Paramedic Credentialing Manual

Transcription

1 Vermont EMS District #3 Paramedic Credentialing Manual Last revised 5/3/17 May 2017 Page 1

2 Vermont EMS District #3 Paramedic Credentialing Manual Contents Purpose... 3 Introduction... 3 Obtaining Initial Credentials... 5 Maintaining Credentials... 7 Appendix A: Forms for New and Probationary Paramedics... 8 Appendix A1: Transport Critique Form Appendix A2: Patient Summary Report Appendix A3: Incident Log Appendix B: District 3 Restrictions on and Clarifications of State Protocols Appendix C: District 3 Controlled Substance Policy Appendix D: Use of the Pyxis Appendix E: Criteria for Service Level Paramedic License May 2017 Page 2

3 Purpose This document has several purposes: Provide a single source of information for paramedics and paramedic agencies on getting individuals credentialed to function as paramedics in District 3 Provide a single source of information for paramedics and paramedic agencies on maintaining credentials to function as paramedic in District 3 Function as a reference for equipment and medications Function as a reference for District 3 variations on state protocols Introduction Welcome to paramedicine in EMS District 3. This document will provide you with everything you need to know about the requirements of becoming and practicing as a paramedic in EMS District 3 and has been approved by the EMS District 3 EMS Board of Directors. Background History Paramedicine began in District 3 on September 15, Essex Rescue and Colchester Rescue were the first two agencies to go online with paramedics, and Charlotte Rescue followed in the spring of Also starting in September of 2010 was the first paramedic course offered by the University of Vermont, made possible by a Regional Homeland Security Grant awarded to the South Burlington Fire Department (SBFD), with the cooperation of Essex Rescue, and Colchester Rescue. When the class ended in December of 2011, it provided SBFD with seven paramedics, bringing their department online in February It also provided an additional five paramedics to Essex Rescue and an additional four paramedics to Colchester Rescue. Definitions As used in this document, the following terms mean: Credential authorization for a Vermont licensed paramedic to practice at the paramedic level in Vermont EMS District 3 after formal review and evaluation of the license, experience and qualifications of the paramedic DPMA (district paramedic medical advisor) the physician with authority and responsibility for oversight of paramedics in an EMS district. Orientation the period at the beginning of a District 3 paramedic s career when she or he is learning how the district works. During this interval, the new paramedic may perform paramedic-level interventions only when working with a credentialed paramedic. Typically, this period lasts about ten calls before she or he moves to probationary status. This manual refers May 2017 Page 3

4 to such a person as a new paramedic even though the person may not be new to District 3 or to paramedicine in another area. Probation a. the period after orientation when a paramedic demonstrates to a preceptor(s) the knowledge, skills and judgment necessary for safe practice. b. the state in which a formerly credentialed paramedic has failed to demonstrate adequate continuing education, knowledge, skills or judgment and must demonstrate to a preceptor(s) the knowledge, skills and judgment necessary for safe practice District paramedic training coordinator the person designated by the Vermont EMS District 3 Board of Directors and District 3 Paramedic Medical Advisor with responsibility for coordinating and overseeing paramedic level continuing education in District 3. Training officer (or designee) the person designated by a District 3 licensed paramedic agency who is responsible for overseeing the orientation and probationary oversight of new paramedics for that agency May 2017 Page 4

5 Obtaining Initial Credentials Phase 1: Orientation and Initial Field Experience 1. The new paramedic meets with the agency training officer and agency head of service to schedule orientation and initial field experience. The training officer must notify and provide the District Paramedic Medical Advisor (DPMA) with the following before any field experience begins: a. The name of the new paramedic b. The name(s) of the preceptor(s) who will be working with the paramedic c. Any additional information the training officer feels is pertinent or that the DPMA requests 2. The orientation must include: a. Review of the State of Vermont EMS protocols b. Review of the District 3 Restrictions on and Clarifications of State Protocols c. Satisfactory performance of skills on the District 3 skill checklist d. Satisfactory performance on the District 3 protocol test 3. The field experience includes the paramedic acting as the primary care provider on at least 10 EMS calls under the direct supervision of a paramedic preceptor who is approved by the DPMA and the training officer. For each call, this includes: i. Handling radio communications with dispatch ii. Acting as the team leader in assessing and managing patients iii. Providing updates to the hospital communication center and ED staff iv. Documenting the patient encounter 4. The calls do not all have to include performance of paramedic procedures or administration of paramedic medications, but they should allow the preceptor, training officer, and DPMA to evaluate the new paramedic s knowledge, skills and attitudes. Depending on the types of calls received, this may not be possible with the first 10 calls and new paramedics with limited experience should expect that 10 calls will not be sufficient. 5. Each of the 10 calls must include transport to a hospital 6. Each of the 10 calls must be reviewed by the paramedic preceptor and agency training officer with the Transport Critique Form. May 2017 Page 5

