2. Can the student explain and assist with the proper method of supply/equipment inventory and restocking?

Transcription

1 FIRST SHIFT Can the student tell you where main areas of equipment are located in the station and on the ambulance? (Backboards, c-collars, drugs, airway equipment, IV solutions, ECG machine, O 2, etc.) Note: If not asked, quite often students fail to realize they will eventually become responsible for the complete inventory of the MICU. Can the student explain and assist with the proper method of supply/equipment inventory and restocking? Can student review with you sections of MOP and SOP that pertain to patient care? a. Check vitals signs on all patients? b. Obtain full sets of vital signs, to include respirations? c. Accurately perform a tilt test and obtain a temperature when applicable? Does the student recognize the significance of: a. Bradycardia, tachycardia? b. Decreased B.P., increased B.P.? c. Increased or decreased respirations? d. Increased or decreased temperature? e. Irregular pulse? f. Can student explain why an alteration in a vital sign occurs? Note: If you do not ask the student to reflect on the vital signs, you may never know if he/she can correlate the findings. At you direction, can the student use all ambulance equipment (i.e., assemble O 2 masks, apply c-collar properly, ECG monitor etc.)? At this time the student should be able to assemble and use all equipment on the MICU. Can the student: a. Explain various sections of the patient form to include the importance of filling out Biographical Data as well as Physical Assessment and Treatment Data? b. Recognize the significance of and appropriately fill in the environment space on the patient form? Does the student know how to store and distribute forms for further disposition? Remember, students can log forms into the computer, but ultimately you, as the certified paramedic, are responsible for all documentation. This objective is not asking for the student to know when to initiate a skill, merely can he perform the skill adequately. a. Have appropriate technique for starting IVs? b. Insert an oral pharyngeal airway prior to ventilating with a BVM? c. Intubate without breaking principles and properly use capnography? d. Apply ECG leads properly? e. Set up an IVPB drip using aseptic technique? f. Push drugs rapidly and slowly using aseptic technique? g. Apply correct principles of bandaging and splinting to patient situations? h. Smoothly extricate patients and apply needed principles? (Stabilization of neck manually during removal, application of head immobilizer and tape before rolling stretcher to ambulance, etc.) 1 Feedback is needed after every run. Too often students reach their last shifts and are surprised to learn they are performing poorly. Teaching and education should come from run reviews of each patient encounter. d. Can the student identify his/her own weaknesses? 1 Based on earlier feedback, does the student alter and/or correct his/her deficiencies, or does the student repeat the same mistakes? 1 hazard to either the patient or EMS co-workers? Can the student: a. Locate the patient refusal of treatment/transportation form? b. Recognize the significance of and document all explanations given to patients regarding potential problems and complications of refusal of treatment and transport? c. Obtain appropriate patient and witness signatures?

