Paramedic Student Clinical Guide

Transcription

1 ATLANTA TECHNICAL COLLEGE PUBLIC SAFETY TECHNOLOGY PARAMEDICINE ATC-10/05-hcb/revised Paramedic Student Clinical Guide STUDENT NAME: GRADE: GRADED BY: / DATE

2 PARAMEDIC STUDENT CLINICAL GUIDE Atlanta Technical College 1560 Metropolitan Parkway, S/W Atlanta, Ga Phone (404) Public Safety Technology Chairperson Paramedicine Program Director Helen C. Burkhalter, BAS, NREMT-P/RN Cellular: EMT Class Lead Instructor: T. Harold Walters, II EMT-P Cellular: Clinical IS a time to: Refine assessment skills. Further develop technical skills. Enlist constructive feedback on performance. Develop professional relationships with colleagues. Actively seek learning experiences

3 EMT Code of Ethics As adopted by the National Association of EMTs Professional status as an Emergency Medical Technician and Emergency Medical Technician-Paramedic is maintained and enriched by the willingness of the individual practitioner to accept and fulfill obligations to society, other medical professionals, and the profession of Emergency Medical Technician. As an Emergency Medical Technician-Paramedic, I solemnly pledge myself to the following code of professional ethics: A fundamental responsibility of the Emergency Medical Technician is to conserve life, to alleviate suffering, to promote health, to do no harm, and to encourage the quality and equal availability of emergency medical care. The Emergency Medical Technician provides services based on human need, with respect for human dignity, unrestricted by consideration of nationality, race creed, color, or status. The Emergency Medical Technician does not use professional knowledge and skills in any enterprise detrimental to the public well being. The Emergency Medical Technician respects and holds in confidence all information of a confidential nature obtained in the course of professional work unless required by law to divulge such information. The Emergency Medical Technician, as a citizen, understands and upholds the law and performs the duties of citizenship; as a professional, the Emergency Medical Technician has the never-ending responsibility to work with concerned citizens and other health care professionals in promoting a high standard of emergency medical care to all people. The Emergency Medical Technician shall maintain professional competence and demonstrate concern for the competence of other members of the Emergency Medical Services health care team. An Emergency Medical Technician assumes responsibility in defining and upholding standards of professional practice and education. The Emergency Medical Technician assumes responsibility for individual professional actions and judgment, both in dependent and independent emergency functions, and knows and upholds the laws which affect the practice of the Emergency Medical Technician. An Emergency Medical Technician has the responsibility to be aware of and participate in matters of legislation affecting the Emergency Medical Service System. The Emergency Medical Technician, or groups of Emergency Medical Technicians, who advertise professional service, do so in conformity with the dignity of the profession. The Emergency Medical Technician has an obligation to protect the public by not delegating to a person less qualified, any service which requires the professional competence of an Emergency Medical Technician The Emergency Medical Technician will work harmoniously with and sustain confidence in Emergency Medical Technician associates, the nurses, the physicians, and other members of the Emergency Medical Services health care team. The Emergency Medical Technician refuses to participate in unethical procedures, and assumes the responsibility to expose incompetence or unethical conduct of others to the appropriate authority in a proper and professional manner. Written by: Charles Gillespie M.D. Adopted by: The National Association of Emergency Medical Technicians, 1978.

4 INTRODUCTION: Clinical education is an important aspect of any professional health care education program. Clinical education provides students with an opportunity to: 1. Actually see visual cues important for patient assessment, such as pale skin, diaphoresis, or upper airway edema. 2. Perform skills in the clinical setting, which have previously only been practiced in the skills laboratory. 3. Integrate theory and practical skills in the treatment of actual patients. 4. See expert clinical practice, including communications with patients and peers, assessment, decision-making, priority setting, and treatment. Clinical preceptors have a significant impact on the learning experience the student has during this phase of the student s education. They are the student s primary resource. They reinforce the student s knowledge and skills and evaluate performance. Please take a few moments to review this Paramedic Student Clinical Guide. ROLE OF THE CLINICAL INSTRUCTOR: The EMS Program Chairperson/Class Lead Instructor will guide students during their clinical experience. During the clinical rotation, an instructor from the college will visit the clinical facility to observe and evaluate the student. These visits are routine and allow the paramedic program to monitor the student s progress. The Atlanta Technical College clinical instructor is responsible for: Scheduling students in the clinical areas. Making sure that student objectives are clear to both students and preceptors. Monitoring students during the clinical experience. Troubleshooting during student clinical. The Paramedicine Program Director or other Atlanta Technical College Paramedicine Instructors will serve as clinical instructors. Please feel free to call the Public Safety Technology Programs Chairperson or Paramedicine Program Director with questions about clinical objectives, student capabilities, or any other issue pertaining to student performance. ROLE OF THE PRECEPTOR: The clinical setting can be intimidating for many students. The clinical preceptor helps the student make the transition from the classroom to the field. In the clinical setting, the preceptor is defined as a physician, registered nurse, paramedic, physician s assistant, nurse anesthetist, or respiratory therapist that has sufficient clinical knowledge and experience to help guide the student in their clinical experience. The clinical preceptor serves as a student advocate and role model for professional practice. The preceptor should have strong clinical skills, teaching ability, working

