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Lisa Cookston
ROP Career Specialist
Orange County Emergency Medical
Services
• Goal to understand and participate in supplementing current EMT curriculum with new nationwide standards.
• I chose to explore Orange County’s EMT program because I work with many students who are interested in EMT and Fire service.
• I also work with Coastline Regional Occupational Program’s EMT courses scheduling EMT students for their clinical experiences.
ParamedicBLS Program Coordinator714-834-6233 Suite 301ASanta Ana, Ca 92701714-834-3500 • EMT classes are offered through out Orange County through community colleges and ROP programs. • The curriculum for these classes encompassed 12 basic life support skills. To meet Orange County Emergency Services accreditation 6 new skills were added to the EMT curriculum.
7. Immobilization skills traction splinting 9. Airway, oxygen and ventillation skills upper airway 10.Mouth to mask with supplemental oxygen 12.Ventilatory management endotracheal intubation (discussed with students but did not test on this •Endotracheal Tube and Tracheostomy Tube Suctioning OCEMS EMT “Accreditation”
Curriculum
Intro to OCEMS
Facilities (base stations, trauma centers, PRCs, CVRCc,
Neuro Centers, Burn, etc…)
Destination decisions (I-40 Transport Guidelines)
The 13 ALS Providers
The 1 air transport provider (Mercy Air), Orange County Fire Authority Air Rescue
occasion may be available
OCEMS approved CE providers with contact information
OCEMS approved/accredited educational programs
EMT Scope of Practice
▫ Handout of review of basic EMT State ▫ Specific Orange County EMS EMT scope of KCL/1000ml, additional other basic solutions per OCEMS medical director 2. Preset self-contained medication infusion Central Lines:• Okay to Transport: Any central vascular access line that does not require a constant infusion to keep the line open.
• Cannot Transport: Any patient with a central vascular access line that is presently being used to monitor the patient’s condition, status, and or signs of life – requires ALS for transport.
• Cannot Transport: Any patient with an arterial line – requires ALS ▫ Provide handout of policy 300 and I-40 ▫ Review of I-40 Procedure, specifically ▫ Provide handout on OCEMS BLS treatment ▫ Review of OCEMS DNR policy and California x Each training program shall use a common OCEMS approved skill checklistx Each student shall have a checklist completed for each skill that requires competency x Each training program may choose to validate skills individually or in a group settingx If skills testing is performed in a group setting the proctor student ration shall not exceed 6 x Administer: A medication carried on a BLS ambulance (Medication brought to the scene by x Assist: A medication that is the patient’s own prescribed medication ▫ Reinforce/review 7 patients rights of medication administration x Right Dosagex Right Routex Right Time (expiration, not exceeding maximum dose, etc…)x Right Documentationx Right Response (Proper reassessment and re-evaluation of patient) CONTACT ALS and RAPID TRANSPORT (refer to I-40) for
ALL of the Patients below:
▫ Use of auto-injector
x Epinephrine Auto-Injector
x Review of Patient’s own epinephrine auto-injector ▫ Medication administration technique▫ Proper disposal Reassessment after interventions (oxygen, positioning, patient’s own epinephrine auto-injector, pulse oximetry monitoring, etc…) x Documentation of all of the abovex Proficient student return demonstration of administration of a prop/trainer epinephrine auto-injector to a mock patient x Mark One® and Duodote® Auto-Injector for self
administration
x Review of S-L-U-D-G-E-M (salivation, lacrimation, urination, defecation, gastroinstestinal, emesis, muscle twitching) symptoms consistent with known or suspected exposure to an organophosphate Mark One® and Duodote® Auto-Injector for self administration
2.Review of the types of antidote auto-injectors available for self 3.Review of technique for self administration 4.Reassessment of self looking for S-L-U-D-G-E-M symptoms or other changes to consider repeating auto-injector dose one time 5.Seek further medical care and documentation 6.Discuss limiting spread of nerve agent/organophosphate compound by speaking with public safety personnel on scene 7.Proficient return student demonstration of self administration Use of metered-dose-inhaler
• Albuterol or Atrovent
x Review of patient’s own metered-dose-inhaler (MDI) ▫ Medication administration technique▫ Spacers x Reassessment after interventions (oxygen, positioning, patient’s own MDI, pulse oximetry monitoring, respiratory rate, tidal volume, effort quality, etc…) x Documentation of all of the abovex Proficient student return demonstration of administration of a prop metered-dose-inhaler to a mock patient Nitroglycerine – tablet and spray
• Contraindications:
x Recent head injuryx Recent use of medications to treat erectile dysfunction such x Nitroglycerine tablets
x Review of patient’s own sublingual nitroglycerine tabletsx Reassessment after interventions (oxygen, positioning, patient’s own nitroglycerine, pulse oximetry, pain scale, x Documentation of all of the abovex Proficient student return demonstration of administration of a prop sublingual nitroglycerine tablet to a mock Nitroglycerine – tablet and spray continued
x Nitroglycerine Spray
x Review of patient’s own sublingual nitroglycerine x Reassessment after interventions (oxygen, positioning, patient’s own nitroglycerine, pulse oximetry, pain scale, respiratory status, etc…) x Documentation of all of the abovex Proficient student return demonstration of administration of a prop sublingual nitroglycerine spray to a mock patient FDA® approved oral glucose agents – gels, tablets, liquid
Contraindications:
x Unresponsivenessx Inability to swallow or control own airway Oral Glucose Gel, Tablets and Liquids
x Review of oral glucose gel, tablets and liquids and x Reassessment after interventions (oxygen, positioning, oral glucose gel, pulse oximetry, mental status, etc…) x Documentation of all of the abovex Proficient student return demonstration of prop oral 12-lead placement
x Review of anatomical landmarks, intercostal spaces, x Demonstration of proper lead placement using x Discuss patient privacy/modesty and appropriate lead placement and techniques on women.
x Proficient return student demonstration indicating proper placement of leads on either a manikin or other appropriate model Pulse Oximetry Use
x Review of proper application and placement of x Treat patient’s symptoms, not the pulse oximeters x Documentation of pulse oximeters readingsx Care and maintenance of common pre-hospital pulse oximeters per manufacturer’s recommendations x Proficient return student demonstration of pulse oximetry use and documentation on a mock Tourniquet application
x Discuss and review control of hemorrhage to an extremity x Demonstrate control of external hemorrhage to an extremity using an OCEMS approved tourniquet (proper placement in relation to wound and x Demonstrate and discuss proper assessment of circulation, sensation and motor of the extremity before and after placement of the tourniquet and x Documentation of tourniquet application x Proficient student return demonstration of application of an OCEMS approved tourniquet or simulated tourniquet to control hemorrhage to an extremity with proper assessment of circulation, sensation and motor before and after tourniquet application on a mock patient Glucometer use
x Review of aseptic technique, BSI and required equipment x Demonstration of the use of an FDA approved glucometer to obtain a fingerstick serum glucose value, including care of the x Discuss and/or demonstrate the care, cleaning and routine calibration of a common FDA approved glucometer per • Proficient student return demonstration of obtaining a fingerstick serum blood glucose value and documentation of the results on a mock patient, with proper wound care, and sharps disposal Monitoring IV site
x Reference OCEMS intravenous policy ## x Review of types of IV tubing x Explanation of TKO (to-keep-open) or KVO (keep- vein-open) rate and how to calculate this by counting the drops per minute x Demonstrate how to prepare an IV bag and tubing Monitoring IV site continued
x Discuss different types of common IV dressing and when it is appropriate to reinforce a dressing, such as when an IV site is x Discuss integrity of IV flow and common causes of occlusions x Signs and symptoms of IV site infiltrationx Signs and symptoms of IV site infection x When to shut off the IV infusion by clamping the tubing and x Discussion of types of preset infusion pumps Student assessment
▫ Final written exam standardized between all • Please see email attachments for skill sheets • Fall 2009 EMT are including new accredited • In the position of Career Specialist I will use I will provide an outline of skills so students are aware of what skills they will learn and be • In recruiting students I will share skills that are taught in EMT course, informing them that with certification in these skills they will be prepared to test in the EMS field.
• One of the most profound lessons was how labor intensive and time consuming it is to review, coordinate, and implement class curriculum.
• The EMT curriculum task force was made up of representatives from Saddleback College, Santa Ana College, Orange County Fire Authority, Care Ambulance, Coastline Regional Occupational • Addition to the current EMT curriculum allows for standardization throughout Orange County • A definite highlight is actually seeing the new skills taught in our current EMT classes and realizing the standard of education and medical services has improved.

Source: http://www.saddleback.edu/uploads/cte/collaborative/media/Cookston-Externship.pdf