Orange County First Response Recertification Guidelines Contents

2012

Section Page 1. Introduction 3 2. Continuing Education Cycle 4 2.1 Training Matrix 6 3. Audit Guidelines 8 3.1 Audit Template 10 4. Approved Continuing Education Sources 11 5. Cross Training 13 6. Appendices a. List of Accepted Standardized Courses 14 b. Definitions 15 c. Module Outlines and Lesson Plans i. Module 1 16 ii. Module 2 25 iii. Module 3 32 iv. Module 4 44 v. Module 5 63 vi. Module 6 69 vii. Module 7 79

Orange County Emergency Services

Colonel F. Rojas Montes de Oca, Jr. Director

Introduction

As the complexity of Emergency Medical Services grows the educational requirements that responders are required to meet also grows. In order to simplify this process and establish working guidelines this recertification package has been developed. This will ensure that all members of non-transporting first response agencies are provided with critical information that is standardized across the county and will reduce stress associated with the recertification process.

This package will serve as a living document as guidelines will be updated with formal appendices due to educational requirements changing at both the national and state level. This package will also be reviewed and updated on a biannual basis to ensure that the most up to date information is available.

To ensure the highest level of quality of education is delivered, this guidance document meets the standards of the Emergency Medical Technician (EMT-B) curriculum. This package is also in accordance with Department of Transportation’s 1996 EMT-B refresher criteria. At the time of the publishing of this package the DOT 1996 curriculum is the most current standard required by the state of North Carolina.

In accordance with 10 A North Carolina Administrative Code 13p (section .0200 (a) (12) this recertification package meets all requirements in alignment of the system wide CE Program.

______Dr. Jane Brice Capt. Kim Woodward Medical Director EMS System Administrator

______

Col. Frank Montes de Oca, Jr. Lt. Ryan Grebe Director of Emergency services Staff Officer-EMS Training

Orange County Emergency Services

Colonel F. Rojas Montes de Oca, Jr. Director

Continuing Education Cycle

The continuing education Matrix serves as an outline for recredentialling emergency medical providers up to the EMT-Basic level. This is also only for those that serve their communities in a non-transport role. Due to the need for advanced scheduling and attendance requirements the four year credentialing matrix has been developed. This matrix meets all Department of Transportation EMT-Basic refresher curriculum standards. The matrix also incorporates all North Carolina Office of EMS standards in conjunction with Orange County System requirements. As the standards of any of the three mentioned curriculums change this matrix will be amended to ensure that compliance will be meet at any time.

The training matrix is divided into four year blocks since this is the Recredentialing cycle of the North Carolina Office of EMS. During the four year cycle there are seven modules that have their own specific objectives that must be met for consideration of recertification. These objectives and their corresponding hours have been divided into the four year time frame. Each continuing education class that is conducted will cover one or more of these objectives and their corresponding lesson plan can be found in the back of this manual under the specific module.

Each year the continuing education schedule will be released no later than June 1st of every year. If an individual department has a specific request for a topic out of sync with the schedule we ask for advance communications with the Orange County Training Officer.

Open or department specific topics are built into the schedule to meet the needs of the individual departments. Sessions that will be typically held during these classes should be topics such as: CPR and Protocol updates. Any other topics must be approved by the Orange County Training Officer in writing prior to the class date. If in a year there is no specific topic that needs to be covered then the department has two options. 1. Move to the next topic that is in continuation with the training schedule or review a previous topic for make-up hours. OR: 2. Cancel the continuing education day. If this is the case this must be communicated in writing to the Orange County Training Officer prior to the scheduled date of the class.

In the interest of annually assessing competency; TSOPEs (Technical Scope of Practice Evaluations) will be conducted. These evaluations provide documented proof that a provider meets the expectations of Orange County System. These TSOPE’s also provide feedback to address and deficiency’s within the system.

The training matrix document also lists the requirement of the minimum number of hours required for recertification. Please reference the training audit procedures and the audit template for allocation of training hour guidance. If there are any questions or concerns please contact the Orange County Training Officer at Emergency Services headquarters at 919-245-6127 or [email protected] .

ISSUED DATE: May 2, 2012

EFFECTIVE DATE: July 1, 2012

REVISION DATE:

Orange County System Training Matrix

This Matrix is the guidline for required continuing education hours in a four year period. There are additional hours included to provide department flexibility. This matrix is broken down into core content that originates from the DOT curriculum required by the State Office of EMS and includes the Orange County System Requirements for recredentialing.

Year Module Topic Lesson Class Hours

Year 1 M-5 Trauma 13 M-2 Airway & Ventilation 13 M-4 Medical-Behavioral 13 M-6 Special Topic 1a (OB/PEDS) 3 M-4 Medical-Behavioral 23 M-3 Patient Assessment 13 M-1 Preparatory 13 M-7 Operations 13 M-4 Medical-Behavioral 33 M-6 Special Topic 1b (OB/Peds) 3 Open or Dept. Specific topic Open 3 TSOPE (Technical Scope of Pratice Evaluation) TSOPE 3 Total Hours Available in Year 1 36 Year 2 M-5 Trauma 23 M-2 Airway & Ventilation 23 M-4 Medical-Behavioral 43 M-6 Special Topic 2a (OB/Peds) 3 M-4 Medical-Behavioral 53 M-3 Patient Assessment 23 M-1 Preparatory 23 MM7-7 Operations 2 3 M-4 Medical-Behavioral 63 M-6 Special Topic 2b (OB/Peds) 3 Open or Dept. Specific topic Open 3 TSOPE (Technical Scope of Pratice Evaluation) TSOPE 3 Total Hours Available in Year 2 36 Year 3 M-5 Trauma 33 M-2 Airway & Ventilation 33 M-4 Medical-Behavioral 73 M-6 Special Topic Geriatrics 3 M-4 Medical-Behavioral 83 M-3 Patient Assessment 33 M-1 Preparatory 33 M-7 Operations 33 M-4 Medical-Behavioral 93 M-6 Special Topic Abuse & Assault 3 Open or Dept. Specific topic Open 3 TSOPE (Technical Scope of Pratice Evaluation) TSOPE 3 Total Hours Available in Year 3 36

6 Orange County System Training Matrix

Class Year Module Topic Lesson Hours

Year 4 Trauma M-5 43 M-2 Airway & Ventilation 43 M-4 Medical-Behavioral 10 3 M-6 Special Topic Special Needs 3 M-4 Medical-Behavioral 11 3 M-3 Patient Assessment 43 M-1 Preparatory 43 M-7 Operations 43 M-4 Medical-Behavioral 12 3 Open or Dept. Specific topic Open 3 Open or Dept. Specific topic Open 3 TSOPE (Technical Scope of Pratice Evaluation) TSOPE 3 Total Hours Available in Year 4 36

96 hours are required in a four year credentialing cycle with the following breakdown in the core content Module 1 Preparatory 12 Module 2 Airway 12 Module 3 Pt. Assessment 8 Module 4 Medical 36 Module 5 Trauma 12 Module 6 Special 12 Module 7 Operations 4 Total hours for recertification 96

Orange County Emergency Services

Colonel F. Rojas Montes de Oca, Jr. Director

Audit Guidelines

In order to speed the process of recertification for all departments the individual agency should conduct an audit on their own personnel prior to meeting with the OCES Training Officer. Audit Form Page 10 contains a sample audit form created to guide training officers through the self auditing process. Departments may choose utilize this form, or create one that suits their individual department’s needs. The main requirement is that this form contains at least the basic information addressed on the sample audit form. This form will also be available on the Orange County Emergency Services web page in a electronic format for ease of use. Orange County, NC Emergency Services (http://www.co.orange.nc.us/emergency/index.asp) Modules/Lessons Appendix B contains each module and the lesson outlines for that module. Each lesson outline contains the objectives that are to be covered for the specific topic.

Audit process Tips for agency training officers for the conduction of training audits: 1. Using the Audit template as a guide begin by matching the lesson plan with the training roster for the day of class attended. 2. Assign the appropriate hours from the training roster to the assigned category. 3. Repeat step 2 until all attended training has been accounted for. 4. After all of the attended training hours have been assigned each module should be totaled. 5. Refer to the training matrix for the minimum number of hours required for each module. 6. After allocating hours training officers should verify that there is current copy of a CPR card on file. 7. Complete the audit template or the department specific documentation and submit to the OCES training officer.

Timeline Department training officers should complete their internal audits no later than 30days prior to expiration of the provider’s credentials. Once the internal audit has been completed department training officers should contact OCES training officer to forward the appropriate paperwork. Once the appropriate paperwork has been received by the OCES training officer the provider will be re-credentialed provided that all requirements have been meet. Recredentialing will not take place any earlier than 30days prior to 8

expiration; however audits can be finished (and encouraged) prior to the 30days from expiration.

Expired credentials In the event that the provider does not meet Recredentialing requirements it is the responsibility of the provider to obtain the necessary training to meet standards. Providers should contact their organizations training officers first for assistance of finding the appropriate training. In the event that additional assistance is needed departmental training officers should contact the OCES training officer. If in the event the providers credential expires prior to verification of standards the provider is immediately suspended from providing emergency medical care. The provider is then required to provide documentation that training standards have been meet. Then individual provider and the department training officer can provide the OCES training officer with a letter requesting reinstatement. The OCES training officer will then contact the state representative for reinstatement of the provider’s credentials. If the provider does not correct the deficiencies within 30days the provider may have to repeat initial class training as required by the state office of EMS.

Orange County EMS System Training Audit

Name: Certification Level:

Recertification Evaluation Date:

Agency:

Training Officer Name: (Please Print Legibally)

Training Officer Signature:

Topic Hours Complete? If incomplete, # of hours needed M1‐Preparatory 12 M2‐Airway (CPR Skills) 12 M3‐Patient Assessment 8 M4‐ Medical /Behavioral 36 M5‐Trauma 12 M6‐OB/GYN/Infant/Peds 12 M7‐Misc 4 Total 96 Copy of current NCOEMS EMS Credential Yes Copy of current CPR certification Yes Copy of Outside course documentation for consideration Yes Certification of current TSOP (Technical Scope of Practice) evaluation Yes ICS 100 Yes ICS 700a Yes ICS 300 Yes N/A ICS 200 Yes ICS 800b Yes ICS 400 Yes N/A Hazmat Awareness Yes N/A HazHC‐Com Yes N/A HIPAA Yes N/A Blood Born Pathogens Yes N/A Immunization records and/or waivers Yes N/A Notes:

Orange County Emergency Services

Colonel F. Rojas Montes de Oca, Jr. Director

Approved Out of County Continuing Education Sources

Scope: Orange County System Medical Providers seeking re-credentialing in Orange County

Purpose: To provide guidelines for receiving continuing education credit for education external to the Orange County Emergency Services Continuing education program.

Objective: To facilitate flexibility and enhanced opportunities to attend and receive credit for non- Orange County Emergency Services Orange County will consider education obtained from other sources within the following guidelines.

