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Pre-Hospital Care Class Objectives image

**Terminal Objective:
At the completion of Pre-Hospital Care, the paramedic student will understand the roles and responsibilities of a paramedic within an EMS system including serving as an example of personal wellness and primary injury prevention, understanding the role of ethics and legal issues that combine with the findings of a complete patient assessment to impact the decisions made in the pre-hospital setting while communicating effectively with patients and other healthcare providers and providing appropriate documentation and transport, all-the-while effecting appropriate patient care including airway management and ventilation.

Pre-Hospital Care Course Outline
I. Introduction to Advanced Pre-Hospital Care**
II. Roles and Responsibilities
III. Well-Being of the Paramedic
IV. Illness and Injury Prevention
V. EMS Systems**
VI. Medical/Legal Aspects of Advanced Pre-hospital Care
VII. Ethics in Advanced Pre-Hospital Care
VIII. Therapeutic Communications
IX. Patient Assessment: History Taking
X. Patient Assessment: Physical Exam Techniques
XI. Patient Assessment
XII. Clinical Decision Making
XIII. EMS Communications
XIV. Documentation
XV. Medical Terminology**
XVI. Airway Management and Ventilation

PROGRAM BEHAVIORAL OBJECTIVES**
Behavioral attributes of the MICT student and certified MICT are very important. Because of this, we have developed behavioral objectives for the Cowley MICT student. These objectives are based on what is required of an MICT and employer expectations.
At the conclusion of the program, the MICT student must exhibit appropriate behavior in the following areas:

  • Integrity
  • Empathy
  • Self-Motivation
  • Appearance and Personal Hygiene
  • Self-Confidence
  • Communications
  • Time Management
  • Teamwork and Diplomacy
  • Respect
  • Patient Advocacy
  • Careful Delivery of Service

Other behavioral objectives, found in specific curricular areas, have also been developed as well (these are found in the specific class objectives). We strongly believe that the entry level MICT must have the knowledge, ability to perform and have obtained appropriate professional behaviors.

KEY TO CLASSIFICATION OF OBJECTIVES
(B) - Denotes a behavioral objective
(C) - Denotes a cognitive objective
(M) - Denotes a psychomotor objective
** Denotes objectives added to curriculum by Cowley

I. Introduction to Advanced Pre-Hospital Care**
**Unit Objective: At the conclusion of this unit, the paramedic student will identify attributes and characteristics of the paramedic, describe the relationship of the paramedic with other allied health care providers, explain elements of paramedic education and define the expanded scope of practice for the paramedic.
**Describe the relationship between the paramedic and other members of the allied health professions.(C)
**Identify the attributes and characteristics of the paramedic.(C)
**Explain the elements of paramedic education and practice that support its stature as a profession. (C)
**Define and give examples of the expanded scope of practice for the paramedic.

II. Roles and Responsibilities
Unit Objective: At the completion of this unit, the paramedic student will understand his or her roles and responsibilities within an EMS system, and how these roles and responsibilities differ from other levels of providers.
*Describe the attributes of a paramedic as a health care professional.(C)
*Describe the recognized levels of EMS training/ education, leading to licensure/ certification in his or her state.(C)
*Explain paramedic licensure/ certification, recertification, and reciprocity requirements in his or her state.(C)
*Evaluate the importance of maintaining one's paramedic license/ certification.(C)
*Describe the benefits of paramedic continuing education.(C)
*List current state requirements for paramedic education in his/ her state.(C)
*Discuss current issues in his/ her state impacting EMS.(C)
*Discuss the roles of various EMS standard setting agencies.(C)
*Describe how professionalism applies to the paramedic while on and off duty.(C)
*Describe examples of professional behaviors in the following areas: integrity, empathy, self- motivation, appearance and personal hygiene, self-confidence, communications, time management, teamwork and diplomacy, respect, patient advocacy, and careful delivery of service.(C)
*Provide examples of activities that constitute appropriate professional behavior for a paramedic.(C)
*Describe the importance of quality EMS research to the future of EMS.(C)
*Identify the benefits of paramedics teaching in their community.(C)
*Analyze how the paramedic can benefit the health care system by supporting primary care to patients in the out-of-hospital setting.(C)
*List the primary and additional responsibilities of paramedics.(C)
*Provide examples of local protocols.(C)
*Analyze the role of continuous quality improvement with respect to continuing medical education and research.(C)
*Define the role of the paramedic relative to the safety of the crew, the patient, and bystanders.(C)
*Identify local health care agencies and transportation resources for patients with special needs.(C)
*Describe the role of the paramedic in health education activities related to illness and injury prevention.(C)
*Describe the importance and benefits of research.(C)
*Explain the EMS provider's role in data collection.(C)
*Explain the basic principles of research.(C)
*Describe a process of evaluating and interpreting research.(C)
*Assess personal practices relative to the responsibility for personal safety, the safety of the crew, the patient, and bystanders.(B)
*Serve as a role model for others relative to professionalism in EMS.(B)
*Value the need to serve as the patient advocate inclusive of those with special needs, alternative life styles and cultural diversity.(B)
*Defend the importance of continuing medical education and skills retention.(B)
*Advocate the need for supporting and participating in research efforts aimed at improving EMS systems.(B)
*Assess personal attitudes and demeanor that may distract from professionalism.(B)
*Value the role that family dynamics plays in the total care of patients. (B)
*Advocate the need for injury prevention, including abusive situations.(B)
*Exhibit professional behaviors in the following areas: integrity, empathy, self-motivation, appearance and personal hygiene, self-confidence, communications, time management, teamwork and diplomacy, respect, patient advocacy, and careful delivery of service.(B)

