Emergency Medical Services Program CLINICAL AND INTERNSHIP

Emergency Medical Services Program

CLINICAL AND INTERNSHIP

POLICIES AND PROCEDURES MANUAL

This version of the manual supersedes all previous versions.

For Paramedic students

Revised August 2011

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Table of Contents

Staff Contact Numbers 3

Agency Contact Numbers 3

Introduction 4

Clinical & Internship Goals 5

Completion Requirements 5

Classroom Attendance 7

Terminal Objectives 7

Clinical and Internship Rotations 9

Grievance Policy 11

Professional Conduct 11

Dress Code 13

Equipment 14

Documentation 14

Patient Care Documentation 14

Accident or Injury 16

Incident Reporting 17

Patient Contacts Requirements 17

Clinical Objectives 19

Shift Evaluation by a Preceptor (Daily Evaluation) 27

Evaluation of a Preceptor 29

Major Phase Evaluation 30

Final Evaluation 33

Single-lead EKG sheets 35

12-lead sheet 37

Clinical Assessment sheets 38

Patient Care Report 48

Patient Care Report with annotation 50

Incident Report Form 55

Student Policy Contract 56

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CCA Program Staff Contact Information

CCA Staff Office Phone Email

Patrick Schooler (Department Chair) 303-340-7217 [email protected]

Beth Lattone (Primary Instructor) 303-340-7075 [email protected]

Kelly Cowan (Primary Instructor) 303-340-7220 [email protected]

Angela Cutler (Clinical Coordinator) 303-340-7219 [email protected]

Cindy Smith (Administration) 303-340-7070 [email protected]

Angela Love (Marketing) 303-340-7072 [email protected]

Pony Anderson (Simulation Coordinator) 303-340-7218 [email protected]

All office numbers listed above have voice mail with date and time stamping.

Office fax #: 303–340-7209

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Introduction

This manual is designed to suit the clinical and field internship needs of Phase I, Phase II and

Phase III students in the Community College of Aurora EMS Program. Some portions of the

manual will apply to all students, while other portions will apply to only specific students in

certain aspects of their training. Please make sure you are using the appropriate paperwork for

the segment of training you are in.

You are about to enter the next exciting phase in your educational experience – your Paramedic

clinicals and field internship. You will be solely responsible from this point forward not only in

how you apply the knowledge you have received from the CCA program, but also for the EMS

professional you will become. The notebook you have just received is intended to ease some of

the stress of what you will be expected to accomplish over the next several months, but will be

useless if you don‟t take some time to understand and use it.

The most important things to keep in mind, as we go through your notebook are:

Every single patient contact must be written on a CCA Patient Care Report, and should

be reviewed and initialed by your preceptor, unless given specific permission by your

primary instructor to use other charting formats. These reports must be turned in to your

primary instructor at the same time as your daily eval: within 72 hours of the shift.

Failure to do so may result in contacts and hours not being accepted.

Every patient contact report that gives an EKG interpretation must have an EKG strip

attached on the back of the form or on a separate piece of paper. No credit will be given

for any cardiac contact without an attached EKG strip.

There are many different interpretations of what constitutes an ALS or advanced

assessment call. To help determine this ask yourself, “Did this call help prepare me to

function as a Paramedic, or am I just trying to be done?” Quite a few of the students in

this class will need extensions to their internships – this is in no way a failure on their

part. The clinical standards set by the state of Colorado and the National Standard

Curriculum are intended to be rigorous, and are difficult to achieve under the best of

circumstances. If your intention is to become a field Paramedic, don‟t cheat yourself

by counting basic calls or getting all your patient contacts in a hospital or scenario-

based setting.

There is a difference between a „procedure‟ and an „assessment‟. A procedure is a

psychomotor skill, such as ventilating a patient. An assessment is performing an

evaluation of a patient, such as a pediatric dyspnea patient. Make sure you understand

this concept when documenting patient contacts.

While doing your Phase I clinical shifts remember that all the psychomotor skills you

perform will count toward your total contacts. A maximum of 50% of patient contacts

will be allowed from clinical time.

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The staff at CCA looks forward to watching you become the EMS Professionals we know you

are capable of becoming and will support you through the process the best way we can. If you

have questions, concerns, or need any guidance, feel free to contact us anytime.

Clinical & Internship Goals

The Clinical portion of the CCA EMS curriculum is meant to provide students with a realistic

means to master the complicated didactic applications, physical skills, and affective behaviors

necessary to become EMS professionals. Additionally, students will have the opportunity to

interact with a wide variety of ill and injured patients (both as team leaders and observers) under

the supervision of an experienced preceptor. Students will develop leadership and delegation

skills and an appreciation for the role of each team member as an integral part of the emergency

medical healthcare system.

Completion Requirements

Successful completion of the clinical phase of the CCA EMS Program requires the following:

Students must complete all required clinical rotation hours before starting field rides.

Students must complete all requirements for EMS 280 before taking the National

Registry Practical Exam. Students must complete all program requirements before taking

the National Registry written exam, including field and hospital hours and contacts.

Students must operate under the direct supervision of a preceptor of equal or higher

certification (and who is recognized by the CCA EMS Program) at all times.

Clinical shifts done by students must be facilitated through the CCA Clinical

Coordinator. Any shifts not authorized by the Clinical Coordinator will not apply toward

final hours for the program, and any patient contacts completed during those shifts will

not be counted toward totals. Students will not be covered by state workers‟

compensation insurance or other program insurance policies during unauthorized shifts,

and attend those shifts at their own risk, and risk expulsion from the program.

Clinical rotations are subject to the attendance policies of the CCA EMS Policies and

Procedures Manual. Clinicals missed without notification will not be tolerated. Please

see the current course syllabus you were given the first day of class for a complete listing

of all attendance policies

Documentation of clinical and internship shifts is the sole responsibility of the student.

All paperwork associated with a clinical/internship rotation must be turned into the

Clinical Coordinator within 72 hours of the completed clinical rotation. Failure to

comply may result in being charged one (1) missed clinical rotation. You are strongly

encouraged to make photo copies of any forms you turn in to the office, unless you fax

your paperwork. Students are strongly encouraged to keep copies of all documentation.

Falsification of documentation may result in discipline meeting with the program

physician advisor possible termination from the program.

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Students will complete only the designated areas on their evaluation forms. That includes

a legible printed name for the preceptor. All other areas will be completed by the

preceptor.

Students who fail to meet any of the program‟s clinical requirements will receive a failing

grade and will not be allowed to graduate or participate in post-graduate testing.

Successful completion of the field internship phase of the CCA EMS Program requires the

following:

Students must complete all required internship rotation hours, required patient contacts,

and research assignments before being allowed to take the National Registry written

exam. Under no circumstances will students be cleared to take the NR written exam

before they have completed their field internship hours and patient contacts.

Students must operate under the direct supervision of a preceptor of equal or higher

certification (and who is recognized by the CCA EMS Program) at all times. The student

must also be a third member of the crew, and their preceptor must be in the patient

compartment with the student during all transports.

Students who choose to ride with preceptors at clinical sites not recognized by the EMS

program will not be covered by state workers‟ compensation insurance or other program

insurance policies, and do so at their own risk. Hours spent at those locations, as well as

any patient contacts acquired, will not be credited toward final numbers.

Field internships are subject to the attendance policy described in the course syllabus

given to each student the first day of class. It is the student‟s sole responsibility to

complete their internship hours and patient contacts.

Documentation of clinical and internship shifts is the sole responsibility of the student.

All paperwork associated with a clinical/internship rotation must be turned into the

Clinical Coordinator within 72 hours of the completed clinical rotation. Failure to

comply may result in being charged one (1) missed clinical rotation. You are strongly

encouraged to make photo copies of any forms you turn in to the office, unless you fax

your paperwork. Falsification of documentation may result in discipline meeting

with the program physician advisor possible termination from the program.

Students are not allowed to fill out their own evaluation forms.

All internship hours and contacts must be completed at the end of a one-year period for

Paramedic students beginning with the completion of the course final practical exam.

Field internship extensions are available, if necessary, by permission of the Primary

Instructor.

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Classroom Attendance Requirements

Students are allowed to miss a maximum of 30 hours of classroom and simulation hours

for the total time of the Program. Students who wish to have missed hours discounted

must notify their Primary Instructor within 24 hours of the missed time that they wish to

grieve the hours, and must provide documentation, i.e. hospital discharge document or

obituary. The grievance committee will meet and determine outcome (make-up work,

etc.) See Grievance Policy.