6 Phase 2: Evaluation 1. After successful completion of phase 1, the training officer in conjunction with the preceptor(s) will evaluate if the new paramedic is ready to be considered a probationary paramedic or to be credentialed as a paramedic. a. If the training officer believes that the new paramedic is ready to be credentialed: i. The training officer submits a letter of recommendation to the DPMA ii. The new paramedic submits a portfolio to the DPMA containing a call log for cases where they acted as the primary care giver, corresponding patient care reports and transport critique forms. iii. The DPMA will notify the service of their decision within seven days. If the DPMA is satisfied that the new paramedic is ready to practice in the field, the DPMA will grant credentialed paramedic status. b. If the training officer believes that the new paramedic is ready to be credentialed as a probationary paramedic only: i. The training officer submits a letter of recommendation to the DPMA and a plan to allow the probationary paramedic to further develop on calls with and without a preceptor. ii. The newparamedic submits a portfolio containing a call log for when they acted as the primary care giver, corresponding patient care reports and transport critique forms. iii. The DPMA will notify the service of their decision within seven days. If the DPMA is satisfied that the new paramedic is ready to practice in the field with restrictions, the DPMA will grant probationary paramedic status. Probationary paramedics must call medical direction for paramedic level interventions excluding cardiac arrest management. 2. The decision to grant probationary or credentialed status ultimately rests with the DPMA. Any time the DPMA denies probationary or credentialed status, they will work with the training officer to identify a plan to further develop the paramedic s skills. a. The goals of any plan are: i. Correct any gaps in the paramedic s knowledge, skills or attitudes ii. Describe what additional training or experience is needed for the paramedic to function in the field with or without a preceptor iii. Provide an opportunity for the probationary paramedic to demonstrate appropriate knowledge, skills and attitudes in an EMS setting b. The plan must include a schedule for reporting progress to the DPMA by the training officer. In general, this should be at least once a month. c. At any time, the training officer may request an informal meeting with the DPMA to evaluate the progress the probationary paramedic is making. d. After three months, if the paramedic has still not accomplished all of the goals of the plan, the training officer should schedule a meeting with the DPMA to reevaluate and possibly revise the plan. May 2017 Page 6

7 Maintaining Credentials 1. Continuing Education The district paramedic training coordinator is responsible for determining monthly training dates, times, and topics based on the National Continued Competency Program. S/He will also determine which paramedic service will be responsible for hosting the monthly trainings throughout the year. The yearly schedule will be published prior to January 1 st of each year Every probationary and credentialed paramedic in District 3 is required to attend four monthly trainings each calendar year. For paramedics starting in District 3 after the beginning of the year, the number of monthly trainings required will be pro-rated on a quarterly basis. If a session is rescheduled or cancelled, the total required number is reduced by one Paramedics may attend a monthly training via video conference, but attendance via video conference may only count towards one of the four total trainings required. The hosting service is responsible for maintaining attendance records and entering the training into CentreLearn. If a paramedic does not attend the required four trainings a year, she or he must attend four in the first six months of the following year and two in the second six months of the year. If a paramedic fails to do so, her or his status reverts to probationary paramedic (all paramedic level interventions require online medical control except for cardiac arrest management). 2. Continued Annual Competency Annually, all probationary and credentialed paramedics will be required to demonstrate competency in the following skills for adult and pediatric patients: o King/iGel/intubation o IV/IO placement o Percutaneous cricothyrotomy o OG tube placement o Advanced airway suctioning o Tracheostomy maintenance o Needle decompression o IV pump use May 2017 Page 7