III. The Well Being of the Paramedic
Unit Objective: At the completion of this unit, the paramedic student will understand and value the importance of personal wellness in EMS and serve as a healthy role model for peers.
*Discuss the concept of wellness and its benefits. (C)
*Define the components of wellness. (C)
*Describe the role of the paramedic in promoting wellness. (C)
*Discuss the components of wellness associated with proper nutrition. (C)
*List principles of weight control. (C)
*Discuss how cardiovascular endurance, muscle strength, and flexibility contribute to physical fitness. (C)
*Describe the impact of shift work on circadian rhythms. (C)
*Discuss how periodic risk assessments and knowledge of warning signs contribute to cancer and cardiovascular disease prevention. (C)
*Differentiate proper from improper body mechanics for lifting and moving patients in emergency and non-emergency situations. (C)
*Describe the problems that a paramedic might encounter in a hostile situation and the techniques used to manage the situation. (C)
*Given a scenario involving arrival at the scene of a motor vehicle collision, assess the safety of the scene and propose ways to make the scene safer. (C)
*List factors that contribute to safe vehicle operations. (C)
*Describe the equipment available for self-protection when confronted with a variety of adverse situations. (C)
*Describe the benefits and methods of smoking cessation. (C)
*Describe the three phases of the stress response. (C)
*List factors that trigger the stress response. (C)
*Differentiate between normal/ healthy and detrimental reactions to anxiety and stress. (C)
*Describe the common physiological and psychological effects of stress. (C)
*Identify causes of stress in EMS. (C)
*Describe behavior that is a manifestation of stress in patients and those close to them and how these relate to paramedic stress. (C)
*Identify and describe the defense mechanisms and management techniques commonly used to deal with stress. (C)
*Describe the components of critical incident stress management (CISM). (C)
*Provide examples of situations in which CISM would likely be beneficial to paramedics. (C)
*Given a scenario involving a stressful situation, formulate a strategy to help cope with the stress. (C)
*Describe the stages of the grieving process (Kubler-Ross). (C)
*Describe the needs of the paramedic when dealing with death and dying. (C)
*Describe the unique challenges for paramedics in dealing with the needs of children and other special populations related to their understanding or experience of death and dying. (C)
*Discuss the importance of universal precautions and body substance isolation practices. (C)
*Describe the steps to take for personal protection from airborne and bloodborne pathogens. (C)
*Given a scenario in which equipment and supplies have been exposed to body substances, plan for the proper cleaning, disinfection, and disposal of the items. (C)
*Explain what is meant by an exposure and describe principles for management. (C)
*Advocate the benefits of working toward the goal of total personal wellness.(B)
*Serve as a role model for other EMS providers in regard to a total wellness lifestyle.(B)
*Value the need to assess his/ her own lifestyle.(B)
*Challenge his/ herself to each wellness concept in his/ her role as a paramedic.(B)
*Defend the need to treat each patient as an individual, with respect and dignity.(B)
*Assess his/ her own prejudices related to the various aspects of cultural diversity.(B)
*Improve personal physical well-being through achieving and maintaining proper body weight, regular exercise and proper nutrition.(B)
*Promote and practice stress management techniques.(B)
*Defend the need to respect the emotional needs of dying patients and their families.(B)
*Advocate and practice the use of personal safety precautions in all scene situations.(B)
*Advocate and serve as a role model for other EMS providers relative to body substance isolation practices.(B)
*Demonstrate safe methods for lifting and moving patients in emergency and non-emergency situations.(M)
*Demonstrate the proper procedures to take for personal protection from disease.(M)

IV. Illness and Injury Prevention
Unit Objective: At the completion of this unit, the paramedic student will be able to integrate the implementation of primary injury prevention activities as an effective way to reduce death, disabilities and health care costs.
*Describe the incidence, morbidity and mortality of unintentional and alleged unintentional events. (C)
*Identify the human, environmental, and socioeconomic impact of unintentional and alleged unintentional events. (C)
*Identify health hazards and potential crime areas within the community. (C)
*Identify local municipal and community resources available for physical, socioeconomic crises. (C)
*List the general and specific environmental parameters that should be inspected to assess a patient's need for preventative information and direction. (C)
*Identify the role of EMS in local municipal and community prevention programs. (C)
*Identify the local prevention programs that promote safety for all age populations. (C)
*Identify patient situations where the paramedic can intervene in a preventative manner. (C)
*Document primary and secondary injury prevention data. (C)
*Value and defend tenets of prevention in terms of personal safety and wellness.(B)
*Value and defend tenets of prevention for patients and communities being served.(B)
*Value the contribution of effective documentation as one justification for funding of prevention programs.(B)
*Value personal commitment to success of prevention programs.(B)
*Demonstrate the use of protective equipment appropriate to the environment and scene. (M)

V. EMS Systems**
**Unit Objective: Describe the key historical events, national groups important to EMS, standard components of an EMS system, the role of the Medical Director and the components and benefits of quality improvement.
*Describe key historical events that influenced the development of national Emergency Medical Services (EMS) systems.(C)
*Identify national groups important to the development, education, and implementation of EMS.(C)
*Differentiate among the four nationally recognized levels of EMS training/ education, leading to licensure/ certification/ registration.(C)
*Identify the standards (components) of an EMS System as defined by the National Highway Traffic Safety Administration.(C)
*Discuss the role of national associations and of a national registry agency.(C)
*Describe what is meant by "citizen involvement in the EMS system."(C)
*Describe the role of the EMS physician in providing medical direction.(C)
*Discuss pre-hospital and out-of-hospital care as an extension of the physician.(C)
*Describe the benefits of medical direction, both on-line and off-line.(C)
*Describe the process for the development of local policies and protocols.(C)
*Describe the relationship between a physician on the scene, the paramedic on the scene, and the EMS physician providing on-line medical direction.(C)
*Describe the components of continuous quality improvement.(C)
*Define the following terms: (C)
a. EMS Systems
b. Licensure
c. Certification
d. Registration
e. Profession
f. Professionalism
g. Health care professional
h. Ethics
I. Peer review
j. Medical direction
k. Protocols