Students who fail to meet any of the program‟s internship requirements will receive a failing

grade and not be allowed to graduate or participate in post-graduate testing.

Field Internship Terminal Objectives

Upon completion of the field internship the Paramedic student will be able to effectively and

accurately:

Understand his or her roles and responsibilities within an EMS system, and how these

roles and responsibilities differ from other levels of providers

Understand and value the importance of personal wellness in EMS and serve as a healthy

role model for peers

Integrate the implementation of primary injury prevention activities as an effective way

to reduce death disabilities and healthcare costs

Understand the legal issues that impact decisions made in the out-of-hospital

environment

Understand the role that ethics plays in decision making in the out-of-hospital

environment

Apply the general concepts of pathophysiology for the assessment and management of

emergency patients

Integrate pathophysiological principles of pharmacology and the assessment findings to

formulate a field impression and implement a pharmacologic management plan

Access the venous circulation and administer medications

Integrate the principles of therapeutic communication to effectively communicate with

any patient while providing care

Integrate the physiological, psychological, and sociological changes throughout human

development with assessment and communication strategies for patients of all ages

Establish and/or maintain a patent airway, oxygenate, and ventilate a patient

Use the appropriate techniques to obtain a medical history from a patient

Explain the pathophysiological significance of physical exam findings

Integrate the principles of history taking and techniques of physical exam to perform a

patient assessment

Apply a process of clinical decision making to use the assessment findings to help form a

field impression

Follow an accepted format for dissemination of patient information in verbal form, either

in person or over the radio

Document the essential elements of patient assessment, care and transport

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Integrate the principles of kinematics to enhance the patient assessment and predict the

likelihood of injuries based on the patient‟s mechanism of injury

Integrate pathophysiological principles and assessment findings to formulate a field

impression and implement the treatment plan for the patient with:

o Shock or hemorrhage

o Soft tissue trauma

o A burn injury

o A suspected head injury

o A suspected spinal injury

o A thoracic injury

o Abdominal trauma

o Musculoskeletal injury


impression and implement the treatment plan for the patient with:

o Respiratory problems

o Cardiovascular disease

o A neurological problem

o An endocrine problem

o An allergic or anaphylactic reaction

o A gastroenterological problem

o A renal or urologic problem

o A toxic exposure

o An environmentally induced or exacerbated medical or traumatic condition

o Infectious and communicable diseases

Integrate the pathophysiological principles of the hematopoietic system to formulate a

field impression and implement a treatment plan

Describe and demonstrate safe empathetic competence in caring for patients with

behavioral emergencies

Utilize gynecological principles and assessment findings to formulate a field impression

and implement the management plan for the patient experiencing a gynecological

emergency

Apply an understanding of the anatomy and physiology of the female reproductive

system to the assessment and management of a patient experiencing normal or abnormal

labor


impression and implement the treatment plan for the:

o Neonatal patient

o Pediatric patient

o Geriatric patient

o Patient who has sustained abuse or assault

Integrate pathophysiological and psychosocial principles to adapt the assessment and

treatment plan for diverse patients and those who face physical, mental, social and

financial challenges

Integrate the pathophysiological principles and the assessment findings to formulate a

field impression and implement a treatment plan for the acute deterioration of a chronic

care patient

Integrate the principles of assessment-based management to perform an appropriate

assessment and implement the management plan for patients with common complaints

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Understand standards and guidelines that help ensure safe and effective ground and air

medical transport

Integrate the principles of general incident management and multiple casualty incident

(MCI) management techniques in order to function effectively at major incidents

Integrate the principles of rescue awareness and operations to safely rescue a patient from

water, hazardous atmospheres, trenches, highways, and hazardous terrain

Evaluate hazardous materials emergencies, call for appropriate resources and work in the

cold zone

Have an awareness of the human hazard of crime and violence and the safe operation at

crime scenes and other emergencies.

Clinical and Internship Rotations Clinical Rotations o Clinical student to instructor ration will not exceed 2:1. o The EMS program MUST facilitate the scheduling of clinical rotations; if a student initiates a

clinical experience without the co-ordination of the Clinical Coordinator, they may receive disciplinary action and will not be given credit for the rotation.

o Rotations will not be scheduled during the winter break when the Community College of Aurora is closed.

o Students will be covered by the State of Colorado Workman‟s Compensation program. o Students may, with permission of the Program, perform clinical rotations at the institution

where they are employed. Under these circumstances the student cannot replace a qualified staff member, and the student must have a preceptor at all times while performing these rotations. These shifts must be arranged through the Clinical Coordinator.

o Failure to appear at the clinical sites will not be tolerated. Absence from a scheduled clinical will result in one (1) missed rotation and may take up to 6 weeks to reschedule. The Primary Instructor and Clinical Coordinator must be notified of any clinical rotation which may be missed within 24 hours of the start time of the scheduled rotation. Failure to notify the Clinical Coordinator and Primary Instructor of a missed clinical within this time frame will be considered falsification of documentation and the student may be dismissed from the program.

o Upon determination that a clinical shift was missed and the program was not notified all scheduled clinical rotations will be suspended pending a student conference with the Primary Instructor and the Clinical Coordinator and at minimum, students will be given a prescription. Students may risk failure of EMS 280/281 and termination from the program.

o Students requesting to reschedule any confirmed clinical rotations must notify the Primary Instructor and Clinical Coordinator with 48 hours of the scheduled start time of the shift they wish to reschedule. Re-scheduling a clinical shift may take up to 6 weeks depending upon availability. Re-scheduling any confirmed clinical rotation will constitute the equivalent of one (1) missed clinical rotation. Failure to notify the Program of a missed clinical within the given time frame may result in dismissal from the program.

o Students will be allowed the following number of missed, cancelled or rescheduled clinical rotations.

EMS 280 = 5 missed, cancelled, or rescheduled clinical rotations Upon the third reschedule, the student will be scripted. Upon the fifth reschedule, the student will be scripted again. The student will fail EMS 280 and risk termination from the program at the

next cancellation/reschedule. EMS 281 = 5 missed, cancelled, or rescheduled clinical rotations

Upon the third reschedule, the student will be scripted. Upon the fifth reschedule, the student will be scripted again. The student will fail EMS 281 and risk termination from the program at the

next cancellation/reschedule.

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o In the event of an emergency the student must contact the Clinical Coordinator and Primary Instructor within 24 hours of the scheduled start time of the clinical. Failure to notify the Clinical Coordinator and Primary Instructor will be considered falsification of documents and the student may be dismissed from the program.

o Any missed clinical which cannot be rescheduled will result in failure to complete the program.

o Any student found to be arriving late to a clinical shift or leaving early from a clinical shift without prior permission may be denied credit for the clinical rotation.

o In the event a student is sent home by the clinical site due to a student not wearing the proper student uniform, not carrying an I.D. badge, not bringing proper paperwork, misconduct, or any other valid reason, the student must notify the Clinical Coordinator and Primary Instructor immediately. In the event of this situation, the student will be charged with one (1) missed clinical rotation. Failure to notify the Clinical Coordinator and Primary Instructor will be considered falsification of documents and the student may be dismissed from the program.

o All paperwork associated with a clinical rotation must be turned into the Clinical Coordinator within seventy two (72) hours of the completed clinical rotation. A prescription will be issued at the third instance of late paperwork, and at the fifth instance of late paperwork. At the sixth instance, the student may fail EMS 280/281, or may be terminated from the program.

o Students are allowed only three prescriptions each for EMS 280 and 281. Students are dismissed from the program upon receiving a fourth prescription, whether the prescriptions was given for attendance at clinical shifts or paperwork.

o A minimum of 80% is required to pass the clinical component of an EMS module (EMS 225, EMS 229).

o Any student found to be falsifying documentation may be dismissed from the program. Each student‟s clinical grade will be determined from the following scale:

A – Superior achievement. Exceedingly high quality work (90%-100%)

B – Above average achievement. Highly satisfactory work (80%-89%)

C – Average achievement. Satisfactory work (70%-79%)

F – Failing. Course requirements have not been met satisfactorily and unsatisfactory progress

toward graduation. (69% or below)

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Grievance Policy

In the event of a missed clinical rotation the student will be given 24 hours from the scheduled start time of the clinical rotation to notify their Primary Instructor and Clinical Coordinator of their intention to grieve the missed clinical. The student will then have 72 hours from the scheduled start of the missed clinical rotation to submit their written grievance. Documentation submitted in support of the grievance must be dated within 24 hours from the scheduled start of the missed clinical rotation (i.e. doctors note, accident report….).