Policy/Procedure: • Standardized courses (canned courses) o Courses that are nationally accredited and widely utilized. These courses have a standardized curriculum and have been approved based on their achievement of objectives. See appendix list for currently accepted standardized courses. Certification cards properly documented by issuing agency will be kept on file with agency training officer. • Community College courses o Within the state of North Carolina the community college system hosts a wide variety of courses that meet a broad scope of educational objectives. o Once a course has been completed it is the individual’s responsibility to provide proof of attendance and documentation of subject material covered within the class. Documents needed for proof are: 1) class roster, or certificate of attendance/completion, and 2) syllabus of course with appropriate dates attended and objectives *If at all possible the course outline should be obtained and kept on file. (List of objectives covered ensures that appropriate material in accordance with DOT requirements are meet.) Courses will be audited and verified on an as needed basis. • Other Emergency Response agencies o Attendance of continuing education delivered at an Emergency Response Agency other than Orange County Emergency Services. Documents needed for proof are: 1) class roster, or certificate of attendance/completion, and 2) syllabus of course with appropriate dates attended along with objectives covered. *If at all possible the course outline should be obtained and kept on file. (List of objectives covered ensures that appropriate material in accordance with DOT requirements are meet.) 11

Courses will be audited and verified on an as needed basis. • Conferences o Education sessions at National or Regional conferences that are accredited for continuing education hours will be accepted. These courses must state on their certificates their accreditation affiliation and list the amount of hours that they issue. Some examples of accrediting agencies are: coaemsp, CAAS, cecbems, ect. Some examples of conferences are: Ems Today, UNC’s May Day trauma conference, Lenoir Community College’s public safety weekend. etc. If there is any question about if a class or a conference is considered creditable the Orange County Training Officer should be contacted. • All other considerations o Any other course that is to be considered must have supporting documentation. In this case the individual must have an attendance roster, syllabus and course outline with objectives that were covered. These documents ensure that continuing education objectives have been meet and can be allocated to specific areas. It is acceptable and suggested that if there is a course that a provider wishes to take and it is not on any of the pre-approved lists that the provider contacts the Orange County Emergency Services Training Officer prior to taking the course to be considered for credit.

DATE ISSUED: May 2, 2012

EFFECTIVE DATE: July 1, 2012

REVISION DATE:

Orange County Emergency Services

Colonel F. Rojas Montes de Oca, Jr. Director

Cross Training

Scope: Non-transporting Medical Providers

Purpose: To establish guidelines for training that can be used across various emergency services

Policy:

The following is a current comprised list of courses that can be considered for crossover education between Fire Department and EMS. These courses have a direct impact on care administered in the emergency setting. Additional courses will be added once requests have been made and verified as defensible for EMS continuing education purposes. All listed courses will be allocated for the Module 7-Operations category for North Carolina EMS certification.

General Courses 1. NIMS 100, 200, 700a, 800b 2. Hazmat Awareness 3. Hazmat Operations

Firefighter 1&2 Department of Insurance Courses 1. Emergency medical care 2. Victim management, Lifts, Carries, Drags & Stretchers

For other courses that are to be considered requests must be made in advance by submitting in writing the course and identifiers of that course to the OCES EMS Training Officer. Additional documentation of course objectives, hours required, and any other supporting documentation as to why that course should be considered should also be included. If there is no supporting documentation then the course may be rejected.

Date Issued: May 2, 2012

Effective Date: July 1, 2012

Revision Date:

Appendix A: List of Accepted Standardized Courses Hours Module allocation Class Abbreviation Card Issued Initial Recert Update Advanced Burn Life Support ABLS Y 8 N/A N/A M‐3; M‐5 Advanced Cardiac Life Support ACLS Y 16 8 6.5 M‐2; M‐3 Advanced Medical Life Support AMLS Y 16 16 N/A M‐3 Advanced Trauma Life Support ATLS N 12 N/A N/A M‐3; M‐5 Cardio Pulmonary Resuscitation (Health Care Provider) CPR Y 8‐Apr 4 N/A M‐2 Emergency Pediatric Care EPC Y 16 8 N/A M‐6 Empact N/A N 16 N/A N/A M‐1 EMS Safety (by NAEMT) N/A Y 8 N/A N/A M‐1 Geriatric Emergency Medical Support GEMS Y 12 8 N/A M‐3; M‐4 International Trauma Life support ITLS Y 16 8 N/A M‐3; M‐5 Pediatric International Trauma Life Support PITLS Y 8 8 N/A M‐3; M‐4; M‐5 Pediatric Advanced Life Support PALS Y 16 8 6.5 M‐6 Prehospital Pediatric Emergency Provider PPEP Y 16 8 N/A M‐6 Prehospital Trauma Life Support PHTLS Y 16 8 N/A M‐5 Tactial Casulity Combat Care TCCC Y 16 N/A N/A M‐5 Trauma First Response N/A y 8 N/A N/A M‐5

14 Definitions

Airway &Ventilation: The structure of the anatomy of the airway and the interventions that are needed to correct emergencies that involve the airway. Additional areas of importance are the diseases process and other events that may be seen in an emergency setting.

Audit: Systematic process to ensure that credentialing requirements have been met.

CAAS: Commission on Accreditation of Ambulance Services

CECBEMS: Continuing Education Coordinating Board for Emergency Medical Services

COAEMSP: Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions

EMT: Emergency Medical Technician

Haz-com: Hazardous Communication

Haz-mat: Hazardous Materials

Lesson: A plan in which objectives are addressed to ensure that education received has purpose and is pertinent to the subject.

Medical-Behavioral: Area of study that address the anatomy and physiology of the medical or behavioral patient in the emergency setting. Additional emphasis is on the interventions and the use of those interventions.

Module: A sub set of overall educational goals and objectives.

NCOEMS: North Carolina Office of Emergency Medical Services

NIMS: National Incident Management System

Objectives: Specific goals to address the area of education to ensure competency.

OCES-TO: Orange County Emergency Services Training Officer

Operations: Area of study that address the environment of emergency services.

Patient Assessment: Area of study that specifically address the evaluation of a patient in the emergency setting.

Preparatory: Area of study that address concerns prior to entering the emergency setting.

Provider: A certified and credentialed person that delivers emergency care to patients in the emergency setting.

Special Topics: Areas of study that are not normally addressed in other curriculum modules.

Trauma: The study of traumatic injuries and interventions.

TSOPE: Technical Scope of Practice Evaluation

15 Module 1 Prepatory

16 Orange County Continuing Education Module Outline

Prepatory‐1

Instructor: See attached Roster

Roster: See attached Roster

Hours: See attached Roster

Objectives

Cognitive:

1. Provide for safety of self, patient and fellow workers

• Discuss the importance of body substance isolation (BSI).

• Describe the steps the EMT‐Basic should take for personal protection from airborne and blood borne pathogens.

2. Identify the presence of hazardous materials

• Break down the steps to approaching a hazardous situation.

Affective:

1. Assess areas of personal attitude and conduct of the EMT‐Basic.

2. Explain the rationale for serving as an advocate for the use of appropriate protection equipment.

Psychomotor:

1. Working with a partner, move a simulated patient from the ground to a stretcher and properly position the patient on the stretcher.

Outline: See attached outline

17 Orange County Continuing Education Module Outline

Prepatory‐2

Instructor: See attached Roster

Roster: See attached Roster

Hours: See attached Roster

Objectives

Cognitive:

3. Participate in the quality improvement process

• Define quality improvement and discuss the EMT‐Basic’s role in the process.

4. Use physician medical direction for authorization to provide care

• Define medical direction and discuss the EMT‐Basic’s role in the process.

Affective:

1. Assess areas of personal attitude and conduct of the EMT‐Basic.

2. Explain the rationale for serving as an advocate for the use of appropriate protection equipment.

Psychomotor:

1. Working with a partner, move a simulated patient from the ground to a stretcher and properly position the patient on the stretcher.

2. Working with a partner, demonstrate the technique for moving a patient secured to a stretcher to the ambulance and loading the patient into the ambulance.

Outline: See attached outline

18 Orange County Continuing Education Module Outline

Prepatory‐3

Instructor: See attached Roster

Roster: See attached Roster

Hours: See attached Roster

Objectives

Cognitive:

5. Use body mechanics when lifting and moving a patient

• Relate body mechanics associated with patient care and it’s impact on the EMT‐Basic.

6. Use methods to reduce stress in self, a patient, bystanders and co‐workers

• Recognize the signs and symptoms of critical incident stress.

• State possible steps that the EMT‐Basic may take to help reduce/alleviate stress.

Affective:

1. Assess areas of personal attitude and conduct of the EMT‐Basic.

2. Explain the rationale for serving as an advocate for the use of appropriate protection equipment.

4. Explain the rationale for properly lifting and moving patients.

Psychomotor:

1. Working with a partner, move a simulated patient from the ground to a stretcher and properly position the patient on the stretcher.

2. Working with a partner, demonstrate the technique for moving a patient secured to a stretcher to the ambulance and loading the patient into the ambulance.

19 Outline: See attached outline

20 Orange County Continuing Education Module Outline

Prepatory‐4

Instructor: See attached Roster

Roster: See attached Roster

Hours: See attached Roster

Objectives

Cognitive:

7. Obtain consent for providing care

• Define consent and discuss the methods of obtaining consent.

• Discuss the implications for the EMT‐Basic in patient refusal of transport.

• Discuss the importance of Do Not Resuscitate [DNR] (advance directives) and local or state provisions regarding EMS application.

8. Assess and provide care to patients and families involved in suspected abuse or neglect

• Discuss the special considerations for assessing and managing a patient with suspected abuse or neglect.

Affective:

1. Assess areas of personal attitude and conduct of the EMT‐Basic.

2. Explain the rationale for serving as an advocate for the use of appropriate protection equipment.

3. Explain the role of EMS and the EMT‐Basic regarding patients with DNR orders.

Psychomotor:

1. Working with a partner, move a simulated patient from the ground to a stretcher and properly position the patient on the stretcher.

21 2. Working with a partner, demonstrate the technique for moving a patient secured to a stretcher to the ambulance and loading the patient into the ambulance.

Outline: See attached outline

22 Module 1: Preparatory Emergency Medical Technician: Basic Refresher

TASK LIST AND EDUCATIONAL OBJECTIVES

At the completion of this lesson, the student will be able to:

COGNITIVE OBJECTIVES 1. Provide for safety of self, patient and fellow workers • Discuss the importance of body substance isolation (BSI). • Describe the steps the EMT-Basic should take for personal protection from airborne and bloodborne pathogens. 2. Identify the presence of hazardous materials • Break down the steps to approaching a hazardous situation. 3. Participate in the quality improvement process • Define quality improvement and discuss the EMT-Basic’s role in the process. 4. Use physician medical direction for authorization to provide care • Define medical direction and discuss the EMT-Basic’s role in the process. 5. Use body mechanics when lifting and moving a patient • Relate body mechanics associated with patient care and it’s impact on the EMT-Basic. 6. Use methods to reduce stress in self, a patient, bystanders and co-workers • Recognize the signs and symptoms of critical incident stress. • State possible steps that the EMT-Basic may take to help reduce/alleviate stress. 7. Obtain consent for providing care • Define consent and discuss the methods of obtaining consent. • Discuss the implications for the EMT-Basic in patient refusal of transport. • Discuss the importance of Do Not Resuscitate [DNR] (advance directives) and local or state provisions regarding EMS application. 8. Assess and provide care to patients and families involved in suspected abuse or neglect • Discuss the special considerations for assessing and managing a patient with suspected abuse or neglect.

AFFECTIVE OBJECTIVES 1. Assess areas of personal attitude and conduct of the EMT-Basic. 2. Explain the rationale for serving as an advocate for the use of appropriate protection equipment. 3. Explain the role of EMS and the EMT-Basic regarding patients with DNR orders. 4. Explain the rationale for properly lifting and moving patients.

PSYCHOMOTOR OBJECTIVES

I - 1 23 Module 1: Preparatory Emergency Medical Technician: Basic Refresher

1. Working with a partner, move a simulated patient from the ground to a stretcher and properly position the patient on the stretcher. 2. Working with a partner, demonstrate the technique for moving a patient secured to a stretcher to the ambulance and loading the patient into the ambulance.

PREPARATION

Motivation: The field of prehospital emergency medical care is an evolving profession in which the reality of life and death is confronted at a moment’s notice. EMT-Basics work side by side with other health care professionals to help deliver professional prehospital emergency medical care. This course will help the EMT-Basic refresh previously learned material while gaining new knowledge, skills and attitudes necessary to be a competent, productive, and valuable member of the emergency medical services team.

MATERIALS AV Equipment: Utilize various audio-visual materials relating to emergency medical care. The continuous design and development of new audio-visual materials relating to EMS requires careful review to determine which best meet the needs of the program. Materials should be edited to assure the objectives of the curriculum are met.

EMS Equipment: None required.

PERSONNEL Primary Instructor: One EMT-Basic instructor knowledgeable in the EMT-Basic refresher course overview, administrative paper work, certification requirements, Americans with Disabilities Act issues, and roles and responsibilities of EMS.