8 Appendix A: Forms for New and Probationary Paramedics Appendix A1: Transport Critique Form Appendix A2: Patient Summary Report Appendix A3: Incident Log May 2017 Page 8

9 TRANSPORT CRITIQUE (This section is to be completed by the trainee) Trainee: Incident #: SIREN Incident Number: Preceptor: Date of Transport: Levels of Care Provided: Paramedic Medication AEMT Medication BLS Transport Paramedic Assessment AEMT Assessment Paramedic Intervention AEMT Intervention (This section is to be completed by the preceptor) Preceptor Evaluation of Performance: Fully Proficient Performs Independently Basic Knowledge Not Applicable Pre-Transport Procedures Lifting & moving patients Familiarity with ambulance Familiarity with equipment Equipment proficiency Cardiac Monitor proficiency Medication Administration Safety procedures Infection control Patient Care Interaction with the team Interaction with hospital staff Pre-hospital report to UVMMC Documentation Distribution of paperwork Returning to service May 2017 Page 9

10 Preceptor Comments: Evaluation of the trainee s performance: Note: Please detail for any categories not deemed fully proficient Evaluation of overall scene management: Signed: May 2017 Page 10

11 Patient Summary Report Trainee: Call # : SIREN Incident Number: Chief Complaint / Primary Problem: Patient Sex / Age: Preceptor: Transporting Agency: Date of Transport: Total Patient Time (min): Category: Medical Trauma Other Initial assessment completed and documented in SIREN? Level of consciousness Yes/No Chief Complaint Yes/No Airway and Breathing Yes/No Circulation Yes/No What was your differential diagnosis for this patient? What initial management was indicated for this patient? May 2017 Page 11

12 Was a focused history and physical exam completed and documented in SIREN? Onset Provocation / Palliation Quality Radiation / Referred Pain Severity Time Interventions Prior to EMS Arrival Chest Exam Breath Sounds Jugular Veins Abdominal Assessment Baseline vital signs and SAMPLE history completed and documented in SIREN? Vitals ETCO2 FSBG Cardiac Rhythm Interpretation Signs and Symptoms Allergies Medications Pertinent Past History Last Oral Intake Events Leading to the Present Illness Yes/No What was your field diagnosis for this patient? May 2017 Page 12

13 Are treatments and procedures documented and completed in SIREN? (Interventions, med administration, etc.) If completed but not documented, please list- Ongoing assessment completed and documented in SIREN? Vitals Yes/No ETCO2 FSBG Cardiac rhythm interpretation Change in pt. condition What was your patient s condition at the time of arrival at the emergency department? What protocol(s) did you follow to treat your patient? May 2017 Page 13

14 Call critique- What went well? What didn t? What did you learn? Trainee Comments: General impression of the transport: Areas where you felt comfortable: Areas where you felt uncomfortable: May 2017 Page 14

15 Requested Training: Signed- May 2017 Page 15

16 Incident Log (The probationary paramedic must act in the capacity of the primary care provider for the call to be counted in this log) Trainee: Probation Start Date: Call # Incident # Date Age & Sex Chief Complaint / Primary Problem Advanced / Paramedic Interventions May 2017 Page 16

17 Appendix B: District 3 Restrictions on and Clarifications of State Protocols May 2017 Page 17

18 Vermont EMS District 3 District 3 Restrictions on and Clarifications of State Protocols 10/12/16 Paramedics who are credentialed in Vermont EMS District 3 are authorized to operate in accordance with the Vermont Department of Health s Statewide EMS Protocols with the following exception: Airway Management Adult: Off-line endotracheal intubation is limited to patients: in cardiac arrest with impending cardiac arrest status post cardiac arrest with respiratory failure Signature on File Laurel Plante, MD, District 3 Paramedic Medical Advisor 10/12/16 Date May 2017 Page 18