If the student fails to notify their Primary Instructor and Clinical Coordinator and/or fails to provide a written grievance within the allotted time frames, the hours for the missed clinical rotation will be officially recorded in the student‟s record without benefit of grievance.

The grievance committee will determine whether missing the clinical rotation was justified. Their decision will be made within 3 working days (Monday-Friday) of submission. The grievance committee will be comprised of the following:

CIT Director (as needed)

Program Chair

Primary Instructors

Professional Conduct

The conduct of students reflects upon the individual, their agency, the CCA EMS Program, and

the EMS profession as a whole. Therefore, students must conduct themselves in a mature,

professional manner at all times.

Students should display professional attitudes towards patients, patient‟s family, preceptors, and

other members of the emergency healthcare system at all times. Patient confidentiality will never

be violated for any reason. Refer to the HIPAA overview in this document. Students are subject

to immediate removal from a clinical or internship site at the discretion of the preceptor for

misbehavior and/or mistreatment of patients or staff, and may be subject to further disciplinary

action by the Program staff.

Other reasons for immediate termination of a clinical or internship may include:

Disregarding directions given by preceptor or other agency personnel

Physical or verbal abuse of a patient, patient‟s family, bystanders, other crew members,

or any other people involved in patient care

Inability to function under stress

Inability to perform at an EMT-Basic skill level

Lack of professionalism

Dishonesty

Failure to adhere to agency or program policies and procedures

Exclusion from clinical site by the clinical site provider for conduct or skills issues

Removal from clinical/internship may result in removal from the program. The Program

Medical Director may revoke medical direction privileges.

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Prior to beginning internship or clinical shifts students must submit their shift schedule in writing

to the Clinical Coordinator.

Students must adhere to the policies set forth by the CCA EMS Program and host agencies

during their internship experience. Failure to do so will result in disciplinary action that may

include dismissal from the program.

Any student dismissed from a clinical or internship shift for any reason must immediately contact

their Primary Instructor AND the Clinical Coordinator. In the event of this situation, the student

will be charged with one (1) missed clinical rotation and will be required to perform a

comparable number of hours of EMS Program Service Hours. Failure to notify the Clinical

Coordinator and Primary Instructor will be considered falsification of documentation and the

student may be dismissed from the program.

All students must arrive at their internship site at least 15 minutes prior to the beginning of

the shift, and students are expected to complete the entire shift as scheduled. (Students may

stay longer on a shift with the permission of their field preceptors.) If a student leaves a

scheduled shift early without permission from the Clinical Coordinator, their Primary Instructor,

or their preceptor, they may lose credit for the entire shift.

The student should make arrangements to provide his/her own meals during the internship

shifts. It is advisable to take a lunch that does not require refrigeration. If afforded an

opportunity to participate in a meal at a station, the student must pay their appropriate share.

During all clinical and internship shifts you should consider yourself to be a guest of the facility

or agency, and conduct yourself appropriately! You need to participate in morning car-check,

equipment and supply inventory and restocking and any other assigned tasks. Any work you do

during your shifts should be under the direct supervision of your preceptor or his/her designee.

You are not there to be utilized as another employee. Do not get involved in agency, shift or

personnel politics. DO NOT give your opinions regarding policy, etc. Also, use your down-time

wisely. This does not mean watching television, using the internet or playing video games.

During times when you are not running calls or performing other work-related tasks get your

books out and study for the National Registry Exam. This is also a perfect time to learn local

protocols.

Do not touch food or any other item that does not belong to you.

All patient encounters must be documented on the form provided for the student by CCA.

Completed forms must be submitted to the program within 72 hours of the assigned shift.

Students are highly encouraged to make copies of all paperwork submitted to the Program.

Student copy services are not available at the Program.

When doing clinical shifts you must remain in the clinical area you were assigned to. DO NOT

go to other departments if the one you have been assigned to is slow, even if directed to do so by

the nursing staff. If the staff tries to send you to another clinical area tell them that Program

policy, as well as facility policy, do not allow for students to move between clinical areas. When

in the Emergency Department at the Medical Center of Aurora EMS students are to stay out of

the EMS lounge unless taking a lunch break. Loitering in the EMS lounge will not be tolerated.

Any physical, mental or sexual harassment must be brought to the attention of the Primary

Instructor or Clinical Coordinator immediately.

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Look at every patient as a learning experience. You will be able to learn something new from

each patient encounter, even if what you learn is to be more comfortable with that particular type

of patient.

Continue to study! Those who excel in EMS do so because they know there is always something

else to learn. Review cardiology, pharmacology, protocols, and theory. This will keep you

prepared for your certification examination.

Communicate with your Primary Instructor regularly, even if just to „catch up‟.

You may not participate in any fire fighting or extrication activities while you are a student. You

are also prohibited from handling the ambulance stretcher while there is a patient loaded on it.

Insurance does not cover you for these activities.

Dress Code

Students are expected to conduct themselves as medical professionals at all times. This includes

dress and hygiene standards as follows:

CCA EMS photo ID badges must be clearly visible at all times.

Students must wear the CCA EMS Program shirts issued to them and dark blue or black

uniform pants at all times. (Students may be subject to the dress code of a host agency.)

Uniforms are expected to be neat and clean, without stains or tears.

Sturdy, closed-toe work shoes are required. Dark tennis shoes are acceptable, but not

recommended. No cowboy boots.

Students are expected to wear appropriate undergarments, including socks. Undershirts

with logos and graphics that are readable through the uniform shirt are not acceptable.

Jewelry can present a safety hazard and should be kept to a minimum.

Hair should be secured out of the face.

Perfumes and colognes can cause severe reactions in patients and other staff members

and should be avoided whenever possible.

Students are expected to exhibit good personal hygiene at all times and are subject to dismissal

from their clinical or internship shift at the discretion of the preceptor.

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Equipment

Students should carry certain equipment with them on all shifts:

A working pen

A watch

Eye protection

Stethoscope

Clinical/internship manual

Documentation

Documentation of each student‟s field internship experience is required at the college, state, and

national level and becomes part of a student‟s permanent record. It is also used to evaluate a

student‟s level of competence to function as a prehospital care professional. It is imperative that

each student properly completes all documentation prior to leaving an internship site.

Incomplete, missing or late paperwork may result in shifts being repeated. Make certain that you

have patient contact forms and daily evaluations with you for every shift. It is your responsibility

to get required signatures and evaluations before leaving at the end of a shift. Falsification of

documentation may result in immediate termination from the program. You are expected to stay

at your shift for the entire time you are scheduled. If you must leave early for an emergency

make certain your preceptor knows why and when you leave, and that it is documented on your

daily evaluation.

Patient Care Documentation

Documentation of patient encounters and patient care is a critical element in the education and

development of a prehospital care provider. Writing a patient care report is challenging on

several levels: the proper information must be included on the chart in a concise, legible manner.

The Primary Instructor will review all patient care reports (PCRs).

All PCRs should include the following information:

Patient‟s age and gender

Patient‟s chief complaint (CC or C/O)

History of this illness or injury

o Including mechanism of injury

o Onset, duration of symptoms

Document OPQRST and SAMPLE

Any associated symptoms

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Pertinent past medical history (PMH)

Vital signs

o Including at least one auscultated BP

o Quality and number of pulse and respirations

o Initial set of vital signs should be within five minutes of making patient contact

o Second set as indicated

o The state of Colorado requires vital signs to be taken at least every 15 minutes

o Orthostatic vital signs as indicated

Neurologic status

o Include mental status, i.e., AAOx NOTE: if the patient is not x3 then explain.

o In addition to using words such as obtunded and semiconscious, describe the

patient‟s specific behavior

o Glasgow Coma Scale

o Neuro exam to include:

Brief cranial nerve check as pertinent

Eyes -- PERRLA (Pupils Equal Round Reactive to Light and

Accommodation)

EOM (Extraocular Movement)

Gag reflex

MOEx4 (Movement of Extremities x 4)

Short and long term memory

History of loss of consciousness or a change in level of consciousness

Head to toe survey or physical exam (PE)

o Include pertinent negatives

o Documentation that a complete PE was done

o Skin; color, temperature, condition

o Specific observations for nature of problem

CMS distally

Breath sounds in all four fields

Jugular venous assessment

Remember, if you didn't record it you not only did not do it, you did not even think of it!