5 knowledge of the paramedic scope of practice and demonstrate professionalism. The preceptor works with the student observing assessments and technical skills. The program has specific objectives for each clinical unit. The goal is for students to achieve as many of these objectives as possible, under the guidance of the unit preceptor and the clinical instructor. Although the clinical instructor plays an important role in student instruction and coordination, it is the preceptor who serves as the clinical expert. The preceptor instructs, guides the student s experience, and provides feedback on student performance through the clinical experience record. Please be sure to set aside a few minutes toward the end of the shift to fill out this sheet. PRECEPTOR EXPECTATIONS: The following preceptor expectations outline how to best assist the student: 1. Read and review the Paramedicine Student s Clinical Competencies. 2. Orient the paramedic student to the department. a. Flow of patients through the department. b. Introduction to personnel. c. Location of equipment and supplies within the EMT-P scope of practice. d. Proper operation of cardiac monitors, defibrillators and suction equipment. e. Review policies and procedures pertinent to the student while assigned to the clinical unit. 3. Supervise and assist the paramedic student while in the clinical environment. 4. Critique all patient contacts made by the student. To include: a. Patient history b. Clinical signs c. Physical findings d. Lab results e. Pathophysiology f. Treatment plan 5. Demonstrate, assist and evaluate the student s performance of approved skills. 6. Observe and review the student s technique and suggest correction or offer alternatives when appropriate. 7. Answer the student s questions concerning assessment, management and/or treatment of patients. 8. Review past patient contact that may be beneficial to the student. 9. Correlate clinical data to the didactic knowledge of the student. 10. Complete the student evaluation form and review with the student some observations you made regarding the student s performance. PERFORMANCE EVALUATIONS: Performance of the student during the clinical rotations will be closely observed and evaluated by the clinical preceptors and the clinical instructors to determine whether the student can demonstrate appropriate application of knowledge and skills acquired during the didactic portion of their education. Accurate documentation of clinical experiences is essential for course completion.

6 DAILY CLINICAL DOCUMENTATION: 1. The Paramedicine student must document their patient care and patient assessments completed during each clinical/field experience/field internship shift. 2. Document these assessments by completing a Hospital Patient Assessment form or EMS Patient Care Report. 3. A Student Clinical Performance Record must be completed for each clinical shift. The record must be completed and signed by a clinical instructor or preceptor. Records without appropriate signatures will not count toward clinical experience requirements. 4. The student must document their procedures and skills performed and patient encounter into the Student Clinical Notebook and in FISDAP. 5. A Clinical Summary Sheet must be filled out at the end of each semester. All documentation must be submitted to the Paramedicine Program Director by the required deadline. Failure to submit complete documentation may result in a reduction of the clinical grade or possible dismissal from the program. Only experiences signed by an instructor or preceptor will count toward program requirements. Falsification of any records pertaining to clinical constitutes cheating and is an academic irregularity that will be handled according to policies outlined in the Atlanta Technical College student handbook and syllabus. CLINICAL AGENCY POLICIES All Atlanta Technical College personnel and students are expected to abide by the rules and regulations of the clinical facilities utilized for clinical experiences. Clinical agencies utilized by the College are on a contractual basis. All contracts contain an agreement that college personnel, nursing and health science students will conform to the rules and regulation of the agencies. Atlanta Technical College personnel or students failing or refusing to abide by these policies will not be permitted to care for patients and may be dismissed under the provisions for non-compliance of rules and regulations of any of the affiliating agencies. Students who are dismissed from clinical experiences may jeopardize their ability to satisfactorily complete the course requirements, and may be dropped from the program.