19 Appendix C: District 3 Controlled Substance Policy May 2017 Page 19

20 Vermont Emergency Medical Services District #3 Policy - Controlled Substance Policy Last revised: 11/4/2016 This policy describes the use, storage, and return of controlled substances. Controlled substances will be used in accordance with Vermont Statewide Emergency Medical Services Protocols. Controlled substances shall be stored within a medication safe approved by the District Paramedic Medical Advisor (DPMA) Safes will meet the following performance specifications: Electronic lock with key override Electronic audit trail Use of Medication Safes Each paramedic shall have an individualized code for entry into a medication safe. Routine use of keys to access controlled substances is prohibited unless there is a failure of the medication safe electronic keypad. In this case, the failure must be corrected as soon as possible, allowing paramedics to return to using electronic access. The DPMA shall be notified of an electronic keypad failure and that a key will be used for safe access. In the case where a service head is not a paramedic: The service head will submit a plan to the DPMA that declares who has access to the medication safe and who holds the keys. Services will re-submit the plan within 10 days to the DPMA when named individuals vacate positions within the service. Medication Safe Access Auditing In January of each year, the DPMA will designate a month from the previous year for an access audit from each service to be submitted at the February paramedic committee meeting. Services will maintain records for review at any time (i.e., spot checks) by the DPMA. Receiving & Storage of Controlled Substances All controlled substances shall be acquired through the pharmacy at the University of Vermont Medical Center and stored in a medication safe. Controlled substances must never be left unattended. Each paramedic service is issued an agreed upon number of sealed controlled substance boxes. Controlled substance boxes will be stocked with DPMA approved controlled substances for VT EMS District #3 paramedics (including an inventory sheet with expiration dates). When a service has a vehicle out for maintenance, the controlled substances box must be moved to another medication safe. Checking Controlled Substances At the beginning of a paramedic s shift, he/she will open the medication safe(s), check that the controlled substance boxes are present, that the tag and box are intact, and complete the log accordingly. All medication safes shall be checked and logged each shift. If a paramedic is not on duty, it shall be documented daily that the medication safe is present and locked on the service s daily vehicle/rig check form. Expired controlled substances will be returned to the pharmacy drop box located next to the paramedic Pyxis. May 2017 Page 20

21 Returning Used Controlled Substance Boxes When a controlled substance is used, the rest of the controlled substance box will be returned to the pharmacy drop box, and a new box signed out from the Pyxis. The controlled substance use will be documented on the inventory sheet that is included. In the case where the remainder of the controlled substance needs to be wasted, it will be witnessed and documented by a RN or another paramedic. A new red tag (supplied by the paramedic service), with the manufacturer s pre-stamped code, will be attached to the used box, securing it. The new tag number shall be recorded on the inventory sheet. Discrepancies in Controlled Substance Boxes If a properly tagged/sealed controlled substance box is opened and the paramedic finds that the proper number of each medication is not present, he/she must have another individual document the count of each medication present. When that box is returned to the pharmacy drop box, the inventory sheet must clearly document the initial discrepancy in addition to medications used, and the individual who confirmed the starting count must sign the appropriate section of form. The paramedic must inform both their head of service and the DPMA immediately following the call, preferably via , describing the circumstances of the discrepancy. Controlled Substance Administration Audits Service heads or their designee should regularly conduct an audit comparing administered doses (documented in SIREN) to documented waste of medications in the controlled substance box (from the yellow sheet attached to the controlled substance box). Spot checks by the DPMA will occur. Signature on File Laurel Plante, MD VTEMSD#3 Medical Advisor Signature on File Kate Soons, RN AEMT VTEMSD#3 Chair May 2017 Page 21

22 Appendix D: Use of the Pyxis May 2017 Page 22

23 Use of the Pyxis Last revised 10/11/16 Paramedics may replace medications from the UVM Medical Center s paramedic Pyxis under the following conditions: Access: To get access to the Pyxis, the paramedic must complete the hospital Pyxis Privileges Form and submit it to the pharmacy. The pharmacy will contact you with your M number (hospital account number) and temporary password. Medications: Medications at the paramedic level (not Advanced EMT level) are available. Passwords: Hospital passwords expire every 90 days and must be changed before they expire. To do this, log in to a hospital computer (not the Pyxis) and change your password. If your password has expired, you must contact the IS Help line at May 2017 Page 23