Cardiac rhythm assessment

o Include rhythm strip with chart

o Properly label the strip; name, date, time, and lead number

o Document any change in rhythm

o Interpretation of ECG

o Treatment

Include all treatment initiated, whether by you or someone else on the call

Record patient‟s response to treatment

For IV starts include:

o Fluid

o Size

o Site

o Location

o Rate

o Initials

o Amount infused

o Chart unsuccessful attempts

Include times, route, and dose on medications

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Call identification information

o Date of call and of incident

o Service name

o Unit number

o Address of incident

o Patient name and address

o Patient destination

o Return code

o Call times

o EMT/Paramedic names

o Base contact

Narrative should justify scene time

o In general for trauma, scene time should be less than 10 minutes

o For medical, scene time should be less than 20 minutes

Nontransports require:

o Good documentation

o Repeat vital signs

o Instructions given to patient*

o Signature of witness - preferably not a member of the EMS service

o Base contact

Refusals require:

o Extremely good documentation, including two complete sets of vitals

o Avoid judgments i.e. intoxicated

Describe patient‟s behavior

Instructions given to patient

o Signature of witness -- preferably not a member of the EMS service

o Base contact

Narrative should justify treatment and treatment should be appropriate

Note any changes during time spent with patient/transport

Use only common accepted abbreviations

* Instructions to patients or family must be given in terms easily understood by that

individual. Medical terminology may not be understood and therefore may result in failure to

comply with the instructions, or failure to recognize complications as they occur. This obviously

increases the liability of the medical personnel involved.

Accident or Injury

If a student is injured or exposed to a potential pathogen while providing patient care, necessary

emergency care should be sought immediately. Any follow-up care (or non-emergent medical

care) must be coordinated through the CCA EMS Program as required by the State of Colorado

Workers Compensation Program. Students are asked to follow these reporting procedures:

Notify your preceptor immediately.

Notify your Primary Instructor immediately. (Contact numbers are included in this

packet.)

Notify the Clinical Coordinator

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Follow all agency/hospital reporting policies.

Complete the enclosed Incident Report, and return to the CCA EMS staff within 24

hours.

Failure to comply with these procedures could result in a denial of compensation claims by

the state.

Incident Reporting

Should a student be involved in or witness an unusual or noteworthy incident that may or

may not cause injury or harm to any person, the Primary Instructor or Department Chair

should be notified immediately. Students should follow the reporting policies of their

host agency and document the incident on one of the enclosed Incident Reports. This

documentation should be returned to the CCA EMS Program within 24 hours. The program

will then take appropriate action and provide follow-up as necessary.

Patient Contact Requirements

Paramedic students must complete the following patient contacts and psychomotor skills during

their clinical and internship rotations of the program:

Psychomotor Skills Minimum # Abdominal Complaints Assessment 20

Adult Assessment 50

Altered Mental Status Assessment 20

Chest Pain Assessment (MUST include copy of EKG) 30

Dyspnea/Respiratory Distress, Adult 20

Dyspnea/Respiratory Distress, Pediatric 8

Endotracheal Intubation 5

Geriatric Assessment 30

Medication administration 15

Obstetric Assessment 10

Pediatric Assessment 30

Psychiatric Assessment 20

Syncope Assessment 10

Team Leader – Prehospital Responses 50

Trauma Assessment 40

Venous Access (IV) 25

Ventilation (BVM, ETT, LMA) 20

These patient assessment/procedure contacts will be accomplished by performing a minimum of

144 hours clinical settings, and a minimum of 500 hours in the field internship setting.

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Clinical shifts will be done in the following departments: emergency, pediatric emergency,

psych, labor and delivery, OR, ICU, respiratory therapy, cath lab and telemetry. All shifts are 8

hours unless otherwise noted. The Program Clinical Coordinator will arrange all shifts.

Students are required to complete the following hospital shifts:

Clinical Site Number of shifts needed

Emergency Department 6

Pediatric E.D. 3

O.R 2

Labor and Delivery 2

Psych 1

ICU 1

Respiratory Therapy 2

Telemetry 1 four-hour shift

Cath Lab 1

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Community College of Aurora EMS Program

Clinical Objectives for

EMERGENCY DEPARTMENT ROTATIONS

At the conclusion of the emergency department rotation the student will have performed

and/or observed the following:

Perform universal (standard) precautions during all procedures

Obtain and record patient vital signs

Manage and care for soft tissue and muscular/skeletal injuries

Perform patient assessment including developing a pertinent medical history and

performing an appropriate physical exam

Administer oxygen using available adjunct equipment (such as nasal cannulas, non-

rebreather masks and CPAP)

Maintain patient airway in varying states of consciousness: includes proper positioning,

suctioning, and use of airway adjuncts (including oral and nasal intubation). Also

includes removal of foreign-body obstructions from airways

Assist with I.V. fluid therapy, including setting up appropriate administration set,

cannulation, blood draws, and monitoring. This includes external jugular and

intraosseous insertion

Assist with preparation and administration of intravenous, endotracheal, subcutaneous,

sublingual, nebulized, rectal, and oral medications

Assist with proper oral and written patient reporting and documentation

Provide comfort, reassurance, and emotional support to patients and their family

members

Perform all types of cardiac monitoring. Interpret EKGs and formulate appropriate

treatment, including defibrillation, and cardioversion and transcutaneous pacing

Assist with resuscitation efforts including performing CPR

Assist with insertion of nasogastric and orogastric tubes, and urinary catheters

At the paramedic level, assist with cricothryroidotomy (surgical and needle), and thoracic

decompression (surgical and needle)

20



INTENSIVE CARE UNIT ROTATIONS



Perform universal precautions during all procedures

Obtain and record patient vital signs



performing an appropriate physical exam

Administer oxygen using available adjunct equipment (such as nasal cannulas and non-

rebreather masks)

Maintain patient airway in varying states of consciousness: includes proper positioning,



Assist with I.V. fluid therapy, including setting up appropriate administration set,



Assist with preparation and administration of intravenous, intraosseous, endotracheal,

subcutaneous, sublingual, nebulized, rectal, and oral medications



members


treatment, including defibrillation, cardioversion and transcutaneous pacing at the

paramedic level



21



PEDIATRIC EMERGENCY DEPARTMENT ROTATIONS




Obtain and record patient vital signs. Review normal ranges for pediatric patients



performing an appropriate physical exam. Discuss special considerations (behavioral,

emotional, and physical) for pediatric assessments at various age levels

Administer oxygen using available adjunct equipment (such as nasal cannulas and non-

rebreather masks)

Maintain patient airway in varying states of consciousness, including proper positioning,



Review anatomical differences between pediatric and adult airways

Perform proper management of the following respiratory disorders: croup, asthma,

bronchiolitis and epiglottitis

Assist with I.V. fluid therapy, including setting up appropriate administration sets,



Assist with preparation and administration of intravenous, intraosseous, endotracheal,

subcutaneous, sublingual, nebulized, rectal, and oral medications



members


treatment, including defibrillation, cardioversion and transcutaneous pacing at the

paramedic level



22



SURGERY ROTATIONS

At the conclusion of the surgery rotation the student will have performed and/or observed

the following:


Perform manual airway maneuvers, including:

o Opening the mouth

o Head-tilt/chin-lift maneuver

o Jaw-thrust and modified jaw-thrust maneuvers

Perform the Sellick maneuver when appropriate

Assist with tracheostomy removal and replacement

Demonstrate proper suctioning technique in adult and pediatric patients

Practice gastric decompression using a suction device, catheter and proper technique

Demonstrate ventilating adult and pediatric patients by the following techniques:

o One-person bag-valve-mask

o Two-person bag-valve-mask

Set up oxygen delivery from a cylinder and regulator using the appropriate oxygen

delivery device

Set up and apply humidified O2 via a humidifier

Use the following O2 delivery devices correctly: nasal cannula, simple face mask, non-

rebreather mask, and Venturi mask

Assess and confirm correct placement of endotracheal tubes

Intubate adult and pediatric patients using the following methods:

o Orotracheal

o Nasotracheal

o LMA

o Combitube

Place and read end-tidal CO2 detector or capnography device

Adequately secure an endotracheal tube

Show proper extubation technique

23



RESPIRATORY THERAPY ROTATIONS



Perform peak expiratory flow testing

Demonstrate ventilating a patient by the following techniques:

o One person bag-valve-mask

o Two person bag-valve-mask

o Flow-restricted, oxygen-powered ventilation device

o Automatic transport ventilator

o Bag-valve-mask-to-stoma ventilation

Perform ventilation with a bag-valve-mask with an in-line small-volume nebulizer

Ventilate a pediatric patient using the one and two person techniques

Perform oxygen delivery from a cylinder and regulator with an oxygen delivery

device

Perform oxygen delivery with an oxygen humidifier

Deliver supplemental oxygen to a breathing patient using the following devices:

nasal cannula, simple face make, non-rebreather mask, and Venturi mask

Perform stoma suctioning

Adequately secure an endotracheal tube

Demonstrate suctioning the upper airway suction device, catheter and technique

Demonstrate the use of continuous positive airway pressure

24



LABOR AND DELIVERY DEPARTMENT ROTATIONS

At the conclusion of the labor and delivery department rotation the student will have

performed and/or observed the following:

Perform universal (standard) precautions during all procedures.

