HSPA1000 Fundamentals of Paramedic Practice Spring 2024 PDF

HSPA1000 Spring 2024 Topics: Paramedicine Take 1 minute to write down what Paramedicine means to you.  Paramedicine is a domain of practice and health...

HSPA1000 Spring 2024 Topics: Paramedicine Take 1 minute to write down what Paramedicine means to you.  Paramedicine is a domain of practice and health Roles: Paramedics work Paramedicine: A healthcare profession specializing in emergency and primary under medical direction profession that specializes across a range of or independently, often in care across various settings, including emergency medical services, hospitals, unpredictable settings, settings including, but not limited to, emergency clinics, and nonclinical roles such as providing advanced education, leadership, public health, and medical care and primary care. research Paramedics work in a variety of clinical settings such as emergency medical services, ambulance Paramedicine services, hospitals and clinics as well as non- clinical roles, such as education, leadership, public health and research. Paramedics possess complex knowledge and skills, a broad scope of practice and are an essential part of the healthcare system. Depending on location, paramedics may practice under medical direction or independently, often in unscheduled, unpredictable or dynamic settings. The Definition of Paramedicine: An International Delphi Study - PubMed (nih.gov)  History of Paramedicine History of Paramedicine Ancient Times: Medical care provided in homes; protocols and reimbursements established by the Code of Hammurabi. 1790s: Jean Larrey developed ambulances volantes for field care. World Wars: Development of ambulance corps and field hospitals. 1960s: Training of nonphysician providers for advanced medical procedures. Medical professionals US considers if non- provided care in homes. World Wars I & II saw the physician providers can The Code of Hammurabi development of the be trained to perform created protocols and ambulance corps to care for advanced medical reimbursements for and remove injured persons procedures outside of medical care. from the battlefields. the hospital. 1700 bc 1790 ad Early 1900’s 1950’s 1960’s Jean Larrey, a French physician, Korean War introduced field developed ambulances volantes, or hospitals, (MASH units) and flying travellers, bringing care to helicopter evacuations as an patients in the field. attempt to increase survivability of war related injuries. History of Paramedicine The Paramedic Association of Canada Dr. Eugene Nagel, often US DOT developed the first (PAC) introduced the called the “Father of National Standard National Occupational Paramedicine”, began Curriculum for paramedics Competency Profile for training firefighters with based on the work of Nancy paramedics along with advanced emergency skills. Caroline. the professional titles 1969 1971 1977 1990’s 2000 The first dedicated EMT textbook Canadian Paramedic education was was published in the US. included in under the Canadian Medical Association (CMA) for accreditation. “Recent” History Recent Developments: Leadership organizations, national regulatory bodies, increased research, expanded education and services, improved technology, and decreased mortality and morbidity in critical conditions Development of leadership Expansion of education; vocational Improvement in technology; organizations to define the pathway diplomas to university graduate 911/999, CAD, EPCR, ECG forward for paramedicine. degrees. transmission, prehospital ultrasound, mechanical ventilators, National regulatory bodies and Expansion of services; Community power lift stretchers, learning licensing for paramedics to improve Paramedics, Industrial Paramedics, management systems, etc. standardization of care. Hospital Paramedics, Wilderness Paramedics, Tactical Paramedics, Decreased mortality and morbidity Significant increase in prehospital Flight Paramedics, etc. in trauma, cardiac arrest, and care research studies and critical illness. paramedic led research. Expansion to scope of practice; shift from protocols based care to Decrease in gender disparity. Improved collaboration and clinical practice guidelines. integration with public safety and Increased awareness and health care providers. prioritization of first responder mental health and wellness. Traditional paramedicine education programs have focused on emergency response and resuscitation, with limited education in patient safety, chronic condition management, care of the elderly or public health promotion. The move to higher education presents an opportunity to advance paramedics from emergency technicians to health care clinicians. Hamad Medical Corporation Ambulance Service The Ambulance Service Group has +1500 employees and +150 ambulance. grown remarkably this decade, and Alpha, Charlie, Delta, Lifeflight. this growth can be seen not only in the size of its workforce, but in the Major Incident Response fleet. range of services it provides. Medical, logistics, decontamination. In 2019, HMCAS responded to more In 2018, the average response time was 7- than 350,000 calls (+30% since 2017). 