2 SECOND SHIFT At this time the evaluator is still directing the intern, and the student is not yet responsible for initiating skills, protocols, or procedures. Rather, at your direction, students must be able to perform all skills accurately and begin the process of patient assessment. At this time, the student should be able to assemble and use all equipment on the MICU. a) Inventory supplies; b) Restock as necessary; c) Clean ambulance c) Completely (to include a complete set of vital signs, all findings, and patient s response to Can the student, when directed: a. Perform a tilt test accurately and in the correct sequence? b. Perform a complete neurological exam? c. Listen to breath sounds d. Palpate an abdomen e. Check pupils f. Perform a complete head to toe exam on trauma victims? g. Obtain a blood glucose evaluation accurately? h. Palpate the pelvic girdle and extremities? i. Palpate for peripheral and carotid pulses? j. Palpate the skin for turgor, warmth, and moisture? k. Assess pediatric fontanels for bulging or depression? l. Palpate the head/scalp for all victims with head trauma? Etc. etc. This objective can best be evaluated through call review i.e.: a. Explain why we started an IV? b. Explain why we transported with lights and sirens? c. What made the bradycardia treatable? d. Why did we apply 100% O 2? Etc. etc. Can the student exit the ambulance with needed equipment? a. Appropriate equipment bag, ECG machine, and oxygen for cardiac emergencies and breathing difficulties? b. OB kit for obstetrical emergencies? c. Appropriate equipment bag, O 2, ECG machine, resuscitator, and stretcher for high rise calls? a. Have an appropriate technique for starting IVs? b. Use a BVM effectively, to include using an oral or nasal airway and reservoir? c. Intubate without breaking principles? d. Apply ECG leads properly? e. Apply oxygen via mask or nasal cannula f. Set up an IVPB using aseptic technique? g. Push drugs rapidly and slowly using aseptic technique? h. Apply correct principles of bandaging and splinting? i. Smoothly extricate patients and apply needed immobilization principles? Etc. etc. Feedback should occur on every shift and after every run. Too often students reach their last shifts and are surprised to learn they are performing poorly. Teaching and education should come from run reviews of each patient encounter. d. Can the student identify his/her own weaknesses? Based on earlier feedback, does the student alter and correct his/her deficiencies, or does the student repeat the same mistakes? hazard to either the patient or EMS co-workers?

3 THIRD SHIFT At this point, the student begins to take a more active roll in patient assessment and routine care of non-critical patients. You, as a paramedic, are still responsible for the patient and direction of the student. It is important at this time that you tell the student at the beginning of the shift that he/she is to initiate questioning, physical assessment, and treatment for non-critical patients. Most students can ask 2-3 questions and then draw a blank. Your role is NOT to take over the rest of the history and physical assessment, but to ask another question or two in the hope of drawing the student back into the H&P and treatment process. This sometimes is really hard for us old timers. Remember, if we don t hold back and give the student plenty of time, we ll never know at what capacity he/she is functioning. Also, if a student knows you will make the assessment for her/him, he/she will wait for you to do just that. Can the student use all ambulance equipment and assure it is in proper working order? At this time, the student should be able to assemble and use all equipment on the MICU. a) Inventory supplies; b) Restock as necessary; c) Clean the ambulance c) Completely (to include a complete set of vital signs, all findings, and patient responses to a. Have an appropriate technique for starting IVs? b. Use a BVM effectively, to include using an oral or nasal airway and reservoir? c. Intubate without breaking principles? d. Apply ECG leads properly? e. Apply oxygen via mask or nasal cannula f. Set up an IVPB using aseptic technique? g. Push drugs rapidly and slowly using aseptic technique? h. Apply correct principles of bandaging and splinting? i. Smoothly extricate patients and apply needed immobilization principles? Etc. etc. / On non-critical patients, can the student ask questions and perform physical assessments relevant to the patient chief complaints? Note: At this point, the questions and physical exam may be scattered and not asked in an orderly fashion. However, the obvious basics should be covered. Examples can include: a. OB PATIENT/LABOR How far apart are the pains? How many children have you had? Check for BOWI/BOW. Place hand on abdomen to time contractions. Checks perineum for crowning or prolapsed cord. b. CHEST PAIN Where is the pain, and does it radiate? What is the past medical history? Does the patient take any medications? Does anything make it worse or better? What brought on the pain? Is there dyspnea or other associated symptoms? Applies ECG. Knows BP must be 100 for NTG. c. ABDOMINAL PAIN Is there any vomiting/diarrhea? If so, what color? Palpate abdomen. Performs tilt. When was the last menstrual period (if applicable)? Has the pain ever occurred before? Etc. etc. This objective is asking the student to further assess and monitor already established treatment while en route. It is not asking the student to initiate patient care and/or treatment. a. Does the student watch the ECG monitor for changes? b. Does the student continue to talk with the patient to monitor neurological status? c. Does the student check the IV flow rate or drip rates on IVPBs? d. Does the student continue to time contractions and check the perineum for crowning? e. Does the student check pulses for strength? f. Does the student reassess skin for color, warmth, moisture, etc? Etc. etc. Feedback should occur on every shift and after every run. Too often students reach their last shifts and are surprised to learn they are performing poorly. Teaching and education should come from run reviews of each patient encounter. d. Can the student identify his/her own weaknesses? Etc. etc. Based on earlier feedback, does the student alter and correct his/her deficiencies, or does the student repeat the same mistakes? hazard to either the patient or EMS co-workers?