Identify and differentiate normal and abnormal events of pregnancy

Perform an assessment on an obstetrical patient

Identify the different stages of labor and know the role of the EMT in each stage

Know how to recognize and treat gynecological emergencies

Recognize the importance of maintaining a patient‟s modesty and privacy while

obtaining necessary information and performing procedures

Observe and perform normal delivery procedures. If possible, observe and assist with

any abnormal delivery procedures (including caesarian section)

Provide initial newborn care (including resuscitation, suctioning, and APGAR scoring)

Perform fundal massage and post-natal care for the mother

25



PSYCHIATRIC DEPARTMENT ROTATIONS

At the conclusion of the psychiatric department rotation the student will have performed


Formulate and demonstrate an empathetic and respectful treatment plan for the patient

with a behavioral emergency

Distinguish between normal and abnormal behaviors

Discuss possible pathophysiological causes of behavioral emergencies

List things that may indicate a patient is at increased risk for suicide or violent behavior

Demonstrate appropriate management measure to insure the safety of patients, student

and others

Demonstrate techniques for restraining violent patients, booth physically and chemically

Demonstrate techniques for physically assessing patients with behavioral problems.

Use therapeutic interviewing techniques, such as active listening, when gathering

information from patients

Discuss legal considerations for managing patients with behavioral emergencies, such as

obtaining mental health holds and transporting patients against their will

26



TELEMETRY DEPARTMENT ROTATIONS

At the conclusion of the telemetry department rotation the student will have performed


Performs body substance isolation (standard) precautions during all procedures

Record and interpret basic ECG tracings

Place the following lead configurations on a patient when possible:

Three Lead

Four Lead

Twelve Lead

27

Community College of Aurora

EMS Program

Clinical/Internship Daily Shift Evaluation Student: Please give this form to your preceptor at the beginning of the shift so they are familiar with what you are to be evaluated on. This

form must be completed and signed by your preceptor, and turned into your primary instructor at CCA before you can get credit for the shift

and the patient contacts.

Preceptor: Please take a few minutes at the end of the shift to complete this form. Please note that students cannot complete these forms and

will not receive credit for a shift if this form is not completed.

Student Name: _____________________________________ Date: ____________________

PRECEPTOR USE ONLY BELOW THIS POINT

Preceptor: please print clearly___________________________ Site:____________ Dept:_________

Time in: _________ Time out: ________ On time?: Y N Total hours:_____

Please rate the student in each category using the following scale:

1 = Unacceptable – needs intervention and remediation.

2 = Tentative – needs frequent guidance.

3 = Competent – able to perform tasks with little or no guidance.

4 = Good – meets the expectations of this level of internship.

5 = Excellent – exceeds the expectations of this level of internship

Topic Evaluated

Score

Professionalism

Motor skills

Basic knowledge

Scene management (internship only)

Communications

Patient management

Please indicate the number of times the student performed each of the following procedures:

Intubation (oral and nasal)

IVs (peripheral, IO and EJ)

Medication administration (all routes)

Assist with delivery of infant

BVM (before and after intubation or LMA)

Defibrillation, cardioversion and external pacing

CPR

Cricothyroidotomy and thoracic decompression

Insertion of urinary catheters

Insertion of NG & OG tubes

Other:

Comments and signature on second page!

28

Preceptor comments or concerns: ___________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Preceptor signature: _________________________________________________________

29


Preceptor Feedback Form (To be completed by student for every shift)

Student Name: _______________________________________________________________

Clinical Site: _________________ Dept: _________________ Clinical Date: _____________

Preceptor Name(s) ____________________________________________________________

Please take a few minutes to evaluate your clinical site and preceptors. Your input helps us

recognize valuable experiences and preceptors, while improving things that could be better.

Use the following rating scale:

1= poor 2 = fair 3 = acceptable 4 = good 5 = excellent

Score

A clinical preceptor was assigned and available to me upon my arrival

My clinical preceptor showed me around the facility and introduced me to other

staff members

My clinical preceptor took time to find out what I was there for and what I could

do

My clinical preceptor explained what was expected of me and what I could

expect from my clinical

My clinical preceptor allowed me to interact with patients and actively

participate in their care

My preceptor allowed me to perform the skills that I am qualified to perform

My clinical preceptor was readily available throughout my shift, answered my

questions, and offered constructive feedback

My clinical preceptor showed enthusiasm towards teaching, and having students

My preceptor was available to sign my paperwork and answer any questions I

had at the end of my shift

Would you recommend this preceptor to other students? YES NO

Was this clinical site beneficial to your learning experience? YES NO

Were the facilities and equipment adequate? YES NO

Were your clinical objectives met? YES NO

What would make this a more valuable experience?

Comments:

30


PARAMEDIC INTERNSHIP

Major Phase Evaluation

Student Name: _____________________________________ Date: _____________

Preceptor: _________________________________________ Agency: ___________

What is the best way for CCA faculty to contact the preceptor?_____________________

How many hours of internship has the student completed? __________

How many hours of internship has the student completed with you? __________

Please rate the student in each category using the following scale. The student should be

rated when compared to an entry-level practitioner, not as a student.

1 = Unacceptable – needs intervention and remediation.

2 = Tentative – needs frequent guidance.

3 = Competent – able to perform tasks with little or no guidance.

4 = Good – meets the expectations of this level of internship.

5 = Excellent – exceeds the expectations of this level of internship

Category Rating

Professionalism and Communication

Reported for shift on time, wearing appropriate attire (including a CCA student photo i.d.

badge)

Interacted and communicated well with crew members, other agency staff members

Maintained professionalism and performed tasks well under stress

Sought feed-back after calls; accepted constructive criticism well

Maintained patient confidentiality

Practiced writing reports that are complete and legible

Participated in thorough checks (and restocking) of equipment.

Reviewed and practiced ALS skills and ALS equipment function

Reviewed ALS medications (Indications, dosage, etc…)

Participated in scenarios and table top exercises

Began to study the Denver/Metro protocols

Comments:

31

Patient Assessment and Management Rate the student on any of the following assessment skills

Assisted in determination of patient‟s chief complaint and gathering of current history

When given the opportunity, established good patient rapport

Performed hands-on patient evaluations in a timely and appropriate manner

Obtained accurate vital signs

Performed interventions as instructed in a timely and appropriate manner

Accurately assessed patient acuity level („sick‟ vs. „not sick‟)

Recognized need for rapid transport vs. treatment on scene

Able to verbalize an appropriate patient destination

Comments:

SKILLS Rate any of the skills the student actually performed.

Mark “O”, if the skill was observed; “D”, if discussed (i.e. scenarios); “P”, if practiced

during down –time.

“o”= observed

“d”=discussed

“p”=practiced

ALS airway management (Oral or nasal ETT, Combitube)

BLS airway management (OPA, NPA, BVM, Suctioning)

O2 administration (N/C, NRB, Nebulizer, Pulse ox)

Bandaging and splinting

Burn care

CPR

Needle decompression

Childbirth

Cricothyrotomy

Defibrillation: Cardioversion: Pacing:

Attaching patient to the EKG monitor: 12-lead Interpretation:

Blood Glucose Levels

Successful

IVs

Unsuccessful

IVs

Blood draws

IOs: External Jugulars:

Medication administration (Describe med and administration route)

Patient restraint (Describe method used)

Spinal immobilization

Special ops (i.e. MCI, Hazmat, Crime scene, etc.)

Other skills / Comments:

32

Scene Management

Verbalized an awareness of any scene hazards

Assisted with scene management as directed

Assumed team leader role, if asked

Performed radio or phone call-in reports

Performed hand-off reports at the receiving facility:

Comments:

Do you feel the student has met the requirements of this stage of their internship?

YES NO

Please explain if you answered „no‟. Did you make any recommendations to the student for the

next phase of their internship?

