KAPI'OLANI COMMUNITY COLLEGE
University of Hawai'i
COURSE OUTLINE (Form: 02/02/02)
MICT 202 Pre-hospital Assessment and Treatment Internship I
1. COURSE INFORMATION:
(11/30/0601/22/07)
MICT 202 Pre-Hospital Assessment and Treatment Internship I (4)
1 hour lecture, 39 hour ambulance internship (4 weeks).
Prerequisite(s): A grade of “C” or higher in MICT 200; a grade of “credit” in MICT 201; acceptance into MICT Program; completion of a State of Hawai‘i approved Emergency Medical Technician program; State licensure at the EMT level.
MICT 202 provides the initial experience as a MICT intern on an advanced life support emergency ambulance. MICT 202 includes rotation one of the required five rotations. Each student is assigned one on one with a preceptor.
Comment: Mandatory credit/no credit grading. MICT 202 may not be audited. MICT 202 may not be taken for a letter grade.
2. COURSE STUDENT LEARNING OUTCOMES:
Upon successful completion of MICT 202, the student should be able to:
· Safely and accurately perform in the emergency situation, at an introductory level, all advanced life support procedures as listed in the Board of Medical Examiners Rules for Emergency Ambulance Personnel.
· Exercise personal judgment in case of interruption in medical direction caused by communication failure or in cases of immediate life threatening conditions; provide such emergency care as has been specifically authorized by approved standing orders.
3. GENERAL EDUCATION AND RELATIONSHIP TO OTHER COURSES:
MICT 202 is a required course in the MICT curriculum. This course provides the student a clinical orientation to healthcare in Hawaii. The students participate in actual clinical settings providing patient care. They are one-on-one with a preceptor and monitored by the instructor. Students are expected to demonstrate their knowledge and skills from MICT 200, MICT 201, and the EMT experience in a controlled environment.
MICT 202 supports the following college competency areas:
· Computation and communication abilities
· Values for living
· Quality of life as affected by technology and science
· Awareness of the dynamics in contemporary issues
· Problem-solving and decision-making abilities
· Responsiveness to the arts and humanities
· Career choices and life-long learning
· Study in a selected program.
This course also satisfies the following Associate in Science degree competencies:
· Understand attitudes and values of various cultures and examine the
potential for improving the quality of life and meaningfulness in work.
· Recognize effects of technology and science on the natural and human environments.
· Understand contemporary issues and problems and respond to the impact of current conditions.
· Demonstrate proficiency in conceptual, analytical, and critical modes of thinking.
· Develop insights into human experience and apply them to personal, occupational, and social relationships.
· Recognize relevance of career choices to life-long learning.
· Demonstrate competence in a selected program of study.
MICT 202 meets the following U.S. Department of Transportation – National Highway Traffic Safety Administration’s Paramedic Program Learning Outcomes.
A graduate from the University of Hawaii – Kapi’olani Community College – Department of Emergency Medical Service’s MICT Program shall be able to:
· Accurately identify street names through map reading, correctly distinguish house numbers or business addresses, and navigate an ambulance to a given address.
· Operate and navigae an emergency vehicle with due regard to the safety of others while responding to a prehospital crisis situation.
· Demonstrate safe operation and navigation of an emergency vehicle with due regard to the safety of others while responding to a prehospital crisis situation.
· Use critical judgment, prioritize decisions, and act quickly and independently in the best interest of a patient, in a non-structured environment that is constantly changing.
· Exercise personal judgment in case of interruption in medical direction caused by communication failure or in cases of immediate life threatening conditions; under these conditions, provide such emergency care as has been specifically authorized
by approved standing orders.
· Remain calm and focused while working in difficult, stressful and/or adverse circumstances, while assuming the leadership role inherent in carrying out the functions of the position.
· Communicate effectively with patients (e.g., develop patient rapport, interview hostile patients) from diverse multicultural groups and ages within those groups).
· Communicate verbally and non-verbally with multicultural patients, healthcare professionals and the public; communicate in writing through report writing and completion of the ambulance report forms.
· Concisely and accurately describe to a dispatcher and other concerned staff, one'shis/her assessment of a patient's condition.
· Communicate effectively via the telephone or radio dispatch for coordination of prompt emergency services.
· Administer appropriate, life-saving medications at the appropriate time and dosage to mitigate a life-threatening situation.
· Administer drugs legally, ethically, and responsibly -- using correct precautions and techniques while observing the effects of the drugs.
· Provide basic and advanced life support emergency medical services to patients. Safely and accurately (without jeopardizing health and safety) perform all basic and advanced life support procedures as listed in Board of Medical Examiners rules for Emergency Ambulance Personnel.
