Standard Categories May 6th Meeting

Duane,

Just a quick observation, these are all standards for an EMS organizations, we need to add topics on Fire related topics (i.e. responsibilities if first unit to arrive at vehicle accident, fire, etc.) Also recommend actual training on CAD so they learn all the ins and outs of the CAD and its capabilities and FIRE RMS for reports. Class on problem resolution would probably be a good topic also since there is the potential if the process changes that the new medics will be much junior to those driving them.

Eric

Here is one from Southside Emergency Crew here in Va that use the FTEP model

1) General Appearance
Evaluates physical appearance, dress, and hygiene as outlined by agency policies and procedures.

2) Acceptance of Feedback
Evaluates the way the EMT receives feedback and how it is applied to further the learning process and improve performance.

3) Attitude Towards EMS Work
Evaluates the EMT’s behavior of EMS in terms of motivation, goals, acceptance of roles and responsibilities, and overall performance.

4) Self-Initiated Field Study
Utilizes time for further familiarization with local protocols, procedures, equipment, and geography. Other examples may include vehicle orientation, journal reading, etc.

5) BLS Skills
Performance of Basic Life Support skills per the SVEC and ODEMSA Patient Treatment Protocols.

6) Knowledge of Agency Policies and Procedures
Demonstrates knowledge of agency policies and procedures.

7) Knowledge of SVEC and ODEMSA protocols
Demonstrates knowledge and field application of EMS protocols for all patients.

8) Knowledge of Equipment
Demonstrates a thorough knowledge of all equipment found on ambulance and in kits.

9) Emergency Vehicle Driving
Operates emergency vehicles safely during both emergent and non-emergent response modes.

10) Orientation, Mapping, Routes, Navigation
Utilizes maps and map books to navigate response routes and to choose the most efficient route to the scene of an emergency incident in a timely fashion. Knows the location and several driving routes to area hospitals. Knows major thoroughfares. Understands layout of district and hospitals. Knows landmarks and corresponding response areas. Communicates routes effectively.

11) Documentation
Completes appropriate documentation for every patient in a timely manner. Calls are posted in a reasonable time and calls are logged appropriately. Narrative is organized, and reflective of patient presentation, assessment, treatment, and response to treatment. Ensures all demographic and billing information is complete and accurate. Maintains 100% signature and HIPAA compliance.

12) Field Performance – Non Stress Conditions
Under routine, non-stressful conditions, properly assesses situations and is able to implement an action plan.

13) Field Performance – Stress conditions
Under stressful conditions, controls scene, assesses situations and implements an action plan.

14) Safety
Works in a safe manner and is aware of safety in all operations. Observes standard precautions. Uses appropriate PPE. Follows safety procedures in agency policies and procedures.

15) Radio procedures
Understands operation of radio equipment and frequencies. Listens and comprehends radio traffic. Transmissions are clear, concise, and complete. Hospital consultations and reports are timely, appropriate, and succinct.

16) Relationships with patients, citizens, coworkers, and other agencies
Communicates and interacts with patients, citizens, coworkers, and other agencies in an appropriate, effective, and professional manner.

Here are the categories I think we should use here in Fairfax. Please respond with a yes, no, or need to add, we don’t need. Thanks

1) Safety

2) Professionalism

3) Diagnostic Equipment

4) Patient Assessment

5) Decision Making Skills under stress (on calls)

6) Decision Making Skills under non-stress (not on calls)

7) Therapeutic Interventions

8) Fairfax County Protocols

9) Non-EMS specific equipment used on medic units

10) Communication with patients and public

11) Communication with Co-Workers and Hospital

12) Orientation to surrounding area

13) Documentation of Patient Care

14) Self Initiated study and Improvement

15) Affective Domain
- Acceptance of Feedback
- Attitude towards EMS work
- Attitude towards Public (patients and citizens)
- Attitude towards co-workers

Remember we are not defining these standards yet just trying to make sure we have all the categories we want covered that is needed to make someone a lead provider

I agree 100% with Provow. For a brand new provider, it can be overwhelming putting them in the front seat to give a size up of an incident and initial actions. While ALS skills, hospital communication, report writing, ect. are equally as important, it seems as though we leave out what to do when your first on scene of a house fire or entrapment. Many times (including today) you hear "Fairfax from BC404, I see Medic _____ on scene, do they have a report?". We need to put size up skills and initial first responder actions into a category.

In terms of categories, I like the way Wake County's flows. Instead of using "professionalism" which can mean a multitude of things, they use appearance/preparedness/condition. The less amount of "interpretation" we have by both the intern and preceptor, the better.