7 PERFORMANCE OBJECTIVES: Upon completion of this course, the student will be able to: CLINICALS: Perform a comprehensive history and physical examination to identify factors affecting the health and health needs of a patient. Construct a field impression based on an analysis of comprehensive assessment findings, anatomy, physiology, pathophysiology, and epidemiology. Apply assessment findings to underlying pathological and physiological changes in the patient's condition. Integrate and synthesize the multiple determinants of health and clinical care. Perform health screening and referrals. Promote communicating in a manner that is culturally sensitive and intended to improve the patient outcome. Perform safely and effectively the psychomotor skills within the National EMS Scope of Practice Model AND state Scope of Practice at the paramedic level. Psychomotor Guided Response Collaborate with other EMS personnel, while serving as a role model of exemplary professional behavior including: but not limited to, integrity, empathy, selfmotivation, appearance/personal hygiene, self-confidence, communications, time management, teamwork/ diplomacy, respect, patient advocacy, and careful delivery of service. Motivate other EMS personnel to display professional behavior including: but not limited to, integrity, empathy, self-motivation, appearance/personal hygiene, selfconfidence, communications, time management, teamwork/ diplomacy, respect, patient advocacy, and careful delivery of service. Integrate performance of basic and advanced interventions as part of a treatment plan intended to mitigate the emergency, provide symptom relief, and improve the overall health of the patient. Adapt treatment plans according to the effectiveness of interventions. Prioritize and report data to be used for epidemiological and research purposes Appreciate the need for data reporting used for epidemiological and research purposes. Adapt to the role of the team leader during various routine, single patient advanced life support emergency calls. Integrate patient assessments and provision of pre-hospital emergency care and transportation for various patient complaints, within the National EMS Scope of Practice Model AND state Scope of Practice at the Paramedic level. Demonstrate completion of the minimum clinical and field competencies for the Paramedic level, as promulgated by the Georgia State Office of EMS/Trauma. Additionally the student will be able to demonstrate the ability to: Perform an assessment, report this information in a brief, organized and accurate manner, and correctly document this information on the EMS Report form or other approved pre-hospital form. Describe the pathophysiology, signs and symptoms and appropriate pre-hospital care and rationale for any disorders discussed during didactic or described in assigned textbooks.

8 Demonstrate correct knowledge of basic and advanced airway management procedures. Demonstrate and describe correct resuscitation procedures. Take accurate vital signs and properly record on patient record. Perform venipuncture for the purpose of withdrawing blood samples. Initiate, maintain, and discontinue intravenous/intraosseous therapy. Prepare and administer medications by intravenous, intraosseous, intramuscular, subcutaneous, sublingual, inhalation, and endotracheal routes. Accurately interpret the cardiac rhythm observed and determine appropriate treatment modalities. Demonstrate and document a neurological assessment. Demonstrate proper technique for lung auscultation and correctly interpret the findings. Identify and demonstrate the correct procedures for treating fractures and hemorrhage. Develop and maintain rapport with health care professionals. Instill patient confidence through the use of appropriate communication techniques. Demonstrate sensitivity to and provide support for the physical and emotional needs of both the patient and their family. Respect confidentiality. Comply with patient privacy rights. Follow the rules and regulations of each clinical site. Demonstrate respect for staff. Demonstrate appropriate work ethic (i.e.: reporting on time) PARAMEDICINE PROGRAM CLINICAL/FIELD EXPERIENCE/FIELD INTERNSHIP REQUIREMENTS: The student will complete, at a minimum, 450 clinical hours: The student must spend a minimum of the following in each area. 1. OR - 24 hours 2. Pediatrics - 32 hours 3. Labor/Delivery/Mother-Baby - 32 hours 4. Critical Care ICU/CCU - 32 hours 5. ER/ED/Clinic/Doctors Office 120 hours 6. EMS (Advanced Life Support Ambulance Transport) hours (field experience) 7. EMS (Advanced Life Support Ambulance Transport) - Field Internship - 90 hours ASSESSMENT OF VARIOUS AGE GROUPS: The student will demonstrate the ability to perform a comprehensive pediatric (0-17 years) assessment on at least 30 live humans, including at least five (5) comprehensive patient assessment on each of the following age ranges: Newborn (0-1 month) Infant (1 month-under 1 year)

9 Toddler (1-3 years) Preschooler (4-5 years) School-age child (6-12 years) Adolescent (13-17 years) The student will perform a comprehensive patient assessment on at least forty (40) assessments on adult patients (18-64 years). The student should perform a comprehensive assessment on at least ten (10) geriatric patients (65+ years). ASSESSMENT OF DISEASE PATHOLOGIES: The student will perform a comprehensive patient assessment on at least five (5) obstetric patients. The student will perform a comprehensive patient assessment on at least twenty (20) trauma patients. The student will perform a comprehensive patient assessment on at least five (5) psychiatric patient ASSESSMENT AND TREATMENT FORMULATION OF VARIOUS PATIENT COMPLAINTS: The student must demonstrate the ability to perform an adequate assessment and formulate and implement a treatment plan for at least ten (10) patients with chest pain. The student must demonstrate the ability to perform an adequate assessment and formulate and implement a treatment plan for at least ten (10) patients with dyspnea/respiratory distress. The student must demonstrate the ability to perform an adequate assessment and formulate and implement a treatment plan for at least ten (10) patients with abdominal complaints (example: abdominal pain, nausea/vomiting, gynecological complaints, etc.) The student must demonstrate the ability to perform an adequate assessment and formulate and implement a treatment plan for at least ten (10) patients with altered mental status (example: syncope, stroke, seizure, overdose, hypoglycemia, electrolyte imbalance, etc). ADVANCED SKILLS/TASK PERFORMANCE REQUIREMENTS: The student will demonstrate the ability to effectively ventilate non-intubated patients of various age groups: The student should effectively, and while performing all steps of each procedure, ventilate at least ten (10) live humans. The student must demonstrate the ability to safely perform endotracheal intubation: The student should safely, and while performing all steps of each procedure, successfully intubate at least five (5) patients. The patients should be alive or recently expired. The student must demonstrate the ability to administer medications other than oxygen, but within the Georgia Paramedic Scope of Practice: The student should safely, while performing all of the steps of the procedure properly administer medications to at least fifty (50) live humans. The following administration routes are required:

10 Subcutaneous five (5) Intramuscular five (5) IV Bolus five (5) **** crystalloid flushes do not count for minimum of 5**** The student must demonstrate the ability to safely gain vascular access: The student must safely and while performing all steps of each procedure, successfully access the venous circulation at least thirty (30) times on live humans of various age groups. FIELD INTERNSHIP REQUIREMENTS (EMSP 2710): The student must perform a minimum of ninety (90) hours of field internship experience (Pre-hospital ALS Team Leadership). These hours are part of the clinical hours required by the Office of Emergency Medical Services & Trauma for completion of the clinical component of the Paramedicine Program. (Refer to SOEMS&T Policy R-T-11-PMDC-C) Failure to complete a minimum of 90 Field Internship hours will result in a failure ( F ) being recorded for EMSP Failure to complete to required 90 hours for EMSP 2710 will prevent the student from qualifying to participate in the final Paramedicine course EMSP 2720, graduating from the Paramedicine Program, and sitting for the NREMT Paramedic exam. The clinical/field experience hour requirements (360) must be completed prior to the beginning of the field internship. (EMSP 2510, 2520, 2530, 2540, 2550, 2560, 2570) The student must act as the team leader on a minimum of twenty (20) EMS responses during the field internship. Students are required to receive a positive evaluation from their preceptors and/or instructors during the field internship to successfully complete the field internship experience. Any negative evaluations may result in failure of EMSP Refer to the Department of Community Health-Office of Emergency Medical Services & Trauma Policy for program mandated minimum requirements for the successful completion of clinical and field internship (Refer to SOEMS&T Policy R-T-11-PMDC-C). Atlanta Technical College and the Public Safety Technology Department reserve the right to require additional student performance or required hours in each area as needed to facilitate a comprehensive clinical experience for each student during the clinical/field internship experience. Students are responsible for knowing which medications they may administer and are required to research any they are not familiar with prior to being supervised in their administration. The student must be familiar with each drugs desired actions, appropriate dose, indications, contraindications, and side effects. The student must draw up or observe the drawing of each medication administered.

11 COMPLETION REQUIREMENTS: All clinical requirements and assignments must be satisfied in EMSP courses 2510, 2520, 2530, 2540, 2550, 2560, 2570 & 2710 in order to be able to graduate and sit for the National Registry Exam and to successfully complete EMS clinical for graduation. The student will be responsible for completion of the required clinical documents. CLINICAL NOTEBOOK: The student will maintain a clinical notebook.. The notebook must remain updated at all times and be in the student s possession at each clinical site. The notebook will be at least two-inches and white with clear cover. FSDAP: Students are required to register for all clinical shifts in the FISDAP Scheduler. Additionally, students are required to enter all patient care information into the FISDAP data base within 72 hours of the completion of all clinical shifts. Failure to do so will result in a grade of "F" being recorded for each deadline for data entry missed.

12 EMERGENCY MEDICAL SERVICES CLINICAL TASKS During ambulance clinical and Summative Evaluations, the student should have, under the direct supervision of a clinical preceptor, the opportunity to practice and demonstrate, under direct supervision, proficiency for each of the following: 1. Perform patient assessments as indicated for trauma, medical, psychiatric, OB/Gyn and pediatric patients. 2. Manage the airway in unconscious patients to include the use of proper head positioning, basic airway adjuncts, and advanced techniques. 3. Administration of oxygen using the appropriate delivery devices. 4. Correctly perform Cardiopulmonary Resuscitation 5. Initiate Peripheral IV or IO insertion in the adult, pediatric, and geriatric patient. 6. Perform venipuncture to obtain blood samples. 7. Place electrodes, record, and interpret ECGs 8. Assess and manage patients to include, if presented, but not limited to the following conditions and/or Tasks (under direct supervision): Major Trauma Myocardial Infarctions Congestive Heart Failure COPD Obstructed Airway Diabetic Emergencies Asthma Attacks Seizures Coma OB/GYN Problems Psychiatric Problems Overdoses Intoxication/Substance Abuse Endotracheal Intubation (adult) Endotracheal Intubation (pediatric) Perform Aseptic Endotracheal Suctioning Fracture and Dislocations Immobilization Spinal Immobilizations - Long Spine Board Spinal Immobilizations KED Application of Traction Splints Communications with Patient and Hospital Needle Chest Decompression Needle Cricothyroidotomy Transcutaneous Cardiac Pacing Supervise in the roll of the lead Paramedic, assuring proper patient care Manage Cardiac Arrest according to AHA standards Prepare and Administer IV push medications Prepare and Administer IV Drip medications Prepare and Administer IM medications Prepare and Administer Subcutaneous medications Prepare and Administer Endotracheal medications Prepare and Administer Inhalation medications