Assistant Instructor: The instructor to Student ratio should be adequate to allow for supervision of psychomotor skill practice. Individuals used as assistant instructors should be knowledgeable in the techniques of lifting and moving patients.

I - 2 24 Module 2 Airway

25 Orange County Continuing Education Module Outline

Airway‐1

Instructor: See attached Roster

Roster: See attached Roster

Hours: See attached Roster

Objectives

Cognitive:

1. Perform techniques to assure a patent airway

• Describe the steps in performing the head‐tilt chin‐lift.

• Describe the steps in performing the jaw thrust.

• Describe the techniques of suctioning.

• Describe how to measure and insert an oropharyngeal (oral) airway.

• Describe how to measure and insert a nasopharyngeal (nasal) airway.

Affective:

1. Explain the rationale for basic life support artificial ventilation and airway protection skills taking priority over most other life support skills.

Psychomotor:

1. Demonstrate the steps in performing the skill of artificially ventilating a patient with a bag‐valve‐mask for one and two rescuers.

Outline: See attached outline

26 Orange County Continuing Education Module Outline

Airway‐2

Instructor: See attached Roster

Roster: See attached Roster

Hours: See attached Roster

Objectives

Cognitive:

2. Provide ventilatory support for a patient

• Describe the steps in performing the skill of artificially ventilating a patient with a bag‐valve‐ mask for one and two rescuers.

• Describe the steps in artificially ventilating a patient with a flow restricted, oxygen‐powered ventilation device.

Affective:

2. Explain the rationale for providing oxygenation through high inspired oxygen concentrations to patients who, in the past, may have received low concentrations.

Psychomotor:

2. Demonstrate how to insert an oropharyngeal and nasopharyngeal airway.

Outline: See attached outline

27 Orange County Continuing Education Module Outline

Airway‐3

Instructor: See attached Roster

Roster: See attached Roster

Hours: See attached Roster

Objectives

Cognitive:

3. Use oxygen delivery system components (nasal cannula, face mask, etc..)

• Identify a non‐rebreather face mask and state the oxygen flow requirements needed for its use.

• Identify a nasal cannula and state the flow requirements needed for its use.

Affective:

2. Explain the rationale for providing oxygenation through high inspired oxygen concentrations to patients who, in the past, may have received low concentrations.

Psychomotor:

3. Demonstrate the use of a non‐rebreather face mask and a nasal cannula.

Outline: See attached outline

28 Orange County Continuing Education Module Outline

Airway‐4

Instructor: See attached Roster

Roster: See attached Roster

Hours: See attached Roster

Objectives

Cognitive:

1. Perform techniques to assure a patent airway

• Describe the steps in performing the head‐tilt chin‐lift.

• Describe the steps in performing the jaw thrust.

• Describe the techniques of suctioning.

• Describe how to measure and insert an oropharyngeal (oral) airway.

• Describe how to measure and insert a nasopharyngeal (nasal) airway.

2. Provide ventilatory support for a patient

• Describe the steps in performing the skill of artificially ventilating a patient with a bag‐valve‐ mask for one and two rescuers.

• Describe the steps in artificially ventilating a patient with a flow restricted, oxygen‐powered ventilation device.

3. Use oxygen delivery system components (nasal cannula, face mask, etc..)

• Identify a non‐rebreather face mask and state the oxygen flow requirements needed for its use.

• Identify a nasal cannula and state the flow requirements needed for its use.

Affective:

29 1. Explain the rationale for basic life support artificial ventilation and airway protection skills taking priority over most other life support skills.

2. Explain the rationale for providing oxygenation through high inspired oxygen concentrations to patients who, in the past, may have received low concentrations.

Psychomotor:

4. Demonstrate artificial ventilation of a patient with a flow restricted, oxygen powered ventilation device.

5. Demonstrate the techniques of suctioning.

Outline: See attached outline

30 Module 2: Airway Emergency Medical Technician: Basic Refresher

TASK LIST AND EDUCATIONAL OBJECTIVES

At the completion of this lesson, the student will be able

COGNITIVE OBJECTIVES 1. Perform techniques to assure a patent airway • Describe the steps in performing the head-tilt chin-lift. • Describe the steps in performing the jaw thrust. • Describe the techniques of suctioning. • Describe how to measure and insert an oropharyngeal (oral) airway. • Describe how to measure and insert a nasopharyngeal (nasal) airway. 2. Provide ventilatory support for a patient • Describe the steps in performing the skill of artificially ventilating a patient with a bag-valve-mask for one and two rescuers. • Describe the steps in artificially ventilating a patient with a flow restricted, oxygen-powered ventilation device. 3. Use oxygen delivery system components (nasal cannula, face mask, etc..) • Identify a non-rebreather face mask and state the oxygen flow requirements needed for its use. • Identify a nasal cannula and state the flow requirements needed for its use.

AFFECTIVE OBJECTIVES 1. Explain the rationale for basic life support artificial ventilation and airway protection skills taking priority over most other life support skills. 2. Explain the rationale for providing oxygenation through high inspired oxygen concentrations to patients who, in the past, may have received low concentrations.

PSYCHOMOTOR OBJECTIVES 1. Demonstrate the steps in performing the skill of artificially ventilating a patient with a bag-valve-mask for one and two rescuers. 2. Demonstrate how to insert an oropharyngeal and nasopharyngeal airway. 3. Demonstrate the use of a non-rebreather face mask and a nasal cannula. 4. Demonstrate artificial ventilation of a patient with a flow restricted, oxygen powered ventilation device. 5. Demonstrate the techniques of suctioning.

PREPARATION

Motivation: The most critical intervention an EMT can provide for a patient is airway management and ventilatory support. A patient without an airway is a dead patient.

II - 1 31 Module 3 Patient Assessment

32 Orange County Continuing Education Module Outline

Patient Assessment‐1

Instructor: See attached Roster

Roster: See attached Roster

Hours: See attached Roster

Objectives

Cognitive:

1. Assess scene safety

• Recognize hazards/potential hazards

• Describe common hazards found at the scene of a trauma and a medical patient

• Determine if the scene is safe to enter

2. Assess the need for additional resources at the scene

• Explain the reason for identifying the need for additional help or assistance

3. Assess mechanism of injury

Affective:

1. Explain the value of performing an each component of the prehospital patient assessment.

2. Recognize and respect the feelings that patients might experience during assessment.

3. Explain the rationale for providing efficient and effective radio and written patient care reports.

Psychomotor:

1. Demonstrate the steps in performing a scene size‐up.

2. Demonstrate the steps in performing an initial assessment.

Outline: See attached outline

34 Orange County Continuing Education Module Outline

Patient Assessment‐2

Instructor: See attached Roster

Roster: See attached Roster

Hours: See attached Roster

Objectives

Cognitive:

4. Assess nature of illness

• Discuss common mechanisms of injury/nature of illness

5. Perform an initial patient assessment and provide care based on initial assessment findings

• Summarize the reasons for forming a general impression of the patient.

• Discuss methods of assessing altered mental status.

• Discuss methods of assessing the airway in the adult, child and infant patient.

• Describe methods used for assessing if a patient is breathing.

• Differentiate between a patient with adequate and inadequate breathing.

• Distinguish between methods of assessing breathing in the adult, child and infant patient.

• Describe the methods used to obtain a pulse.

• Describe normal and abnormal findings when assessing skin color, temperature and condition.

• Explain the reason for prioritizing a patient for care and transport.

Affective:

1. Explain the value of performing an each component of the prehospital patient assessment.

2. Recognize and respect the feelings that patients might experience during assessment.

35 3. Explain the rationale for providing efficient and effective radio and written patient care reports.

Psychomotor:

3. Demonstrate the rapid trauma assessment that should be used to assess a patient based on mechanism of injury.

Outline: See attached outline

36 Orange County Continuing Education Module Outline

Patient Assessment‐3

Instructor: See attached Roster

Roster: See attached Roster

Hours: See attached Roster

Objectives

Cognitive:

6. Obtain a SAMPLE history (Signs and Symptoms of the present illness/injury,

Allergy, Medications, Past medical History, Last oral intake, Events leading to present illness/injury)

• Identify the components of a SAMPLE history

7. Perform a rapid trauma assessment and provide care based on assessment findings

• State the reasons for performing a rapid trauma assessment

• Recite examples and explain why patients should receive a rapid trauma assessment

8. Perform a history and physical examination focusing on the specific injury and provide care based on assessment findings.

• Discuss the reason for performing a focused history and physical examination.

Affective:

1. Explain the value of performing an each component of the prehospital patient assessment.

2. Recognize and respect the feelings that patients might experience during assessment.

3. Explain the rationale for providing efficient and effective radio and written patient care reports.

Psychomotor:

37 4. Demonstrate the steps in performing a focused history and physical on a medical and a trauma patient.

Outline: See attached outline

38 Orange County Continuing Education Module Outline

Patient Assessment‐4

Instructor: See attached Roster

Roster: See attached Roster

Hours: See attached Roster

Objectives

Cognitive:

9. Perform a history and physical examination focusing on a specific medical condition and provide care based on assessment findings.

• Differentiate between the history and physical examination that are performed for responsive patients with no known prior history and responsive patients with a known history.

• Differentiate between the assessment that is performed for a patient who is unresponsive or has an altered mental status and other medical patients requiring assessment.

10. Perform a detailed physical examination and provide care based on assessment findings

• State the areas of the body that are evaluated during the detailed physical examination.

• Explain what additional care should be provided while performing the detailed physical examination.

11. Perform on‐going assessments and provide care based on assessment findings.

• Discuss the reasons for repeating the initial assessment as part of the on‐going assessment.

• Describe the components of the on‐going assessment.

12. Complete a prehospital care report

• Apply the components of the essential patient information in a written report.

13. Communicate with the patient, bystanders, other health care provider and patient family members while providing patient care

• Discuss the communication skills that should be used to interact with the patient.

39 • Discuss the communication skills that should be used to interact with the family, bystanders, individuals from other agencies while providing patient care and hospital personnel, and the difference between skills used to interact with the patient and those used to interact with others.

14. Provide a report to medical direction of assessment findings and emergency care given

• Explain the importance of effective communication of patient information.

Affective:

1. Explain the value of performing an each component of the prehospital patient assessment.

2. Recognize and respect the feelings that patients might experience during assessment.

3. Explain the rationale for providing efficient and effective radio and written patient care reports.

Psychomotor:

5. Demonstrate the skills involved in performing a detailed physical examination.

6. Demonstrate the skills involved in performing an on‐going assessment.

7. Complete a prehospital care report.

Outline: See attached outline

40 Module 3: Patient Assessment Emergency Medical Technician: Basic Refresher

TASK LIST AND EDUCATIONAL OBJECTIVES

At the completion of this lesson, the student will be able to:

COGNITIVE OBJECTIVES 1. Assess scene safety • Recognize hazards/potential hazards • Describe common hazards found at the scene of a trauma and a medical patient • Determine if the scene is safe to enter 2. Assess the need for additional resources at the scene • Explain the reason for identifying the need for additional help or assistance 3. Assess mechanism of injury 4. Assess nature of illness • Discuss common mechanisms of injury/nature of illness 5. Perform an initial patient assessment and provide care based on initial assessment findings • Summarize the reasons for forming a general impression of the patient. • Discuss methods of assessing altered mental status. • Discuss methods of assessing the airway in the adult, child and infant patient. • Describe methods used for assessing if a patient is breathing. • Differentiate between a patient with adequate and inadequate breathing. • Distinguish between methods of assessing breathing in the adult, child and infant patient. • Describe the methods used to obtain a pulse. • Describe normal and abnormal findings when assessing skin color, temperature and condition. • Explain the reason for prioritizing a patient for care and transport. 6. Obtain a SAMPLE history (Signs and Symptoms of the present illness/injury, Allergy, Medications, Past medical History, Last oral intake, Events leading to present illness/injury) • Identify the components of a SAMPLE history 7. Perform a rapid trauma assessment and provide care based on assessment findings • State the reasons for performing a rapid trauma assessment • Recite examples and explain why patients should receive a rapid trauma assessment 8. Perform a history and physical examination focusing on the specific injury and provide care based on assessment findings.