· Document precisely and accurately the treatments and effects of drugs.
· Report all relevant patient data, including, as needed, a detailed narrative on extenuating circumstances or conditions following federal guidelines for patient privacy.
· Enter data on a computer from a laptop in the ambulance.
· Participate in continuing education activities for self improvement and for the education of others within the field, including following up on selected cases for education and quality assurance.
· Initiate and continue emergency medical care under medical control including the recognition of presenting conditions and initiation of appropriate invasive and non-invasive treatments for: surgical, medical, cardiac and psychiatric emergencies; trauma; and airway and respiratory problems.
· Take a leadership role with ambulance, first responder, and other personnel to ensure the safety and care of the patient.
4. COURSE CONTENT:
Students follow the work schedule of the Preceptor. They are on internship 40 hours per week. They meet frequently with their instructor and return to the classroom monthly for case presentations.
5. POSSIBLE TEXTS (Resources):
Bledsoe BE, Porter RS Cherry RA. Essentials of Paramedic Care: Upper Saddle River, NJ: Pearson Education; 2003. (ISBN: 0-13-098792-1) or latest edition
Porter RS. Essentials of Paramedic Care Workbook: Upper Saddle River, NJ: Pearson Education; 2003. (ISBN: 0-13-099521-5) or latest edition
Cherry RA, Bledsoe B.E. Drug Guide for Paramedics: Upper Saddle River, NJ: Pearson Education; 2001. (ISBN: 0-13-028798-9) or latest edition
American Heart Association, ACLS: The Reference Textbooks, 2003 or latest edition
American Heart Association, Handbook of Emergency Cardiac Care for Healthcare Providers, need update of 2005, 2006 or latest edition
American Heart Association/American Academy of Pediatrics. Textbook of Pediatric Advanced Cardiac Life Support, 2002 or latest edition
NAEMT, PHTLS Basic and Advanced: Prehospital Trauma Life Support Fifth Edition, Mosby or latest edition
NAEMT, AMLS Advanced Medical Life Support, second edition or latest edition. Brady.
6. METHODS OF INSTRUCTION:
This course is an Internship. Students are actively involved in patient care on an ambulance. Each student is assigned a preceptor that mentors the student throughout his or her experience (1 rotation). Students are required to meet criteria for skills and complete case studies. Students are required to successfully complete 5 internship rotations and may only repeat one rotation.
7. METHOD OF EVALUATION:
Mandatory credit/no credit grading. No letter grade. No audit option.
Student performance is evaluated daily, weekly and the end of each rotation. The evaluation is based on a series of graduated competencies becoming increasingly more complex as the experience progresses. The following areas are assessed:
Professionalism
Conduct
Motivation
Call Management
Scene/Call Management
Leadership/Teamwork
Judgment/Adaptability
Time Management
BLS Call Management
Patient Assessment
Pertinent Assessment/PE
Pertinent History
Clinical Impression/differential diagnosis
Reassessment
Didactic Application
Pathophysiology
Pharmacology
ACLS/PALS/PHTLS
Patient Management and Treatment
Standing Orders
ALS Treatment Plan
BLS Treatment Plan
Skills
IV Technique
Intubation/Airway Management
Medication Administration
EKG Interpretation
Oral Communication
Written Communication
The students are assessed on a scale (1-4) of:
Meets Standards 4
Needs Improvement 3
Unacceptable Performance 2
Not Assessed -
Each parameter of the scale is defined in the student guidelines and scaled to the rotation requirements. The findings are converted to a numeric value established for each rotation. The student must meet the numeric value for each competency to pass. Each rotation is PASS/FAIL and the course is graded as Credit/No Credit.
Passing Average (Scale 1-4)
Rotation 1
Professionalism
Conduct 3.5
Motivation 3.5
Call Management
Scene/Call Management 3.1
Leadership/Teamwork 3.1
Judgment/Adaptability 3.1
Time Management 3.1
BLS Call Management 3.1
Patient Assessment
Pertinent Assessment/PE 3.1
Pertinent History 3.1
Clinical Impression/differential diagnosis 3.1
Reassessment 3.1
Didactic Application
Pathophysiology 3.1
Pharmacology 3.1
ACLS/PALS/PHTLS .1
Patient Management and Treatment
Standing Orders 3.5
ALS Treatment Plan 3.5
BLS Treatment Plan 3.5
Skills
IV Technique 3.1
Intubation/Airway Management 3.1
Medication Administration 3.1
EKG Interpretation 3.1
Oral Communication 3.1
Written Communication 3.1
Standards of Evaluation
1-5 before each competency represents the rotation that the competency is evaluated. The mastery of the competency must be maintained after the rotation until internship is completed.