VI. Medicolegal Issues
Unit Objective: At the completion of this unit, the paramedic student will understand the legal issues that impact decisions made in the out-of-hospital environment.
*Differentiate between legal and ethical responsibilities.(C)
*Describe the basic structure of the legal system in the United States.(C)
*Differentiate between civil and criminal law as it pertains to the paramedic.(C)
*Identify and explain the importance of laws pertinent to the paramedic.(C)
*Differentiate between licensure and certification as they apply to the paramedic.(C)
*List the specific problems or conditions encountered while providing care that a paramedic is required to report, and identify in each instance to whom the report is to be made.(C)
*Define the following terms:(C)
a. Abandonment
b. Advance directives
c. Assault
d. Battery
e. Breach of duty
f. Confidentiality
g. Consent (expressed, implied, informed, involuntary)
h. Do not resuscitate (DNR) orders
i. Duty to act
j. Emancipated minor
k. False imprisonment
l. Immunity
m. Liability
n. Libel
o. Minor
p. Negligence
q. Proximate cause
r. Scope of practice
s. Slander
t. Standard of care
u. Tort
*Differentiate between the scope of practice and the standard of care for paramedic practice.(C)
*Discuss the concept of medical direction, including off-line medical direction and on-line medical direction, and its relationship to the standard of care of a paramedic.(C)
*Describe the four elements that must be present in order to prove negligence.(C)
*Given a scenario in which a patient is injured while a paramedic is providing care, determine whether the four components of negligence are present.(C)
*Given a scenario, demonstrate patient care behaviors that would protect the paramedic from claims of negligence.(C)
*Explain the concept of liability as it might apply to paramedic practice, including physicians providing medical direction and paramedic supervision of other care providers.(C)
*Discuss the legal concept of immunity, including Good Samaritan statutes and governmental immunity, as it applies to the paramedic.(C)
*Explain the importance and necessity of patient confidentiality and the standards for maintaining patient confidentiality that apply to the paramedic.(C)
*Differentiate among expressed, informed, implied, and involuntary consent.(C)
*Given a scenario in which a paramedic is presented with a conscious patient in need of care, describe the process used to obtain consent.(C)
*Identify the steps to take if a patient refuses care.(C)
*Given a scenario, demonstrate appropriate patient management and care techniques in a refusal of care situation.(C)
*Describe what constitutes abandonment.(C)
*Identify the legal issues involved in the decision not to transport a patient, or to reduce the level of care being provided during transportation.(C)
*Describe how hospitals are selected to receive patients based on patient need and hospital capability and the role of the paramedic in such selection.(C)
*Differentiate between assault and battery and describe how to avoid each.(C)
*Describe the conditions under which the use of force, including restraint, is acceptable.(C)
*Explain the purpose of advance directives relative to patient care and how the paramedic should care for a patient who is covered by an advance directive.(C)
*Discuss the responsibilities of the paramedic relative to resuscitation efforts for patients who are potential organ donors.(C)
*Describe the actions that the paramedic should take to preserve evidence at a crime or accident scene.(C)
*Describe the importance of providing accurate documentation (oral and written) in substantiating an incident.(C)
*Describe the characteristics of a patient care report required to make it an effective legal document.(C)
*Given a scenario, prepare a patient care report, including an appropriately detailed narrative.(C)
*Advocate the need to show respect for the rights and feelings of patients.(B)
*Assess his/ her personal commitment to protecting patient confidentiality.(B)
*Given a scenario involving a new employee, explain the importance of obtaining consent for adults and minors.(B)
*Defend personal beliefs about withholding or stopping patient care.(B)
*Defend the value of advance medical directives.(B)

VII. Ethics
Unit Object: At the completion of this unit, the paramedic student will understand the role that ethics plays in decision making in the out-of-hospital environment.
*Define ethics. (C)
*Distinguish between ethical and moral decisions.(C)
*Identify the premise that should underlie the paramedic's ethical decisions in out-of hospital care.(C)
*Analyze the relationship between the law and ethics in EMS.(C)
*Compare and contrast the criteria that may be used in allocating scarce EMS resources.(C)
*Identify the issues surrounding the use of advance directives, in making a pre-hospital resuscitation decision.(C)
*Describe the criteria necessary to honor an advance directive in your state.(C)
*Value the patient's autonomy in the decision-making process.(B)
*Defend the following ethical positions:(B)
a. The paramedic is accountable to the patient.
b. The paramedic is accountable to the medical director.
c. The paramedic is accountable to the EMS system.
d. The paramedic is accountable for fulfilling the standard of care.
*Given a scenario, defend or challenge a paramedic's actions concerning a patient who is treated against his/ her wishes.(B)
*Given a scenario, defend a paramedic's actions in a situation where a physician orders therapy the paramedic feels to be detrimental to the patient's best interests.(B)

VIII. Therapeutic Communications
Unit Objective: At the completion of this unit, the paramedic student will be able to integrate the principles of therapeutic communication to effectively communicate with any patient while providing care.
*Define communication. (C)
*Identify internal and external factors that affect a patient/ bystander interview conducted by a paramedic.(C)
*Restate the strategies for developing patient rapport.(C)
*Provide examples of open-ended and closed or direct questions.(C)
*Discuss common errors made by paramedics when interviewing patients.(C)
*Identify the nonverbal skills that are used in patient interviewing.(C)
*Restate the strategies to obtain information from the patient.(C)
*Summarize the methods to assess mental status based on interview techniques.(C)
*Discuss the strategies for interviewing a patient who is unmotivated to talk.(C)
*Differentiate the strategies a paramedic uses when interviewing a patient who is hostile compared to one who is cooperative.(C)
*Summarize developmental considerations of various age groups that influence patient interviewing.(C)
*Restate unique interviewing techniques necessary to employ with patients who have special needs.(C)
*Discuss interviewing considerations used by paramedics in cross-cultural communications.(C)
*Serve as a model for an effective communication process.(B)
*Advocate the importance of external factors of communication.(B)
*Promote proper responses to patient communication.(B)
*Exhibit professional non-verbal behaviors.(B)
*Advocate development of proper patient rapport.(B)
*Value strategies to obtain patient information.(B)
*Exhibit professional behaviors in communicating with patients in special situations.(B)
*Exhibit professional behaviors in communication with patient form different cultures.(B)

