Extended Care Paramedic Guidelines Quiz
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Questions and Answers

What is the primary role of an Extended Care Paramedic (ECP)?

  • To provide emergency medical services in the community.
  • To provide primary care services in the community.
  • To provide transportation services for critically ill patients in the community.
  • To provide specialized care to patients with complex medical needs in the community. (correct)

    • ECPs are authorized to administer opioids via any route, including ketamine.

    False

    Which of the following is a key difference between ECP and Emergency Ambulance Service (EAS) practice in terms of analgesia?

  • ECPs can only administer analgesics through the intravenous route.
  • ECPs can administer analgesics for a longer duration than EAS paramedics. (correct)
  • ECPs cannot administer local anesthetics.
  • ECPs cannot administer opioids in the community.

    • What is the general principle for administering analgesia in ECP practice?

    <p>Administer the lowest effective dose of analgesics to achieve the longest possible duration of pain relief.</p> Signup and view all the answers

    Which of the following is NOT a common point of care test (POCT) used in ECP practice?

    <p>X-ray.</p> Signup and view all the answers

    ECPs are trained to interpret chest x-rays.

    <p>False</p> Signup and view all the answers

    What are the four components of the Te Whare Tapa Whā framework?

    <p>Taha Tinana (Physical health), Taha Wairua (Spiritual health), Taha Whānau (Family health), Taha Hinengaro (Mental health)</p> Signup and view all the answers

    ECPs are encouraged to use local pathways whenever possible.

    <p>True</p> Signup and view all the answers

    What is the primary avenue for ECPs seeking clinical advice?

    <p>The Clinical Desk</p> Signup and view all the answers

    Which of the following is NOT a key principle of crew resource management (CRM) in ECP practice?

    <p>Prescribe medications according to their individual expertise and preference.</p> Signup and view all the answers

    What is the significance of the 'hop test' in assessing abdominal pain in children?

    <p>The hop test is a manoeuvre used to assess for appendicitis, which is a common cause of abdominal pain in children. It involves having the child hop on one leg, often while holding the other leg still, and observing for signs of pain or resistance.</p> Signup and view all the answers

    A normal electrocardiogram (ECG) rules out myocardial ischemia in a patient presenting with upper abdominal pain.

    <p>False</p> Signup and view all the answers

    What is the most specific indicator of urinary tract infection (UTI) on a dipstick urinalysis?

    <p>Positive nitrite.</p> Signup and view all the answers

    What are the advantages of POCT in ECP practice?

    <p>POCT offers several advantages in ECP practice, including faster results, portability, expanded capability, and enhanced availability.</p> Signup and view all the answers

    ECPs are required to perform a complete neurological assessment on every patient they see.

    <p>False</p> Signup and view all the answers

    Which of the following is a common risk factor for delayed wound healing?

    <p>Smoking.</p> Signup and view all the answers

    In assessing the cardiovascular system, which of the following is NOT a finding to be documented?

    <p>Presence of murmurs.</p> Signup and view all the answers

    What does the acronym 'TIMES' stand for in the TIMES model for assessing chronic wounds?

    <p>Tissue, Infection, Moisture, Edges, Surrounding skin</p> Signup and view all the answers

    ECPs are trained to interpret and manage all potential incidental findings on POCUS.

    <p>False</p> Signup and view all the answers

    ECPs are authorized to perform fasciotomy.

    <p>False</p> Signup and view all the answers

    ECPs are encouraged to provide treatment for conditions like a radial head subluxation in children?

    <p>True</p> Signup and view all the answers

    ECPs are discouraged from utilizing local pathways, as these are often out of date?

    <p>False</p> Signup and view all the answers

    Match the following clinical assessments with their corresponding body system:

    <p>Visual acuity assessment = Eye Auscultation of bowel sounds = Abdomen Assessment of joint range of motion = Musculoskeletal Palpation of lymph nodes = Lymphatic Assessment of breath sounds = Respiratory Palpation of the chest wall = Respiratory Assessment of hearing using whispered words = Ear</p> Signup and view all the answers

    What is the purpose of the 1-minute sit-to-stand test?

    <p>The 1-minute sit-to-stand test is a useful tool to assess occult respiratory compromise in patients with seemingly mild respiratory illness. It helps identify patients who may have borderline respiratory function and require further evaluation.</p> Signup and view all the answers

    What are the two main categories of risk factors for delayed wound healing?