III - 1 41 Module 3: Patient Assessment Emergency Medical Technician: Basic Refresher

• Discuss the reason for performing a focused history and physical examination. 9. Perform a history and physical examination focusing on a specific medical condition and provide care based on assessment findings. • Differentiate between the history and physical examination that are performed for responsive patients with no known prior history and responsive patients with a known history. • Differentiate between the assessment that is performed for a patient who is unresponsive or has an altered mental status and other medical patients requiring assessment. 10. Perform a detailed physical examination and provide care based on assessment findings • State the areas of the body that are evaluated during the detailed physical examination. • Explain what additional care should be provided while performing the detailed physical examination. 11. Perform on-going assessments and provide care based on assessment findings. • Discuss the reasons for repeating the initial assessment as part of the on-going assessment. • Describe the components of the on-going assessment. 12. Complete a prehospital care report • Apply the components of the essential patient information in a written report. 13. Communicate with the patient, bystanders, other health care provider and patient family members while providing patient care • Discuss the communication skills that should be used to interact with the patient. • Discuss the communication skills that should be used to interact with the family, bystanders, individuals from other agencies while providing patient care and hospital personnel, and the difference between skills used to interact with the patient and those used to interact with others. 14. Provide a report to medical direction of assessment findings and emergency care given • Explain the importance of effective communication of patient information.

AFFECTIVE OBJECTIVES 1. Explain the value of performing an each component of the prehospital patient assessment. 2. Recognize and respect the feelings that patients might experience during assessment. 3. Explain the rationale for providing efficient and effective radio and written patient care reports.

PSYCHOMOTOR OBJECTIVES

III - 2 42 Module 3: Patient Assessment Emergency Medical Technician: Basic Refresher

1. Demonstrate the steps in performing a scene size-up. 2. Demonstrate the steps in performing an initial assessment. 3. Demonstrate the rapid trauma assessment that should be used to assess a patient based on mechanism of injury. 4. Demonstrate the steps in performing a focused history and physical on a medical and a trauma patient. 5. Demonstrate the skills involved in performing a detailed physical examination. 6. Demonstrate the skills involved in performing an on-going assessment. 7. Complete a prehospital care report.

PREPARATION

Motivation: The EMT-Basic will encounter patients who require emergency medical care. It is important to identify those patients who require rapid assessment, critical intervention and immediate transport. The components of the assessment will assist the EMT-Basic in making patient intervention decisions.

EMS Equipment: Exam gloves, airway management equipment, stethoscope, blood pressure cuff and a penlight.

PERSONNEL Primary Instructor: One EMT-Basic instructor knowledgeable in scene management and patient assessment.

Assistant Instructor: The instructor-to-student ratio should be adequate to allow for supervision of psychomotor skills practice. Individuals used as assistant instructors should be knowledgeable in scene management and patient assessment.

III - 3 43 Module 4 Medical Behavioral

44 Orange County Continuing Education Module Outline

Medical/Behavioral‐1

Instructor: See attached Roster

Roster: See attached Roster

Hours: See attached Roster

Objectives

Cognitive:

1. Provide treatment for a patient in respiratory distress

• List the signs and symptoms of difficulty breathing

• Describe the emergency medical care of the patient with breathing difficulty.

• Recognize the need for medical direction to assist in the emergency medical care of the patient with breathing difficulty.

• State the generic name, medication forms, dose, administration, action, indications and contraindications for the prescribed inhaler.

Affective:

2. Recognize and respond to the feelings of the patient who may require interventions to be performed.

Psychomotor:

1. Given medical scenarios, demonstrate the ability to properly assess the patient and demonstrate the ability to properly utilize the intervention to include inhaler, nitroglycerin, oral glucose and activated charcoal.

Outline: See attached outline

45 Orange County Continuing Education Module Outline

Medical/Behavioral‐2

Instructor: See attached Roster

Roster: See attached Roster

Hours: See attached Roster

Objectives

Cognitive:

2. Provide care to a patient experiencing chest pain/discomfort

• Describe the emergency medical care of the patient experiencing chest pain/discomfort.

• Discuss the position of comfort for patients with various cardiac emergencies.

• Recognize the need for medical direction of protocols to assist in the emergency medical care of the patient with chest pain.

• List the indications for the use of nitroglycerin.

Affective:

2. Recognize and respond to the feelings of the patient who may require interventions to be performed.

Psychomotor:

Outline: See attached outline

46 Orange County Continuing Education Module Outline

Medical/Behavioral‐3

Instructor: See attached Roster

Roster: See attached Roster

Hours: See attached Roster

Objectives

Cognitive:

3. Attempt to resuscitate a patient in cardiac arrest

• Discuss the circumstances which may result in inappropriate shocks.

• Explain the considerations for interruption of CPR, when using the automated external defibrillator.

• List the steps in the operation of the automated external defibrillator.

• Discuss the need to complete the Automated Defibrillator: Operator’s Shift Checklist.

• Explain the role medical direction plays in the use of automated external defibrillation.

Affective:

1. Defend the rationale for the EMT‐Basic to carry and assist with medications.

2. Recognize and respond to the feelings of the patient who may require interventions to be performed.

Psychomotor:

3. Given a cardiac arrest scenario, demonstrate the use of the AED.

Outline: See attached outline

47 Orange County Continuing Education Module Outline

Medical/Behavioral‐4

Instructor: See attached Roster

Roster: See attached Roster

Hours: See attached Roster

Objectives

Cognitive:

4. Provide care to a patient with an altered mental status

• State the steps in the emergency medical care of the patient taking diabetic medicine with an altered mental status and a history of diabetes.

• Evaluate the need for medical direction in the emergency medical care of the diabetic patient.

Affective:

1. Defend the rationale for the EMT‐Basic to carry and assist with medications.

2. Recognize and respond to the feelings of the patient who may require interventions to be performed.

Psychomotor:

Outline: See attached outline

48 Orange County Continuing Education Module Outline

Medical/Behavioral‐5

Instructor: See attached Roster

Roster: See attached Roster

Hours: See attached Roster

Objectives

Cognitive:

5. Provide care of the patient experiencing an allergic reaction

• Recognize the patient experiencing an allergic reaction.

• Describe the emergency medical care of the patient with an allergic reaction.

• State the generic and trade names, medication forms, dose, administration, action, and contraindications for the epinephrine autoinjector.

• Evaluate the need for medical direction in the emergency medical care of the patient with an allergic reaction.

• Differentiate between the general category of those patients having an allergic reaction and those patients having an allergic reaction and requiring immediate medical care, including immediate use of epinephrine auto‐injector.

Affective:

1. Defend the rationale for the EMT‐Basic to carry and assist with medications.

2. Recognize and respond to the feelings of the patient who may require interventions to be performed.

Psychomotor:

2. Demonstrate the use of an epinephrine auto‐injector.

49 Outline: See attached outline

50 Orange County Continuing Education Module Outline

Medical/Behavioral‐6

Instructor: See attached Roster

Roster: See attached Roster

Hours: See attached Roster

Objectives

Cognitive:

6. Provide care to a suspected poison/overdose patient

• Describe the steps in the emergency medical care for the patient with suspected poisoning.

• Discuss the emergency medical care for the patient with possible overdose.

Affective:

1. Defend the rationale for the EMT‐Basic to carry and assist with medications. 2. 2. Recognize and respond to the feelings of the patient who may require interventions to be performed.

Psychomotor:

Outline: See attached outline

51 Orange County Continuing Education Module Outline

Medical/Behavioral‐7

Instructor: See attached Roster

Roster: See attached Roster

Hours: See attached Roster

Objectives

Cognitive:

7. Provide care to a patient experiencing a behavioral problem

• Discuss the characteristics of an individual’s behavior which suggests that the patient is at risk for suicide.

• Discuss the special considerations for assessing a patient with behavioral problems.

• Discuss the general principles of an individual’s behavior which suggests that he is at risk for violence.

• Discuss methods to calm behavioral emergency patients.

Affective:

2. Recognize and respond to the feelings of the patient who may require interventions to be performed.

Psychomotor:

Outline: See attached outline

52 Orange County Continuing Education Module Outline

Medical/Behavioral‐8

Instructor: See attached Roster

Roster: See attached Roster

Hours: See attached Roster

Objectives

Cognitive:

1. Provide treatment for a patient in respiratory distress

• List the signs and symptoms of difficulty breathing

• Describe the emergency medical care of the patient with breathing difficulty.

• Recognize the need for medical direction to assist in the emergency medical care of the patient with breathing difficulty.

• State the generic name, medication forms, dose, administration, action, indications and contraindications for the prescribed inhaler.

Affective:

1. Defend the rationale for the EMT‐Basic to carry and assist with medications.

2. Recognize and respond to the feelings of the patient who may require interventions to be performed.

Psychomotor:

2. Demonstrate the use of an epinephrine auto‐injector.

53 Outline: See attached outline

54 Orange County Continuing Education Module Outline

Medical/Behavioral‐9

Instructor: See attached Roster

Roster: See attached Roster

Hours: See attached Roster

Objectives

Cognitive:

2. Provide care to a patient experiencing chest pain/discomfort

• Describe the emergency medical care of the patient experiencing chest pain/discomfort.

• Discuss the position of comfort for patients with various cardiac emergencies.

• Recognize the need for medical direction of protocols to assist in the emergency medical care of the patient with chest pain.

• List the indications for the use of nitroglycerin.

Affective:

1. Defend the rationale for the EMT‐Basic to carry and assist with medications.

2. Recognize and respond to the feelings of the patient who may require interventions to be performed.

Psychomotor:

2. Demonstrate the use of an epinephrine auto‐injector.

3. Given a cardiac arrest scenario, demonstrate the use of the AED.

55 Outline: See attached outline

56 Orange County Continuing Education Module Outline

Medical/Behavioral‐10

Instructor: See attached Roster

Roster: See attached Roster

Hours: See attached Roster

Objectives

Cognitive:

3. Attempt to resuscitate a patient in cardiac arrest

• Discuss the circumstances which may result in inappropriate shocks.

• Explain the considerations for interruption of CPR, when using the automated external defibrillator.

• List the steps in the operation of the automated external defibrillator.

• Discuss the need to complete the Automated Defibrillator: Operator’s Shift Checklist.

• Explain the role medical direction plays in the use of automated external defibrillation.

Affective:

1. Defend the rationale for the EMT‐Basic to carry and assist with medications.

2. Recognize and respond to the feelings of the patient who may require interventions to be performed.

Psychomotor:

3. Given a cardiac arrest scenario, demonstrate the use of the AED.

Outline: See attached outline

57 Orange County Continuing Education Module Outline

Medical/Behavioral‐11

Instructor: See attached Roster

Roster: See attached Roster

Hours: See attached Roster

Objectives

Cognitive:

5. Provide care of the patient experiencing an allergic reaction

• Recognize the patient experiencing an allergic reaction.

• Describe the emergency medical care of the patient with an allergic reaction.

• State the generic and trade names, medication forms, dose, administration, action, and contraindications for the epinephrine autoinjector.

• Evaluate the need for medical direction in the emergency medical care of the patient with an allergic reaction.

Affective:

1. Defend the rationale for the EMT‐Basic to carry and assist with medications.

2. Recognize and respond to the feelings of the patient who may require interventions to be performed.

Psychomotor:

58 2. Demonstrate the use of an epinephrine auto‐injector.

Outline: See attached outline

59 Orange County Continuing Education Module Outline

Medical/Behavioral‐12

Instructor: See attached Roster

Roster: See attached Roster

Hours: See attached Roster

Objectives

Cognitive:

6. Provide care to a suspected poison/overdose patient

• Describe the steps in the emergency medical care for the patient with suspected poisoning.