IX. Patient Assessment -- History Taking
Unit Objective: At the completion of this unit, the paramedic student will be able to use the appropriate techniques to obtain a medical history from a patient.
*Describe the techniques of history taking.(C)
*Discuss the importance of using open ended questions.(C)
*Describe the use of facilitation, reflection, clarification, empathetic responses, confrontation, and interpretation.(C)
*Differentiate between facilitation, reflection, clarification, sympathetic responses, confrontation, and interpretation.(C)
*Describe the structure and purpose of a health history. (C)
*Describe how to obtain a comprehensive health history.(C)
*List the components of a comprehensive history of an adult patient.(C)
*Demonstrate the importance of empathy when obtaining a health history.(B)
*Demonstrate the importance of confidentiality when obtaining a health history.(B)

X. Patient Assessment -- Techniques of Physical Examination
Unit Objective: At the completion end of this unit, the paramedic student will be able to explain the pathophysiological significance of physical exam findings.
*Define the terms inspection, palpation, percussion, auscultation.(C)
*Describe the techniques of inspection, palpation, percussion, and auscultation.(C)
*Describe the evaluation of mental status.(C)
*Evaluate the importance of a general survey.(C)
*Describe the examination of skin, hair and nails.(C)
*Differentiate normal and abnormal findings of the assessment of the skin.(C)
*Distinguish the importance of abnormal findings of the assessment of the skin.(C)
*Describe the examination of the head and neck.(C)
*Differentiate normal and abnormal findings of the scalp examination.(C)
*Describe the normal and abnormal assessment findings of the skull.(C)
*Describe the assessment of visual acuity.(C)
*Explain the rationale for the use of an ophthalmoscope.(C)
*Describe the examination of the eyes.(C)
*Distinguish between normal and abnormal assessment findings of the eyes.(C)
*Explain the rationale for the use of an otoscope.(C)
*Describe the examination of the ears.(C)
*Differentiate normal and abnormal assessment findings of the ears.(C)
*Describe the examination of the nose.(C)
*Differentiate normal and abnormal assessment findings of the nose.(C)
*Describe the examination of the mouth and pharynx.(C)
*Differentiate normal and abnormal assessment findings of the mouth and pharynx.(C)
*Describe the examination of the neck.(C)
*Differentiate normal and abnormal assessment findings the neck.(C)
*Describe the survey of the thorax and respiration.(C)
*Describe the examination of the posterior chest.(C)
*Describe percussion of the chest.(C)
*Differentiate the percussion notes and their characteristics.(C)
*Differentiate the characteristics of breath sounds.(C)
*Describe the examination of the anterior chest.(C)
*Differentiate normal and abnormal assessment findings of the chest examination.(C)
*Describe special examination techniques related to the assessment of the chest.(C)
*Describe the examination of the arterial pulse including rate, rhythm, and amplitude.(C)
*Distinguish normal and abnormal findings of arterial pulse.(C)
*Describe the assessment of jugular venous pressure and pulsations.(C)
*Distinguish normal and abnormal examination findings of jugular venous pressure and pulsations.(C)
*Describe the examination of the heart and blood vessels.(C)
*Differentiate normal and abnormal assessment findings of the heart and blood vessels.(C)
*Describe the auscultation of the heart.(C)
*Differentiate the characteristics of normal and abnormal findings associated with the auscultation of the heart.(C)
*Describe special examination techniques of the cardiovascular examination.(C)
*Identify the components of physical assessment as they relate to the hematologic system.(C)
*Integrate pathophysiological principles into the assessment of a patient with hematologic disease.(C)
*Describe the examination of the abdomen.(C)
*Differentiate normal and abnormal assessment findings of the abdomen.(C)
*Describe auscultation of the abdomen.(C)
*Distinguish normal and abnormal findings of the auscultation of the abdomen.(C)
*Describe the examination of the female genitalia.(C)
*Differentiate normal and abnormal assessment findings of the female genitalia.(C)
*Describe the examination of the male genitalia.(C)
*Differentiate normal and abnormal findings of the male genitalia.(C)
*Describe the examination of the anus and rectum.(C)
*Distinguish between normal and abnormal findings of the anus and rectum.(C)
*Describe the examination of the peripheral vascular system.(C)
*Differentiate normal and abnormal findings of the peripheral vascular system.(C)
*Describe the examination of the musculoskeletal system.(C)
*Differentiate normal and abnormal findings of the musculoskeletal system.(C)
*Describe the examination of the nervous system.(C)
*Differentiate normal and abnormal findings of the nervous system.(C)
*Describe the assessment of the cranial nerves.(C)
*Differentiate normal and abnormal findings of the cranial nerves.(C)
*Describe the general guidelines of recording examination information.(C)
*Discuss the considerations of examination of an infant or child.(C)
*Demonstrate a caring attitude when performing physical examination skills.(B)
*Discuss the importance of a professional appearance and demeanor when performing physical examination skills.(B)
*Value the sense of urgency for initial assessment and interventions for patients with hematologic crises.(B)
*Appreciate the limitations of conducting a physical exam in the out-of-hospital environment.(B)
*Demonstrate the examination of skin, hair and nails.(M)
*Demonstrate the examination of the head and neck.(M)
*Demonstrate the examination of the eyes.(M)
*Demonstrate the examination of the ears.(M)
*Demonstrate the assessment of visual acuity.(M)
*Demonstrate the examination of the nose.(M)
*Demonstrate the examination of the mouth and pharynx.(M)
*Demonstrate the examination of the neck.(M)
*Demonstrate the examination of the thorax and ventilation.(M)
*Demonstrate the examination of the posterior chest.(M)
*Demonstrate auscultation of the chest.(M)
*Demonstrate percussion of the chest.(M)
*Demonstrate the examination of the anterior chest.(M)
*Demonstrate special examination techniques related to the assessment of the chest.(M)
*Demonstrate the examination of the arterial pulse including location, rate, rhythm, and amplitude.(M)
*Demonstrate the assessment of jugular venous pressure and pulsations.(M)
*Demonstrate the examination of the heart and blood vessels.(M)
*Demonstrate special examination techniques of the cardiovascular examination.(M)
*Perform an assessment of the patient with hematologic disorder.(M)
*Demonstrate the examination of the abdomen.(M)
*Demonstrate auscultation of the abdomen.(M)
*Demonstrate the external visual examination of the female genitalia.(M)
*Demonstrate the examination of the male genitalia.(M)
*Demonstrate the examination of the peripheral vascular system.(M)
*Demonstrate the examination of the musculoskeletal system.(M)
*Demonstrate the examination of the nervous system.(M)