    <p>Patient risk factors (e.g., age, immunocompromise, smoking) and wound risk factors (e.g., infection, contamination, size, location)</p> Signup and view all the answers

    In the context of managing acute pain, which of the following is NOT considered a key difference between ECP and EAS practice?

    <p>ECPs use a more limited range of oral analgesic options.</p> Signup and view all the answers

    ECPs should always perform a rectal examination when assessing abdominal pain.

    <p>False</p> Signup and view all the answers

    ECPs are authorized to perform a regional anesthesia block, such as a fascia iliaca block.

    <p>True</p> Signup and view all the answers

    What is the purpose of the 'four frames' approach to history taking?

    <p>The 'four frames' approach provides a structured framework for obtaining a comprehensive patient history. It helps ensure that ECPs gather information about the presenting complaint, past medical history, social and family history, and the patient's own ideas, concerns, and expectations.</p> Signup and view all the answers

    ECPs are trained to perform advanced life-saving interventions, such as chest compressions.

    <p>True</p> Signup and view all the answers

    What is the recommended approach to managing concerning incidental findings on point-of-care ultrasound (POCUS)?

    <p>Concerning incidental findings discovered on POCUS should be referred to the patient's usual primary care provider for further assessment and management.</p> Signup and view all the answers

    ECPs are always required to contact the Clinical Desk before providing any treatment to a patient.

    <p>False</p> Signup and view all the answers

    ECPs are authorized to remove foreign bodies from the eye using forceps.

    <p>False</p> Signup and view all the answers

    What is the importance of documenting all treatment and referral decisions made by an ECP?

    <p>Comprehensive documentation of treatment and referral decisions ensures continuity of care, accountability, and potential for clinical audit. It allows other healthcare providers to understand the patient's history and follow up appropriately.</p> Signup and view all the answers

    ECPs are not required to seek permission from a patient before performing an intimate physical examination?

    <p>False</p> Signup and view all the answers

    ECPs are trained to perform spinal manipulation?

    <p>False</p> Signup and view all the answers

    The ECP document states that all patients must have a rectal examination.

    <p>False</p> Signup and view all the answers

    When performing a gastrointestinal assessment, what is the best way to document bowel sounds?

    <p>Present.</p> Signup and view all the answers

    Why are the elderly more susceptible to AKI from NSAIDs?

    <p>The elderly are vulnerable to AKI (Acute Kidney Injury) from NSAIDs due to age-related decreased renal function, pre-existing renal disease, and polypharmacy (multiple medications).</p> Signup and view all the answers

    What does the acronym 'MCS' stand for in the context of wound assessment?

    <p>Microbiological Culture Sensitivity.</p> Signup and view all the answers

    ECPs are authorized to perform a full assessment of the ear without an otoscope?

    <p>False</p> Signup and view all the answers

    ECPs should administer medications based on their personal preference rather than following CPG guidelines.

    <p>False</p> Signup and view all the answers

    ECPs should always document the rationale for any treatment/referral decisions they make.

    <p>True</p> Signup and view all the answers

    What is the recommended method for assessing the presence of dehydration?

    <p>All of the above.</p> Signup and view all the answers

    What is the primary purpose of the 'Ideas, Concerns, and Expectations' (ICE) component of the history-taking process?

    <p>The ICE component of history taking allows ECPs to understand the patient's perspective and expectations regarding their health condition and the desired outcome of the encounter.</p> Signup and view all the answers

    Why is it important to check for pertinent negatives in the patient's history?

    <p>Identifying pertinent negatives helps to exclude possible diagnoses and guide the ECP's assessment and treatment plan.</p> Signup and view all the answers

    The Te Whare Tapa Whā framework recognizes that health is more than just physical problems?

    <p>True</p> Signup and view all the answers

    ECPs are trained to diagnose and treat acute myocardial infarction?

    <p>False</p> Signup and view all the answers

    ECPs are authorized to perform a complete physical assessment on all patients.

    <p>False</p> Signup and view all the answers

    ECPs are trained to perform advanced airway management techniques, such as intubation?

    <p>True</p> Signup and view all the answers

    ECPs are authorized to administer medications that are not listed in the ECP CPGs?

    <p>True</p> Signup and view all the answers

    The ECP CPGs are intended to replace the EAS CPGs.

    <p>False</p> Signup and view all the answers

    Study Notes

    Extended Care Paramedic (ECP) Clinical Practice Guidelines

    • ECP Delegated Scope of Practice (CPG ECP 1.1): The ECP's scope includes all paramedic skills and medicines, plus additional ones listed in the guideline. This includes various medications (e.g., oral and injectable forms of amlodipine, amoxicillin, codeine, and others), local anesthetics, vaccines, and procedures (e.g., abscess incision, ingrown toenail management, NGT placement).