• Discuss the emergency medical care for the patient with possible overdose.

Affective:

1. Defend the rationale for the EMT‐Basic to carry and assist with medications.

2. Recognize and respond to the feelings of the patient who may require interventions to be performed.

Psychomotor:

2. Demonstrate the use of an epinephrine auto‐injector.

Outline: See attached outline

60 Module 4: Medical/Behavioral Emergency Medical Technician: Basic Refresher

TASK LIST AND EDUCATIONAL OBJECTIVES

At the completion of this lesson, the student will be able to:

COGNITIVE OBJECTIVE 1. Provide treatment for a patient in respiratory distress • List the signs and symptoms of difficulty breathing • Describe the emergency medical care of the patient with breathing difficulty. • Recognize the need for medical direction to assist in the emergency medical care of the patient with breathing difficulty. • State the generic name, medication forms, dose, administration, action, indications and contraindications for the prescribed inhaler. 2. Provide care to a patient experiencing chest pain/discomfort • Describe the emergency medical care of the patient experiencing chest pain/discomfort. • Discuss the position of comfort for patients with various cardiac emergencies. • Recognize the need for medical direction of protocols to assist in the emergency medical care of the patient with chest pain. • List the indications for the use of nitroglycerin. 3. Attempt to resuscitate a patient in cardiac arrest • Discuss the circumstances which may result in inappropriate shocks. • Explain the considerations for interruption of CPR, when using the automated external defibrillator. • List the steps in the operation of the automated external defibrillator. • Discuss the need to complete the Automated Defibrillator: Operator’s Shift Checklist. • Explain the role medical direction plays in the use of automated external defibrillation. 4. Provide care to a patient with an altered mental status • State the steps in the emergency medical care of the patient taking diabetic medicine with an altered mental status and a history of diabetes. • Evaluate the need for medical direction in the emergency medical care of the diabetic patient. 5. Provide care of the patient experiencing an allergic reaction • Recognize the patient experiencing an allergic reaction. • Describe the emergency medical care of the patient with an allergic reaction. • State the generic and trade names, medication forms, dose, administration, action, and contraindications for the epinephrine autoinjector.

IV - 1 61 Module 4: Medical/Behavioral Emergency Medical Technician: Basic Refresher

• Evaluate the need for medical direction in the emergency medical care of the patient with an allergic reaction. • Differentiate between the general category of those patients having an allergic reaction and those patients having an allergic reaction and requiring immediate medical care, including immediate use of epinephrine auto-injector. 6. Provide care to a suspected poison/overdose patient • Describe the steps in the emergency medical care for the patient with suspected poisoning. • Discuss the emergency medical care for the patient with possible overdose. 7. Provide care to a patient experiencing a behavioral problem • Discuss the characteristics of an individual’s behavior which suggests that the patient is at risk for suicide. • Discuss the special considerations for assessing a patient with behavioral problems. • Discuss the general principles of an individual’s behavior which suggests that he is at risk for violence. • Discuss methods to calm behavioral emergency patients.

AFFECTIVE OBJECTIVES 1. Defend the rationale for the EMT-Basic to carry and assist with medications. 2. Recognize and respond to the feelings of the patient who may require interventions to be performed.

PSYCHOMOTOR OBJECTIVES 1. Given medical scenarios, demonstrate the ability to properly assess the patient and demonstrate the ability to properly utilize the intervention to include inhaler, nitroglycerin, oral glucose and activated charcoal. 2. Demonstrate the use of an epinephrine auto-injector. 3. Given a cardiac arrest scenario, demonstrate the use of the AED.

PREPARATION

Motivation: Many of the emergencies that an EMT-Basic responds to will be of a medical nature. The ability to recognize a medical emergency through proper assessment and questioning techniques and then providing the appropriate intervention is critical to the well-being of the patient.

MATERIALS AV Equipment: Utilize various audio-visual materials relating to general pharmacology medical emergencies. The continuous design and development of new audio-visual materials relating to EMS requires careful review to determine which best meets

IV - 2 62 Module 5 Trauma

63 Orange County Continuing Education Module Outline

Trauma‐1

Instructor: See attached Roster

Roster: See attached Roster

Hours: See attached Roster

Objectives

Cognitive:

1. Provide care to a patient with shock (hypoperfusion)

• State methods of emergency medical care of external bleeding.

• List signs and symptoms of shock (hypoperfusion).

• State the steps in the emergency medical care of the patient with signs and symptoms of shock (hypoperfusion).

4. Provide care to a patient with a soft tissue injury

• Describe the emergency medical care of the patient with a closed soft tissue injury.

• Describe the emergency medical care of the patient with an open soft tissue injury.

Affective:

1. Explain the sense of urgency to transport patients that are bleeding and show signs of hypoperfusion.

Psychomotor:

1. Demonstrate care of the patient experiencing external bleeding.

2. Demonstrate care of the patient exhibiting signs and symptoms of shock (hypoperfusion.)

Outline: See attached outline

64 Orange County Continuing Education Module Outline

Trauma‐2

Instructor: See attached Roster

Roster: See attached Roster

Hours: See attached Roster

Objectives

Cognitive:

2. Provide care to a patient with suspected spinal injury

• State the signs and symptoms of a potential spine injury.

• Describe how to stabilize the spine.

Affective:

2. Explain the rationale for splinting at the scene versus load and go.

Psychomotor:

4. Demonstrate the steps in the care of a patient with a head or spine injury.

5. Demonstrate the procedure for rapid extrication.

Outline: See attached outline

65 Orange County Continuing Education Module Outline

Trauma‐3

Instructor: See attached Roster

Roster: See attached Roster

Hours: See attached Roster

Objectives

Cognitive:

3. Provide care to a patient with a suspected head injury

• Relate mechanism of injury to potential injuries of the head and spine.

Affective:

1. Explain the sense of urgency to transport patients that are bleeding and show signs of hypoperfusion.

Psychomotor:

4. Demonstrate the steps in the care of a patient with a head or spine injury.

Outline: See attached outline

66 Orange County Continuing Education Module Outline

Trauma‐4

Instructor: See attached Roster

Roster: See attached Roster

Hours: See attached Roster

Objectives

Cognitive:

5. Perform a rapid extrication of a trauma patient

• Describe the indications for the use of rapid extrication.

• List steps in performing rapid extrication.

Affective:

3. Explain the rationale for using rapid extrication approaches only when they will make the difference between life and death.

Psychomotor:

3. Demonstrate the steps in the care of open and closed soft tissue injuries. (chest injuries, abdominal injuries, burns and amputations).

Outline: See attached outline

67 Module 5: Trauma Emergency Medical Technician: Basic Refresher

TASK LIST AND EDUCATIONAL OBJECTIVES

At the completion of this lesson, the student will be able to:

COGNITIVE OBJECTIVES 1. Provide care to a patient with shock (hypoperfusion) • State methods of emergency medical care of external bleeding. • List signs and symptoms of shock (hypoperfusion). • State the steps in the emergency medical care of the patient with signs and symptoms of shock (hypoperfusion). 2. Provide care to a patient with suspected spinal injury • State the signs and symptoms of a potential spine injury. • Describe how to stabilize the spine. 3. Provide care to a patient with a suspected head injury • Relate mechanism of injury to potential injuries of the head and spine. 4. Provide care to a patient with a soft tissue injury • Describe the emergency medical care of the patient with a closed soft tissue injury. • Describe the emergency medical care of the patient with an open soft tissue injury. 5. Perform a rapid extrication of a trauma patient • Describe the indications for the use of rapid extrication. • List steps in performing rapid extrication.

AFFECTIVE OBJECTIVES 1. Explain the sense of urgency to transport patients that are bleeding and show signs of hypoperfusion. 2. Explain the rationale for splinting at the scene versus load and go. 3. Explain the rationale for using rapid extrication approaches only when they will make the difference between life and death.

PSYCHOMOTOR OBJECTIVES 1. Demonstrate care of the patient experiencing external bleeding. 2. Demonstrate care of the patient exhibiting signs and symptoms of shock (hypoperfusion. 3. Demonstrate the steps in the care of open and closed soft tissue injuries. (chest injuries, abdominal injuries, burns and amputations). 4. Demonstrate the steps in the care of a patient with a head or spine injury. 5. Demonstrate the procedure for rapid extrication.

PREPARATION

V - 1 68 Module 6 Pediatrics

69 Orange County Continuing Education Module Outline

Pediatrics‐1a

Instructor: See attached Roster

Roster: See attached Roster

Hours: See attached Roster

Objectives

Cognitive:

1. Assess and provide care to the obstetric patient

2. Assist with the delivery of an infant

Affective:

1. Explain the rationale for having knowledge and skills appropriate for managing infant and child patients.

Psychomotor:

1. Demonstrate steps to assist in the normal cephalic delivery.

Outline: See attached outline

70 Orange County Continuing Education Module Outline

Pediatrics‐1b

Instructor: See attached Roster

Roster: See attached Roster

Hours: See attached Roster

Objectives

Cognitive:

3. Assess and provide care to the newborn

Affective:

1. Explain the rationale for having knowledge and skills appropriate for managing infant and child patients.

2. Understand the provider’s own response (emotional) to caring for infants and children.

Psychomotor:

2. Demonstrate post‐delivery care of the infant.

Outline: See attached outline

71 Orange County Continuing Education Module Outline

Pediatrics‐2a

Instructor: See attached Roster

Roster: See attached Roster

Hours: See attached Roster

Objectives

Cognitive:

4. Assess and provide care to the mother immediately following delivery of a newborn

• Identify pre‐delivery emergencies.

• State the steps to assist in the delivery.

• Discuss the steps in the delivery of the placenta.

• List the steps in the emergency medical care of the mother post‐delivery.

• Summarize neonatal resuscitation procedures.

• Describe the procedures for the following abnormal deliveries

Affective:

1. Explain the rationale for having knowledge and skills appropriate for managing infant and child patients.

2. Understand the provider’s own response (emotional) to caring for infants and children.

Psychomotor:

3. Demonstrate post‐delivery care of the mother.

Outline: See attached outline

73 Orange County Continuing Education Module Outline

Pediatrics‐2b

Instructor: See attached Roster

Roster: See attached Roster

Hours: See attached Roster

Objectives

Cognitive:

5. Assess and provide care to an ill or injured infant or child with:

• Respiratory distress

• Shock (hypoperfusion)

• Cardiac Arrest

• Seizures

• Trauma

Affective:

1. Explain the rationale for having knowledge and skills appropriate for managing infant and child patients.

2. Understand the provider’s own response (emotional) to caring for infants and children.

Psychomotor:

N/A

Outline: See attached outline

74 Orange County Continuing Education Module Outline

Pediatrics‐3 Geriatrics

Instructor: See attached Roster

Roster: See attached Roster

Hours: See attached Roster

Objectives

Cognitive:

Affective:

Psychomotor:

Outline: See attached outline

75 Orange County Continuing Education Module Outline

Pediatrics‐4 Abuse & Assult

Instructor: See attached Roster

Roster: See attached Roster

Hours: See attached Roster

Objectives

Cognitive:

Affective:

Psychomotor:

Outline: See attached outline

76 Orange County Continuing Education Module Outline

Pediatrics‐5 Special Needs

Instructor: See attached Roster

Roster: See attached Roster

Hours: See attached Roster

Objectives

Cognitive:

Affective:

Psychomotor:

Outline: See attached outline

77 Module 6: Infants and Children Emergency Medical Technician: Basic Refresher

TASK LIST AND EDUCATIONAL OBJECTIVES

At the completion of this lesson, the student will be able to:

COGNITIVE OBJECTIVE 1. Assess and provide care to the obstetric patient 2. Assist with the delivery of an infant 3. Assess and provide care to the newborn 4. Assess and provide care to the mother immediately following delivery of a newborn • Identify pre-delivery emergencies. • State the steps to assist in the delivery. • Discuss the steps in the delivery of the placenta. • List the steps in the emergency medical care of the mother post-delivery. • Summarize neonatal resuscitation procedures. • Describe the procedures for the following abnormal deliveries 5. Assess and provide care to an ill or injured infant or child with: • Respiratory distress • Shock (hypoperfusion) • Cardiac Arrest • Seizures • Trauma

AFFECTIVE OBJECTIVES 1. Explain the rationale for having knowledge and skills appropriate for managing infant and child patients. 2. Understand the provider’s own response (emotional) to caring for infants and children.

