycardia (VT) arrest Methodologies to maximise effective CPR between deliveries of shocks The rationale for the use of Advanced Paramedic medications in cardiac emergencies and their relevant importance in cardiac arrest compared to CPR and DC shocks Understand the aetiology and treatment rationale for non-shockable arrests The complex issues surrounding when not to resuscitate and when to cease resuscitative efforts The benefits of induced hypothermia post VF arrest The role of AED and ECG in trauma
4.1.7 4.1.8 4.1.9 4.1.10
Attitudinal Objectives Demonstrate ability to: 4.1.11 4.1.12 Understand the sense of urgency for assessment and care management in the patient with apparent cardiac arrest Advocate for the patient who has arrested
Skills Objectives Demonstrate ability to: 4.1.13 4.1.14 Perform the pre-hospital emergency assessment and *care management of the patient with all the conditions listed above Decide which actions are appropriate when treating such patients as a solo responder or as part of a team
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4.
MEDICAL EMERGENCIES
4.2 Abnormal cardiac conditions Objectives Refer also to the relevant units of the 2007 Education and Training Standard- Paramedic level Knowledge Objectives Demonstrate adequate working knowledge and comprehension of: 4.2.1 4.2.2 4.2.3 4.2.4 4.2.5 The incidence, morbidity and mortality of cardiovascular disease (CVD) in Ireland Prevention strategies that may reduce the morbidity and mortality of CVD The risk factor profile of CVD The zones of ischaemia, injury and infarct and differentiate between a transmural and subendocardial infarct The aetiology and pathophysiology of: Atherosclerosis Arteriosclerosis Thrombosis Ischaemia Angina, stable and unstable Acute myocardial infarct Left ventricular failure Cardiogenic shock The pre-hospital emergency assessment findings and *care management of the patient with the conditions listed above The differential diagnosis of chest pain The difference between pain of cardiac and non-cardiac origin The time/ transport critical features of cardiac conditions The role of aspirin, oxygen, nitrates, analgesia, thrombolytic agents and any other relevant PHECC CPG treatments in treating myocardial infarction The role of percutaneous coronary intervention (PCI) The rationale and evidence base for pre-hospital administration of thrombolytic agents The selection of a patient eligible for thrombolytic therapy The administration of thrombolytics, and their contra-indications and side effects The recommendations of the DoHC (2006) Task Force Report on Sudden Cardiac Death as it relates to timely reperfusion (R 5.37 and 5.38, p. 108111) The cardiac surfaces or areas represented by the ECG leads The changes to each monitoring lead that occurs as a result of the following conditions: ST elevation myocardial infarction Non-ST elevation myocardial infarction Ischaemia/ angina
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4.2.6 4.2.7 4.2.8 4.2.9 4.2.10
4.2.11 4.2.12 4.2.13 4.2.14 4.2.15
4.2.16 4.2.17
4.2.18 4.2.19 4.2.20 4.2.21 4.2.22 4.2.23 4.2.24 4.2.25
Right bundle branch block Left bundle branch block The three abnormal pulses deficit, paradoxus and alternans The timeline window of opportunity as it pertains to reperfusion of a myocardial injury or infarction The characteristics of a patient who is eligible for thrombolytic therapy The options available for reperfusion therapy The characteristics of, clinical feature of, interpretation and management of patients in hypertensive crisis The pathophysiology of vascular disorders Define the terms aneurysm, cardiac tamponade, claudication and phlebitis The signs and symptoms that develop following peripheral artery occlusion, dissecting thoracic or abdominal aneurysm and the prehospital treatment plan for these patients
Attitudinal Objectives Demonstrate ability to: 4.2.26 4.2.27 4.2.28 Understand the sense of urgency for assessment and care management in the patient with cardiac compromise Understand the sense of urgency required to protect the reperfusion opportunity in the patient suspected of a myocardial infarct Understand the decision to possibly discontinue resuscitative efforts in cardiac arrest patients
Skills Objectives Demonstrate ability to: 4.2.29 4.2.30 Perform the pre-hospital emergency assessment and *care management of the patient with all the conditions listed above Using the CPG differentiate between the patient that will be transported to a facility for PCI verses a patient who will receive pre-hospital thrombolytic therapy Using a PCR identify a patient who qualifies for thrombolysis Demonstrate the pre-hospital emergency *care management of the patient with cardiac tamponade, a hypertensive emergency, peripheral artery occlusion, a dissecting thoracic or abdominal aneurysm Use semi-automatic and manual defibrillators
4.2.31 4.2.32
4.2.33
23
4.
MEDICAL EMERGENCIES
4.3 Cardiac arrhythmias Objectives Refer also to the relevant units of the 2007 Education and Training Standard- Paramedic level
Knowledge Objectives Demonstrate adequate working knowledge and comprehension of: 4.3.1 4.3.2 4.3.3 4.3.4 Patient presentations where ECG rhythm analysis is indicated How to identify and correct the various causes of artefact on a 12 lead ECG The characteristics, description and significance of the ECG waves, complexes, interval and segments The electrophysiological and haemodynamic events occurring throughout the entire cardiac cycle with the various ECG waves, segments and intervals The aetiology and pathophysiology of each of the following conditions: Ventricular fibrillation and Pulseless ventricular tachycardia Pulseless electrical activity Asystole Symptomatic bradycardia Supraventricular tachycardia Atrial Flutter Atrial Fibrilation The pre-hospital emergency assessment findings and *care management of the patient with the conditions listed above The features of an automated implantable defibrillator and any special considerations when caring for a patient with one The ECG characteristics of an implantable pacemaker system and recognise a malfunctioning internal pacemaker The benefits of early advanced cardiac life support to patients pre-hospital The significance of hypothermia in cardiac arrest
4.3.5
4.3.6 4.3.7 4.3.8 4.3.9 4.3.10
Attitudinal Objectives Demonstrate ability to: 4.3.11 Collaborate with all members of the pre-hospital emergency care team to maximise the benefits to patients with cardiac compromise
24
Skills Objectives Demonstrate ability to: 4.3.12 4.3.13 Perform the pre-hospital emergency assessment and *care management of the patient with all the conditions listed above Perform 12 lead ECG and interpret a wide range of arrhythmias, including: Ventricular fibrillation Idioventricular rhythm Premature atrial contractions Premature ventricular contraction First degree AV-nodal block Second degree Wenkebach block Second degree Mobitz II block Third degree block Junctional escape beats and rhythms Right bundle branch block
Normal Sinus rhythm Sinus arrhythmias Atrial flutter Atrial fibrillation Junctional rhythm Supraventricular tachycardia (SVT) SVT with aberrant conduction Ventricular tachycardia Torsades-de-Pointes Ventricular escape beats and rhythms Left bundle branch block
25
4.
MEDICAL EMERGENCIES
4.4 Neurological disorders Objectives Refer also to the relevant units of the 2007 Education and Training StandardParamedic level Knowledge Objectives Demonstrate adequate working knowledge and comprehension of: 4.4.1 The aetiology and pathophysiology of each of the following conditions: Stroke Intracranial haemorrhage Transient ischemic attack Meningitis/ meningococcal septicaemia Multiple sclerosis Parkinsons disease Neurogenic shock Seizure disorders/ convulsions Headache Intra cerebral mass The aetiology of convulsions to include: Epilepsy Hypoxia Febrile convulsions Intracerebral insult/ head injury Hypoglycaemia Hypothermia Drug related Eclampsia Meningitis The pre-hospital emergency assessment findings and *care management of the patient with the conditions listed above The major types of seizures The phases of a generalised seizure The categories of Stroke Rationale behind stroke thrombolysis AHA guideline The time/ transport critical features of neurological disorders The protective measures for exposure prone procedures for patients with confirmed meningococcal disease and outline public health guidelines for follow up