If we are operating under the assumption that the intern is well-versed with our protocols and are (somewhat) comfortable with their skills, I also believe that a significant part of the focus needs to be on creating a well rounded lead provider. There should be a General Operations category. Including: scene size up, scene management, vehicle positioning on accidents and suppression incidents, on scene reports, rehab, mutual aid, EMS reporting/narrative writing, MCT/CAD ops, logistical procedures, Target Solutions, IPAD/SIOC, portable radios, exposure reporting, bariatric equipment, hospital familiarization, and I'm sure another 30 topics I can not think of at this time. But they all fall under General Operations.

Ok so I think are good, we do not need to break everything out to the lowest common denominator since not all preceptors will teach the same way. I do like your last post that had simple categories. We can break these down a bit more.

1) Safety

2) Professionalism

3) Diagnostic Equipment

4) Patient Assessment

5) Decision Making Skills under stress (on calls)

6) Decision Making Skills under non-stress (not on calls)

7) Therapeutic Interventions

8) Fairfax County Protocols

9) Non-EMS specific equipment used on medic units

10) Communication with patients and public

11) Communication with Co-Workers and Hospital

12) Orientation to surrounding area

13) Documentation of Patient Care

14) Self Initiated study and Improvement

15) Affective Domain
- Acceptance of Feedback
- Attitude towards EMS work
- Attitude towards Public (patients and citizens)
- Attitude towards co-workers

Thanks for all the great responses. There will be two parts to this project and the standards is just part 1. The standards are the everyday evaluation that the intern will be graded on. That mean that the categories should be a little broad and when the evaluator grades them the remarks as to why the qualify for a particular mark need to be documented. I think a broad category of overall “operations” as a standard to be evaluated may be valid to have.

Breaking it down into where to park on scene, how to work this piece of equipment and various tasks will be included in the second part of the project “the task book” that will have a specific set of training to become a lead provider. Currently it is a set of objectives to completed each tour. That part of the project will begin July 1 and I will be asking for help again with portion as well. Currently we are finishing up the task book for the next 4 month internship, it has been updated and is awaiting final approval from the intern committee before being published.

Here is an example of Tour One to give you a preview of the task book and how it will be separate from the standards

Tour 1

Tasks:

Adult Protocol Review: Acute Coronary Syndrome, Cardiac Arrest, Cardiac Dysrhythmias

Protocol Review: Team Work & Decision Making, When a person Becomes a patient, Decision-Making Capacity

Protocol Review: Cardiac Medications
Discuss with your preceptor the common medications used for cardiac patients and the strategy, tactics, and roles for a cardiac arrest call


Equipment Familiarization: Philips MRx monitor
1. Demonstrate proper safe storage of unit and securing during transport
2. Demonstrate performing operational check and troubleshooting common problems such as a battery change-out, AC power connection, battery rotation
policy, changing paper
3. Demonstrate proper cleaning techniques and accessory storage
4. Demonstrate proper 4- and 12-lead placement and acquisition
5. Demonstrate proper defibrillation pad placement and use of AED mode

Equipment Familiarization: Philips MRx Operation
1. Demonstrate the proper sequence to set up and initiate pacing and the difference between fixed and demand pacing
2. Demonstrate the proper sequence to perform Defibrillation and Cardioversion
3. Discuss the benefits of and demonstrate how to obtain a 15-Lead EKG
4. Prepare an in-station drill to give to your shift next week on the basic operation of the MRx and assisting with 12-Lead acquisition

Area Familiarization: Receiving Facilities
Using your favorite online mapping program, find the three closest hospitals to your station and the best route of travel.
1. Name: Miles from station:
2. Name: Miles from station:
3. Name: Miles from station:

Target Solutions: Take Tour 1 Quiz by last day of Tour.


Information Technology: MCT & CAD
1. Demonstrate using the unit roster to add personnel and assign the portable radio
2. Demonstrate how to obtain medic “unit history”, last incident number and times from the vehicle MCT and station CAD terminals
3. Explain the concept of a “Julian Date”

Equipment Familiarization:
Perform a full inventory inspection utilizing FRD-209-A


Station Orientation: EMS Resupply
1. Locate the EMS supply closet(s) and explain the station security policy to keep
ALS items locked and secure
2. Locate the battery charges and spare batteries for all items on your unit (radios, suction unit, heart monitor, pulse ox, laryngoscope, power cot, etc)

Administrative: Chain of Command
Identify the three shift leaders at your station. Discuss the relationship between a
Captain I and Captain II at the station level.



This book will need to updated to include everything we think a lead provider should be able to do at the end of 6 months. Whereas the Standard Evaluation Guide is how the function with-in our department on a day-to-day basis.