PSYCHOMOTOR OBJECTIVE 1. Demonstrate steps to assist in the normal cephalic delivery. 2. Demonstrate post delivery care of the infant. 3. Demonstrate post delivery care of the mother.

PREPARATION

Motivation: Infant and child patients, as well as expectant mothers, often cause anxiety for the prehospital care provider. This is caused by a lack of dealing with this special population as well as a fear of failure. Understanding the special factors involved, such as body size, developmental considerations and normal ranged vital signs of infant and child patients is important in their emergency medical care.

MATERIALS

VI - 1 78 Module 7 Operations

79 Orange County Continuing Education Module Outline

Operations‐1

Instructor: See attached Roster

Roster: See attached Roster

Hours: See attached Roster

Objectives

Cognitive:

7‐1.1 Discuss the medical and non‐medical equipment needed to respond to a call.

7‐1.2 List the phases of an ambulance call.

7‐1.3 Describe the general provisions of state laws relating to the operation of the ambulance and privileges in any or all of the following categories:

• Speed • Warning lights • Sirens • Right‐of‐way • Parking • Turning

7‐1.4 List contributing factors to unsafe driving conditions.

Affective:

7‐1.15 Explain the rationale for appropriate report of patient information.

7‐1.16 Explain the rationale for having the unit prepared to respond.

Psychomotor:

N/A

Outline: See attached outline

80 Orange County Continuing Education Module Outline

Operations‐2

Instructor: See attached Roster

Roster: See attached Roster

Hours: See attached Roster

Objectives

Cognitive:

7‐2.1 Describe the purpose of extrication.

7‐2.2 Discuss the role of the EMT‐Basic in extrication.

7‐2.3 Identify what equipment for personal safety is required for the EMT‐Basic.

7‐2.4 Define the fundamental components of extrication.

7‐2.5 State the steps that should be taken to protect the patient during extrication.

7‐2.6 Evaluate various methods of gaining access to the patient.

7‐2.7 Distinguish between simple and complex access.

Affective:

N/A

Psychomotor:

N/A

Outline: See attached outline

81 Orange County Continuing Education Module Outline

Operations‐3

Instructor: See attached Roster

Roster: See attached Roster

Hours: See attached Roster

Objectives

Cognitive:

7‐3.1 Explain the EMT‐Basic's role during a call involving hazardous materials.

7‐3.2 Describe what the EMT‐Basic should do if there is reason to believe that there is a hazard at the scene.

7‐3.3 Describe the actions that an EMT‐Basic should take to ensure bystander safety.

7‐3.4 State the role the EMT‐Basic should perform until appropriately trained personnel arrive at the scene of a hazardous materials situation.

7‐3.5 Break down the steps to approaching a hazardous situation.

Affective:

N/A

Psychomotor:

N/A

Outline: See attached outline

82 Orange County Continuing Education Module Outline

Operations‐4

Instructor: See attached Roster

Roster: See attached Roster

Hours: See attached Roster

Objectives

Cognitive:

7‐3.6 Discuss the various environmental hazards that affect EMS.

7‐3.7 Describe the criteria for a multiple‐casualty situation.

7‐3.8 Evaluate the role of the EMT‐Basic in the multiple‐casualty situation.

7‐3.9 Summarize the components of basic triage.

7‐3.10 Define the role of the EMT‐Basic in a disaster operation.

7‐3.11 Describe basic concepts of incident management.

7‐3.12 Explain the methods for preventing contamination of self, equipment and facilities.

7‐3.13 Review the local mass casualty incident plan.

Affective:

N/A

Psychomotor:

N/A

Outline: See attached outline

83 MODULE 7

Operations

Lesson 7-1

Ambulance Operations

84 EMT-Basic: National Standard Curriculum Module 7: Operations Lesson 7-1: Ambulance Operations ------

OBJECTIVES

OBJECTIVES LEGEND

C=Cognitive P=Psychomotor A=Affective 1 = Knowledge level 2 = Application level 3 = Problem-solving level

COGNITIVE OBJECTIVES At the completion of this lesson, the EMT-Basic student will be able to: 7-1.1 Discuss the medical and non-medical equipment needed to respond to a call.(C-1) 7-1.2 List the phases of an ambulance call.(C-1) 7-1.3 Describe the general provisions of state laws relating to the operation of the ambulance and privileges in any or all of the following categories:(C- 1) ! Speed ! Warning lights ! Sirens ! Right-of-way ! Parking ! Turning 7-1.4 List contributing factors to unsafe driving conditions.(C-1) 7-1.5 Describe the considerations that should by given to: ! Request for escorts. ! Following an escort vehicle ! Intersections(C-1) 7-1.6 Discuss "Due Regard For Safety of All Others" while operating an emergency vehicle.(C-1) 7-1.7 State what information is essential in order to respond to a call. (C-1) 7-1.8 Discuss various situations that may affect response to a call.(C-1)

------United States Department of Transportation 7-487 National Highway Traffic Safety Administration EMT-Basic: National Standard Curriculum 85 EMT-Basic: National Standard Curriculum Module 7: Operations Lesson 7-1: Ambulance Operations ------

7-1.9 Differentiate between the various methods of moving a patient to the unit based upon injury or illness.(C-3) 7-1.10 Apply the components of the essential patient information in a written report.(C- 2) 7-1.11 Summarize the importance of preparing the unit for the next response.(C-1) 7-1.12 Identify what is essential for completion of a call.(C-1) 7-1.13 Distinguish among the terms cleaning, disinfection, high-level disinfection, and sterilization.(C-3) 7-1.14 Describe how to clean or disinfect items following patient care.(C-1)

AFFECTIVE OBJECTIVES At the completion of this lesson, the EMT-Basic student will be able to: 7-1.15 Explain the rationale for appropriate report of patient information.(A-3) 7-1.16 Explain the rationale for having the unit prepared to respond.(A-3)

PSYCHOMOTOR OBJECTIVES No psychomotor objectives identified.

PREPARATION

Motivation: As an EMT-Basic, the student may be required to function in the prehospital environment. A solid foundation related to the operational aspects of prehospital care is required.

The EMT-Basic should be familiar with the medical and non- medical equipment for use in patient care. The EMT-Basic should also be aware of the phases of a response and their role.

Prerequisites: BLS, Preparatory, Airway and Patient Assessment, Physical Exam and SAMPLE history for Medical and Trauma Patients.

MATERIALS

------7-488 United States Department of Transportation National Highway Traffic Safety Administration EMT-Basic: National Standard Curriculum 86 EMT-Basic: National Standard Curriculum Module 7: Operations Lesson 7-1: Ambulance Operations ------

AV Equipment: Utilize various audio-visual materials relating to ambulance operations. The continuous design and development of new audio-visual materials relating to EMS requires careful review to determine which best meet the needs of the program. Materials should be edited to assure meeting the objectives of the curriculum.

EMS Equipment: An ambulance, properly stocked.

PERSONNEL Primary Instructor: One EMT-Basic instructor, knowledgeable in ambulance and equipment operations.

Assistant Instructor: Not required.

Recommended Minimum Time to Complete: One hour

PRESENTATION

Declarative (What) IV. Phases of an ambulance call A. Preparation for the call 1. Equipment a. Medical (1) Basic supplies (2) Patient transfer equipment (3) Airways (4) Suction equipment (5) Artificial ventilation devices (6) Oxygen inhalation equipment (7) Cardiac compression equipment (8) Basic wound care supplies

------United States Department of Transportation 7-489 National Highway Traffic Safety Administration EMT-Basic: National Standard Curriculum 87 EMT-Basic: National Standard Curriculum Module 7: Operations Lesson 7-1: Ambulance Operations ------

(9) Splinting supplies (10) Childbirth supplies (11) Medications (12) Automated external defibrillator b. Non-medical (1) Personal safety equipment per local, state, and federal standards (2) Pre-planned routes or comprehensive street maps 2. Personnel a. Available for response b. At least one EMT-Basic in patient compartment is minimum staffing for an ambulance - two is preferred. 3. Daily inspections a. Inspection of vehicle systems (1) Fuel (2) Oil (3) Engine cooling system (4) Battery (5) Brakes (6) Wheels and tires (7) Headlights (8) Stoplights (9) Turn signals (10) Emergency warning lights (11) Wipers (12) Horn (13) Siren (14) Doors closing and latching (15) Communication system (16) Air conditioning/heating system (17) Ventilation system b. Equipment (1) Checked and maintained (2) Restocked and repaired (3) Batteries for defibrillator, suction, oxygen, etc. 4. Utilization of safety precautions and seat belts. B. Dispatch 1. Central access 2. 24-hour availability 3. Trained personnel 4. Dispatch information

------7-490 United States Department of Transportation National Highway Traffic Safety Administration EMT-Basic: National Standard Curriculum 88 EMT-Basic: National Standard Curriculum Module 7: Operations Lesson 7-1: Ambulance Operations ------

a. Nature of call b. Name, location, and callback number of caller c. Location of patient d. Number of patients and severity e. Other special problems C. En route 1. Seat belts 2. Notify dispatch - refer to Communications module 3. Essential information a. Nature of the call b. Location of the call

------United States Department of Transportation 7-491 National Highway Traffic Safety Administration EMT-Basic: National Standard Curriculum 89 EMT-Basic: National Standard Curriculum Module 7: Operations Lesson 7-1: Ambulance Operations ------

4. Driving the ambulance a. Emergency vehicle operations (1) It is recommended, and in some states mandated, that the driver of an emergency vehicle attend an approved driving course. (2) Characteristics of good ambulance operators (a) Physically fit (b) Mentally fit (c) Able to perform under stress (d) Positive attitude about abilities (e) Tolerant of other drivers (3) Safe driving is an important phase in the emergency medical care of the ill or injured patient. (a) The driver and all passengers should wear safety belts. (b) Become familiar with the characteristics of your vehicle. (c) Be alert to changes in weather and road conditions. (d) Exercise caution in use of red lights and siren. (e) Select appropriate route. (f) Maintain safe following distance. (g) Drive with due regard for safety of all others. (h) Know appropriateness of using lights and sirens. (i) Headlights are the most visible warning device on an emergency vehicle. b. Obtain additional information from dispatch. c. Assign personnel to specific duties. d. Assess specific equipment needs. e. Positioning the unit (1) For safety (a) Uphill from leaking hazards (b) 100 feet from wreckage i) In front of the wreckage or, ii) Beyond the wreckage (c) Set parking brake (d) Utilize warning lights

------7-492 United States Department of Transportation National Highway Traffic Safety Administration EMT-Basic: National Standard Curriculum 90 EMT-Basic: National Standard Curriculum Module 7: Operations Lesson 7-1: Ambulance Operations ------

(e) Shut off headlights unless there is a need to illuminate the scene. (2) To exit the scene. Avoid parking in a location that will hamper exit from the scene. f. Laws, regulations and ordinances - review state and local laws, regulations or ordinances in the area relative to the operations of an emergency vehicle, including as needed: (1) Vehicle parking or standing (2) Procedures at red lights, stop signs and intersections (3) Regulations regarding speed limits (4) Direction of flow or specified turns (5) Emergency or disaster routes (6) Use of audible warning devices (7) Use of visual warning devices (8) School buses g. Escorts and multiple vehicle response (1) Extremely dangerous (2) Used only if unfamiliar with location of patient or receiving facility (a) No vehicle should use lights or siren. (b) Provide a safe following distance. (c) Recognize hazards of multiple vehicle response. h. Intersection crashes - most common type (1) Motorist arriving at intersection as light changes and does not stop. (2) Multiple emergency vehicles following closely and waiting motorist does not expect more than one. (3) Vision is obstructed by vehicles. D. Arrival at scene 1. Notify dispatch 2. Size-up a. Body substance isolation (1) Should be a consideration prior to patient contact. (2) Use gloves, gowns and eyewear when appropriate. b. Scene safety - assess the scene for hazards. (1) Is the emergency vehicle parked in a safe location? (2) Is it safe to approach the patient? (3) Does the victim require immediate movement because of hazards? c. Mechanism of injury/nature of illness