24 Appendix E: Criteria for Service Level Paramedic License May 2017 Page 24

25 VT EMS District #3 Criteria for Service Level Paramedic License Implemented: May 2013 Last Revised 10/11/16 This document outlines the process for becoming a paramedic level service. Paramedic Committee: for questions: D3ParamedicComm@gmail.com The committee is composed of representatives of each paramedic service in District 3: Burlington Fire Department Charlotte Rescue Colchester Rescue Essex Rescue Richmond Rescue Saint Michael s Fire and Rescue South Burlington Fire Department Process: 1. A service representative must attend at least two Paramedic Committee meetings prior to asking the committee for approval to become a paramedic level service. 2. A proposal covering the topics discussed within this document must be presented to and approved by the Paramedic Committee 3. A State License Status Change Application must be completed by the service and approved by the District Board 4. The State EMS Office approves the license change 5. Once you become a paramedic level service in District 3, a representative must regularly attend committee meetings. May 2017 Page 25

26 System Criteria Before providing paramedic level care, the service must demonstrate a commitment to: Support communities by providing paramedic coverage provide a written proposal indicating how they will commit to providing consistent scheduled paramedic coverage provide a Resolution of Support signed by municipalities in the primary service area show financial feasibility to initiate and sustain a paramedic service demonstrate a need that supports paramedic level care have a medical advisor Quality Care provide sufficient supplies and equipment have in place a quality improvement program, including ensuring competency in skills Compliance with state and local requirements agree to participate in an intercept program provide continuing education conduct background checks (VCIC) have a drug & alcohol policy in place gain the recommendation of the District 3: o medical advisor, o paramedic medical advisor and o Board of Directors Equipment List D3 paramedic services are currently carrying the following equipment in line with state protocol: 12-lead ECG monitor with defibrillator, pacing and capnography Quicktrach Supraglottic airways Laryngoscopy kit (laryngoscope, blades. tubes, Magill forceps). Video laryngoscopy is optional Needle chest decompression kit Morgan lens EZ-IO Drill & needles B Braun IV pump Medication List Medications as outlined in state protocols. Services may choose to only carry one steroid, dexamethasone. Services may choose which anti-dysrhythmic they will use in v-fib/v-tach arrest, lidocaine or amiodarone. If carrying amiodarone, a push dose of lidocaine should still be available for IO access. May 2017 Page 26

27 Resolution in Support of Paramedic Level Care In Vermont EMS District #3 Whereas, paramedic level care is throughout the State of Vermont, and Whereas, the de facto standard of prehospital emergency care throughout Vermont and the nation is paramedic care, and Whereas, Vermont EMS District #3, the greater Chittenden County area, has an excellent basic and intermediate life support system that is essential to the success of advanced life support, and Whereas, the public s perception is that paramedic level care is already available and being provided, and Whereas paramedics are trained, equipped and authorized to perform enhanced assessment, administer advanced resuscitation techniques, provide pain management, administer potentially life-saving medication and interventions, and Whereas, The University of Vermont Medical Center supports the provision of paramedic care, Now, therefore, be it resolved, the community of s governing body supports the coordinated efforts of [the community], [the community s EMS agency], and Vermont District #3 (greater Chittenden County area) in providing paramedic level care in its efforts to enhance prehospital emergency medical care. DATE May 2017 Page 27