4.4.2
4.4.3 4.4.4 4.4.5 4.4.6 4.4.7 4.4.8 4.4.9
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Attitudinal Objectives Demonstrate ability to: 4.4.10 4.4.11 Convey empathy to patients whose ability to communicate is limited by their condition Empathise with the patient who regains consciousness among strangers
Skills Objectives Demonstrate ability to: 4.4.12 Perform the pre-hospital emergency assessment and *care management of the patient with all the conditions listed above
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4.
MEDICAL EMERGENCIES
4.5 Abdominal emergencies Objectives Refer also to the relevant units of the 2007 Education and Training Standard- Paramedic level
Knowledge Objectives Demonstrate adequate working knowledge and comprehension of: 4.5.1 4.5.2 4.5.3 The common causes of an acute abdomen The typical history and presenting symptoms and signs of an acute abdomen and of obstruction The pre-hospital emergency assessment findings and *care management of the patient with the conditions listed above
Attitudinal Objectives Demonstrate ability to: 4.5.4 Understand the need for urgency and analgesia for patients with acute abdominal emergencies
Skills Objectives Demonstrate ability to: 4.5.5 Perform the pre- hospital assessment and *care management of the patient with all the conditions listed above
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4.
MEDICAL EMERGENCIES
4.6 Pain management Objectives Refer also to the relevant units of the 2007 Education and Training StandardParamedic level
Knowledge Objectives 4.6.1 Demonstrate adequate working knowledge and comprehension of: 4.6.2 4.6.3 4.6.4 4.6.5 4.6.6 4.6.7 The physiology of pain The various types of pain The pre-hospital emergency assessment findings and *care management of pain The therapeutic goals of pain relief The non medicinal options for pain relief The benefits and limitations of the interview mnemonic (PQRST) Provocation, Quality, Region / Referral / Recurrence / Relief, Severity and Time and the analogue scale 0-10 The difference between the descriptors: Stabbing/ Sharp Crushing Acute Chronic Pulsating Burning Dull Cramps The time/ transport critical features of pain The medical, pharmacological, physiological and legal aspects of pain management using the medication within the relevant PHECC CPGs
4.6.8
4.6.9 4.6.10
Attitudinal Objectives Demonstrate ability to: 4.6.11 Respect the feelings that patient with pain, acute or chronic may be experiencing and support empathetically
Skills Objectives Demonstrate ability to: Perform the pre-hospital emergency assessment and *care management of the patient in pain *Care management includes the administration of approved medication(s) as per the PHECC CPGs
4.6.12
4.
MEDICAL EMERGENCIES
4.7 Diabetic and Endocrine emergencies Objectives Refer also to the relevant units of the 2007 Education and Training Standard- Paramedic level
Knowledge Objectives Demonstrate adequate working knowledge and comprehension of: 4.7.1 4.7.2 4.7.3 4.7.4 4.7.5 4.7.6 4.7.7 4.7.8 4.7.9 4.7.10 4.7.11 4.7.12 4.7.13 The aetiology and pathophysiology of diabetes mellitus including ketone formation The normal range of blood glucose levels and the significance of variations to these The difference between the types of diabetes mellitus The complications of diabetes mellitus How insulin and glucagon work and incidents when they dont The abnormal findings in assessment with clinical significance in the patient with hypoglycaemia The bodys physiological reaction to hypoglycaemia including gluconeogenesis The abnormal findings in assessment with clinical significance in the patient with hyperglycaemia The signs and symptoms of the patient with diabetic ketoacidosis The pre-hospital emergency assessment findings and *care management of diabetic emergencies The time/ transport critical features of diabetic emergencies Common diabetic medication including insulin Definition of Addisonian crisis and its appropriate treatment
Attitudinal Objectives Demonstrate ability to:
4.7.14
Empathise with the patient who regains consciousness among strangers
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4.
MEDICAL EMERGENCIES
4.8 Allergies and anaphylaxis Objectives Refer also to the relevant units of the 2007 Education and Training Standard- Paramedic level
Knowledge Objectives Demonstrate adequate working knowledge and comprehension of: 4.8.1 4.8.2 4.8.3 4.8.4 4.8.5 4.8.6 4.8.7 4.8.8 4.8.9 4.8.10 4.8.11 4.8.12 The inflammatory response including causes and cardinal signs The benefits and harmful effects of acute inflammation The types of allergic response The risk factors most predisposing to anaphylaxis The pathophysiology of allergy and anaphylaxis including the formation of antibodies The common antigens most frequently associated with anaphylaxis The common methods of entry of substances into the body The difference between manifestations of an allergic reaction from anaphylaxis The abnormal findings in assessment with the clinical significance in the patient with anaphylaxis The aetiology and pathophysiology of anaphylactic shock The pre-hospital emergency assessment findings and *care management of the patient with anaphylaxis The time/ transport critical features of anaphylaxis
Attitudinal Objectives Demonstrate ability to: 4.8.13 Empathise with the patient, relatives or bystanders who witness a patient with anaphylaxis understanding the acuteness of the condition
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4.
MEDICAL EMERGENCIES
4.9 Poisoning/ overdose emergencies Objectives Refer also to the relevant units of the 2007 Education and Training Standard- Paramedic level Knowledge Objectives Demonstrate adequate working knowledge and comprehension of: 4.9.1 4.9.2 4.9.3 4.9.4 4.9.5 The time/ transport critical features of poisoning/ overdose emergencies The term antidote The role of the National Poisons Information Centre The assessment findings associated with various toxic groups The treatment and pharmacological interventions including antidotes available to the Advanced Paramedic in the management of the poisonings The term overdose The most common poisonings by overdose The signs and symptoms related to the most common poisonings by overdose The pre-hospital emergency assessment findings and *care management of the patient with poisoning and overdose The time/ transport critical features of poisoning and overdose Drug abuse in Ireland The most commonly abused drugs (both by chemical name and street names) The pathophysiology of commonly used drugs The signs and symptoms related to the most commonly abused drugs The pathophysiological principles and the assessment findings to formulate a clinical impression and implement a *care management plan for the patient with the most common poisonings and overdose The unreliable nature of the history in cases of overdose
4.9.6 4.9.7 4.9.8 4.9.9 4.9.10 4.9.11 4.9.12 4.9.13 4.9.14 4.9.15
4.9.16
Attitudinal Objectives Demonstrate ability to: 4.9.17 4.9.18 Empathise with the patient, relatives or bystanders who witness a patient with poisoning or overdose understanding the acuteness of the condition Act in a non- judgemental and professional manner when managing selfpoisoning and harm cases
4. 4.10
MEDICAL EMERGENCIES Environmental emergencies
Objectives Refer also to the relevant units of the 2007 Education and Training Standard- Paramedic level
Knowledge Objectives Demonstrate adequate working knowledge and comprehension of: 4.10.1 4.10.2 4.10.3 4.10.4 The time/ transport critical features of environmental emergencies The aetiology and pathophysiology of heat / cold emergencies The role of fluid therapy in the treatment of a heat / cold emergencies The pre-hospital emergency assessment findings and *care management of the patient with heat / cold emergencies a bite or sting an immersion incident a diving emergency The time/ transport critical features of the conditions listed above
4.10.5