Professionalism
1) Conduct:
Displays general character of honesty, integrity, positive attitude, good work ethic,
self control, and acceptance of responsibility for actions.
Places the well being of the patient first after personal safety.
Displays respect and compassion for others (patient, family, co-workers, hospital staff)
Does not display attitude/behaviors, which might be considered rude, antagonistic, egotistical, or sexual harassment.
Respects patient’s confidentiality and rights.
Performs duties/treatments fairly and without prejudice.
Demonstrates high priority for the safety of self and others.
Adheres to deadlines and arrives at scheduled activities on time.
1) Motivation:
Displays desire to perform at his/her best.
Accepts constructive criticism well, and strives to improve.
Learns from mistakes so they are not repeated.
Constantly works on improving weak areas by self initiating learning opportunities during downtime through asking questions, doing research, and studying to improve knowledge base.
Call Management
Scene / Call Management:
1) Able to manage all aspects of any BLS call.
2) Able to confidently formulate and implement an appropriate and timely extrication plan.
3) Able to accurately assess scene and involved individuals for safety, priorities, additional resources needed, and time utilization needs.
3) Interacts well with others; establishes good rapport with patient & family.
3) Able to complete documentation, restock, and return to service in a timely manner.
5) Able to confidently formulate an effective scene and call management plan and implement it in an efficient, and timely manner.
5) Able to handle all aspects of any ALS call.
Critical Call Management:
2) Able to identify life-threatening critical calls upon completion of primary survey, then
suggest and assist in performing appropriate interventions.
4) Able to provide appropriate care for critical patients without major hesitation.
5) Able to orchestrate simultaneous actions to provide appropriate, efficient, and timely
care for critical patients.
Leadership/Teamwork:
1) Interacts appropriately with all members of team (see Conduct), and pulls his/her share of the workload.
1) Displays knowledge of operational procedures/policies, & chain of command of all agencies (EMS, fire, police, hospital, etc.) and how they impact effective teamwork.
2) Able to follow and keep up with other leaders.
2) Delegates responsibilities to individuals consistent with their abilities/ certification level.
3) Takes initiative for making, communicating, and implementing decisions.
4) Displays confidence in making and implementing decisions.
4) Sets clear and accurate priorities for managing patients, and call.
5) Does not allow situation to deteriorate; restores control & takes command.
Judgment/adaptability:
3) Displays ability to think clearly in stressful situations.
3) Frequently reassesses the effectiveness of strategies and treatments throughout the call and adapts them as needed.
4) Evaluates situations accurately for urgency and needs, considering all aspects and ramifications of choices when making decisions.
4) Displays creativity and adaptability when dealing with adversity and making decisions.
Time Management:
3) Completes tasks in a reasonable amount of time.
3) Sets accurate priorities and uses time well.
4) Is in control of events to prevent inattentive loss of time.
Patient Assessment
Pertinent Assessment/PE:
1) Demonstrates knowledge of and ability to correctly perform initial assessment (1° survey) of patient I n accordance with the KCC Skills sheets (see attached form).
1) Demonstrates knowledge of and ability to correctly perform detailed assessment
(2° Survey) of patients in accordance with the KCC Skills Sheets (see attached form).
1) Able to identify chief complaint and formulate appropriate rule-outs for the cause.
4) Performs assessments and interventions in a timely, organized & appropriate manner, prioritizing actions correctly, and focusing on pertinent details.
Pertinent History :
1) Able to recognize and acquire most major elements of a pertinent history.
3) Able to elicit complete history (both present illness and past) relative to chief complaint/mechanism of injury.
3) Utilizes all appropriate sources for history gathering, aware of accuracy concerns.
Clinical Impression / Differential Diagnosis:
2) Able to Identify Life-threatening situations and unstable patients in a timely manner.
*) Demonstrates ability to integrate history and physical assessment to accurately form a clinical impression. * 3) simple 1 system ALS call 4) multiple system ALS call
4) Able to refine differential diagnosis through further assessment of possible rule-outs.
Reassessment:
2) Reassessments of key findings are done throughout the call, especially to evaluate effectiveness of treatments, or when findings are abnormal or unstable.
Didactic Application
Pathophysiology:
1) Able to verbalize major aspects of human anatomy, physiology and disease states.
2) Able to utilize knowledge of pathophysiology to direct appropriate patient assessment.
3) Able to utilize knowledge of pathophysiology to direct appropriate patient treatment.