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

________________________________________________

Please feel free to discuss this evaluation with the student. You may mail it to us at:


EMS Program

9235 E. 10th

Drive #154

Denver, CO 80230

Or fax it to us at:

303.340.7209

CCA EMS Department Chair

303.340.7217

Preceptor signature: ___________________________________ Date: ______________

33


PARAMEDIC INTERNSHIP

500 HOUR FINAL EVALUATION Student Name: ______________________________________

Preceptor Name: ____________________________________ Agency: __________________________________

Approximate number of hours the preceptor spent evaluating this student: ______________

Please use the following Likert Scale to evaluate the student:

5=Strongly agree 4=Somewhat agree 3=Not Sure 2= Somewhat disagree 1=Strongly disagree

STUDENT PERFORMANCE

BLS KNOWLEDGE: Student is consistently able to apply BLS knowledge and skills to all patients

in a timely fashion, with minimal prompting.

ALS KNOWLEDGE: Student is consistently able to apply ALS knowledge and skills to all patients

in a timely fashion, with minimal prompting.

PATIENT ACCUITY: Student is consistently able to quickly determine patient acuity and react

accordingly.

PATIENT HISTORY: Student is able to consistently obtain pertinent information from the patient

(or bystanders) and formulate an appropriate treatment plan in a timely manner.

PATIENT ASSESSMENT: Student performs good ‘hands-on’ patient assessments and makes

appropriate medical interventions based on these findings.

VERBAL COMMUNICATION:

Student is able to communicate effectively with team members, and interact appropriately

with patients, their families, and other ancillary EMS agencies and staff members.

The student was able to delegate tasks throughout the call, and deliver effective radio and

hand-off reports to receiving facilities.

WRITTEN COMMUNICATION: Student is able to thoroughly and legibly document all patient

contacts, including refusals and field pronouncements. This documentation would meet my agency’s

minimum quality assurance standards.

STUDENT BEHAVIOR AND ATTITUDE

GENERAL ATTITUDE: Student conducted themselves in a professional and ethical manner

during their internship and was able to integrate smoothly into the overall performance of the crew.

INTERPERSONAL RELATIONSHIPS: Student was self-directed during down times, was able to

accept constructive criticism and incorporate it into their performance; took responsibility for his or

her actions and avoided making excuses when performance was sub-standard.

LEADERSHIP SKILLS: Student exhibited sound judgment, performed well in stressful situations,

and was able to assume a lead-role with minimal prompting or supervision.

OTHER AREAS OF CONCERN: Please document specific concerns with the student‟s behavior and/or

performance not listed above:

34

Please use the following Likert Scale to evaluate the student:

5 = Strongly agree 4 = Somewhat agree 3 = Not Sure 2 = Somewhat disagree 1 = Strongly disagree

1.This student is ready to function in an entry-level paramedic 5 4 3 2 1

position.

2. I would not be reluctant to allow this student to treat me, a 5 4 3 2 1

member of my crew or a member of my family.

3. Based on overall performance, this student has met the 5 4 3 2 1

requirements of this phase of their internship.

Preceptor signature: ____________________________________ Date: __________________

Phone number(s) for contacting preceptor: ___________________________________________

Student signature: ___________________________________ Date: _____________________

Primary instructor signature: ___________________________ Date: _____________________

Addendums or comments:

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

CCA FAX number: 303-340-7209

35

Community College of Aurora EMS EKG Interpretation Sheet

Collect four (4) EKG strips from your clinical experience each shift. Post and complete the

requested information.

Student name: _________________________________ Clinical date: ______________

1.

Regular/irregular Rate – (A) (V)

PRI Measurement QRS Measurement

Is there a P wave for every QRS? Is there a QRS for every P wave?

Axis_______________

Paramedic Field Impression:

2.




Axis_______________


36

3.




Axis_______________


4.




Axis_______________


37

COMMUNITY COLLEGE OF AURORA EMS PROGRAM 12 Lead EKG Interpretations

APPLY 12 LEAD ECG TRACING HERE

RATE: ______________ RHYTHM: ___________________ P WAVE: _______________

PR INTERVAL: _____________ PATHOLOGIC Q WAVE: _____________

QRS COMPLEX: ___________QRS DURATION: ______________ ST ELEV: _______________

ST DEPRESS: ______________AXIS: ________________________

INTRP: ____________________________________________________

38

Abdominal Assessment Abd Adult (18-65) Adult Dys AMS Cardiac ETT Ger (65+) IV

Medication OB Ped (<18) Ped Dys Psych Syncope Trauma Vent

Student name: Date: Patient age:

List all medications administered by student:

Level of consciousness: A V P U Agitated Obtunded Confused Uncooperative

Airway patent: Yes No Respirations: Normal Labored Hypo Hyper Absent

Circulation: Pulse found at: Radius Carotid Strong Weak Absent

Pupils: Equal Unequal Reactive Fixed Dilated Pinpoint

Description of breath sounds:

Onset: Gradual Sudden

Provocation (what makes it better or worse): movement rest food/drink position

Quality: Constant Intermittent Sharp Dull Tearing Cramping Burning

Radiation: Back Shoulder Arm Leg Flank Neck Other:

Severity: 1-10 scale: At onset: 1 2 3 4 5 6 7 8 9 10 Currently: 1 2 3 4 5 6 7 8 9 10

Time: Hours: Days:

Location: RLQ RUQ LUQ LLQ Epigastric Diffuse Periumbilical Suprapubic

Abdomen: Normal Guarded Rigid Distended Tender

Activity at onset:

Bladder: Normal Retention Frequency Hematuria Burning

Has this happened before? Yes No Diagnosis:

Other S/S: Nausea Vomiting Constipation Diarrhea

Fever: Yes No Chills: Yes No

Rectal bleeding: Yes No Color: Bright red Tarry

Last oral intake: When:

Skin signs: Temp: Normal Cold Hot Moisture: Dry Moist Color: Pink Pale Cyanotic

Patient final diagnosis:

Briefly review the pathophysiology of the patient‟s problem:

Briefly review potential sequelae of patient‟s problem and/or treatment received:


EMS Education

Clinical Assessment Sheet

39

Adult Assessment Abd Adult (18-65) Adult Dys AMS Cardiac ETT Ger(65+) IV


Student Name: Date: Patient Age:

EKG interpretation:

Physical Assessment

Patient‟s chief complaint(if C/C is listed above, use that specific assessment sheet):


Circulation: Pulse found at: Radius Carotid Strong Weak Absent Regular Irregular




Cap refill <2 secs? Yes No JVD? Yes No Pitting edema? Yes No


Does the patient have any pain? If yes, where?


Radiation: Back Shoulder Arm Shoulders Flank Neck Jaw Other:


PMH:

Medications:

Allergies:

Associated S/S: Nausea Dyspnea Vomiting Malaise Weakness

Activity at onset:

Pain worse with respirations? Yes No With movement? Yes No


Cardiac history? Yes No Diagnosis:

Did patient do any self-treatment?:

Any ETOH or drugs involved?:

Any trauma involved?:



Briefly review potential sequelae of patient‟s problem and treatment received:


EMS Education


40

Adult Dyspnea Assessment Abd Adult (18-65) Adult Dys AMS Cardiac ETT Ger (65+) IV




Physical Assessment







Use of accessory muscles? Yes No

Patient‟s chief complaint:

Onset: Gradual Sudden Time: Hours: Days:

Activity at onset:

Any prior episodes? Yes No Hospitalization? Yes No Intubated? Yes No

Does pt. use an inhaler? Yes No What?



Recent respiratory problems?


Heart rate: Respiratory rate:


Other S/S:






EMS Education


41

Altered Mental Status Assessment Abd Adult (18-65) Adult Dys AMS Cardiac ETT Ger (65+) IV









Loss of consciousness: Yes No


Trauma? Yes No Describe:

Onset: Gradual Sudden





Time: Hours: Days:


Activity at onset:

Can pt. describe the event? Yes No Amnesia: Antegrade Retrograde No




Impaired speech? Yes No Description:

Weakness: Describe:

Chest or abdominal pain? Yes No Cardiac history? Yes No

Flu-like symptoms? Yes No With: Nausea Vomiting Diarrhea

Diabetes? Yes No Insulin dependant? Yes No


Intake of drugs/ETOH/medications? Yes No What:






EMS Education


42

Cardiac Assessment Abd Adult (18-65) Adult Dys AMS Cardiac ETT Ger (65+) IV




EKG interpretation:

Note: You MUST attach a copy of the EKG in order to get cardiac assessment credit!