Attitudinal Objectives Demonstrate ability to: 4.10.6 Empathise with the patient, relatives or bystanders who witness a patient with an environmental emergency understanding the acuteness of the condition
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4. 4.11
MEDICAL EMERGENCIES Behavioural emergencies
Knowledge Objectives Demonstrate adequate working knowledge and comprehension of: 4.11.1 4.11.2 4.11.3 4.11.4 4.11.5 4.11.6 The time/ transport critical features of behavioural emergencies Behavioural emergencies The medical legal considerations for management of behavioural emergency The pathophysiology of behavioral disorders The techniques for physical assessment in a patient with behavioral disorder The pre-hospital emergency assessment findings and *care management of the patient with a behavioral disorder
Attitudinal Objectives Demonstrate ability to: 4.11.7 4.11.8 Empathise with the relatives or bystanders who witness a patient with a behavioural emergency understanding the acuteness of the condition Understand that a behavioural disorder may have a complex aetiology
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4. 4.12
MEDICAL EMERGENCIES Special patient groups
Knowledge Objectives Demonstrate adequate working knowledge and comprehension of: 4.12.1 Brief overview of Minority ethnic and cultural groups Hearing impaired Vision impaired Life-limiting illness patients Arthritis patients Psychiatric illness patients Those with learning disabilities including Downs Syndrome Multiple Sclerosis patients Spina Bifida patients Myaesthenia Gravis patients Chronic Fatigue patients Elderly patients, in particular the polypathology and polypharmacy implications of assessment and treatment of this group Elder abuse and abuse of any special patient groups, and the role of patient advocacy The common causes of acute and chronic confusion in the elderly, and the key differences in the history, presentation, findings and management between these two groups
4.12.2 4.12.3 4.12.4
Attitudinal Objectives Demonstrate ability to: 4.12.5 Empathise with the patient who may have communication, sensory, mobility or learning difficulties and make appropriate remediation and/or allowances for these
Skills Objectives Demonstrate ability to: Perform the pre-hospital emergency assessment and *care management of a patient within any of the above groups 4.12.7 Differentiate between acute and chronic confusion in the elderly by history or presentation *Care management includes the administration of approved medication(s) as per the PHECC CPGs
4.12.6
4. 4.13
MEDICAL EMERGENCIES Septicaemia and meningitis
Knowledge Objectives Demonstrate adequate working knowledge and comprehension of: 4.13.1 4.13.2 4.13.3 The key causes and presentations of septicaemia and meningitis, including meningococcal disease and toxic shock syndrome The difference between septicaemia and meningitis The time/ transport critical features of septicaemia and meningitis
Attitudinal Objectives Demonstrate ability to: 4.13.4 Empathise with the relatives or bystanders who witness a patient with septicaemia or meningitis understanding the acuteness of the condition
Skills Objectives Demonstrate ability to: 4.13.5 4.13.6 4.13.7 Consider septicaemia and meningitis in all appropriate patients Recognise rapid deterioration a critical history finding in meningococcal disease Perform the pre-hospital emergency assessment and *care management of the patient with all the conditions listed above
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4. 4.14
MEDICAL EMERGENCIES Viral and non-viral influenza type illness
Knowledge Objectives Demonstrate adequate working knowledge and comprehension of: 4.14.1 4.14.2 4.14.3 4.14.4 Common routes of spread of flu-type infection and methods to reduce risk Usual history and presentation, signs and symptoms of flu-like illness The currently available tools to prioritise patients with flu-like illness Currently available guidance on case identification, appropriate reporting, transportation and admission arrangements
Attitudinal Objectives Demonstrate ability to: 4.14.5 Deal sensitively with patients and relatives of patients with flu-like illness
Skills Objectives Demonstrate ability to: 4.14.6 Use currently available guidance in prioritising, transporting and managing patients with the above types of illness while managing infection control precautions
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5.
OBSTETRICS & GYNAECOLOGY
5.1 Pregnancy and pre and post-delivery emergencies Objectives Refer also to the relevant units of the 2007 Education and Training Standard- Paramedic level
Knowledge Objectives Demonstrate adequate working knowledge and comprehension of: 5.1.1 5.1.2 5.1.3 5.1.4 5.1.5 5.1.6 5.1.7 5.1.8 5.1.9 The normal anatomical and physiological changes during pregnancy and limits beyond which they become pathological The changes in and resulting from pre-existing disease, including asthma, diabetes, heart disease and hypertension The significance of trauma during pregnancy including seat belt injury and domestic violence The significance of cardiac arrest during pregnancy The pre-hospital emergency care assessment findings of a pregnant woman and relate these to the gestational period The position of the fundus and gestational age The indications for an inspection of the vulva, taking into account consent and cultural issues into consideration Gestational diabetes The pre-hospital emergency care assessment findings and *care management of the patient with the following emergencies: antepartum haemorrhage ectopic pregnancy pre-eclampsia eclampsia post-partum haemorrhage The time/ transport critical features of pregnancy related conditions
5.1.10
Attitudinal Objectives Demonstrate ability to: 5.1.11 Value the importance of maintaining a patients modesty and privacy while being able to examine physically and interview as appropriate
5.
5.2 Childbirth and neonatal resuscitation Objectives Refer also to the relevant units of the 2007 Education and Training Standard- Paramedic level
Knowledge Objectives Demonstrate adequate working knowledge and comprehension of: 5.2.1 5.2.2 5.2.3 5.2.4 The stages of labour and describe the mechanisms responsible for parturition The physiology of the umbilical cord and maternal/ baby circulation after birth The pre-hospital emergency care assessment findings of a pregnant woman when birth is imminent and during a delivery The pre-hospital emergency assessment findings and *care management of the following umbilical cord complications; Prolapsed cord Cord rupture Short cord Cord around the babys neck The types of breech presentation The pre-hospital emergency assessment findings and *care management of the following deliveries; multiple deliveries breech presentation limb presentations post partum haemorrhage The consequences of the presence of meconium amniotic fluid during delivery The causes of haemorrhage during pregnancy and postpartum Normal and pathological levels of blood loss during childbirth The pre-hospital emergency assessment findings and *care management of perineal tearing and post partum haemorrhage The significance of a premature baby The importance of post delivery temperature control for the newly born The time/ transport critical features of childbirth and neonatal care Neonatal and maternal resuscitation as per the PHECC CPGs
5.2.5
5.2.6 5.2.7 5.2.8 5.2.9 5.2.10 5.2.11 5.2.12 5.2.13
Attitudinal Objectives Demonstrate ability to: 5.2.14 Value the importance of maintaining a patients modesty and privacy during assessment and management of a delivery
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Skills Objectives Demonstrate ability to: 5.2.15 5.2.16 Perform the pre-hospital emergency assessment and *care management of the patient with all the conditions listed above Demonstrate inserting a urinary catheter
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5.
5.3 Gynaecological emergencies Objectives Refer also to the relevant units of the 2007 Education and Training Standard- Paramedic level
Knowledge Objectives Demonstrate adequate working knowledge and comprehension of: 5.3.1 5.3.2 5.3.3 5.3.4 5.3.5 Toxic shock syndrome Threatened miscarriage Ectopic pregnancy The time/ transport critical features of these conditions Managing sexual assault for males and females