XI. Patient Assessment
Unit Objective: At the end of this unit, the paramedic student will be able to integrate the principles of history taking and techniques of physical exam to perform a patient assessment.
*Recognize hazards/ potential hazards. (C)
*Describe common hazards found at the scene of a trauma and a medical patient.(C)
*Determine hazards found at the scene of a medical or trauma patient.(C)
*Differentiate safe from unsafe scenes. (C)
*Describe methods to making an unsafe scene safe.(C)
*Discuss common mechanisms of injury/ nature of illness.(C)
*Predict patterns of injury based on mechanism of injury.(C)
*Discuss the reason for identifying the total number of patients at the scene.(C)
*Organize the management of a scene following size-up.(C)
*Explain the reasons for identifying the need for additional help or assistance.(C)
*Summarize the reasons for forming a general impression of the patient.(C)
*Discuss methods of assessing mental status.(C)
*Categorize levels of consciousness in the adult, infant and child.(C)
*Differentiate between assessing the altered mental status in the adult, child and infant patient.(C)
*Discuss methods of assessing the airway in the adult, child and infant patient. (C)
*State reasons for management of the cervical spine once the patient has been determined to be a trauma patient.(C)
*Analyze a scene to determine if spinal precautions are required.(C)
*Describe methods used for assessing if a patient is breathing.(C)
*Differentiate between a patient with adequate and inadequate minute ventilation.(C)
*Distinguish between methods of assessing breathing in the adult, child and infant patient.(C)
*Compare the methods of providing airway care to the adult, child and infant patient.(C)
*Describe the methods used to locate and assess a pulse.(C)
*Differentiate between locating and assessing a pulse in an adult, child and infant patient.(C)
*Discuss the need for assessing the patient for external bleeding.(C)
*Identify the components of physical assessment as they relate to the hematologic system.(C)
*Describe normal and abnormal findings when assessing skin color.(C)
*Describe normal and abnormal findings when assessing skin temperature.(C)
*Describe normal and abnormal findings when assessing skin condition.(C)
*Explain the reason for prioritizing a patient for care and transport.(C)
*Identify patients who require expeditious transport.(C)
*Describe the evaluation of patient's perfusion status based on findings in the initial assessment.(C)
*Describe orthostatic vital signs and evaluate their usefulness in assessing a patient in shock.(C)
*Apply the techniques of physical examination to the medical patient.(C)
*Differentiate between the assessment that is performed for a patient who is unresponsive or has an altered mental status and other medical patients requiring assessment.(C)
*Discuss the reasons for reconsidering the mechanism of injury.(C)
*State the reasons for performing a rapid trauma assessment.(C)
*Recite examples and explain why patients should receive a rapid trauma assessment.(C)
*Apply the techniques of physical examination to the trauma patient.(C)
*Describe the areas included in the rapid trauma assessment and discuss what should be evaluated.(C)
*Differentiate cases when the rapid assessment may be altered in order to provide patient care.(C)
*Discuss the reason for performing a focused history and physical exam.(C)
*Describe when and why a detailed physical examination is necessary.(C)
*Discuss the components of the detailed physical exam in relation to the techniques of examination.(C)
*State the areas of the body that are evaluated during the detailed physical exam.(C)
*Explain what additional care should be provided while performing the detailed physical exam.(C)
*Distinguish between the detailed physical exam that is performed on a trauma patient and that of the medical patient.(C)
*Differentiate patients requiring a detailed physical exam from those who do not.(C)
*Discuss the reasons for repeating the initial assessment as part of the on-going assessment.(C)
*Describe the components of the on-going assessment.(C)
*Describe trending of assessment components.(C)
*Discuss medical identification devices/ systems.(C)
*Describe the rapid pediatric cardiopulmonary assessment.(C)
*Explain the rationale for crew members to evaluate scene safety prior to entering.(B)
*Serve as a model for others explaining how patient situations affect your evaluation of mechanism of injury or illness.(B)
*Explain the importance of forming a general impression of the patient.(B)
*Explain the value of performing an initial assessment.(B)
*Value the sense of urgency for initial assessment and interventions for patients with hematologic crises.(B)
*Demonstrate a caring attitude when performing an initial assessment.(B)
*Attend to the feelings that patients with medical conditions might be experiencing.(B)
*Value the need for maintaining a professional caring attitude when performing a focused history and physical examination.(B)
*Explain the rationale for the feelings that these patients might be experiencing.(B)
*Demonstrate a caring attitude when performing a detailed physical examination.(B)
*Explain the value of performing an on-going assessment.(B)
*Recognize and respect the feelings that patients might experience during assessment.(B)
*Explain the value of trending assessment components to other health professionals who assume care of the patient.(B)
*Observe various scenarios and identify potential hazards.(M)
*Demonstrate the scene-size-up.(M)
*Demonstrate the techniques for assessing mental status.(M)
*Demonstrate the techniques for assessing the airway.(M)
*Demonstrate the techniques for assessing if the patient is breathing.(M)
*Demonstrate the techniques for assessing if the patient has a pulse.(M)
*Demonstrate the techniques for assessing the patient for external bleeding.(M)
*Demonstrate the techniques for assessing the patient's skin color, temperature, and condition.(M)
*Demonstrate the ability to prioritize patients.(M)
*Using the techniques of examination, demonstrate the assessment of a medical patient.(M)
*Demonstrate a rapid pediatric cardiopulmonary assessment.(M)
*Demonstrate the patient care skills that should be used to assist with a patient who is responsive with no known history.(M)
*Demonstrate the patient care skills that should be used to assist with a patient who is unresponsive or has an altered mental status.(M)
*Perform a rapid medical assessment.(M)
*Perform a focused history and physical exam of the medical patient.(M)
*Using the techniques of physical examination, demonstrate the assessment of a trauma patient.(M)
*Demonstrate the rapid trauma assessment used to assess a patient based on mechanism of injury.(M)
*Perform an assessment of the patient with hematologic disorder.(M)
*Perform a focused history and physical exam on a non-critically injured patient.(M)
*Perform a focused history and physical exam on a patient with life-threatening injuries.(M)
*Perform a detailed physical examination.(M)
*Demonstrate the skills involved in performing the on-going assessment.(M)