------United States Department of Transportation 7-493 National Highway Traffic Safety Administration EMT-Basic: National Standard Curriculum 91 EMT-Basic: National Standard Curriculum Module 7: Operations Lesson 7-1: Ambulance Operations ------

(1) Medical (a) Mass casualty incident i) Number of patients. ii) Obtain additional help. iii) Begin triage. (b) Spine stabilization if necessary. (2) Trauma (a) Mass casualty incident i) Number of patients. ii) Obtain additional help. iii) Begin triage. (b) Spine stabilization if necessary. d. Total number of patients. e. Need for additional help or assistance. 3. Actions at scene. a. Organized b. Rapid/efficient c. Goal of transport in mind E. Transferring the patient to the ambulance 1. Preparing the patient for transport a. Completion of critical interventions b. Check dressings and splints. c. Patient covered and secured to moving device 2. Lifting and moving is accomplished using the guidelines of the lifting/moving module (Module 1, Lesson 1-5). F. En route to the receiving facility 1. Notify dispatch. 2. On-going assessment should be continued. 3. Additional vital sign measurements should be obtained. 4. Notify receiving facility. 5. Reassure patient. 6. Complete prehospital care reports. G. At receiving facility 1. Notify dispatch. 2. Transferring the patient at the facility a. Reports (1) Complete verbal report is given at bedside. (2) Complete written report is completed and left prior to returning to service.

------7-494 United States Department of Transportation National Highway Traffic Safety Administration EMT-Basic: National Standard Curriculum 92 EMT-Basic: National Standard Curriculum Module 7: Operations Lesson 7-1: Ambulance Operations ------

b. Lifting and moving is accomplished using the guidelines of the lifting/moving module (Module 1, Lesson 1-5). H. En route to station 1. At station or receiving facility, notify dispatch. 2. Prepare for the next call. a. Clean and disinfect the ambulance as needed. b. Clean and disinfect ambulance equipment. c. Restock the disposable supplies. I. Post run 1. Refuel unit. 2. File reports. 3. Complete cleaning and disinfection procedures. 4. Notify dispatch. V. Air Medical Consideration A. Utilization B. Landing zones C. Safety

APPLICATION

Procedural (How) None identified for this lesson.

Contextual (When, Where, Why) The knowledge of ambulance operations is applied throughout the career of the EMT-Basic. Although some EMT-Basics may never acutely operate on a transporting unit, the knowledge can be applied to their situation.

STUDENT ACTIVITIES Auditory (Hear) 1. Students should hear audio tapes of actual dispatch conversations with callers to the 9-1-1 system. 2. Students should hear audio tapes of actual dispatch information.

------United States Department of Transportation 7-495 National Highway Traffic Safety Administration EMT-Basic: National Standard Curriculum 93 EMT-Basic: National Standard Curriculum Module 7: Operations Lesson 7-1: Ambulance Operations ------

Visual (See) 1. Students should see an ambulance. 2. Students should see actual equipment or audio-visual aids or materials of ambulance equipment.

------7-496 United States Department of Transportation National Highway Traffic Safety Administration EMT-Basic: National Standard Curriculum 94 EMT-Basic: National Standard Curriculum Module 7: Operations Lesson 7-1: Ambulance Operations ------

3. Students should see audio-visual aids or materials depicting an actual ambulance run.

Kinesthetic (Do) 1. Students should practice receiving and sending information to dispatch.

INSTRUCTOR ACTIVITIES Supervise student practice. Reinforce student progress in cognitive, affective, and psychomotor domains. Redirect students having difficulty with content (complete remediation forms).

EVALUATION

Written: Develop evaluation instruments, e.g., quizzes, verbal reviews, handouts, to determine if the students have met the cognitive and affective objectives of this lesson.

Practical: Evaluate the actions of the EMT-Basic students during role play, practice or other skill stations to determine their compliance with the cognitive and affective objectives and their mastery of the psychomotor objectives of this lesson.

Identify students or groups of studentsREMEDIATION who are having difficulty with this subject content. Complete remediation sheet from the instructor's course guide.

------United States Department of Transportation 7-497 National Highway Traffic Safety Administration EMT-Basic: National Standard Curriculum 95 EMT-Basic: National Standard Curriculum Module 7: Operations Lesson 7-1: Ambulance Operations ------

ENRICHMENT

What is unique in the local area concerning this topic? Complete enrichment sheets from the instructor's course guide and attach with lesson plan.

------7-498 United States Department of Transportation National Highway Traffic Safety Administration EMT-Basic: National Standard Curriculum 96 MODULE 7

Operations

Lesson 7-2

Gaining Access

97 EMT-Basic: National Standard Curriculum Module 7: Operations Lesson 7-2: Gaining Access ------

OBJECTIVES

OBJECTIVES LEGEND

C=Cognitive P=Psychomotor A=Affective 1 = Knowledge level 2 = Application level 3 = Problem-solving level

COGNITIVE OBJECTIVES At the completion of this lesson, the EMT-Basic student will be able to: 7-2.1 Describe the purpose of extrication.(C-1) 7-2.2 Discuss the role of the EMT-Basic in extrication.(C-1) 7-2.3 Identify what equipment for personal safety is required for the EMT-Basic.(C-1) 7-2.4 Define the fundamental components of extrication.(C-1) 7-2.5 State the steps that should be taken to protect the patient during extrication.(C-1) 7-2.6 Evaluate various methods of gaining access to the patient.(C-3) 7-2.7 Distinguish between simple and complex access.(C-3)

AFFECTIVE OBJECTIVES No affective objectives identified.

PSYCHOMOTOR OBJECTIVES No psychomotor objectives identified.

PREPARATION

------7-500 United States Department of Transportation National Highway Traffic Safety Administration EMT-Basic: National Standard Curriculum 98 EMT-Basic: National Standard Curriculum Module 7: Operations Lesson 7-2: Gaining Access ------

Motivation: Although the EMT-Basic is not usually responsible for rescue and extrication, a fundamental understanding of the process is required.

------United States Department of Transportation 7-501 National Highway Traffic Safety Administration EMT-Basic: National Standard Curriculum 99 EMT-Basic: National Standard Curriculum Module 7: Operations Lesson 7-2: Gaining Access ------

Prerequisites: BLS, Preparatory, Airway, Patient Assessment, Physical Exam and SAMPLE history for Medical and Trauma Patients.

MATERIALS AV Equipment: Utilize various audio-visual materials relating to extrication. The continuous design and development of new audio- visual materials relating to EMS requires careful review to determine which best meet the needs of the program. Materials should be edited to assure meeting the objectives of the curriculum.

EMS Equipment: Exam gloves, stethoscopes, blood pressure cuffs, penlight.

PERSONNEL Primary Instructor: One EMT-Basic instructor knowledgeable in gaining access.

Assistant Instructor: The instructor-to-student ratio should be 1:6 for psychomotor skill practice. Individuals used as assistant instructors should be knowledgeable in extrication procedures.

Recommended Minimum Time to Complete: One hour

PRESENTATION

Declarative (What) I. Fundamentals of Extrication A. Role of the EMT-Basic 1. Non-rescue EMS a. Administer necessary care to the patient before extrication and assure that the patient is removed in a way to minimize further injury.

------7-502 United States Department of Transportation National Highway Traffic Safety Administration EMT-Basic: National Standard Curriculum 100 EMT-Basic: National Standard Curriculum Module 7: Operations Lesson 7-2: Gaining Access ------

b. Patient care precedes extrication unless delayed movement would endanger life of the patient or rescuer.

------United States Department of Transportation 7-503 National Highway Traffic Safety Administration EMT-Basic: National Standard Curriculum 101 EMT-Basic: National Standard Curriculum Module 7: Operations Lesson 7-2: Gaining Access ------

c. Working with others (1) The non-rescue EMS provider will need to work together with the providers of rescue. (2) The non-rescue EMT-Basic should cooperate with the activities of the rescuers, and not allow their activities to interfere with patient care. 2. Rescue EMS a. In some instances, the EMS providers are also the rescue providers. b. A chain of command should be established to assure patient care priorities. (1) Administer necessary care to the patient before extrication and assure that the patient is removed in a way to minimize further injury. (2) Patient care precedes extrication unless delayed movement would endanger life of the patient or rescuer. II. Equipment A. Personal safety 1. The number one priority for all EMS personnel. 2. Protective clothing that is appropriate for the situation should be utilized. B. Patient safety - following the safety of the EMS responders, the next priority is the safety of the patient. 1. The patient should be informed of the unique aspects of extrication. 2. The patient should be protected from broken glass, sharp metal and other hazards, including the environment. III. Getting to the Patient A. Simple access - does not require equipment. 1. Try opening each door. 2. Roll down windows. 3. Have patient unlock doors. B. Complex access - requires use of tools, special equipment. These are separate programs that should be taken (Trench, High Angle, Basic Vehicle Rescue). IV. Removing the Patient A. Maintain cervical spine stabilization. B. Complete initial assessment. C. Provide critical interventions.

------7-504 United States Department of Transportation National Highway Traffic Safety Administration EMT-Basic: National Standard Curriculum 102 EMT-Basic: National Standard Curriculum Module 7: Operations Lesson 7-2: Gaining Access ------

D. Immobilize spine securely. 1. Short spine board 2. Rapid extrication considerations E. Move the patient, not the immobilization device. F. Use sufficient personnel. G. Choose path of least resistance. H. Continue to protect patient from hazards.

APPLICATION

Procedural (How) None identified for this lesson.

Contextual (When, Where, Why) Gaining access is intended to be an overview of the actions required to extricate a patient. It is not the intent of this lesson to teach the EMT-Basic the techniques of extrication. A number of special classes are available to teach such specialized knowledge and skills. This lesson should emphasize the safety and medical aspects of this process.

STUDENT ACTIVITIES Auditory (Hear) None identified for this lesson.

Visual (See) 1. Students should see various crash scenes to determine if additional help will be necessary to remove the patient. 2. Students should see the various options of personal protective equipment. 3. Students should see patients being removed from vehicles.

Kinesthetic (Do) 1. Students should practice evaluating crash scenes to determine the need for complex rescue.

------United States Department of Transportation 7-505 National Highway Traffic Safety Administration EMT-Basic: National Standard Curriculum 103 EMT-Basic: National Standard Curriculum Module 7: Operations Lesson 7-2: Gaining Access ------

2. Students should practice removing patients from simulated crashed vehicles in the lab setting using short and long backboards.

------7-506 United States Department of Transportation National Highway Traffic Safety Administration EMT-Basic: National Standard Curriculum 104 EMT-Basic: National Standard Curriculum Module 7: Operations Lesson 7-2: Gaining Access ------

EVALUATION

Written: Develop evaluation instruments, e.g., quizzes, verbal reviews, handouts, to determine if the students have met the cognitive and affective objectives of this lesson.

REMEDIATION

Identify students or groups of students who are having difficulty with this subject content. Complete remediation sheet from the instructor's course guide.

ENRICHMENT

------United States Department of Transportation 7-507 National Highway Traffic Safety Administration EMT-Basic: National Standard Curriculum 105 EMT-Basic: National Standard Curriculum Module 7: Operations Lesson 7-2: Gaining Access ------

What is unique in the local area concerning this topic? Complete enrichment sheets from the instructor's course guide and attach with lesson plan.