Attitudinal Objectives Demonstrate ability to: 5.3.6 Empathise with the relatives or bystanders who witness a patient with any of these conditions understanding the acuteness of the condition
Skills Objectives Demonstrate ability to: 5.3.7 5.3.8 5.3.9 Consider pregnancy, threatened miscarriage and toxic shock in all appropriate patients (i.e. any woman of child bearing age) Take a focussed clinical history Perform the pre-hospital emergency assessment and *care management of the patient with all the conditions listed above
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6.
TRAUMA
6.1 Overview of the mechanisms and kinematics of trauma Objectives Refer also to the relevant units of the 2007 Education and Training Standard- Paramedic level
Knowledge Objectives Demonstrate adequate working knowledge and comprehension of: 6.1.1 6.1.2 6.1.3 6.1.4 6.1.5 Energy and force as they relate to trauma The terms; mechanism of injury, down and under, up and over velocity, acceleration, deceleration, kinetic energy and gravity The pathophysiology of the head, spine, thorax and abdomen that occur from the result of the above forces How trauma injuries may be predicted based on the mechanism of injury The principles of kinetic energy transfer in relation to the three impacts of a road traffic accident
Attitudinal Objectives Demonstrate ability to: 6.1.6 6.1.7 Adopt a cautious approach to patients with significant mechanism of injury but who appear initially stable Respond to the feelings that the patient or family may be experiencing at the scene of a traumatic injury
Skills Objectives Demonstrate ability to: 6.1.8 6.1.9 Relate energy and force to possible occult injury Assess and prioritise patients injured in the setting of a traumatic incident
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6.
TRAUMA
6.2 Haemorrhage and hypovolaemic shock Objectives Refer also to the relevant units of the 2007 Education and Training Standard- Paramedic level
Knowledge Objectives Demonstrate adequate working knowledge and comprehension of: 6.2.1 6.2.2 6.2.3 6.2.4 6.2.5 6.2.6 6.2.7 6.2.8 6.2.9 6.2.10 6.2.11 6.2.12 6.2.13 The various types of and degrees of haemorrhage and shock The pathophysiology of haemorrhage and shock The bodys physiological response to changes in perfusion The difference between controlled and uncontrolled haemorrhage The difference between compensated and uncompensated haemorrhagic shock The pre-hospital emergency assessment findings and *care management of the patient with haemorrhage and shock, including tourniquet use The time/ transport critical features of haemorrhage and hypovolaemic shock The requirement to replace lost blood volume The differences between Crystalloid and Colloid fluid The role of medical direction in fluid replacement therapy The routes of administration of fluid therapy The difference in selecting a cannula and a site for vascular access in the trauma patient The difference between manual and mechanical intraosseous devices
Attitudinal Objectives Demonstrate ability to: 6.2.14 6.2.15 Understand the importance of a thorough patient assessment Defend why basic life support takes priority over wound closure
Skills Objectives Demonstrate ability to: 6.2.16 6.2.17 Perform the pre-hospital emergency assessment and *care management of the patient with all the conditions listed above Demonstrate tourniquet use
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6.
TRAUMA
6.3 Soft tissue and musculoskeletal injuries including crush injuries Objectives Refer also to the relevant units of the 2007 Education and Training Standard- Paramedic level
Knowledge Objectives Demonstrate adequate working knowledge and comprehension of: 6.3.1 6.3.2 6.3.3 The assessment, prevention and pre-hospital emergency *care management of wound infection The time/ transport critical features of soft tissue, musculoskeletal and crush injuries The pathophysiology, presentation and pre-hospital emergency *care management of the following: Fractures Contusion Haematoma Abrasions Lacerations Major arterial lacerations Avulsions Impaled objects Amputations Incisions Blast injuries Penetrations/ punctures including those from conducted electrical weapons (Taser guns) Barotrauma Chest wall injuries i. Rib fractures ii. Flail segment iii. Sternal Fracture iv. Sucking wounds Lung injury i. Simple, open, closed and tension pneumothorax ii. Haemothorax iii. Pulmonary contusion iv. Traumatic asphyxia Myocardial injury i. Cardiac tamponade (pericardiocentesis) ii. Myocardial contusion and rupture Vascular injury including to major vessels Visceral injury including i. Oesophagus, Trachea, Bronchus, Diaphragm
44
6.3.4
Pelvic injury i. Basin effect Crush syndrome i. Renal failure ii. Rhabdomyolyosis Compartment syndrome Abdominal injury i. Open injury ii. Closed injury iii. Solid and hallow organ injuries The pre-hospital emergency assessment findings and *care management of the patient with the trauma injuries above according to the mechanisms involved
6.3.5 6.3.6
Understand the importance of a thorough patient assessment, with soft tissue, and musculoskeletal injuries including crush injuries. Empathise with the relatives or bystanders who witness a patient with a soft tissue and musculoskeletal injuries understanding the acuteness of the condition
6.3.7
Perform the pre-hospital emergency assessment and *care management of the patient with all the conditions listed above
45
6.
TRAUMA
6.4 Head, brain and spinal injuries Objectives Refer also to the relevant units of the 2007 Education and Training Standard- Paramedic level
Knowledge Objectives Demonstrate adequate working knowledge and comprehension of: 6.4.1 6.4.2 6.4.3 The motion and energy considerations of mechanisms of injury other than a road traffic accident The pathophysiology of the following traumatic injuries Head / Brain Injuries Raised ICP (relationship of O2 & CO2) Diffuse axonal injury GCS and the classification into mild, moderate and severe head injury Brain haemorrhage i. Extra dural ii. Sub dural iii. Intra cerebral iv. Sub arachnoid Facial - Including the specific consequences Eye Ear Nose Throat Mouth Affects on the airway Spinal- Spinal cord syndromes Traumatic Non traumatic i. Low back pain ii. Herniated intervertebral disc
6.4.4
Attitudinal Objectives Demonstrate ability to: 6.4.5 The pre-hospital emergency assessment findings and *care management of the patient with the trauma injuries above according to the mechanisms involved The principles underlying the PHECC CPG spinal immobilisation decision tree The time/ transport critical features of traumatic injuries Respond to the feelings that the patient or family may be experiencing at the scene and during transport of a traumatic injury
46
6.4.6 6.4.7 6.4.8
6.4.9 6.4.10
Perform the pre-hospital emergency assessment and *care management of the patient with all the conditions listed above Practical application of the PHECC CPG spinal immobilisation decision tree to the trauma patient
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6.
TRAUMA
6.5 Burn injuries Objectives Refer also to the relevant units of the 2007 Education and Training Standard- Paramedic level
Knowledge Objectives Demonstrate adequate working knowledge and comprehension of: 6.5.1 The pathophysiology of local and systemic responses to burns Inhalation Electrical (Based on an understanding of electrical conduction) Thermal Chemical Radiation Cold burns The pre-hospital emergency assessment findings and *care management of burns Personal safety issues involved in treating patients with chemical and electrical injury
6.5.2 6.5.3
6.5.4
Understand the importance of a thorough patient assessment, with the realisation that burns are often associated with other significant injuries
Skills Objectives Demonstrate ability to: Perform the pre-hospital emergency care assessment and *care management of the patient with burn injury
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7.
PAEDIATRIC EMERGENCIES
7.1 Paediatric general Objectives Refer also to the relevant units of the 2007 Education and Training Standard- Paramedic level