XII. Clinical Decision Making
Unit Objective: At the end of this unit, the paramedic student will be able to apply a process of clinical decision making to use the assessment findings to help form a field impression.
*Compare the factors influencing medical care in the out-of-hospital environment to other medical settings.(C)
*Differentiate between critical life-threatening, potentially life-threatening, and non life- threatening patient presentations.(C)
*Evaluate the benefits and shortfalls of protocols, standing orders and patient care algorithms.(C)
*Define the components, stages and sequences of the critical thinking process for paramedics.(C)
*Apply the fundamental elements of critical thinking for paramedics. (C)
*Describe the effects of the "fight or flight" response and the positive and negative effects on a paramedic's decision making.(C)
*Summarize the "six Rs" of putting it all together: Read the patient, Read the scene, React, Reevaluate, Revise the management plan, Review performance.(C)
*Defend the position that clinical decision making is the cornerstone of effective paramedic practice.(B)
*Practice facilitating behaviors when thinking under pressure.(B)

XIII. EMS Communications
Unit Objective: At the completion of this unit, the paramedic student will be able to follow an accepted format for dissemination of patient information in verbal form, either in person or over the radio.
*Identify the importance of communications when providing EMS. (C)
*Identify the role of verbal, written, and electronic communications in the provision of EMS. (C)
*Describe the phases of communications necessary to complete a typical EMS event. (C)
*Identify the importance of proper terminology when communicating during an EMS event. (C)
*Identify the importance of proper verbal communications during an EMS event. (C)
*List factors that impede effective verbal communications. (C)
*List factors which enhance verbal communications. (C)
*Identify the importance of proper written communications during an EMS event. (C)
*List factors which impede effective written communications. (C)
*List factors which enhance written communications. (C)
*Recognize the legal status of written communications related to an EMS event. (C)
*State the importance of data collection during an EMS event. (C)
*Identify technology used to collect and exchange patient and/ or scene information electronically. (C)
*Recognize the legal status of patient medical information exchanged electronically. (C)
*Identify the components of the local EMS communications system and describe their function and use. (C)
*Identify and differentiate among the following communications systems: (C)
a. Simplex
b. Multiplex
c. Duplex
d. Trunked
e. Digital communications
f. Cellular telephone
g. Facsimile
h. Computer
*Identify the components of the local dispatch communications system and describe their function and use. (C)
*Describe the functions and responsibilities of the Federal Communications Commission. (C)
*Describe how an EMS dispatcher functions as an integral part of the EMS team. (C)
*List appropriate information to be gathered by the Emergency Medical Dispatcher. (C)
*Identify the role of Emergency Medical Dispatch in a typical EMS event. (C)
*Identify the importance of pre-arrival instructions in a typical EMS event. (C)
*Describe the purpose of verbal communication of patient information to the hospital. (C)
*Describe information that should be included in patient assessment information verbally reported to medical direction. (C)
*Diagram a basic model of communications. (C)
*Organize a list of patient assessment information in the correct order for electronic transmission to medical direction according to the format used locally. (C)
*Show appreciation for proper terminology when describing a patient or patient condition.(B)
*Demonstrate the ability to use the local dispatch communications system.(M)
*Demonstrate the ability to use a radio.(M)
*Demonstrate the ability to use the biotelemetry equipment used locally.(M)

XIV. Documentation
Unit Objective: At the completion of this unit, the paramedic student will be able to effectively document the essential elements of patient assessment, care and transport.
*Identify the general principles regarding the importance of EMS documentation and ways in which documents are used.(C)
*Identify and use medical terminology correctly.(C)
*Recite appropriate and accurate medical abbreviations and acronyms.(C)
*Record all pertinent administrative information.(C)
*Explain the role of documentation in agency reimbursement.(C)
*Analyze the documentation for accuracy and completeness, including spelling.
*Identify and eliminate extraneous or nonprofessional information.(C)
*Describe the differences between subjective and objective elements of documentation.(C)
*Evaluate a finished document for errors and omissions.(C)
*Evaluate a finished document for proper use and spelling of abbreviations and acronyms.(C)
*Evaluate the confidential nature of an EMS report.(C)
*Describe the potential consequences of illegible, incomplete, or inaccurate documentation.(C)
*Describe the special considerations concerning patient refusal of transport.(C)
*Record pertinent information using a consistent narrative format.(C)
*Explain how to properly record direct patient or bystander comments.(C)
*Describe the special considerations concerning mass casualty incident documentation.(C)
*Apply the principles of documentation to computer charting, as access to this technology becomes available.(C)
*Identify and record the pertinent, reportable clinical data of each patient interaction.(C)
*Note and record "pertinent negative" clinical findings.(C)
*Correct errors and omissions, using proper procedures as defined under local protocol.(C)
*Revise documents, when necessary, using locally-approved procedures.(C)
*Assume responsibility for self-assessment of all documentation.(C)
*Demonstrate proper completion of an EMS event record used locally.(C)
*Advocate among peers the relevance and importance of properly completed documentation.(C)
*Resolve the common negative attitudes toward the task of documentation.(C)
**Understand documentation as it pertains to insurance concerns.(C)