4 FOURTH SHIFT During this shift, the student s primary focus is patient assessment. Students should be relieved of basic EMT duties such as vital signs, bandaging/splinting etc. so they can focus on history taking and physical assessment skills. However, make it clear that you expect the student to direct you to perform the basic skills. It is important that students be placed in the role of directing you so they can begin the process of assuming responsibility for ALL patient care. Can the student use all ambulance equipment and assure it is in proper working order? At this time, the student should be able to assemble and use all equipment on the MICU. a) Inventory supplies; b) Restock as necessary; c) Clean the ambulance c) Completely (to include a complete set of vital signs, all findings, and patient s response to Can the student: a. Gather appropriate history information based on chief complaints? b. Apply appropriate physical exam and assessment techniques to chief complaints (tilt, d-stick, breath sounds, neuro exam, etc.)? c. When obvious, determine the primary patient problems based on thorough history taking and physical assessment skills? Can the student: a. Apply assessment findings to patient management? For 1) Contractions every 45 secs, patient crowning = deliver on scene. 2) Emphysema patient with SOB and chest pain = administer O2 via venti mask and ECG. 3) Suspected GI bleed with tender abdomen = perform tilt test. 4) MVA patient with tingling to lower legs = apply XP1 and manually immobilize head and neck. Etc. etc. b. Begin to apply appropriate protocols to patient findings? Can the student continually monitor any conscious patient enroute, to include: ABC s? oxygen therapy? neurological status? ECG? spinal immobilization? drug therapy, IV rates, response to drugs? Etc. etc. Can the student establish communication with Biotel? a. Work the radio to get in touch with Biotel? b. Know the order in which to report information to Biotel? c. Ask for a physician in a certain specialty (OB, Medicine, etc.)? d. Request appropriate treatment for the patient? a. Have an appropriate technique for starting IVs? b. Use a BVM effectively, to include using an oral or nasal airway and reservoir? c. Intubate without breaking principles? d. Apply ECG leads properly? e. Apply oxygen via mask or nasal cannula (Can he/she put together a venti mask, fill reservoir of NRB before applying mask, etc.)? f. Set up an IVPB using aseptic technique? g. Push drugs rapidly and slowly using aseptic technique? h. Apply correct principles of bandaging and splinting? i. Smoothly extricate patients and apply needed principles? Etc. etc. Feedback should occur on very shift and after every run. Too often students reach their last shifts and are surprised to learn they are performing poorly. Teaching and education should come from run reviews of each patient encounter. d. Can the student identify his/her own weaknesses? Etc. etc. Based on earlier feedback, does the student alter and correct his/her deficiencies, or does the student repeat the same mistakes? 1 hazard to either the patient or EMS co-workers?