Knowledge Objectives Demonstrate adequate working knowledge and comprehension of: 7.1.1 7.1.2 7.1.3 7.1.4 7.1.5 7.1.6 7.1.7 7.1.8 The key anatomical, pharmacological and clinical differences between children at different ages and adults Assessment of children using the Paediatric Assessment Triangle The signs of a seriously ill or deteriorating child The Advanced Paramedics role in the reduction of infant and childhood morbidity and mortality from acute illness and injury The importance of obtaining the patients weight for effective care Normal age group related vital signs The care management for sudden infant death syndrome (SIDS) infants The assessment and care management of suspected abuse/ neglect infant or child and the special considerations
Attitudinal Objectives Demonstrate ability to: 7.1.9 7.1.10 Understand the emotional dependence of the infant/child on their parent/ guardian Interact with the infant/ child that conveys an understanding of their developmental stage
Skills Objectives Demonstrate ability to: 7.1.11 7.1.12 7.1.13 7.1.14 Use parent / caregiver interviewing techniques and emotional support for infant and child death situations Use parent / caregiver interviewing techniques for suspected infant and child abuse/ neglect situations Make accurate and detailed records in cases of suspected non-accidental injury and neglect Calculate a paediatric weight using a Braslow tape and age formulae
49
7.
7.2 Paediatric medical Objectives Refer also to the relevant units of the 2007 Education and Training Standard- Paramedic level
Knowledge Objectives Demonstrate adequate working knowledge and comprehension of: 7.2.1 The aetiology and pathophysiology of each of the following conditions: Inadequate respirations Upper and lower airway obstruction Foreign body/ Croup/ Epiglottitis/ Stridor Asthma Bronchiolitis Tension pneumothorax Respiratory arrest Asystole/ Pulseless electrical activity Ventricular fibrillation and Pulseless VT Symptomatic bradycardia External haemorrhage Hypovolaemic shock Seizure disorders/ convulsions (febrile and afebrile) Glycaemic emergencies Anaphylaxis Pain Burns Septic shock including Meningococcal sepsis
7.2.2 7.2.3 7.2.4
7.2.5 7.2.6
The pre-hospital emergency assessment findings and *care management of the conditions listed above The benefits of having a nasogastric tube in place for prolonged airway and ventilatory support The indications, contraindications, benefits, limitations, complications, equipment and procedure of endotrachael intubation, Laryngeal mask airway/ laryngeal tube (LMA/LT) insertion and use of any other PHECC CPG approved advanced airway devices for paediatrics The indications, contraindications, procedure and complications for paediatric extubation The time/ transport critical features of infant/ children with illness
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Attitudinal Objectives Demonstrate ability to: 7.2.7 Understand common response of families with acute illness of an infant or child
Skills Objectives Demonstrate ability to: 7.2.8 7.2.9 7.2.10 Perform the pre-hospital emergency assessment and *care management of the patient with all the conditions listed above Perform laryngoscopy and foreign body airway removal, and endotracheal intubation where this is unsuccessful Perform the *care management options for airway and ventilatory support (basic airway adjuncts, LMA/ LT and ETT, nasogastric tube or any other as indicated in PHECC CPGs) Extubate or remove any advanced airway as defined by PHECC CPGs
7.2.11
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7.
7.3 Paediatric trauma Objectives Refer also to the relevant units of the 2007 Education and Training Standard- Paramedic level
Knowledge Objectives Demonstrate adequate working knowledge and comprehension of: 7.3.1 7.3.2 7.3.3 7.3.4 7.3.5 The common causes and characteristics of paediatric burns The mechanisms of injury which commonly involve children The pathophysiology of trauma in infants and children The specific physiological responses to trauma in children The pre-hospital emergency assessment findings and *care management of the paediatric trauma patient compared with the adult emphasising the needs of the injured child The time/ transport critical features of infant/ children with traumatic injury
7.3.6
Attitudinal Objectives Demonstrate ability to: 7.3.7 Understand common response of families with acute injury of an infant or child
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8. PRE-HOSPITAL EMERGENCY CARE OPERATIONS 8.1 Major Incident Medical Management and Support Objectives Refer also to the relevant units of the 2007 Education and Training Standard- Paramedic level
Knowledge Objectives Demonstrate adequate working knowledge and comprehension of: 8.1.1 8.1.2 8.1.3 Major Incident Medical Management and Support (MIMMS) The need for accurate record keeping A Framework for Major Emergency Management Published by the Department for the Environment
8.1.4 8.1.5 8.1.6
Act in a calm, professional and controlled manner contributing in whatever role is required Co-operate with other professionals in a post-incident debrief Co-operate with legal and other agencies post-incident as required
Skills Objectives Demonstrate ability to: 8.1.7 Apply the knowledge of MIMMS dynamically in a Major Emergency situation as per the PHECC CPGs
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9.
Professional development
Refer also to the following sections of the 2007 Education and Training StandardParamedic level: 9.1 Communication 9.2 Manage personal work priorities and professional development 9.3 Work effectively with others 9.4 Mentorship These four sections if not previously completed as part of Paramedic education and training must be made available for Advanced Paramedic students.
9.5 Lead and participate in work teams Aims of the Unit To develop students understanding and application of what leadership is and how appropriate styles improve working relationship and productivity within the organisation.
Objectives Knowledge Objectives: Demonstrate adequate working knowledge and comprehension of: 9.5.1 9.5.2 9.5.3 9.5.4 9.5.5 9.5.6 9.5.7 9.5.8 9.5.9 How motivation affects productivity Intrinsic and extrinsic motivation and its application in the workplace The roles and responsibilities of a team leader The differences between assessment and evaluation The methods and application of Planning, Organising and Controlling The three elements of a contract How a contract can be terminated Industrial relations procedures and how they protect both employer and employee. How productivity can be evaluated in the health sector.
Attitudinal Objectives Demonstrate ability to: 9.5.10 9.5.11 9.5.12 Empower team members Use appropriate interpersonal skills when dealing with resistance, conflict and difficult situations Commit as a team player
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Skills Objectives Demonstrate ability to: 9.5.13 9.5.14 9.5.15 9.5.16 9.5.17 9.5.18 9.5.19 9.5.20 9.5.21 Draw a concept map Write a learning objective that can be measured Produce monitoring, assessment and evaluation tools Draw a process chart and demonstrate the advantages of applying it to problem definition and resolution Show key abilities as a team member Delegate responsibility with commensurate accountability Defuse a conflict based interaction Conduct an investigative interview Document/ Report a problem
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9.
PROFESSIONAL DEVELOPMENT
9.6 Clinical quality improvement Aims of the Unit It is becoming increasingly important for healthcare professionals to become familiar with the methods of research employed within their particular field of occupation or interest. Understanding the techniques of problem identification, the formulation and testing of hypotheses, data collection methods and analysis, is fundamental to ensure credible quantifiable results are obtained. Students also need to be able to interpret research reports in professional publications. The aim of the research subsection is to develop the students understanding and skills of research in a clinical and professional development context and to: Develop students criticality in reviewing a range of research methodologies. Develop students ability to critically review relevant literature. Develop students application of practical aspects of planning, conducting and writing up a small scale research project. The topics covered will guide the student through a process from which they will meet the basic criteria to conduct a small scale research project. Consequently students will be able to contribute to a growing body of knowledge within pre-hospital emergency care.