28 Advanced Life Support (ALS) Intercept Agreement The purpose of this agreement is to facilitate payment for care, and define obligations of the Town of, a Vermont municipal entity operating, (hereafter called Intercept Agency ), and, (hereafter called Transporting Agency ), during BLS/ALS Joint Responses, commonly referred to as Advanced Life Support (ALS) intercepts (hereinafter called ALS Intercept(s)). This Agreement shall be effective as of / / WHEREAS both entities are Medicare Participating Ambulance Service Suppliers, and WHEREAS from time to time patients served by the Transporting Agency may benefit from certain ALS services that meet the Medicare Fee Schedule definition of an ALS intervention, that are not available at the time from the Transporting Agency, and WHEREAS the Intercept Agency may be in a position to provide those certain ALS services to assist the Transporting Agency in the care and treatment of its patients, and WHEREAS certain written understanding will assist in the effective care and treatment of the Transporting Agency s patients, and WHEREAS such a written agreement allows the Transporting Agency to bill for the ALS services, NOW THEREFORE it is agreed that: RESPONSE GUIDELINES: Upon dispatch, the transporting agency must respond with a legal crew as defined by Vermont Emergency Medical Services Rules for at least a BLS response before asking for an ALS intercept. The ALS provider involved in the intercept CANNOT be considered as the second required certified crew member per State EMS guidelines. The Intercept Agency will respond to requests for ALS intercepts when the Intercept Agency has ALS certified personnel available that are surplus to its own needs. The Transporting Agency understands that the Intercept Agency makes no assurances, guarantees, or warrantees as to the availability of ALS intercepts at any time. Each agency is responsible for compensation, insurance, disability, and liability for their respective members or employees. May 2017 Page 28

29 The Transporting Agency will request an ALS intercept as soon as its personnel determines that that the patient s condition may benefit from ALS intervention. The Intercept Agency will attempt to intercept the Transporting Agency as close to the original scene as possible, allowing for sufficient time to obtain a history and provide ALS care, prior to arriving at the hospital. Upon intercepting, the Transporting Agency s crew chief will give a full patient update to the Intercept Agency, and allow for a further assessment as the ALS provider sees appropriate for patient care. It will be the duty of the Transporting Agency s crew to provide all Basic and/or Intermediate care needed, and to update the hospital with the patient condition and vital signs, prior to intercepting with the Intercept Agency, after which time the ALS provider may need to speak with the hospital to obtain orders for further treatment of the patient. The Crew Chief or EMS Commander remains responsible and in command of the call and patient in terms of patient care, resources and transport decisions. In some cases, the Crew Chief may decide to transfer responsibility of the call to the ALS provider by clearly requesting that he/she take over the call. Once at the hospital, both agencies will document the assessment and treatment they provided jointly on separate Patient Care Reports. Both agencies agree to provide a completed copy of their documentation to each other, and to the receiving Emergency Department (ED) before departing the ED (In compliance with current HIPAA/Privacy regulations). If one agency receives another call prior to completing all documentation, they agree to provide copies at their earliest convenience. In most cases the Intercept Agency will proceed to the hospital to retrieve personnel. However, if the Intercept Agency is unable to do so, the Transporting Agency will return the Intercept Agency s personnel to their station, scene, or where the intercept vehicle is located. BILLING All Medical Transportation Services, including all ALS interventions provided by Intercepting Agency personnel, will be billed by the Transporting Agency as allowable under each payer s applicable guidelines for Joint Responses. The Intercept Agency will bill the Transporting Agency $225 for each Paramedic intercept response provided. Invoices for intercept responses will be sent on a quarterly basis, and payment is due within 30 days of the invoice date. May 2017 Page 29

30 GENERAL PROVISIONS This agreement doesn t cover instances where the Intercept Agency is also the Transporting Agency. Such circumstances are considered Mutual Aid, and covered under the District# 3 Mutual Aid Plan. Either party may terminate their participation in this agreement at any time, by providing 30 days advanced written notice to the other participating party, however, the obligation to pay for any services provided shall survive termination. This agreement shall have a term of one year, and, unless terminated or non-renewed in writing by either party, shall automatically renew for subsequent 12 month terms. Severability. If any portion or portions of this agreement shall be for any reason invalid or unenforceable, the remaining portion(s) shall be valid and enforceable and carried into effect unless to do so would clearly violate the present legal and valid intention of the parties hereto. The Response guidelines outlined in this agreement are meant as guidelines, and this agreement recognizes that the unpredictable and changing nature of emergencies may require occasional deviation from those guidelines. This agreement shall provide no benefits to third parties including actual or potential patients of the Transporting Agency. The billing and General Provisions contained in this agreement constitutes the entire agreement and understanding between the parties with respect to the subject matter hereof and supersedes any previous agreement or understanding, whether oral or otherwise. No modification of this agreement shall be valid unless in writing and signed by each of the parties hereto. [Name of Signature] [Name of Signature] [Name of Signature] [Name of Signature] May 2017 Page 30