13 Demonstrate proper use of communications equipment Demonstrate proper use of suction equipment Demonstrate proper use of the cardiac monitor Assist in the delivery of a newborn. Apply pediatric immobilization device Performs blood glucose test. Demonstrates the proper use of a pulse oximeter Demonstrates the proper use of a scoop stretcher Perform Carotid Sinus Massage Properly Defibrillate V-Fib/V-Tach Perform the proper techniques for synchronized cardioversion Perform Intraosseous infusion Perform External Jugular Vein Cannulation Supervision: Paramedic Preceptor, Registered Nurse, Physician s Assistants or Physician.

14 EMERGENCY DEPARTMENT CLINICAL TASKS During Emergency Department clinical, the student should have the opportunity to practice and demonstrate, under the direct supervision of an Paramedic Preceptor, Instructor, R.N., Physician, or Physician s Assistant, proficiency for each of the following: 1. Perform patient assessments, including obtaining medical history and a physical examination. The assessment should include a primary and secondary survey, taking and recording the information obtained. 2. Assist and review the treatment of the following trauma and medical patients, when presenting to the ED: Major Trauma Myocardial Infarctions Congestive Heart Failure COPD Diabetic Emergencies Asthma Attacks Seizures Psychiatric Problems Overdoses Intoxication/Substance Abuse Renal Failure GI Emergencies Stroke Extremity Fractures Poisoning Fever 3. Observe and assist in the triage and assessment of all types of patients. 4. Perform peripheral IV or IO insertion on adult, pediatric, and geriatric patients. 5. Perform pharmacological procedures as directed by the clinical faculty. 6. Prepare and administer IM, SQ, SL, PO, and IV medications as directed by and under the direct supervision of the clinical faculty. 7. Observe patients for effects of pharmacological agents administered. 8. Assist in cases of cardiac arrest as directed, including the performance of CPR, management of the airway and other appropriate procedures. 9. Assist in trauma cases requiring hemorrhage control, suturing, immobilization and splinting. 10. Carry out the physical assessment of a patient with coronary artery disease. 11. Recognize cardiac dysrhythmias on a cardiac monitor. 12. Identify the signs, symptoms, and treatment of cardiogenic shock. 13. Identify the signs, symptoms, and treatment of congestive heart failure. 14. Participate in the pharmacological and electrical management of the cardiac patient when needed. Supervision: Paramedic Preceptor, Registered Nurse, Physician s Assistants or Physician.

15 ICU/CCU CLINICAL TASKS During Intensive Care Unit clinical, the student should have the opportunity to practice and demonstrate, under direct supervision, proficiency for each of the following: 1. Perform patient assessments, including obtaining medical history and a physical examination. The assessment should include a primary and secondary survey, taking and recording the information obtained. 2. Assist and review the treatment of the following trauma and medical patients: Major Trauma Myocardial Infarctions Congestive Heart Failure COPD Diabetic Emergencies Asthma Attacks Seizures Psychiatric Problems Overdoses Intoxication/Substance Abuse Renal Failure GI Emergencies Stroke Extremity Fractures Poisoning Fever 3. Observe and assist in the assessment of all types of patients. 4. Perform peripheral IV insertion on adult, pediatric, and geriatric patients. 5. Perform pharmacological procedures as directed by the clinical faculty. 6. Prepare and administer IM, SQ, SL, PO, and IV medications as directed by and under the direct supervision of the clinical faculty. 7. Observe patients for effects of pharmacological agents administered. 8. Assist in cases of cardiac arrest as directed, including the performance of CPR, management of the airway and other appropriate procedures. 9. Carry out the physical assessment of a patient with coronary artery disease. 10. Recognize cardiac dysrhythmias on a monitor. 11. Identify the signs, symptoms, and treatment of cardiogenic shock. 12. Identify the signs, symptoms, and treatment of congestive heart failure. 13. Participate in the pharmacological and electrical management of the cardiac patient when needed. Supervision: Paramedic Preceptor, Registered Nurse, Physician s Assistants or Physician.