The overall aim of the subsection Clinical Audit is to improve patient outcomes by improving professional practice and the general quality of services being delivered. This is achieved through a continuous process where Advanced Paramedics review patient care against agreed (PHECC) standards and identify areas of practice that need to be considered for further change. As and when changes are made by the PHECC, the audit is then repeated to see if the changes have been made and the quality of patient care improved. Clinical Audit is directly related to improving services against a standard that has already been set; Students will review and examine issues such as: Whether or not what ought to be happening is happening. Whether current practice meets required standards. Whether current practice follows published guidelines. Whether clinical practice is applying the knowledge that has been gained through research. Whether current evidence is being applied in a given situation. Whether clinical management is having optimal effect.
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Objectives Knowledge Objectives: Demonstrate adequate working knowledge and comprehension of: 9.6.1 9.6.2 9.6.3 9.6.4 9.6.5 9.6.6 9.6.7 The term Clinical Audit The differences between Clinical Audit and Research Formulating and clarifying a research topic Critically appraise relevant research literature using available critical appraisal frameworks/ tools The differences between the deductive and inductive approaches to research The process and layout of writing up the research findings The clinical audit cycle
Attitudinal Objectives Demonstrate ability to: 9.6.8 9.6.9 9.6.10 9.6.11 Fully participate in the clinical audit process Contribute toward augmenting the body of knowledge to promote evidence based practice Promote and promulgate professional requirements for a scientific approach to underpin professional practice Encourage other professionals to endorse and participate in research and clinical audit
Skills Objectives Demonstrate ability to: 9.6.12 9.6.13 9.6.14 9.6.15 9.6.16 9.6.17 9.6.18 9.6.19 Conduct a literature review and produce a critical appraisal of findings Design a research question Write the objectives for a small scale research project Conduct a small scale research project Produce a report on the findings of the research project Construct a small scale clinical audit process Measure a clinical outcome within the pre-hospital setting Contribute towards the National PHECC clinical audit process
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9.
9.7 Change management Aims of the Unit The unit aims to develop students understanding and practical abilities within the context of organisational and professional change. The question what is change, will be reviewed from various perspectives, including sponsors, agents and targets of change, roles and responsibilities, reaction and resistance. The Unit aims to develop students knowledge and skills of applying theoretical models to assist in understanding the implications of change and the forecasting of potential outcomes. Professionals experience change as an ongoing process, however, on occasions prejudice sometimes confuses the issues resulting in resistance and conflict. Evaluation of change from various perspectives is sometimes necessary to quantify and qualify its implications. Therefore this Unit will develop students criticality in valuing the change process from various stakeholder perspectives, in order to develop competence in making informed decisions relating to organisational and professional change. The practical elements of the Unit will ensure that students are able to design various models that assist with the introduction of change. Also, applying the three key skills of Empathy, Communication and Participation advocated by Fossum (1989 p8-10). From this work students will be able to recognise the important factors of change and consequently adopt a more objective rational approach when confronted with change.
Fossum, L, B. (1989) Understanding Organizational Change. USA. Crisp Publications, Inc.
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Objectives Knowledge Objectives: Demonstrate adequate working knowledge and comprehension of: 9.7.1 9.7.2 9.7.3 9.7.4 9.7.5 9.7.6 The advantages and disadvantages of the SWOT Analysis Each of the areas investigated in a PESTEL Analysis The application of a Force Field Analysis Emotion within a contextual setting of change How attitudes and motivation can support or inhibit the change process The attributes of relationship management within the context of change
Attitudinal Objectives Demonstrate ability to: 9.7.7 Motivate and use a rational approach toward the change process 9.7.8 Use a level of interpersonal skills that encourages open communication and rationality toward the change process 9.7.9 Perform objectivity when analysing an intended change Skills Objectives Demonstrate ability to: 9.7.10 Construct a SWOT Analysis of change in an organisational context 9.7.11 Conduct a PESTEL Analysis 9.7.12 Construct a Force Field Analysis to identify the pressure of opposing forces acting on a change process 9.7.13 Deliver a short presentation to a peer group which clarify the important factors of change 9.7.14 Produce an objective evaluative model for a contextualised change affecting the students organisation
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9.
9.8 Experiential learning and reflective practice Aims of the Unit The aim of this Unit is to equip students with the knowledge, skills and attitudes to develop their own ongoing and reflective learning profile. Experiential learning can be traced back to that famous dictum: "Tell me, and I will forget. Show me, and I may remember. Involve me, and I will understand." Confucius around 450 BC The Unit will develop students cognisance and practical abilities of how to write lessons learned and reflection papers, reviewing the following aspects; 1. Choosing a critical incident (This incident could be something that was felt to be correct or something that is believed to be suboptimal). This incident will be reflected in the students process documents. 2. Students will then, consider the components of that incident, from various perspectives, e.g. different time frames, or third party positions. From which they will review and determine aspects that proved difficult and the final accomplishment, identifying the light bulb that helped them make sense of it. From this, students will be able to review and quantify prior and post accomplishment. If its something that was still not mastered, students will review what was achieved and what they would have liked to have achieved. From this reflection, students will write up personal accounts of the experiences and their outcomes. 3. Students will be able to review the structure and thinking process that either existed, or needed to exist, between the different perspectives. 4. Students will be encouraged to enhance their research techniques and draw on resources (book, articles, journals and the web etc.) to assist them to explain the incident and what lessons were learned. 5. Finally students will summarise what has been learned, consequently developing their reflective practice ability, to enable progress which recognises new or modified understanding.
Objectives Knowledge Objectives Demonstrate adequate working knowledge and comprehension of: 9.8.1 9.8.2 9.8.3 9.8.4 9.8.5 9.8.6 The importance of reflective practice in pre-hospital emergency care The term experiential learning How experiential learning is accomplished Each of the four elements of Kolbs Experiential Learning Cycle Honey and Mumfords Learning Styles to Kolbs Experiential Learning Cycle The terms reflection-in-action and reflection-on-action as per Schns postulation