5 FIFTH SHIFT This shift evaluates the student s willingness to take control of any patient situation. Students must be given every opportunity to direct patient care. Evaluators must stand back, and intervene only when students need redirection, so as not to compromise patient care. You and your partner are ultimately responsible for patient care, so you must give additional direction and help if the treatment initiated by the student is inadequate. This is only shift #5, so some of the student s decisions may not be on target. You are looking for the student s ability to be assertive and make decisions about patient care. Don t hesitate to redirect the student. Always, explain to the student (outside of earshot of the patient) why you think his decisions(s) need to be altered. 10 Can the student use all ambulance equipment and assure it is in proper working order? At this time, the student should be able to assemble and use all equipment on the MICU. a) Inventory supplies; b) Restock as necessary; c) Clean the ambulance c) Completely (to include a complete set of vital signs, all findings, and patient s response to The student should: a. Gain the confidence of patients and establish good rapport for history taking. b. Ask open-ended questions. c. Be able to initiate all history taking. If he/she becomes stumped, 1-2 questions from you should stimulate more questions from the student. d. Avoid jumping to conclusions based on too little history gathering. Can the student put patient findings together and come to correct conclusions based on thorough histories and physical assessments? Without prompting, does the student direct you as to needed procedures, skills, protocol application, etc.? Does the student respond quickly to significant problems with the airway, breathing or circulation? Examples of not accomplishing this can include: a. Setting up an IV rather than directing someone to defibrillate. Etc. etc. b. Filling out the run form when a patient has a resp. rate of Does the student quickly recognize critical patients and take appropriate action? For student make airway and LOAD & GO the priorities? the student anticipate the need for an IV, Atropine and perhaps pacing? Etc. etc. a. 85 y/o MVA, with rib pain and bruising to the chest. VSs WNL, ECG NSR. Does he/she b. 25 y/o with GSW to abdomen. PB: 110/60, R: 16, P: 10 Does the student LOAD & GO? regarding transports, no transports, and treatment? a. Apply appropriate treatment protocols? b. Make accurate decisions regarding no transports? Etc. etc. The student should be responsible for the continuation of all care while enroute to the hospital: a. Does he have to be prompted to check IV s, LOC, ECG monitor, etc.? b. Does he observe for changes in patient condition? a. Have an appropriate technique for starting IVs? b. Use a BVM effectively, to include using an oral or nasal airway and reservoir? c. Intubate without breaking principles? d. Apply ECG leads properly? e. Apply oxygen via mask or nasal cannula f. Set up an IVPB using aseptic technique? g. Push drugs rapidly and slowly using aseptic technique? h. Apply correct principles of bandaging and splinting? i. Smoothly extricate patients and apply needed immobilization principles? Etc. etc. shifts and are surprised to learn they are performing poorly. Teaching and education should come from run reviews of each patient encounter. d. Can the student identify his own weaknesses? Based on earlier feedback, does the student alter and correct his/her deficiencies, or does the student repeat the same mistakes? Can the student, based on sound history and physical assessments, initiate accurate decisions

6 SIXTH SHIFT The primary goals of shifts 6 10 are that the student initiate and refine all aspects of patient assessment and management. He/she should function as the team leader, and after obtaining thorough history and assessment data, come to accurate and consistent decisions regarding the management of patients. Can the student use all ambulance equipment and assure it is in proper working order? a) Inventory supplies; b) Restock as necessary; c) Clean the ambulance c) Completely (to include a complete set of vital signs, all findings, and patient responses to Is the student able to assess the scene and recognize/respond appropriately to: critical patients, multiple patients, triage situations, etc.? When needed, does the student call for additional manpower and equipment? Does the student respond appropriately to significant problems with airway, breathing, and or circulation? I.e. for patients in v-fib, are priorities given to CPR and rapid defibrillation? For a patient with a respiratory rate of 4, are an oral airway and ventilation with a BVM the priorities? Without prompting from you, can the student verbalize and direct all assessment and management of patient care, to include history taking, physical assessment, priority setting, protocol application, and skills? 