16 LABOR AND DELIVERY CLINICAL TASKS During Labor & Delivery Department clinical, the student should have the opportunity to practice and demonstrate, under direct supervision, proficiency for each of the following: 1. Monitor the vital signs of a patient in active labor. 2. Observe fetal monitoring. 3. Monitor fetal heart tones, with the nurse s and mother s permission. 4. Feel and time uterine contractions, with the mother s permission. 5. Observe the signs and symptoms of pre-eclampsia and eclampsia. 6. Assist with the treatment of any patient in eclampsia. 7. Observe cephalic vaginal deliveries, with patient and physician s permission. 8. Observe complicated deliveries such as breech and prolapsed cord. 9. Discuss the inverted triangle in the resuscitation of a newborn. 10. Assist in the management/resuscitation of the newborn. 11. Note and record 1 minute and 5 minute APGAR scores. 12. Observe/assist with the immediate post-delivery care of the mother. 13. Take and record the vital signs of the newborn and mother. 14. Perform IV cannulation, using the proper catheter, drip set, and fluids, for the mother in preparation for delivery. 15. Assist in the administration of medications to the newborn. Supervision: Paramedic Preceptor, Registered Nurse, Physician s Assistants or Physician.

17 PEDIATRIC - CLINICAL TASKS During Pediatric Department clinical, the student should have the opportunity to practice and demonstrate, under direct supervision, proficiency for each of the following: 1. Perform patient assessments, including obtaining medical history and a physical examination. The assessment should include a primary and secondary survey, taking and recording the information obtained. 2. Assist and review the treatment of the following trauma and medical patients: Major Trauma Diabetic Emergencies Asthma Attacks Seizures Psychiatric Problems Overdoses Extremity Fractures Poisoning Fever GI Problems 3. Observe and assist in the triage and assessment of all types of patients. 4. Perform peripheral IV insertion on pediatric patients. 5. Perform pharmacological procedures as directed by the clinical faculty. 6. Prepare and administer IM, SQ, SL, PO, and IV medications as directed by the clinical faculty. 7. Observe patients for effects of pharmacological agents administered. 8. Assist in cases of cardiac arrest as directed, including the performance of CPR, management of the airway and other appropriate procedures. 9. Assist in trauma cases requiring hemorrhage control, suturing, immobilization and splinting. 10. Recognize cardiac dysrhythmias on a monitor. 11. Participate in the pharmacological and electrical management of the cardiac patient when needed. Supervision: Paramedic Preceptor, Registered Nurse, Physician s Assistants or Physician.

18 OPERATING ROOM CLINICAL EXPERIENCE The purpose of the Operating Room experience is to give students an opportunity to observe and participate in respiratory assessment, airway control, and assisted ventilation. Teaching by anesthesiologists provides students with an opportunity to see and practice specific techniques, often beyond those taught in class, which will be of use in performing field intubations. Additional experiences may also involve the insertion of IV lines. During the Operating Room experience, the student should have the opportunity to practice (under direct supervision) and demonstrate proficiency for each of the following: 1. Perform pre-intubation assessment, including breath sounds, skin signs and pulse oximetry. 2. Perform peripheral IV insertions. 3. Prepare for and perform endotracheal intubation and LMA insertion UNDER DIRECT SUPERVISION. (5 times if allowed) 4. Perform patient ventilation using a bag-valve-mask. 5. Ongoing monitoring of patients, including respiratory rate, depth, breath sounds, pulmonary compliance, pulse oximetry, and end-tidal CO2. 6. Evaluation and monitoring of patients who are coming out of anesthesia and/or have been extubated. 7. Record and interpret electrocardiograms. 8. Demonstrate knowledge of all medications, within scope of practice. Supervision: CRNA, physician s assistants or physicians working in the Operating Room

19 ATLANTA TECHNICAL COLLEGE PARAMEDICINE HOSPITAL ASSESSMENT FORM Student Name: Date: Patient Location: Patient Diagnosis: Attach Rhythm Strip Here Regularity: PRI: QRS: P Wave: Atria Rate: Ventricle Rate: Interpretation: Age: Sex: BP: P: R: T: CRT: Skin: LOC: Pupils: Distal Sensory Motor Function: Medical History Medications Treatment and Lab Results Other Information and Comments Place SOAP Narrative on Back

20 SOAP: DATE: PT AGE/GENDER: TIME: STUDENT NAME:

21 Student Name: Attach Rhythm Strip Here Regularity: PRI: QRS: P Wave: Atria Rate: Ventricle Rate: Interpretation: Attach Rhythm Strip Here Regularity: PRI: QRS: P Wave: Atria Rate: Ventricle Rate: Interpretation: Attach Rhythm Strip Here Regularity: PRI: QRS: P Wave: Atria Rate: Ventricle Rate: Interpretation:

22 ATLANTA TECHNICAL COLLEGE PARAMEDICINE IV LOG Student Name: (Print Name) Year: Page Number: of Date Pt. Condition IV Site Gauge Needle Fluid Type Clinical Site Hospital/ EMS Preceptor Initials I certify the above IV information to be accurate. Student Signature Date Signed: ****Preceptor s initials must appear in the shaded area or IV will not count****

23 ATLANTA TECHNICAL COLLEGE PARAMEDICINE MEDICATION LOG Name: Year: (Print Name) Date Medication Route IV/IM/SQ Clinical site Hospital/ EMS Preceptor Initials I certify the above Medication information to be accurate. Student Signature Date Signed: ****Preceptor s initials must appear in the shaded area or IV will not count****

24 ATLANTA TECHNICAL COLLEGE PARAMEDICINE ENDOTRACHEAL INTUBATION CLINICAL PERFORMANCE RECORD DATE TIME SUCCESSFUL BLADE* TUBE* # OF ATTEMPTS PRECEPTOR INITIALS YES NO Mac Miller mm YES NO Mac Miller mm YES NO Mac Miller mm YES NO Mac Miller mm YES NO Mac Miller mm YES NO Mac Miller mm YES NO Mac Miller mm YES NO Mac Miller mm YES NO Mac Miller mm YES NO Mac Miller mm YES NO Mac Miller mm YES NO Mac Miller mm * STUDENTS ARE TO CIRCLE THE TYPE OF BLADE USED AND DOCUMENT THE TUBE SIZE IN THE APPROPRIATE COLUMN. **ALL ATTEMPTS ARE TO BE DOCUMENTED, WHETHER SUCCESSFUL OR UNSUCCESSFUL** I certify the above ETT information to be accurate. Student Signature Date: ****Preceptor s initials must appear in the shaded area or IV will not count****

25 ATLANTA TECHNICAL COLLEGE PARAMEDICINE DRUG REFERNECE FORM Generic Name: Trade Name: Drug Class: Indications: Contraindications: Precautions: Side Effects: Dosage: Adult: Pediatric: Route of Administration: Adverse Reactions: Source of Information: Student Signature: Date:

26 ATLANTA TECHNICAL COLLEGE EMS PATIENT CARE REPORT DATE PATIENT GENDER: M F AGE: TIME CURRENT MEDICATIONS: NONE KNOWN ALLERGIES: NONE KNOWN PAST MEDICAL HX: NONE KNOWN CHIEF COMPLAINT: NONE KNOWN NARRATIVE/S.O.A.P CHART FORMAT: TIME PULSE B/P RESP SP02 GCS D STICK TREATMENT-AIRWAY-IV-RX-EKG-ETC / / / / / / / / / DIAGNOSIS: STUDENT NAME: PLEASE PRINT OUTCOME: PRECEPTOR NAME: PLEASE PRINT

27 ATC PCR PAGE #2 NARRATIVE/S.O.A.P CHARTING FORMAT: DATE: TIME: PT AGE/GENDER: STUDENT NAME:

28 Student's Name: Clinical Area: ATLANTA TECHNICAL COLLEGE PARAMEDICINE DAILY CLINICAL EVALUATION FORM Preceptor: Date: Time In: Time Out: Total Hours Present: Preceptor - Please complete this form and discuss with student prior to end of shift. Affective Evaluation Please indicate one of the following: Attendance On Time 1-10 Min Late > 10 Min Late Appearance Professional Non- Professional Attitude Positive Negative Study Time Satisfactory Needs Improvement Never Self Motivation Satisfactory Needs Improvement Unsatisfactory Safety Satisfactory Needs Improvement Unsatisfactory Patient Communication Satisfactory Needs Improvement Unsatisfactory Preceptor Communication Satisfactory Needs Improvement Unsatisfactory Team Work Satisfactory Needs Improvement Unsatisfactory Psychomotor Evaluation Please indicate one of the following: *Student knows which skills are indicated, but requires instruction to accomplish the skill. *Student knows which skills are indicated, but is unable to perform skill. *Student does not know which skills are indicated. * Preceptor - Please indicate which skills are deficient in comment section. Shift Summary: (To be completed by student) Preceptor's comment on overall performance: Preceptor Signature Date:

29 Skills Airway Adjunct Insertion (OPA/NPA) Bandaging Bleeding Control Blood Draw BVM Ventilations Cardiac Lead Placement (12 leads) Cardiac Lead Placement (Limb leads) Cardioversion Child Birth CPAP/BiPAP CPR Defibrillation End Tidal CO 2 Monitoring Endotracheal Intubation Endotracheal Suction Glucose monitor IO Insertion IVs (Adult) IVs (Pediatric) IVs External Jugular Manual Airway Maneuvers Medication Administration Mega Code (Cardiac Arrest Participation) Nebulized Medication Needle Cricothyrotomy Oropharyngeal Suction Oxygen Administration Pleural Decompression Pulse Oximetry Radio Report to ED Scoop stretcher Shock Management Spinal Immobilization (KED) Spinal Immobilization (LSB) Splinting (Extremities) Stair Chair Stretcher Operation Supra Glottic Airway (Combi-Tube, etc.) Traction Splint Transcutaneous Pacing Transport Ventilator Use Vagal Maneuvers Vital Signs Other (explain on front) Assessments Newborn - Birth to 1 month old Medical Trauma Infant - 1 month to 1 year old Medical Trauma Toddler - 1 to 3 years old Medical Trauma Pre-Schooler - 4 to 5 years old Medical Trauma School Age - 6 to 12 years old Medical Trauma Adolescents - 13 to 17 years old Medical Trauma Adults Geriatrics > 65 years old Obstetric Trauma Medical Psychiatric Chest Pain Respiratory Syncope Abdominal Complaint Altered Mental Status Specialties Cardiac Rhythm Interpretation Breath Sounds Identification 12-lead Acquisition and Interpretation Interfacility Transfer Other (explain on front)

30 ATLANTA TECHNICAL COLLEGE PARAMEDICINE INTERNSHIP EVALUATION FORM STUDENT NOTE: List only calls requiring ALS Patient Contact Log NOTE: List only calls requiring ALS Run # Date Time Patient's Chief Complaint Clinical Area Instructions Rating Scale 1. All ratings of 1 or 2 must be explained in detail. 1. Skill/procedure was required but not performed. Attach additional pages if necessary. 2. Performed the skill/procedure but exhibited poor technique. 2. Student fails the call if the preceptor must 3. Performed the skill/procedure in a safe and competent manner. intercede to protect the patient or personnel. 4. Excelled in ability to perform the skill/procedure. 3. A Patient Assessment form must be submitted 5. N/A - Skill/procedure was not required for each call listed above. EVALUATION FACTORS PATIENT CONTACT Evaluation and Control of Scene #1 #2 #3 #4 #5 #6 #7 #8 #9 #10 #11 #12 1. Utilized appropriate BSI. 2. Determined scene safety or takes steps to secure scene. 3. Initiated crowd control as necessary. 4. Managed resources as necessary (i.e. Rescue, PD, etc.) 5. Established and maintained good rapport with patient. 6. Established and maintained good rapport with bystanders. Patient Assessment Skills #1 #2 #3 #4 #5 #6 #7 #8 #9 #10 #11 #12 7. Performed a complete initial assessment. (LOC,ABC, etc) 8. Performed adequate SAMPLE history. 9. Performed appropriate physical exam when indicated. 10. Obtained accurate vital signs in a timely manner 11. Recognized need for for on-scene care vs load and go. 12. Correctly interpreted ECG strip. 13. Field diagnosis identified and took appropriate actions. Communication Skills #1 #2 #3 #4 #5 #6 #7 #8 #9 #10 #11 # Accurately reported all pertinent information to ED 15. Spoke clearly and concisely to patient(s) and bystanders 16. Kept accurate, complete and legible written records 17. Anticipated orders and the needs of other team members 18. Established appropriate working relationship with crew 19. Assumed leadership role and directed crew appropriately. 20. Communicated appropriately with all crew members 21. Performed well under stress and used good judgement. 22. Was able to accept constructive criticism and guidance. Treatment Skills #1 #2 #3 #4 #5 #6 #7 #8 #9 #10 #11 # Successfully started an intravenous line. 24. Successfully administered medications. 25. Performed BVM ventilations 26. Performed adult endotracheal intubation. 27. Performed pediatric endotracheal intubation. 28. Performed defibrillation. 29. Performed synchronized cardioversion 30. Performed transcutaneous pacing. 31. Performed 12 lead EKG List other advanced skills below #1 #2 #3 #4 #5 #6 #7 #8 #9 #10 #11 # Student Name and Signature Preceptor Name and Signature Date Completed Date Completed REVISED 12/2012

31 ATLANTA TECHNICAL COLLEGE PUBLIC SAFETY TECHNOLOGY CLINICAL TIME SHEET STUDENT: EMT / PARAMEDIC STUDENT Date Site/Area Preceptor (Printed Name of Evaluator ) Time In (Beginning of shift) Preceptor Initials Time Out (Leaving facility) Preceptor Initials Preceptor Initials and Certification MD/RN/Paramedic Total Time

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