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9.8.7 9.8.8 9.8.9 9.8.10 9.8.11 9.8.12
The adult learning preferences and motivational influences that maximise learning outcomes Knowles five assumptions for adult learning How individual differences in learning styles affect the learning process The terms andragogical and pedagogical Reflective practice can improve the quality of care delivered Reflective practice informs personal and professional development processes
Attitudinal Objectives Demonstrate ability to: 9.8.13 9.8.14 9.8.15 9.8.16 9.8.17 9.8.18 9.8.19 9.8.20 9.8.21 9.8.22 9.8.23 9.8.24 9.8.25 Commit and motivate toward experiential learning and reflective practice Demonstrate enthusiasm when conducting reflective practice Seek regular feedback on how the student responds to the diverse needs of patients, peers and other interested parties Show a willingness to learn from what happens in practice Being open enough to share elements of practice with other people Value the potential for clinical practice to emerge from within, as well as outside the profession Value the conditions necessary for reflection to occur Develop a belief that it is possible to change as a practitioner as a result of learning Develop a belief that there is no end point in learning about clinical and professional practice Refrain from being defensive about what other people notice about ones practice Be courageous enough to act on reflection Work out schemes to personally action what has been learned Be honest in describing clinical practice to others
Skills Objectives Demonstrate ability to: 9.8.26 9.8.27 9.8.28 9.8.29 9.8.30 9.8.31 9.8.32 9.8.33 9.8.34 Construct a concept map (mind map) within the students area of learning and identify knowledge gaps that need to be addressed Write a reflective practice document Demonstrate application of experiential learning applying Kolbs Experiential Learning Cycle Use reflection to illustrate personal and professional strengths and weaknesses Work reflectively as part of a Pre-Hospital Emergency care team Reflect routinely on everyday practice in both a clinical and professional development context Describe in detail clinical practice problems Describe the consequences of not applying reflective practice as part of professional development Articulate what happens in clinical and professional practice and evaluate it
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10. CLINICAL PROCEDURES 10.1 Pharmacology
Knowledge Objectives Demonstrate adequate working knowledge and comprehension of: 10.1.1 10.1.2 10.1.3 The legal framework and system of best practice that empowers Advanced Paramedics to administer medications The principles and special considerations when administering medication under a medical practitioners direction The terms: action pharmacokinetics pharmacodynamics drug half life potentiation side effects adverse reaction indication contraindication precaution anaphylactic reaction Units of measurement of medications Alpha, beta and nicotinic receptors, their function and how certain medications affect them The factors that may influence a medications absorption, distribution and elimination The factors that can affect the actions of a medication How cardiovascular function affects medication distribution The characteristics of paediatric, elderly and pregnant patients that influence medication distribution, metabolism and excretion The medication which the Advanced Paramedic may administer to the patient from PHECC CPGs The medication which the Advanced Paramedic can administer under medical practitioners direction The class, action, dose, route of administration, indications, contraindications and side effects of the *approved medications for use by Advanced Paramedics Formulas used as a basis for performing medication calculations Calculation of all approved medication and intravenous infusion rates for adults, infant and children
10.1.4 10.1.5 10.1.6 10.1.7 10.1.8 10.1.9 10.1.10 10.1.11 10.1.12
10.1.13 10.1.14
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Attitudinal Objectives Demonstrate ability to: 10.1.15 Understand the importance of identifying the correct medication and dosage, as well as knowing the contra-indications, side effects, pharmacokinetics of all medications used by practitioners pre-hospital. Skills Objectives Demonstrate ability to: 10.1.16 Locate and interpret information about the properties of medications from sources such as the British National Formulary (BNF), the Monthly Index of Medical Specialities (MIMS) and the PHECC Formulary 10.1.17 Calculate the correct dosage of all *approved medications for adults, infant and children 10.1.18 Calculate the correct intravenous infusion rates of all *approved infusions for adults, infant and children
* Approved medication as per the PHECC CPGs
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10. CLINICAL PROCEDURES 10.2 Infection prevention and control
Knowledge Objectives Demonstrate adequate working knowledge and comprehension of: 10.2.1 The role of Post Exposure Prophylaxis (PEP) and the timeframe in which it is effective if taken
Attitudinal Objectives Demonstrate ability to: 10.2.2 Act responsibly and with care relating to Advanced Paramedic procedures
Skills Objectives Demonstrate ability to: 10.2.3 Apply safe practice relating to practice of Advanced Paramedic procedures
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10. CLINICAL PROCEDURES 10.3 Medication administration
Knowledge Objectives Demonstrate adequate working knowledge and comprehension of: 10.3.1 10.3.2 10.3.3 10.3.4 10.3.5 10.3.6 10.3.7 10.3.8 10.3.9 10.3.10 10.3.11 10.3.12 10.3.13 10.3.14 10.3.15 10.3.16 10.3.17 10.3.18 10.3.19 10.3.20 10.3.21 10.3.22 The preferred sites for an intravenous cannula, intraosseous needle and an intramuscular injection The indications, equipment required, procedure and general principles of inserting an intravenous cannula The indications, equipment required, procedure and general principles of intravenous medication injection and infusion The special considerations for intravenous access in the trauma patient The special considerations for intravenous access in the paediatric patient The special considerations for injections for the paediatric patient The indications, equipment required, procedure and general principles of intraosseous needle placement, injection and infusion The indications, equipment required, procedure and general principles of administering medication by the oral sublingual and buccal routes inhalation route intramuscular route subcutaneous route intravenous route intraosseous route rectal route transdermal route The procedure of drawing up medication from both a glass and plastic ampoules List the common complications of an intramuscular and intraosseous injection The assessment findings and documentation of the patient response to all medication administered The indications, equipment required, procedure and general principles of obtaining a blood sample The dangers associated with inappropriate administration of medication The procedure to be followed in the event of a medication error
Attitudinal Objectives Demonstrate ability to: 10.3.23 10.3.24 Accept responsibility for potential drug errors and report same Accept responsibility for the secure handling and recording of Morphine and any other approved Controlled Drug use
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10.3.25
Act responsibly and with care relating to each of the above Advanced Paramedic procedures
Skills Objectives Demonstrate ability to: 10.3.26 10.3.27 10.3.28 Apply safe practice relating to each of the above Advanced Paramedic procedures Safely handle, secure and store all approved medication carried including additional precautions with Morphine Administer all approved medication for Advanced Paramedic use; by oral, buccal, sublingual, inhalation, rectal, intravenous, intraosseous, intramuscular, subcutaneous and transdermal routes. Assess and document the patients responses to medication administered
10.3.29
*Approved medication as per the PHECC CPGs
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Advanced Paramedic Standard 2008