XV. Medical Terminology**
**Unit Objective: At the conclusion of this unit, the paramedic student will be able to identify and correctly use word roots, prefixes, suffixes, and combining forms while paying attention to spelling and pronunciation and recognizing commonly accepted medical abbreviations.
**Identify the role and recognize examples of word roots, prefixes, suffixes, and combining forms.(C)
**Demonstrate correct usage of the combining vowel by correctly joining word parts to write medical terms.(M)
**Recognize the importance of always spelling medical terms correctly.(B)
**Correctly pronounce medical terms.(M)
**Recognize a list of commonly accepted medical abbreviations.(C)

XVI. Airway Management and Ventilation
**Unit Objective: At the completion of this unit, the paramedic student will be able to establish and/ or maintain a patent airway, oxygenate, and ventilate a patient.
*Explain the primary objective of airway maintenance.(C)
*Identify commonly neglected pre-hospital skills related to airway.(C)
*Identify the anatomy of the upper and lower airway.(C)
*Describe the functions of the upper and lower airway.(C)
*Explain the differences between adult and pediatric airway anatomy.(C)
*Define gag reflex.(C)
*Explain the relationship between pulmonary circulation and respiration.(C)
*List the concentration of gases that comprise atmospheric air.(C)
*Describe the measurement of oxygen in the blood.(C)
*Describe the measurement of carbon dioxide in the blood.(C)
*Describe peak expiratory flow.(C)
*List factors that cause decreased oxygen concentrations in the blood.(C)
*List the factors that increase and decrease carbon dioxide production in the body.(C)
*Define atelectasis.(C)
*Define FiO2.(C)
*Define and differentiate between hypoxia and hypoxemia.(C)
*Describe the voluntary and involuntary regulation of respiration.(C)
*Describe the modified forms of respiration.(C)
*Define normal respiratory rates and tidal volumes for the adult, child, and infant.(C)
*List the factors that affect respiratory rate and depth.(C)
*Explain the risk of infection to EMS providers associated with ventilation.(C)
*Define pulsus paradoxus.(C)
*Define and explain the implications of partial airway obstruction with good and poor air exchange.(C)
*Define complete airway obstruction.(C)
*Describe causes of upper airway obstruction.(C)
*Describe causes of respiratory distress.(C)
*Describe manual airway maneuvers.(C)
*Describe the Sellick (cricoid pressure) maneuver.(C)
*Describe complete airway obstruction maneuvers.(C)
*Explain the purpose for suctioning the upper airway.(C)
*Identify types of suction equipment.(C)
*Describe the indications for suctioning the upper airway.(C)
*Identify types of suction catheters, including hard or rigid catheters and soft catheters.(C)
*Identify techniques of suctioning the upper airway.(C)
*Identify special considerations of suctioning the upper airway.(C)
*Describe the indications, contraindications, advantages, disadvantages, complications, equipment and technique of tracheobronchial suctioning in the intubated patient.(C)
*Describe the use of an oral and nasal airway.(C)
*Identify special considerations of tracheobronchial suctioning in the intubated patient.(C)
*Define gastric distention.(C)
*Describe the indications, contraindications, advantages, disadvantages, complications, equipment and technique for inserting a nasogastric tube and orogastric tube.(C)
*Identify special considerations of gastric decompression.(C)
*Describe the indications, contraindications, advantages, disadvantages, complications, and technique for inserting an oropharyngeal and nasopharyngeal airway.(C)
*Describe the indications, contraindications, advantages, disadvantages, complications, and technique for ventilating a patient by:(C)
a. Mouth-to-mouth
b. Mouth-to-nose
c. Mouth-to-mask
d. One person bag-valve-mask
e. Two person bag-valve-mask
f. Three person bag-valve-mask
g. Flow-restricted, oxygen-powered ventilation device
*Explain the advantage of the two person method when ventilating with the bag-valve-mask.(C)
*Compare the ventilation techniques used for an adult patient to those used for pediatric patients. (C)
*Describe indications, contraindications, advantages, disadvantages, complications, and technique for ventilating a patient with an automatic transport ventilator (ATV). (C)
*Explain safety considerations of oxygen storage and delivery.(C)
*Identify types of oxygen cylinders and pressure regulators (including a high-pressure regulator and a therapy regulator).(C)
*List the steps for delivering oxygen from a cylinder and regulator.(C)
*Describe the use, advantages and disadvantages of an oxygen humidifier.(C)
*Describe the indications, contraindications, advantages, disadvantages, complications, liter flow range, and concentration of delivered oxygen for supplemental oxygen delivery devices.(C)
*Define, identify and describe a tracheostomy, stoma, and tracheostomy tube.(C)
*Define, identify, and describe a laryngectomy.(C)
* Define how to ventilate with a patient with a stoma, including mouth-to-stoma and bag-valve- mask-to-stoma ventilation.(C)
*Describe the special considerations in airway management and ventilation for patients with facial injuries.(C)
*Describe the special considerations in airway management and ventilation for the pediatric patient.(C)
*Differentiate endotracheal intubation from other methods of advanced airway management.(C)
*Describe the indications, contraindications, advantages, disadvantages and complications of endotracheal intubation.(C)
*Describe laryngoscopy for the removal of a foreign body airway obstruction.(C)
*Describe the indications, contraindications, advantages, disadvantages, complications, equipment, and technique for direct laryngoscopy.(C)
*Describe visual landmarks for direct laryngoscopy.(C)
*Describe use of cricoid pressure during intubation.(C)
*Describe indications, contraindications, advantages, disadvantages, complications, equipment and technique for digital endotracheal intubation.(C)
*Describe the indications, contraindications, advantages, disadvantages, complications, equipment and technique for using a dual lumen airway.(C)
**Describe and differentiate between at least three dual lumen airways: PtL, Combitube and King Airway.(C)
*Describe the indications, contraindications, advantages, disadvantages, complications and equipment for rapid sequence intubation with neuromuscular blockade.(C)
*Identify neuromuscular blocking drugs and other agents used in rapid sequence intubation.(C)
