Extended Care Paramedic Guidelines Quiz

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.