1 1 the student recheck LOC, the ECG monitor, and BP? b. A patient awakened with Narcan again develops a decreased LOC enroute. Does the student recheck pupils, vitals, etc. and anticipate that more Narcan may be needed? a. Instill confidence in the patient, family, friends, bystanders, and hospital personnel? b. Communicate in hostile or abusive ways to patients, families, friends, bystanders, or hospital personnel? c. Effectively and diplomatically control the scene? d. Relay a systematic, clear, and concise report to Biotel and hospital personnel? e. Obtain necessary treatment orders based on the history and findings given to Biotel? Independent function - Does the student consistently and accurately: a. Initiate all assessment and patient care? b. Make decisions, or still rely on you to intervene? c. Direct you, your partner, and engine crews? d. Set all priorities and assure they are met? e. Recognize and intervene when patient conditions change? e. Function independently? I.e., does the student perform well on routine MVAs, but falter when assessing a patient who is weak and dizzy? Does the student quickly recognize critical patients and take appropriate action? For student make airway, spinal immobilization, and LOAD & GO the priorities? the student anticipate the need for an IV, Atropine, and perhaps pacing? Etc. etc. Based on thorough histories and physical assessments, does the student consistently and accurately determine the cause behind patient chief complaints? a. 85 y/o MVA patient with rib pain and bruising to the chest. VSs WNL, ECG NSR. Does he/she b. 25 y/o with GSW to abdomen. PB: 110/60, R: 16, P: 10 Does the student LOAD & GO? The student should consistently be able to direct you as to all aspects of patient management, including appropriate protocol applications Does the student consistently and accurately perform skills and direct you to initiate all patient skills? shifts and are surprised to learn they are performing poorly. Teaching and education should come from run reviews of each patient encounter. d. Can the student identify his/her own weakness? Based on earlier feedback, does the student alter and correct his/her deficiencies, or does the student repeat the same mistakes? 1 Can the student recognize when patient conditions changes and redirect patient care? I.e.: a. An initially stable patient with chest pain becomes pale and diaphoretic enroute. Does

7 SEVENTH SHIFT The primary goals of shifts 6 10 are that the student initiate and refine all aspects of patient assessment and management. He/she should function as the team leader, and after obtaining thorough history and assessment data, come to accurate and consistent decisions regarding the management of patients. Can the student use all ambulance equipment and assure it is in proper working order? a) Inventory supplies; b) Restock as necessary; c) Clean the ambulance c) Completely (to include a complete set of vital signs, all findings, and patient responses to Is the student able to assess the scene and recognize/respond appropriately to: critical patients, multiple patients, triage situations, etc.? When needed, does the student call for additional manpower and equipment? Does the student respond appropriately to significant problems with airway, breathing, and or circulation? I.e. for patients in v-fib, are priorities given to CPR and rapid defibrillation? For a patient with a respiratory rate of 4, are an oral airway and ventilation with a BVM the priorities? Without prompting from you, can the student verbalize and direct all assessment and management of patient care, to include history taking, physical assessment, priority setting, protocol application, and skills? 1 1 the student recheck LOC, the ECG monitor, and BP? b. A patient awakened with Narcan again develops a decreased LOC enroute. Does the student recheck pupils, vitals, etc. and anticipate that more Narcan may be needed? a. Instill confidence in the patient, family, friends, bystanders, and hospital personnel? b. Communicate in hostile or abusive ways to patients, families, friends, bystanders, or hospital personnel? c. Effectively and diplomatically control the scene? d. Relay a systematic, clear, and concise report to Biotel and hospital personnel? e. Obtain necessary treatment orders based on the history and findings given to Biotel? Independent function - Does the student consistently and accurately: a. Initiate all assessment and patient care? b. Make decisions, or still rely on you to intervene? c. Direct you, your partner, and engine crews? d. Set all priorities and assure they are met? e. Recognize and intervene when patient conditions change? e. Function independently? I.e., does the student perform well on routine MVAs, but falter when assessing a patient who is weak and dizzy? Does the student quickly recognize critical patients and take appropriate action? For student make airway, spinal immobilization, and LOAD & GO the priorities? the student anticipate the need for an IV, Atropine, and perhaps pacing? Etc. etc. Based