QUICK-LOOK NCTI Bay Area Newsletter May 2016

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Martha Walton
6 years ago
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We have welcomed a new Program Manager and a full-time clinical coordinator to our staff in the past couple of months.

1 QUICK-LOOK NCTI Bay Area Newsletter May 2016 Our focus is to identify and meet the needs of our students by equipping them with the knowledge, technical skills, and a commitment to excellence in self. The patients entrusted to their care expect and deserve nothing less than that excellence.- NCTI Transition The last few weeks have been a blur with many new and exciting changes underway at NCTI. We have welcomed a new Program Manager and a full-time clinical coordinator to our staff in the past couple of months. Our staff now brings a wealth of field and educational experience to the classroom and a renewed focus to the success of the student. See page 4 to learn more about our staff and their roles at NCTI. In This Issue Online Tools and Resources Instructional Notes Staff Profile Case Study

Airway Management for the Paramedic Sway Presentation by Mark Betterton Equipment Notes To enhance our instructors in the classroom, we are adding a new projector in Livermore classroom 1 that will

We think you will love the ability to have notes and diagrams from the board sent to your device along with many other cool new features.

2 Airway Management for the Paramedic Sway Presentation by Mark Betterton Equipment Notes To enhance our instructors in the classroom, we are adding a new projector in Livermore classroom 1 that will provide an interactive experience and facilitate interaction between the content on the board and your computer, tablet or smartphone. We think you will love the ability to have notes and diagrams from the board sent to your device along with many other cool new features. We hope to see this addition coming soon and look forward to this enhanced learning experience in the classroom. Online Tools and Resources Do you sometimes feel like you need just a tad more information or a different perspective to help you understand a topic? The internet is for more than Facebook and Twitter. Many resources exist online ranging from blogs to the latest science presented in peer reviewed papers. As a start, I thought I would provide you with a list of some initial stopping points on the internet to help with your studies. These can be quite deep, but as the program manager I want you to challenge yourself and never accept the bare minimum as adequate. Your patients will deserve more than just adequate medicine and I challenge you to never accept adequate competence. I have included a few links below to get you started in your journey. The last link goes to my Sway presentations on various topics that you my find helpful. If you have others to share please let us know and we will include them here for your peers SIM PRACTICE As a reminder, simulation practice is held every Thursday from 5-9 at Livermore. Click on the icon below to sign up for a session SIMULATION

Bay Area Contacts Mark Betterton, BS, FP-C Program manager 925-454-6184 Mark.Betterton@amr.net Steve Seoane, BA, EMTP Lead Instructor Livermore 925-454-6031 Steve.Seoane@amr.

3 Bay Area Contacts Mark Betterton, BS, FP-C Program manager Steve Seoane, BA, EMTP Lead Instructor Livermore Nick Matley, Concord and South Bay Lead Instructor Michelle Franklin Lead Instructor Monterey Chris Morehouse, EMT Instructor Christine Gonzales Clinical Coordinator Dawn Avila Internship Coordinator Ray Bakker Lead Lab Instructor Instructional Notes Effective with any student in cohort Livermore 1503 and later, we will be transitioning to a new summative end -of- program exam process. The exit process will include a proctored 200 question exam that is hosted on FISDAP that will be taken at the NCTI campus. This exam has been utilized on a national level and success on the exam is a strong predictor of success on the NREMT exam. Additionally, students will complete a scenario based psychomotor exam which will evaluate performance in the role of team lead. Effective 1/1/17, all paramedic candidates taking the NREMT Paramedic psychomotor exam will be required to complete a scenario based team-lead station. As with the end of program FISDAP exam, this scenario /psychomotor exam will serve to provide a measure of readiness for the NREMT exam. To help prepare students who are out of didactic, but not anticipated to complete field and NREMT testing by 1/1/17, we will begin to offer scenario based training to bring clinical and field students up to speed in this element. More information will be coming in the next month, but we will begin those sessions in August and will require attendance to one day of training for each student who meets the following requirements: Student is out of didactic training Student has not yet started field or has less than 120 hours in field internship as of August 1st, 2016 Student has not successfully completed the NREMT skills exam as of August 1, 2016 Students who meet all of the these criteria will be required to attend a one-day scenario training session. A listing of dates and times will be forthcoming soon.

4 STAFF UPDATE NCTI BAY AREA STAFF PROFILES MARK BETTERTON PROGRAM MANAGER BAY AREA Mark became the Bay Area Program Manager on February 29th. He is new to California and comes to us from his role as Paramedic Educator and Critical Care Course Developer at HealthONE EMS in the Denver area. Mark is originally from Mississippi and has spent 28 years in EMS starting as a Corpsman in the U.S. Navy before becoming a civilian paramedic. He has also served as a field paramedic, educator and flight paramedic in Alabama and Arizona before later moving to the corporate office at Air Methods Corporation in Colorado as a Clinical Education Coordinator for their flight programs nationwide. He is happy about the move to California and away from the cold and snow of Colorado. He has a wife and 5 children; one in the U.S. Navy, one is a pursuing her Masters in Speech Language Pathology, one in nursing school, and two still at home consuming food and money. Mark s wife is an elementary teacher and will be working in the area beginning in the fall. As for hobbies, Mark enjoys hiking and 14ers, having completed 9 of Colorado s 14,000 foot peaks and looks to add California s 14ers to the list starting this summer.