8 minutes (urban vs rural). Hamad Medical Corporation Ambulance Service  Roles and Responsibilities EMS Systems: Integration with public safety and healthcare providers. Roles and Patient Care: Providing quality care, maintaining patient dignity, and ensuring confidentiality. Documentation: Accurate and thorough documentation of patient care events, including electronic patient care reports (EPCRs) Responsibilities EMS Systems The Community The Dispatcher Cardiac Arrest - YouTube The Paramedic CANADA QATAR Roles and Responsibilities Nancy Caroline Emergency Care in the Streets 8th Edition (Canadian) Chapter 1; page 12-13 Nancy Caroline Emergency Care in the Streets 8th Edition (Canadian) Chapter 1; page 12-13 Canada: Licensing & Provincial Registration Qatar: Licensing & HMCAS https://www.moph.gov.qa/english/derpartments/policyaffairs/DHP/Pages/default.aspx Scope of Practice https://dhp.moph.gov.qa/en/Documents/Paramedic%20Scopes.pdf Scope of Practice Scope of Practice Acting Outside the Scope of Practice Deviation from Protocols What is “Medical Oversight”? What is “Medical Oversight”? Paramedic Clinical Support Documentation   A Patient Care Report (PCR) is a legal document that contains all the information about the patient care event, such as the patient assessment, history and treatment provided.  PCR’s must contain specific details such as times, assessment Documentation findings, treatments and interventions, and patient responses.  Fill in sections – drug therapy, vital signs, pain scales, injuries, etc.  Narrative section where the health care provided can “tell the Patient Care story” and provide assessment and treatment details. Report (PCR)  It is required to be completed for every patient care event.  Ambulance services keep a record of the PCR, as well as the hospital in which patient care was transferred.  In hospital settings, patient care documentation is often referred to as the “Patient Chart” or “Health Care Record”.  “Not Documented, Not Done.”  EPCR’s allow for automatic upload of CAD incident data to support the patient care documentation. For example, the dispatch, arrival, Electronic and departure times, as well as location of the incident. Patient Care Report (EPCR) Allow for improved accuracy and safety in documentation by setting mandatory fields and providing diagrams and references for clarification. Patient Care Report  Continuous Quality Improvement (CQI) Nancy Caroline Emergency Care in the Streets 8th Edition (Canadian) Chapter 1; page 14-15 (Improving System Quality)  Continuous Quality Improvement Nancy Caroline Emergency Care in the Streets 8th Edition (Canadian) Chapter 1; page 14-15 (Improving System Quality) What is Professional Development? Professional Development Importance: Safeguards public, employer, and professional; supports evolving medical practices and licensing requirements. Benefits: Improved patient outcomes, increased employability, and enhanced team efficiency. acquisition of skills and knowledge both for personal development and for career advancement. “…acquisition of skills and knowledge both for personal development and for career advancement.” Why do we need Professional Development? safeguards the public, the employer, the professional and the professional’s career. 1. We forget things 1. Low volume skills 2. In depth knowledge 2. Medicine is ALWAYS evolving 1. More efficient and safer practices 2. New research 3. New equipment 4. New protocols 5. Change in population needs 3. Licensing 1. Learning is a requirement to obtain and maintain medical licenses 2. Mitigate practitioner, patient, and public safety concerns 3. Support of new protocols, policies, and changes 4. Evolving scope of practice 5. Proof of competency 6. Liability  Obtaining new and relevant Knowledge, Skills, & Attitudes will make you a more desirable employee. Who Benefits from Professional Development? Paramedic Patient Team Industry Paramedic Gains Knowledge, Skills & Attitudes Intellectual stimulus Increased employability Patient Improved outcomes Efficient treatment Safer treatment Team Peer teaching Diversity Efficiency Industry Shift in mentality Evolving protocols Increased Scope of Practice Safer workplace Evolving workforce What is Professionalism? Professionalism Attributes: Integrity, empathy, self-motivation, communication, teamwork, patient advocacy, and careful delivery of service. Personal Hygiene: Maintaining a neat appearance, using deodorant, and practicing infection control. In your words, please take a moment to write down what you consider the TOP 3 traits a Health Care professional must have. Professionalism: Professionalism in the context of health professions and paramedicine refers to the consistent demonstration of behaviors, attitudes, and values that reflect a commitment to ethical practice, competence, accountability, and respect for patients, colleagues, and the broader community. It encompasses adherence to standards, continuous self-improvement, and the prioritization of patient safety and well-being.  