on thorough histories and physical assessments, does the student consistently and accurately determine the cause behind patient chief complaints? a. 85 y/o MVA patient with rib pain and bruising to the chest. VSs WNL, ECG NSR. Does he/she b. 25 y/o with GSW to abdomen. PB: 110/60, R: 16, P: 10 Does the student LOAD & GO? The student should consistently be able to direct you as to all aspects of patient management, including appropriate protocol applications Does the student consistently and accurately perform skills and direct you to initiate all patient skills? shifts and are surprised to learn they are performing poorly. Teaching and education should come from run reviews of each patient encounter. d. Can the student identify his/her own weakness? Based on earlier feedback, does the student alter and correct his/her deficiencies, or does the student repeat the same mistakes? 1 Can the student recognize when patient conditions changes and redirect patient care? I.e.: a. An initially stable patient with chest pain becomes pale and diaphoretic enroute. Does

8 EIGHTH SHIFT The primary goals of shifts 6 10 are that the student initiate and refine all aspects of patient assessment and management. He/she should function as the team leader, and after obtaining thorough history and assessment data, come to accurate and consistent decisions regarding the management of patients. Can the student use all ambulance equipment and assure it is in proper working order? a) Inventory supplies; b) Restock as necessary; c) Clean the ambulance c) Completely (to include a complete set of vital signs, all findings, and patient responses to Is the student able to assess the scene and recognize/respond appropriately to: critical patients, multiple patients, triage situations, etc.? When needed, does the student call for additional manpower and equipment? Does the student respond appropriately to significant problems with airway, breathing, and or circulation? I.e. for patients in v-fib, are priorities given to CPR and rapid defibrillation? For a patient with a respiratory rate of 4, are an oral airway and ventilation with a BVM the priorities? Without prompting from you, can the student verbalize and direct all assessment and management of patient care, to include history taking, physical assessment, priority setting, protocol application, and skills? 1 1 the student recheck LOC, the ECG monitor, and BP? b. A patient awakened with Narcan again develops a decreased LOC enroute. Does the student recheck pupils, vitals, etc. and anticipate that more Narcan may be needed? a. Instill confidence in the patient, family, friends, bystanders, and hospital personnel? b. Communicate in hostile or abusive ways to patients, families, friends, bystanders, or hospital personnel? c. Effectively and diplomatically control the scene? d. Relay a systematic, clear, and concise report to Biotel and hospital personnel? e. Obtain necessary treatment orders based on the history and findings given to Biotel? Independent function - Does the student consistently and accurately: a. Initiate all assessment and patient care? b. Make decisions, or still rely on you to intervene? c. Direct you, your partner, and engine crews? d. Set all priorities and assure they are met? e. Recognize and intervene when patient conditions change? e. Function independently? I.e., does the student perform well on routine MVAs, but falter when assessing a patient who is weak and dizzy? Does the student quickly recognize critical patients and take appropriate action? For student make airway, spinal immobilization, and LOAD & GO the priorities? the student anticipate the need for an IV, Atropine, and perhaps pacing? Etc. etc. Based on thorough histories and physical assessments, does the student consistently and accurately determine the cause behind patient chief complaints? a. 85 y/o MVA patient with rib pain and bruising to the chest. VSs WNL, ECG NSR. Does he/she b. 25 y/o with GSW to abdomen. PB: 110/60, R: 16, P: 10 Does the student LOAD & GO? The student should consistently be able to direct you as to all aspects of patient management, including appropriate protocol applications Does the student consistently and accurately perform skills and direct you to initiate all patient skills? shifts and are surprised to learn they are performing poorly. Teaching and education should come from run reviews of each patient encounter. d. Can the student identify his/her own weakness? Based on earlier feedback, does the student alter and correct his/her deficiencies, or does the student repeat the same mistakes? 1 Can the student recognize when patient conditions changes and redirect patient care? I.e.: a. An initially stable patient with chest pain becomes pale and diaphoretic enroute. Does