------7-508 United States Department of Transportation National Highway Traffic Safety Administration EMT-Basic: National Standard Curriculum 106 MODULE 7

Operations

Lesson 7-3

Overviews

107 EMT-Basic: National Standard Curriculum Module 7: Operations Lesson 7-3: Overviews ------

OBJECTIVES

OBJECTIVES LEGEND

C=Cognitive P=Psychomotor A=Affective 1 = Knowledge level 2 = Application level 3 = Problem-solving level

COGNITIVE OBJECTIVES At the completion of this lesson, the EMT-Basic student will be able to: 7-3.1 Explain the EMT-Basic's role during a call involving hazardous materials.(C-1) 7-3.2 Describe what the EMT-Basic should do if there is reason to believe that there is a hazard at the scene.(C-1) 7-3.3 Describe the actions that an EMT-Basic should take to ensure bystander safety.(C-1) 7-3.4 State the role the EMT-Basic should perform until appropriately trained personnel arrive at the scene of a hazardous materials situation.(C-1) 7-3.5 Break down the steps to approaching a hazardous situation.(C-1) 7-3.6 Discuss the various environmental hazards that affect EMS.(C-1) 7-3.7 Describe the criteria for a multiple-casualty situation.(C-1) 7-3.8 Evaluate the role of the EMT-Basic in the multiple-casualty situation.(C-3) 7-3.9 Summarize the components of basic triage.(C-1) 7-3.10 Define the role of the EMT-Basic in a disaster operation.(C-1) 7-3.11 Describe basic concepts of incident management.(C-1) 7-3.12 Explain the methods for preventing contamination of self, equipment and facilities.(C-1) 7-3.13 Review the local mass casualty incident plan.(C-1)

AFFECTIVE OBJECTIVES No affective objectives identified.

------7-510 United States Department of Transportation National Highway Traffic Safety Administration EMT-Basic: National Standard Curriculum 108 EMT-Basic: National Standard Curriculum Module 7: Operations Lesson 7-3: Overviews ------

PSYCHOMOTOR OBJECTIVES At the completion of this lesson, the EMT-Basic student will be able to: 7-3.16 Given a scenario of a mass casualty incident, perform triage.(P-2)

PREPARATION

Motivation: EMT-Basics respond to scenes that require special considerations. These include hazardous materials and multi-patient considerations. It is the intent of this lesson to provide the EMT-Basic with an overview of these areas.

Prerequisites: BLS, Preparatory, Airway, Patient Assessment, Physical Exam and SAMPLE History of Medical and Trauma Patients.

MATERIALS AV Equipment: Utilize various audio-visual materials relating to operations. The continuous design and development of new audio- visual materials relating to EMS requires careful review to determine which best meet the needs of the program. Materials should be edited to assure meeting the objectives of the curriculum.

EMS Equipment: Triage tags.

PERSONNEL Primary Instructor: One EMT-Basic instructor knowledgeable in hazardous materials, triage and disaster operations.

Assistant Instructor: Not required.

Recommended Minimum Time to Complete: Two hours

------United States Department of Transportation 7-511 National Highway Traffic Safety Administration EMT-Basic: National Standard Curriculum 109 EMT-Basic: National Standard Curriculum Module 7: Operations Lesson 7-3: Overviews ------

PRESENTATION

Declarative (What) I. Hazardous Materials A. Common problem B. Actual extent unknown C. Safety is the primary concern 1. EMT-Basic and crew 2. Patient 3. Public D. Approaching the scene 1. Identification a. Occupancy b. Containers - size/shape c. Placards d. Shipping papers e. Senses 2. General procedures a. Park upwind/uphill from the incident, safe distance. b. Keep unnecessary people away from area. c. Isolate the area. (1) Keep people out. (2) Do not enter unless fully protected with proper equipment and SCBA. d. Avoid contact with material. e. Remove patients to a safe zone, if no risk to EMT-Basic. f. Do not enter a HazMat area unless you are trained as a HazMat Tech and have proper training in SCBA. E. Environmental hazards F. Resources 1. Local hazardous materials response team 2. CHEMTREC 800-424-9300 3. Hazardous Materials, The Emergency Response Handbook, published by the United States Department of Transportation G. National Fire Protection Association Haz Mat requirements for EMS providers 1. NFPA 479 2. OSHA 1910.120

------7-512 United States Department of Transportation National Highway Traffic Safety Administration EMT-Basic: National Standard Curriculum 110 EMT-Basic: National Standard Curriculum Module 7: Operations Lesson 7-3: Overviews ------

II. Incident Management Systems A. An incident management system has been developed to assist with the control, direction, and coordination of emergency response resources. 1. It provides an orderly means of communication and information for decision making. 2. Interactions with other agencies are easier because of the single coordination. B. Structure - after an incident manager is determined, EMS sectors are established as needed. 1. Extrication sector 2. Treatment sector 3. Transportation sector 4. Staging sector 5. Supply sector 6. Triage sector 7. Mobile command center C. Role of various individuals/organizations at the scene 1. Individuals at the scene will be assigned to particular roles in one of the sectors. 2. Upon arrival, the EMT-Basic should report to the sector officer for specific duties. 3. Once assigned a specific task, the EMT-Basic should complete the task and report back to the sector officer. III. Multiple Casualty Situations (MCS) A. Definition - an event that places a great demand on resources, be it equipment or personnel. B. Basic triage - sorting multiple casualties into priorities for emergency care or transportation to definitive care. Priorities are given in three levels. 1. Highest priority a. Airway and breathing difficulties b. Uncontrolled or severe bleeding c. Decreased mental status d. Patients with severe medical problems e. Shock (hypoperfusion) f. Severe burns 2. Second Priority a. Burns without airway problems b. Major or multiple bone or joint injuries c. Back injuries with or without spinal cord damage 3. Lowest priority a. Minor painful, swollen, deformed extremities

------United States Department of Transportation 7-513 National Highway Traffic Safety Administration EMT-Basic: National Standard Curriculum 111 EMT-Basic: National Standard Curriculum Module 7: Operations Lesson 7-3: Overviews ------

b. Minor soft tissue injuries c. Death C. Procedures 1. Most knowledgeable EMS provider arriving on-scene first becomes triage officer. 2. Additional help should be requested. 3. Perform initial assessment on all patients first. 4. Assign available personnel and equipment to priority one patients. 5. Patient transport decisions are based on a variety of factors a. Prioritization b. Destination facilities c. Transportation resources 6. Triage officer remains at scene to assign and coordinate personnel, supplies and vehicles.

APPLICATION

Procedural (How) 1. Demonstrate how to recognize hazardous materials situations. 2. Demonstrate how to function within an incident management system. 3. Demonstrate how to complete a triage tag. 4. Demonstrate triage procedures.

Contextual (When, Where, Why) The recognition of hazardous materials is an important aspect of emergency medical care. It is not the intent of the EMT-Basic course to make you proficient in dealing with hazardous materials. Dealing with the situation requires specialized training. It is more important for the EMT-Basic to recognize that a hazardous materials situation exists, and to prevent further illness or injury. This should be a consideration before you respond to a scene and as you size up the scene.

------7-514 United States Department of Transportation National Highway Traffic Safety Administration EMT-Basic: National Standard Curriculum 112 EMT-Basic: National Standard Curriculum Module 7: Operations Lesson 7-3: Overviews ------

Disaster operations can be extremely difficult. Understanding the concept of incident management systems will help to manage the situation. As with hazardous materials, this program is not designed to make the EMT-Basic an incident manager. The process of sorting patients and determining the priority of their care is a difficult process. It should begin upon arrival at scene, following determination that the scene is safe.

STUDENT ACTIVITIES Auditory (Hear) None identified for this lesson.

Visual (See) 1. Students should see audio-visual aids or materials of various situations to determine if a hazardous materials incident exists. 2. Students should see a copy of the Hazardous Materials Response Guidebook. 3. Students should see a triage tag. 4. Students should see a sample disaster plan.

Kinesthetic (Do) 1. Students should practice recognizing a hazardous materials incident and identify basic interventions that should be performed. 2. Students should practice participating in a simulated mass casualty incident. 3. Students should practice triaging patients at a simulated mass casualty incident.

EVALUATION

------United States Department of Transportation 7-515 National Highway Traffic Safety Administration EMT-Basic: National Standard Curriculum 113 EMT-Basic: National Standard Curriculum Module 7: Operations Lesson 7-3: Overviews ------

Written: Develop evaluation instruments, e.g., quizzes, verbal reviews, handouts, to determine if the students have met the cognitive and affective objectives of this lesson.

REMEDIATION

psychomotor objectives of this lesson. Identify students or groups of students who are having difficulty with this subject content. Complete remediation sheet from the instructor's course guide.

ENRICHMENT

What is unique in the local area concerning this topic? Complete enrichment sheets from the instructor's course guide and attach with lesson plan.

------7-516 United States Department of Transportation National Highway Traffic Safety Administration EMT-Basic: National Standard Curriculum 114 MODULE 7

Operations

Lesson 7-4

Evaluation: Operations

115 EMT-Basic: National Standard Curriculum Module 7: Operations Lesson 7-4: Evaluation: Operations ------

OBJECTIVES

OBJECTIVES LEGEND

C=Cognitive P=Psychomotor A=Affective 1 = Knowledge level 2 = Application level 3 = Problem-solving level

COGNITIVE OBJECTIVES At the completion of this lesson, the EMT-Basic student will be able to: ! Demonstrate knowledge of the cognitive objectives of Lesson 7-1: Ambulance Operations

! Demonstrate knowledge of the cognitive objectives of Lesson 7-2: Gaining Access

! Demonstrate knowledge of the cognitive objectives of Lesson 7-3: Overviews

AFFECTIVE OBJECTIVES At the completion of this lesson, the EMT-Basic student will be able to: ! Demonstrate knowledge of the affective objectives of Lesson 7-1: Ambulance Operations

PSYCHOMOTOR OBJECTIVES

At the completion of this lesson, the EMT-Basic student will be able to: ! Demonstrate proficiency in the psychomotor objectives of Lesson 7-3: Overviews

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PREPARATION

Motivation: Evaluation of the student's attainment of the cognitive and affective knowledge and psychomotor skills is an essential component of the EMT-Basic educational process. The modules are presented in a "building block" format. Once the students have demonstrated their knowledge and proficiency, the next lesson should be built upon that knowledge. This evaluation will help to identify students or groups of students having difficulty with a particular area. This is an opportunity for the instructor to evaluate his performance, and make appropriate modifications to the delivery of material.

Prerequisites: Completion of Lessons 7-1 through 7-3.

MATERIALS AV Equipment: Typically none required.

EMS Equipment: Equipment required to evaluate the students proficiency in the psychomotor skills of this module.

PERSONNEL Primary Instructor: One proctor for the written evaluation.

Assistant Instructor: One practical skills examiner for each 6 students.

Recommended Minimum Time to Complete: One hour

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PRESENTATION

Declarative (What) I. Purpose of the evaluation

II. Items to be evaluated

III. Feed back from evaluation

APPLICATION

Procedural (How) 1. Written evaluation based on the cognitive and affective objectives of Lesson 7-1 through 7-3. 2. Practical evaluation stations based on the psychomotor objectives of Lesson 7-1 through 7-3.

Contextual (When, Where and Why) The final lesson in this module is designed to bring closure to the module, and to assure that students are prepared to move to the next module.

This modular evaluation is given to determine the effectiveness of the presentation of materials and how well students have retained the material. This is an opportunity for the students to make necessary adjustments in study habits or for the instructor to adjust the manner in which material is presented.

INSTRUCTOR ACTIVITIES Supervise student evaluation. Reinforce student progress in cognitive, affective, and psychomotor domains. Redirect students having difficulty with content (complete remediation forms).

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REMEDIATION

Identify students and/or groups of students who are having difficulty with this subject content. Complete a remediation sheet from the instructor's course guide. If students continue to have difficulty demonstrating knowledge of the cognitive and affective objectives, or demonstrating proficiency in psychomotor skills, the students should be counseled, remediated and re-evaluated. If improvements in cognitive, affective or psychomotor skills are not achieved, consideration regarding the ability of the student to progress in the program should be taken into account.

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