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Advanced Paramedic Education and Training Standard

Version 1- Council approved 16th June 2008

6.1 6.2 6.3 6.4 6.5 7.

____________________________________________________________________________________________ PHECC Education and Training Standards Section G- Advanced Paramedic

8.PREHOSPITALEMERGENCYCAREOPERATIONS..................................................................................53 8.1 9. MAJORINCIDENTMEDICALMANAGEMENTANDSUPPORT........................................................................53

____________________________________________________________________________________________ PHECC Education and Training Standards Section G- Advanced Paramedic

INTRODUCTION TO PRE-HOSPITAL EMERGENCY CARE

1.1.7 1.1.8 1.1.9 1.1.10

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INTRODUCTION TO PRE-HOSPITAL EMERGENCY CARE

Skills Objectives Demonstrate ability to:

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INTRODUCTION TO PRE-HOSPITAL EMERGENCY CARE

Skills Objectives Demonstrate ability to:

1.3.9 1.3.10 1.3.11 1.3.12 1.3.13 1.3.14

____________________________________________________________________________________________ PHECC Education and Training Standards Section G- Advanced Paramedic

INTRODUCTION TO PRE-HOSPITAL EMERGENCY CARE

Skills Objectives Demonstrate ability to:

1.4.12 1.4.13 1.4.14

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INTRODUCTION TO PRE-HOSPITAL EMERGENCY CARE

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____________________________________________________________________________________________ PHECC Education and Training Standards Section G- Advanced Paramedic

____________________________________________________________________________________________ PHECC Education and Training Standards Section G- Advanced Paramedic

____________________________________________________________________________________________ PHECC Education and Training Standards Section G- Advanced Paramedic

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2.4.4 2.4.5 2.4.6 2.4.7 2.4.8

Skills Objectives Demonstrate ability to:

2.4.11 2.4.12 2.4.13

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Skills Objectives Demonstrate ability to:

2.5.12 2.5.13 2.5.14 2.5.15

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3.1.12 3.1.13 3.1.14 3.1.15 3.1.16

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3.2.5 3.2.6 3.2.7 3.2.8

3.2.11 3.2.12 3.2.13 3.2.14 3.2.15

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3.3.2 3.3.3 3.3.4 3.3.5 3.3.6 3.3.7

4.1.7 4.1.8 4.1.9 4.1.10

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4.2.6 4.2.7 4.2.8 4.2.9 4.2.10

4.2.11 4.2.12 4.2.13 4.2.14 4.2.15

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4.2.18 4.2.19 4.2.20 4.2.21 4.2.22 4.2.23 4.2.24 4.2.25

____________________________________________________________________________________________ PHECC Education and Training Standards Section G- Advanced Paramedic

4.3.6 4.3.7 4.3.8 4.3.9 4.3.10

____________________________________________________________________________________________ PHECC Education and Training Standards Section G- Advanced Paramedic

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4.4.3 4.4.4 4.4.5 4.4.6 4.4.7 4.4.8 4.4.9

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Attitudinal Objectives Demonstrate ability to:

Empathise with the patient who regains consciousness among strangers

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MEDICAL EMERGENCIES Environmental emergencies

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MEDICAL EMERGENCIES Behavioural emergencies