9 NINTH SHIFT The primary goals of shifts 6 10 are that the student initiate and refine all aspects of patient assessment and management. He/she should function as the team leader, and after obtaining thorough history and assessment data, come to accurate and consistent decisions regarding the management of patients. Can the student use all ambulance equipment and assure it is in proper working order? a) Inventory supplies; b) Restock as necessary; c) Clean the ambulance c) Completely (to include a complete set of vital signs, all findings, and patient responses to Is the student able to assess the scene and recognize/respond appropriately to: critical patients, multiple patients, triage situations, etc.? When needed, does the student call for additional manpower and equipment? Does the student respond appropriately to significant problems with airway, breathing, and or circulation? I.e. for patients in v-fib, are priorities given to CPR and rapid defibrillation? For a patient with a respiratory rate of 4, are an oral airway and ventilation with a BVM the priorities? Without prompting from you, can the student verbalize and direct all assessment and management of patient care, to include history taking, physical assessment, priority setting, protocol application, and skills? 1 1 the student recheck LOC, the ECG monitor, and BP? b. A patient awakened with Narcan again develops a decreased LOC enroute. Does the student recheck pupils, vitals, etc. and anticipate that more Narcan may be needed? a. Instill confidence in the patient, family, friends, bystanders, and hospital personnel? b. Communicate in hostile or abusive ways to patients, families, friends, bystanders, or hospital personnel? c. Effectively and diplomatically control the scene? d. Relay a systematic, clear, and concise report to Biotel and hospital personnel? e. Obtain necessary treatment orders based on the history and findings given to Biotel? Independent function - Does the student consistently and accurately: a. Initiate all assessment and patient care? b. Make decisions, or still rely on you to intervene? c. Direct you, your partner, and engine crews? d. Set all priorities and assure they are met? e. Recognize and intervene when patient conditions change? e. Function independently? I.e., does the student perform well on routine MVAs, but falter when assessing a patient who is weak and dizzy? Does the student quickly recognize critical patients and take appropriate action? For student make airway, spinal immobilization, and LOAD & GO the priorities? the student anticipate the need for an IV, Atropine, and perhaps pacing? Etc. etc. Based on thorough histories and physical assessments, does the student consistently and accurately determine the cause behind patient chief complaints? a. 85 y/o MVA patient with rib pain and bruising to the chest. VSs WNL, ECG NSR. Does he/she b. 25 y/o with GSW to abdomen. PB: 110/60, R: 16, P: 10 Does the student LOAD & GO? The student should consistently be able to direct you as to all aspects of patient management, including appropriate protocol applications Does the student consistently and accurately perform skills and direct you to initiate all patient skills? shifts and are surprised to learn they are performing poorly. Teaching and education should come from run reviews of each patient encounter. d. Can the student identify his/her own weakness? Based on earlier feedback, does the student alter and correct his/her deficiencies, or does the student repeat the same mistakes? 1 Can the student recognize when patient conditions changes and redirect patient care? I.e.: a. An initially stable patient with chest pain becomes pale and diaphoretic enroute. Does

10 TENTH SHIFT The primary goals of shifts 6 10 are that the student initiate and refine all aspects of patient assessment and management. He/she should function as the team leader, and after obtaining thorough history and assessment data, come to accurate and consistent decisions regarding the management of patients. Can the student use all ambulance equipment and assure it is in proper working order? a) Inventory supplies; b) Restock as necessary; c) Clean the ambulance c) Completely (to include a complete set of vital signs, all findings, and patient responses to Is the student able to assess the scene and recognize/respond appropriately to: critical patients, multiple patients, triage situations, etc.? When needed, does the student call for additional manpower and equipment? Does the student respond appropriately to significant problems with airway, breathing, and or circulation? I.e. for patients in v-fib, are priorities given to CPR and rapid defibrillation? For a patient with a respiratory rate of 4, are an oral airway and ventilation with a BVM the priorities? Without prompting from you, can the student verbalize and direct all assessment and management of patient care, to include history taking, physical assessment, priority setting, protocol application, and skills? 