5 STAFF UPDATE NCTI BAY AREA STAFF PROFILES CHRISTINE GONZALES CLINICAL COORDINATOR BAY AREA Christine is the new Bay Area Clinical Coordinator. She came to this position from AMR Stanislaus where she served as a Field Operations Supervisor for the past two years. She is experienced in EMS operations and education having spent 20-plus years in Santa Clara County as an EMT and Paramedic. Her tour in Santa Clara also included time as an FTO and QLC member. She brings educational experience as a prior instructor at San Jose City College and has been a terrific addition to our team. As the Clinical Coordinator, Christine works tirelessly to develop relationships with hospitals that will facilitate placement of students for their clinical internship. The job doesn t stop there however, as she is also responsible for monitoring student progress in the clinical environment through FISDAP audits, preceptor communications, and clinical site visits with the students. Her thoroughness and attention to detail helps students understand what it takes to be successful in EMS. She sets an example with a high expectation for precise documentation; this example, when heeded by students will help them to avoid many of the documentation pitfalls that come with the job of completing EMS paperwork

6 CASE STUDIES Points to Ponder in the Prehospital Arena Lets take a look at the case from the last issue: A 23 year old, obese motorcyclist has crashed his bike and you have arrived on scene to care for the patient. The patient is a short, round looking male who is fully immobilized on a backboard and is blowing blood out of his nose and mouth with exaggerated work of breathing. Suction is being attempted, but the patient has his jaw clenched. The patient's BP is 192/112, pulse rate is 121, respiration rate is 31, breathing is labored with shallow breath sounds, and Sao2 by pulse oximetry is 88%. Your partner is establishing an IV while you contemplate best airway management for the patient. You are unable to evaluate the patient's mouth due to jaw clench, but you suspect intraoral trauma. The outward appearance of the patient's head is that of an upside down triangle with a very short neck. The evaluation was incomplete because of jaw clench, but from the chin to the hyoid was 1-2 finger breadths and from the thyroid to the floor of the mouth was 1 finger breadth. You have applied your BVM flush to the patient's face with good mask seal to provide 100% oxygen. TheSao2 is slowly increasing to >95%. You have decided to administer sedation only to attempt intubation in this patient, because of his anatomic challenges. All the equipment is set up, and you have a standard direct laryngoscope, Bougie introducer, and extraglottic backup airway out and ready. Etomidate 0.3 mg/kg is injected, and the patient quickly shows myoclonus. The assistant applies cricoid pressure as you insert the laryngoscope blade into position, suction the oropharynx, and attempt to view the vocal cords. You can now see that the patient's upper airway qualifies as Mallampati class IV with a continuous flow of blood from lacerations in the tongue. You are unable to see the vocal cords, and after 30 seconds into your intubation attempt, the patient's heart rate is falling and his Sao2 is at 90%. You quickly stop the procedure, resuction the oropharynx and ventilate the patient with the BVM. You are concerned, but the patient's vital sign values are returning to preintubation levels as you prepare for the next step So what did you decide was the best approach? This patient is obviously in extremis and in need of airway management with the only question really being the type and approach to the management. A failed initial attempt does not represent a failure at airway management as long as we do not allow desaturation below 90% and prevent decompensation. The correct choice as indicated in the initial description was to stop the attempt, maintain oxygenation, and to formulate a new plan. What will it be? Another oral intubation attempt? A supraglottic attempt? Surgical airway? The focus should always remain on the patient s airway and ventilation status. Suction and maintain patency while deciding upon a new strategy. Certainly nothing wrong with a second oral attempt as long as you have maintained oxygenation via BVM and are prepared for the attempt. Change something on the second attempt. The blade, use a bougie, change provider, position.just change something. If you failed the first time don t make the mistake of doing the exact same thing on the second attempt; if you were unsuccessful on the initial attempt and have made no adjustments why should you expect to be successful on the second go? There is no need for a needle or surgical approach at this time. The surgical or needle cric is reserved for situations in which you can t intubate and can t ventilate. If you can ventilate with a BVM effectively then you should not be attempting a cric. How about a King, AirQ or other supraglottic airway? Sure, certainly not a problem and may be a very safe approach to management in this patient. Just keep in mind that the airway is not protected from aspiration with all that frank bleeding present. Still, the supraglottic could give you a bridge and provide adequate support of ventilation in the short term. Send me questions or comments to Mark.Betterton@amr.net

Clinical Preceptor Orientation Training Guidelines and Documents

Clinical Preceptor Orientation Training Guidelines and Documents Table of Contents Trenholm State EMS Program Contact Information Clinical Preceptor Requirements Purposes of student rotation (minimum competencies,