Physical Assessment



Circulation: Pulse found at: Radius Carotid Strong Weak Absent Regular Irregular


Cap refill <2 secs? Yes No JVD? Yes No Pitting edema? Yes No




Description of chest pain: Pressure Crushing Dull Burning Tearing Throbbing Stabbing

Onset: Gradual Sudden Pain is: Constant Intermittent



Radiation: Back Shoulder Arm Shoulders Flank Neck Jaw Other:


Time: Hours: Days:

Location: Substernal Left lateral Right lateral Left anterior Right lateral

Associated S/S: Nausea Dyspnea Vomiting Malaise Weakness

Activity at onset:

Pain worse with respirations? Yes No With movement? Yes No


Cardiac history? Yes No Diagnosis?

Cardiac surgery? Yes No What?

Did pt. take NTG? Yes No Relief? Yes No ASA? Yes No





EMS Education


43

Labor and Delivery Assessment Abd Adult (18-65) Adult Dys AMS Cardiac ETT Ger (65+) IV




Physical Assessment








Edema? Yes No Describe:

Contractions? Yes No Onset: Duration: Minutes apart:

Spontaneous? Yes No Trauma induced? Yes No Describe:

Description of pain:

Para: Gravida: Gestational week:

Due date: Single Twins Triplets Other

Prenatal care? Yes No Fertility drugs? Yes No

Past OB problems? Anemia Bleeding Breech Ectopic C-section Diabetes HPTN

Multiple births Preeclampsia Other:

Last oral intake: Food/fluid Amount?

History of drug/alcohol abuse? Yes No

Did you witness childbirth? Yes No

APGAR Score One minute Five minutes

Appearance

Pulse Rate

Grimace

Activity

Respiratory effort




EMS Education


44

Pediatric Assessment Abd Adult (18-65) Adult Dys AMS Cardiac ETT Ger (65+) IV




Physical Assessment

Patient‟s chief complaint: LOC Fever Hives Rash SOB Not eating Vomiting

Diarrhea Seizures Trauma Other:






Accessory muscle use? Yes No Describe:

Recent illness? Yes No Describe:

Recent trauma? Yes No Describe:

Recent surgery? Yes No Describe:

Vomiting? Yes No Onset: Number of times:

Diarrhea? Yes No Onset: Number of times:

Urinary output: Normal High Low Number of wet diapers in the last 24 hours:

Dehydrated? Yes No Describe:

Taking fluid or food? Yes No What: When: How much?







Time: Hours: Days: Onset: Gradual Sudden



Activity at onset:





EMS Education


45

Psychiatric Assessment Abd Adult (18-65) Adult Dys AMS Cardiac ETT Ger (65+) IV




Physical Assessment







What triggered this episode?

Similar past episodes? Describe

What, if anything, resolved past episodes?

History of hospitalization for mental illness? Yes No When?

History of suicide attempt? Yes No How?

Current medications:

Recent medication change? Yes No What?

History of drug/alcohol abuse? Yes No Recent use? Yes No

Head trauma? Yes No When?

Alzheimer‟s? Yes No Stroke/TIA? Yes No When?

Distinct odor on breath? Yes No Describe:






EMS Education


46

Syncope Assessment Abd Adult (18-65) Adult Dys AMS Cardiac ETT Ger (65+) IV










Onset: Witnessed? Yes No Duration:

Can patient describe events? Yes No





Activity at onset:

Trauma involved? Yes No Describe:


Cardiac history? Yes No Hematemesis? Yes No


Weakness? Yes No Which Side? R L Facial droop? Yes No Which side? L R


Recent cold/flu-like symptoms? Yes No With: Nausea Vomiting Diarrhea

Recent alcohol/drugs/medications? Yes No What:

History of diabetes? Yes No Insulin dependant? Yes No

Impaired speech? Yes No Describe:

Incontinence? Yes No Dehydration? Yes No




EMS Education


47

Trauma Assessment

Abd Adult (18-65) Adult Dys AMS Cardiac ETT Ger (65+) IV




Description of incident:

Can pt. describe event? Yes No Loss of consciousness? Yes No







Numbness/weakness? Yes No Where?

Onset:





Time: Hours: Days:


Recent alcohol/drugs/medications? Yes No What?

Tetanus shot in the last 5 years? Yes No

Bleeding: Mild Moderate Severe Arterial Venous Where?


Extremities: Lacerations Fractures Dislocations Describe:

Any odor on breath? Yes No Describe:







EMS Education


48

Abd Adult (18-65) Adult Dys AMS Cardiac ETT Ger (65+) IV

Medication OB Ped (<18) Ped Dys Psych Syncope TL Trauma Vent Student‟s name Circle one

B P

Date of call Precepting agency Preceptor‟s name

Nature of call Pt. age Patient transport by

Patient destination

Refusal

Base Contact Physician:

Narrative: SUBJECTIVE or C/C

Objective or History

Assessment

Plan or Treatment and Transport

Past medical history

Patient Medications Allergies


Student Patient Care Report Form

49

Patient vital signs

Time Respirations Heart

rate

Blood

pressure

Pupils

L R

GCS

Eyes Verbal Motor

Pulse

ox

Blood

sugar

Cardiac Interpretation

(attach copy of strip to back)

/

/

/

IV: Time Size Location S/U Initials Time Size Location S/U Initials Time Size Location S/U Initials

Medications (includes O2)

Dose Route Time Medication Dose Route Time

Medications


Medications


Treatment Response Time By

Field Differential Interpretation:

Student Signature: _________________________________________________

Reviewing Preceptor signature________________________________________

Comments:

Advanced Airway

Performed by:_______________________________

Skill attempted:______________________________

Time: ___________Time 2nd

Attempt:____________

No. of Attempts:___________ S / U

B/S: __________________ Cords Visualized: Y / N

ETCO2 Color Change: Y / N

Chest Compliance:___________________________

Tube size:_______

___cm @ teeth p/t tx ____cm @ teeth @ handoff

Cricothyrotomy:_________________________ S / U

Combitube: S / U

Airway verified by Dr._______________________

50

1. Abd Adult (18-65) Adult Dys AMS Cardiac ETT Ger (65+) IV

Medication OB Ped (<18) Ped Dys Psych Syncope TL Trauma Vent Student‟s name Circle one

2. B P

Date of call

3. Precepting agency

4. Preceptor‟s name

5. Nature of call

6. Pt. age

7. Patient transport by

8.

Patient destination

9. Refusal

10. Base Contact Physician:

11. Narrative: SUBJECTIVE or C/C

12.

Objective or History

13.

Assessment

14.

Plan or Treatment and Transport

15.

Past medical history

16. Patient Medications

17. Allergies

18.


Student Patient Care Report Form

51

Patient vital signs

Time Respirations Heart

rate

Blood

pressure

Pupils

L R

GCS

Eyes Verbal Motor

Pulse

ox

Blood

sugar

Cardiac Interpretation

(attach copy of strip to back)

19.

20.

21. /22.

23.

24.

25.

26.

27.

/

/

IV:

28.

Time Size Location S/U Initials Time Size Location S/U Initials Time Size Location S/U Initials

Medications (includes O2)

29. Dose Route Time Medication Dose Route Time

Medications


Medications


Treatment Response Time By

30.

31.

Field Differential Interpretation:

32.

Student Signature: _________________35.________________________________

Reviewing Preceptor signature_________________36._______________________

Comments:

33. Advanced Airway

Performed by:_______________________________

Skill attempted:______________________________

Time: ___________ Time 2nd

Attempt:___________

No. of Attempts:______________ S / U

B/S: __________________ Cords Visualized: Y / N

ETCO2 Color Change: Y / N

Chest Compliance:___________________________

Tube size:_______

___cm @ teeth p/t tx ____cm @ teeth @ handoff

Cricothyrotomy:_______________________ S / U

Combitube: S / U

Airway verified by Dr._______________________

34.

52

Patient Care Form annotation guide

1. This section is used to mark the type of patient contacts and skills that were performed on

the run being documented. Do mark a box if the skill or assessment was not performed by YOU.

In your PCR you must document all patient care, whether performed by you or not, but this

section is only to document what you did.

Abd = abdominal assessment

Adult = assessment of a patient between the ages of 18 and 64

AMS = altered mental status. This does NOT include cardiac arrest. This would be used

for anyone with a low GCS, slow to respond verbally (or not at all) such as ETOH,

hypoglycemia, hypoxia, etc.

Cardiac = cardiac assessment of a patient, regardless of their chief complaint. If you feel

that their complaint of abdominal pain, for instance, may have a cardiac element, and you

do a cardiac assessment, then that is appropriate. However, you MUST attach a copy of

the EKG to the PCR in order to get credit for a cardiac assessment.