    General Principles (CPG ECP 1.2)

    • Relationship with EAS CPGs: The ECP guidelines complement the Emergency Ambulance Sector (EAS) guidelines. If a condition is covered by both sets, the ECP guidelines supersede the EAS guidelines, specifically regarding patient referral criteria.

    • Clinical Judgement: Use clinical judgment when applying ECP criteria to ensure patient benefit without unnecessary risk. Community management typically involves referral back to the patient's primary care provider.

    • Clinical Advice: The Clinical Desk is the primary source for ECPs seeking clinical advice. Personnel should follow EAS guidelines when obtaining advice. Alternative avenues (e.g., on-call primary care provider) can be used where feasible.

    • Treatment Outside CPGs: If necessary, ECPs may administer medications or provide treatments not specified in the guidelines. This must be clearly in the patient's best interest, documented, and sent for audit.

    • Adoption by Other Employers: These guidelines must be formally endorsed as standing orders for any employer other than St John or Wellington Free Ambulance. Additional medications or interventions must be covered by employer clinical governance personnel.

    Crew Resource Management in ECP Practice (CPG ECP 1.3)

    • Adaptation of CRM: ECPs often work alone or in less time-constrained environments than traditional ambulance situations. Crew resource management (CRM) principles need adapting. This includes considering early if ECP vs. EAS model is most appropriate, clearly establishing a team leader (if applicable), ensuring effective communication with patient and caregivers, obtaining and communicating the transport/referral plan, and using resources appropriately.

    Clinical Assessment (CPG ECP 1.4)

    • Comprehensive Assessment: ECPs should conduct thorough assessments, beyond basic requirements, when indicated, with patient consent, and appropriate equipment/facilities. The Te Whare Tapa Whā framework can be used to consider physical, spiritual, family, and mental health.

    • History: Use the 'four frames' approach: presenting complaint (including history and pertinent negatives), past medical history (including medications and allergies), social/family history (including mobility, support, and ADLs), and ideas, concerns, and expectations.

    • Examination: Tailor the examination to the presenting complaint. A general examination should be conducted on all patients, including vital signs, and observations. Specific consent is required for sensitive assessments.

    • Systems Assessment: A head to toe, multisystem assessment may not be necessary; specific systems (e.g., cardiovascular, respiratory, abdominal, neurological, musculoskeletal, eye, ear, nose, throat (ENT), dental, wound, lymphatic) are detailed, including relevant assessments, findings, and considerations for referral.

    • Urinalysis: Dipstick tests are crucial; specific interpretations for UTI, kidney issues, dehydration, and pregnancy are described.

    • Medical Imaging: Guidelines for referring to X-rays and ultrasound are included.

    Point of Care Testing (POCT) (CPG ECP 1.5)

    • Definition and Types: POCT are tests performed without external lab analysis, including blood glucose, pregnancy tests, urinalysis, PEFR, and ECG. POC testing is an adjunct to overall assessment.

    • Advantages: Speed, portability, availability and expanded capability.

    • Disadvantages: Quality control maintenance, validity concerns, record linkage challenges and cost.

    • Quality Control: Devices have built-in internal quality controls. Daily checks, logging, and proper storage/maintenance are crucial.

    • i-STAT and POCUS: i-STAT, while available in other settings, is not always common. POC Ultrasounds (POCUS) have a more limited scope, and focused use is outlined.

    Analgesia: Acute Pain (CPG ECP 1.6)

    • Focus on Community Management: ECPs manage acute pain in the community, including supplying analgesia for several days, and have a range of oral and local anaesthetic options.

    • Stepwise Progression: Use a multi-modal, stepwise approach (different steps for ages <14 and ≥14) according to pain severity, using the 'analgesia steps table'.

    • Elderly Considerations: Administering medications to the elderly is more complex due to polypharmacy and potential interactions. Consider specific risk factors and adverse effects when selecting analgesia for older patients.

    • Referral Guidance: Severe, undiagnosed pain requires urgent referral to an Emergency Department.

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    ECP Clinical Practice Guidelines PDF

    Description

    Test your knowledge on the Extended Care Paramedic (ECP) Clinical Practice Guidelines. This quiz covers the ECP's delegated scope of practice, general principles, and the relationship between ECP guidelines and Emergency Ambulance Sector guidelines. Assess your understanding of clinical judgment and patient management practices.

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