*Describe the indications, contraindications, advantages, disadvantages, complications and equipment for sedation during intubation.(C)
*Identify sedative agents used in airway management.(C)
*Describe the indications, contraindications, advantages, disadvantages, complications, equipment and technique for nasotracheal intubation.(C)
*Describe the indications, contraindications, advantages, disadvantages and complications for performing an open crichothyrotomy.(C)
*Describe the equipment and technique for performing an open cricothyrotomy.(C)
*Describe the indications, contraindications, advantages, disadvantages, complications, equipment and technique for translaryngeal catheter ventilation (needle cricothyrotomy).(C)
*Describe methods of assessment for confirming correct placement of an endotracheal tube.(C)
**Describe the indications, contraindications, advantages, disadvantages, complications, equipment and technique for capnography.(C)
**Differentiate possible causes of various waveforms observed on a capnograph.(C)
**Describe the correct positioning and use of the ResQpod during cardiac arrest.(C)
*Describe methods for securing an endotracheal tube.(C)
*Describe the indications, contraindications, advantages, disadvantages, complications, equipment and technique for extubation.(C)
**Describe the indications, contraindications, advantages, disadvantages, complications, equipment and technique for LMA insertion.(C)
*Describe methods of endotracheal intubation in the pediatric patient.(C)
*Defend the need to oxygenate and ventilate a patient.(B)
*Defend the necessity of establishing and/ or maintaining patency of a patient's airway.(B)
**Describe the indications, contraindications, advantages, disadvantages, complications, equipment and technique for Continuous Positive Airway Pressure.(C)
**Identify patients that would benefit from the use of Continuous Positive Airway Pressure.(C)
*Comply with standard precautions to defend against infectious and communicable diseases.(B)
*Perform body substance isolation (BSI) procedures during basic airway management, advanced airway management, and ventilation.(M)
*Perform pulse oximetry.(M)
*Perform end-tidal CO2 detection.(M)
*Perform peak expiratory flow testing.(M)
*Perform manual airway maneuvers, including:(M)
a. Opening the mouth
b. Head-tilt/ chin-lift maneuver
c. Jaw-thrust without head-tilt maneuver
d. Modified jaw-thrust maneuver
*Perform manual airway maneuvers for pediatric patients, including:(M)
a. Opening the mouth
b. Head-tilt/ chin-lift maneuver
c. Jaw-thrust without head-tilt maneuver
d. Modified jaw-thrust maneuver
*Perform the Sellick maneuver (cricoid pressure). (M)
*Perform complete airway obstruction maneuvers, including:(M)
a. Heimlich maneuver
b. Finger sweep
c. Chest thrusts
d. Removal with Magill forceps
*Demonstrate suctioning the upper airway by selecting a suction device, catheter and technique.(M)
*Perform tracheobronchial suctioning in the intubated patient by selecting a suction device, catheter and technique.(M)
*Demonstrate insertion of a nasogastric tube.(M)
*Demonstrate insertion of an orogastric tube.(M)
*Perform gastric decompression by selecting a suction device, catheter and technique.(M)
*Demonstrate insertion of an oropharyngeal airway.(M)
*Demonstrate insertion of a nasopharyngeal airway.(M)
*Demonstrate ventilating a patient by the following techniques:(M)
a. Mouth-to-mask ventilation
b. One person bag-valve mask
c. Two person bag-valve-mask
d. Three person bag-valve-mask
e. Flow-restricted, oxygen-powered ventilation device
f. Automatic transport ventilator
g. Mouth-to-stoma
h. Bag-valve-mask-to-stoma ventilation
*Ventilate a pediatric patient using the one and two person techniques.(M)
*Perform ventilation with a bag-valve-mask with an in-line small-volume nebulizer.(M)
*Perform oxygen delivery from a cylinder and regulator with an oxygen delivery device.(M)
*Perform oxygen delivery with an oxygen humidifier.(M)
*Deliver supplemental oxygen to a breathing patient using the following devices: nasal cannula, simple face mask, partial rebreather mask, non-rebreather mask, and venturi mask. (M)
*Perform stoma suctioning.(M)
*Perform retrieval of foreign bodies from the upper airway.(M)
*Perform assessment to confirm correct placement of the endotracheal tube.(M)
*Intubate the trachea by the following methods:(M)
a. Orotracheal intubation
b. Nasotracheal intubation
c. Multi-lumen airways
d. Digital intubation
e. Transillumination
f. Open cricothyrotomy
*Adequately secure an endotracheal tube.(M)
*Perform endotracheal intubation in the pediatric patient.(M)
*Determine appropriate airway adjuncts for infants and children.(M)
*Discuss complications of improper utilization of airway adjuncts with infants and children.(M)
*Discuss appropriate ventilation devices for infants and children.(M)
*Discuss complications of improper utilization of ventilation devices with infants and children.(M)
*Discuss appropriate endotracheal intubation equipment for infants and children.(M)
*Identify complications of improper endotracheal intubation procedure in infants and children.(M)
*Perform transtracheal catheter ventilation (needle cricothyrotomy).(M)
*Perform extubation.(M)
*Perform replacement of a tracheostomy tube through a stoma.(M)
*Demonstrate the application of a CPAP/ BiPAP unit.(M)
*Demonstrate proper technique for administering blow-by oxygen to infants and children.(M)
*Demonstrate the proper utilization of a pediatric non-rebreather oxygen mask.(M)
*Demonstrate proper technique for suctioning of infants and children.(M)
*Demonstrate appropriate use of airway adjuncts with infants and children.(M)
*Demonstrate appropriate use of ventilation devices for infants and children.(M)
*Demonstrate endotracheal intubation procedures in infants and children.(M)
*Demonstrate appropriate treatment/ management of intubation complications for infants and children.(M)
*Demonstrate appropriate needle cricothyroidotomy in infants and children.(M)
*Demonstrate appropriate interventions for infants and children with a partially obstructed airway.(M)
*Demonstrate age appropriate basic airway clearing maneuvers for infants and children with a completely obstructed airway.(M)
*Demonstrate proper technique for direct laryngoscopy and foreign body retrieval in infants and children with a completely obstructed airway.(M)
*Demonstrate appropriate airway and breathing control maneuvers for infant and child trauma patients.(M)
*Demonstrate appropriate treatment of infants and children requiring advanced airway and breathing control.(M)

 

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