Adult Dys = adult dyspnea. Anyone over the age of 17 with a complaint or component of

dyspnea fits this category.

Ped Dys = pediatric dyspnea. Anyone up to the age of 17 with a complaint or component

of dyspnea fits this category.

Ger = geriatric. Anyone above the age of 64 fits this category.

ETT = Endotracheal tube. If YOU intubate the patient SUCCESSFULLY than mark this

category.

IV = well, IV. Again, just like ETT, YOU must perform the skill SUCCESSFULLY in

order to get credit.

Med = medication administration, regardless of the route. If you give more than one

medication to the same patient, mark the box then put how many meds you gave.

Oxygen does not count.

OB = obstetric. An OB assessment does not equal an abdominal assessment. However,

if suspect that your abdominal complaint patient may also be pregnant, you can mark

both boxes.

Ped = pediatric. Any patient 17 or under.

Psych = psychiatric. Any obvious history of a psychiatric illness or any bizarre or erratic

behavior fits this category.

Syncope = just that. Syncope does not mean unconscious. If your patient was out for

more than a few seconds it wasn‟t syncope. Hypoglycemia, stroke, hypoxia, ETOH, etc.

do not count as syncope.

TL = team lead. This means that you were in charge of the call, at least at some point in

the call. You made decisions as to patient treatment and transport, as well as logistical

decisions such as additional resources and calling a trauma alert.

Trauma = any patient with trauma from any source.

Vent = ventilation. Every time you ventilate a patient you can check this box, as long as

it is a different ventilation technique. If you bag a patient before they are intubated, then

bag them via the ETT, you can get credit for two ventilations. However, if you bag the

same patient through the ETT at different times during the call, you still only get credit

for one vent.

2. Print your name and circle whether you are a Basic or a Paramedic student.

3. The date you were dispatched to the call. If you were dispatched before midnight but

arrived on scene after midnight, the date of the call is the date you were dispatched.

4. The name of the agency you are riding with.

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5. The name of your preceptor. Include their last name!

6. Give the nature of the call. This is based on what you were dispatched to, like an

MVA or chest pain.

7. List the patient‟s age. If you don‟t have an exact age, estimate.

8. Who transported the patient? If the patient went by private vehicle put POV. If they

weren‟t transported put N/A.

9. Where was the patient transported to? If they weren‟t transported put N/A.

10. If the patient refused transport put a check mark or „yes‟ in this box.

11. If you or anyone else on the crew contacted the base station for orders list the

physician who gave you the orders.

12. This is where you describe the scene and how you find the patient. For instance: “this

44-year-old female was found lying left-lateral recumbent on the living room floor,

conscious and alert, but slow to respond, complaining of a severe right parietal

headache.”

13. This is where you document what you are told about the patient and/or the scene by

bystanders and the patient. For instance: “the patient‟s husband states that he heard a

loud noise from the living room while he was in the kitchen, and when he checked he

found the patient lying on the floor. He also says that the patient has been c/o of a

headache all day (about 6 hours).”

14. Document your focused, detailed and ongoing assessments here.

15. Document your treatment plan and transport mode here. For instance: “patient was

placed in position of comfort, IV, O2 and cardiac monitor applied and analgesic

administered.”

16. List the patient‟s significant past medical history here. We don‟t need to know that

they had an appendectomy twenty years ago, but we do need to know about MIs,

CVAs, relevant surgeries, etc. If the patient has none put N/A.

17. List all significant medications the patient is on. DO NOT put „see attached list‟

unless you actually attach a list. If the patient has none put N/A.

18. List all significant food and medication allergies. If the patient has none put NKDA.

19. Put the time that the vitals were taken. It is appropriate to list vitals taken before your

arrival on scene. In that case put PTA.

20. Respiratory count is the single most important vital sign there is. Make sure there is a

respiratory count on all patients!

21. List the heart rate as counted on the patient, not the cardiac monitor.

22. Auscultated blood pressure is okay, as long as you list at least one diastolic blood

pressure, if can get one. If you‟re unable to get a BP then indicate where you found

your pulse on the patient.

23. Indicate the size of the pupils in millimeters.

24. Everyone gets a GCS, including patients in cardiac arrest.

25. If the pulse ox was applied, list the reading here.

26. If a blood sugar was taken, list it here.

27. Indicate your interpretation of the cardiac rhythm and attach a copy of the strip to the

back of the chart. You will NOT get credit for a cardiac assessment if there is not a

strip attached to the PCR.

28. For IVs you need to document the time the line was started, what size catheter was

used, the location of the IV insertion (back of the hand, etc.), whether the attempt was

successful or not, and the initials of the person starting the IV. If you didn‟t start the

IV you can put the initials of the agency that the person who did start the IV is from,

like AFD or AMR.

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29. List all medications that were administered to the patient, whether by you or someone

else on the call. This list includes oxygen, but you do not receive medication

administration credit for giving oxygen. List the dose, route of administration and

time of the medication was given. If you need more space, list further meds on the

back of the PCR.

30. List treatment that was administered to the patient, whether by you or someone else.

For instance: pillow splint applied to left ankle.

31. Indicate how the patient responded to the treatment. For instance: patient got

moderate pain relief with application of splint. Also list the time the treatment was

administered and the initials of the person performing the treatment.

32. Indicate what you think was wrong with the patient. For instance: subdural

hematoma, fractured tibia, or inferior MI. Things like MVA, chest pain and

abdominal pain are not acceptable.

33. The Advanced Airway box should be self-explanatory. Fill in all areas that are

applicable to any advanced airway maneuvers performed on the patient.

34. Use this diagram to indicate where trauma patients were injured.

35. Sign your PCR here.

36. Submit all your PCRs to your preceptor for their review and comment.

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EMS Program Incident Report

Student Name: ________________________________ Date: ___________________________

Preceptor Name: _______________________________________________________________

Description of Incident: __________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Student signature: ______________________________________________________________

Instructor follow-up: ____________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Instructor signature: ______________________________________________________

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Student Internship Contract – EMT Paramedic I, __________________________________ understand that I am about to enter into an ALS (Paramedic level) of

field training. This training is a critical piece of my success as an EMS professional and patient care provider.

Because of the importance of this internship, I agree to abide by the following policies:

_____1.) I have read and understand the contents of the CCA EMS Clinical Policies and

Procedures Notebook. I understand that failure to comply with these P&Ps could result

in failure of my internship and a failing grade for the course.

_____2.) I have one year from the course final practical to complete my entire internship. My

completion deadline is: _________________________.

_____3.) I will provide my primary instructor with a written copy of my ride and clinical

schedule as quickly as possible. Attending rides without providing a written schedule

will result in an absence and repeating the shift. The deadline for having my initial rides scheduled is

__________________________.

_____4.) I will be allowed to reschedule a total of 5-twelve hour shifts (or a total of 60

hours) for any reason before I am terminated from my internship.

Written documentation of any rescheduled shifts must be submitted to my primary

instructor within 72 hours of the missed rotation.

____5.) I will fax or deliver a copy of my daily evals to my primary instructor within 72 hours of

the completion of each of my shifts Every eval must include the shift start and finish

time and a complete evaluation and signature from my preceptor. Failure to do so the first

time will result in the shift being counted towards one of my 3 allowed reschedules and

a repeat of the shift. A second violation could result in failure of my internship and a

failing grade for the course. (The CCA EMS FAX # is 303.340.7209 or 303.340.7080.)

_____6.) I must successfully complete 4 major phase evaluations with my preceptors: These

evaluations and a meeting with my primary instructor to discuss them must

occur within 72 hours of the completion of 100, 250, 400, and 500 hours of field rides.

Failure to do so could result in failure of my internship and a failing grade for the course.

____7.) I am required to maintain a current copy of all required certifications with the CCA EMS

office. This includes Colorado EMT, CPR, ACLS, etc…Failure to do so will result in

loss of credit for all rides completed beyond the expiration date and could result in

termination from my internship.

_____8.) It is my responsibility to stay in contact with my primary instructor at all times to advise

him or her of my progress or any problems that may develop during my internship.

_____9.) As a working guest of the agencies I am riding with, I promise to be a good ambassador

for myself and the CCA EMS program at all times. I will behave in a manner that

reflects the high standards of professionalism and patient care required of an advanced-

level EMS provider.

I understand that failure to comply with any of the terms of this contract may result in immediate termination from

both my internship and the CCA EMS Program.

Student signature: ___________________________ Date: _____________________________

Primary Instructor: __________________________Signature:__________________________

Documents

Emergency Medical Services Program CLINICAL AND INTERNSHIP