1 1 the student recheck LOC, the ECG monitor, and BP? b. A patient awakened with Narcan again develops a decreased LOC enroute. Does the student recheck pupils, vitals, etc. and anticipate that more Narcan may be needed? a. Instill confidence in the patient, family, friends, bystanders, and hospital personnel? b. Communicate in hostile or abusive ways to patients, families, friends, bystanders, or hospital personnel? c. Effectively and diplomatically control the scene? d. Relay a systematic, clear, and concise report to Biotel and hospital personnel? e. Obtain necessary treatment orders based on the history and findings given to Biotel? Independent function - Does the student consistently and accurately: a. Initiate all assessment and patient care? b. Make decisions, or still rely on you to intervene? c. Direct you, your partner, and engine crews? d. Set all priorities and assure they are met? e. Recognize and intervene when patient conditions change? e. Function independently? I.e., does the student perform well on routine MVAs, but falter when assessing a patient who is weak and dizzy? Does the student quickly recognize critical patients and take appropriate action? For student make airway, spinal immobilization, and LOAD & GO the priorities? the student anticipate the need for an IV, Atropine, and perhaps pacing? Etc. etc. Based on thorough histories and physical assessments, does the student consistently and accurately determine the cause behind patient chief complaints? a. 85 y/o MVA patient with rib pain and bruising to the chest. VSs WNL, ECG NSR. Does he/she b. 25 y/o with GSW to abdomen. PB: 110/60, R: 16, P: 10 Does the student LOAD & GO? The student should consistently be able to direct you as to all aspects of patient management, including appropriate protocol applications Does the student consistently and accurately perform skills and direct you to initiate all patient skills? shifts and are surprised to learn they are performing poorly. Teaching and education should come from run reviews of each patient encounter. d. Can the student identify his/her own weakness? Based on earlier feedback, does the student alter and correct his/her deficiencies, or does the student repeat the same mistakes? 1 Can the student recognize when patient conditions changes and redirect patient care? I.e.: a. An initially stable patient with chest pain becomes pale and diaphoretic enroute. Does

11 INTERNSHIP EXTENSIONS (Additional Shifts) An extension of the internship phase of training may be granted after a station conference is held to include the student, paramedic evaluators, a representative from UT Southwestern, and if needed, a department representative. At this time, identification of specific areas of strengths and weaknesses, as well as a written plan for improvement, will be developed and discussed with the student. Additional shifts are utilized because the student has known deficiencies. If a student needs additional shifts, you are making the decision that the student has not successfully obtained the objectives of his/her first 10 shifts. Additional shifts are not granted merely so a student can gain more experience. If you should have a student who has had a limited number of runs, the principle is to bet on the come so to speak. In other words, if the student performed well on the runs he/she did have, he/she will pass. Also, if a student is assigned additional shifts, the daily evaluations must reflect the objectives that were not obtained with a written comment out beside each. Early intervention and notification of known problems to the paramedic instructors is critical for the student. If the student is a fire department employee, their department is also notified. All too often, shift 10 occurs with those involved scrambling to hold last minute meetings with the student, preceptors, and paramedic instructor. This can lead to confusion and frustration, especially for the student. Most students, if well informed of their weaknesses early in the internship, will make every opportunity to improve. Additional shifts are typically due to, but not limited to, the following reasons: Inability to perform adequate field assessments. Inability to identify chief complaints. Inability to determine appropriate field protocols when the chief complaint is identified. Inability to determine what is wrong with the patient. Inability to set priorities. Inability to anticipate appropriate Biotel orders. Inability to apply classroom knowledge to patient situations. Inability to demonstrate adequate communication techniques. Inability to accept and apply feedback and guidance. Inability to perform consistently in the following areas: history taking/communication, patient assessment, treatment/transport decisions, priority setting. An internship extension is normally completed in increments of five (5) shifts, but may require more. Daily evaluations must be completed during each five shift increment. A candidate who is unable to attain a competent rating at the completion of additional shifts fails the internship requirement. Dr. Atkins will make the final decision. 1991, UT Southwestern Medical Center at Dallas, Emergency Medicine Education Revised 05/06