Health Care Professional: A paramedic is considered a health care professional through the following attributes: Conforms to the same standards as other health care professionals Provides quality patient care Instills pride in the profession Strives continuously for high standards Earns respect from others in the profession Meets societal expectations of the profession, whether on of off duty Other attributes of professionalism in paramedicine include: Integrity Empathy Self-motivation Communication Teamwork and respect Patient advocacy Injury prevention Careful delivery of service Nancy Caroline Emergency Care in the Streets 8th Edition (Canadian) Chapter 1; pages 10-12 (Professionalism) Professionalism – Personal Hygiene Maintaining appropriate personal hygiene is an expected action of a professional. You are also expected to assess your own personal hygiene before, during and at the end of each shift. Use the following to guide you; ABC’s of Personal Hygiene Appearance Body Odours Contamination Professionalism – Personal Hygiene Appearance After a busy call, it is especially Uniform: Wearing all approved uniform clothing appropriately. important to do an Appearance check and adjust as required. Clean, pressed, and free of stains or odors. Maximum of 1 shirt button undone. Do not roll sleeves. Having an additional clean uniform at your hub is highly Hijabs tucked completely within the shirt collar. recommended. Personal Appearance: Maintaining a neat and tidy outward appearance. Visible hair (short or long) neat and tidy. Long hair pulled back with hair-tie. Face and teeth clean, free of food and hygienic. Make-up appropriate for a professional environment. Nails are short, clean and free of coloured polish. Professionalism – Personal Hygiene Body Odours It is common to sweat during a busy call or in our hot environment. Keep deodorant and disposable wipes in Wear deodorant your work bag. Use disposable cleansing wipes We all have to eat, but your patient may not appreciate the garlicky Brush teeth regularly shawarma as much as you! Carry a tooth brush, breath mints, or mouth Use breath fresheners wash in your work bag. Stay hydrated Check on your B mid shift (12 hours is a long time) Perform personal hygiene before and after each shift Professionalism – Personal Hygiene Safety first! Protect yourself, your Contamination partner, your patients, your families and the community Wash your hands with soap & water whenever possible. by staying aware and always practicing infection control. Use alcohol based hand rub as an alternative. Your gloves are dirty as soon as you touch your patient. Don’t touch your hair, hijab, glasses, face, etc. Dirty gloves always go into the garbage; not pockets, work bags, or the front of the ambulance. Don’t forget to decontaminate your stethoscope, pen, phone, tablet, and anything else you touched. Don’t put contaminated stethoscopes, pens, phones, etc. in your work bag or lunch bag. Get a designated work bag that is only used for your shifts. Take your uniform off as soon as you get home. Wash your uniform after each wear, even if it doesn’t look dirty. Recommended to have 3 uniforms.  Paramedic Patient Relationship Patient Rights and Advocacy Rights: Informed consent, privacy, autonomy, access to care, respect, safety, and participation in care. Advocacy: Supporting patient rights, ensuring equitable access to care, and addressing systemic issues Nancy Caroline Emergency Care in the Streets 8th Edition (Canadian) Chapter 4; pages 58-76 Patient Rights: The fundamental entitlements of patients to receive respectful, safe, and competent care, ensuring that patients are treated fairly, ethically, and with the utmost respect in all healthcare interactions. These rights include: Informed Consent: Patients have the right to receive clear, comprehensive information about their medical condition, treatment options, and potential risks, enabling them to make informed decisions about their care. Privacy and Confidentiality: Patients have the right to expect that their personal and medical information will be kept confidential and shared only with authorized individuals involved in their care. Autonomy: Patients have the right to make decisions about their own healthcare, including the right to refuse treatment. Access to Care: Patients have the right to access necessary medical care without discrimination. Respect and Dignity: Patients have the right to be treated with respect and dignity, regardless of their background, beliefs, or health condition. Safety: Patients have the right to receive care in a safe environment, free from harm. Participation in Care: Patients have the right to be involved in all aspects of their care planning and treatment. Patient Dignity: The quality of being worthy of esteem or respect the respect and honor given to patients, ensuring their intrinsic value and worth are recognized and preserved. It involves treating patients with compassion, maintaining their privacy, valuing their autonomy and choices, and ensuring they feel respected and valued throughout their care. Confidentiality: Noun; discretion in keeping secret (private) information “The word confidentiality includes the Latin root fides, which means "faith," or "trust.“ Confidentiality is the ethical and legal obligation to safeguard all patient information shared within a healthcare setting, including sensitive medical details, personal data, and any other relevant information. In healthcare and paramedicine, confidentiality ensures that patient privacy is respected and that all patient-related information is disclosed only to authorized individuals involved in the patient's care. Paramedics also have a responsibility to consider the communication environment, ensuring that patient information is not inadvertently disclosed to those outside the circle of care, thus maintaining confidentiality and trust. Behaving Ethically: Behaving ethically entails adhering to principles of morality, integrity, and fairness in one's actions, decisions, and interactions. In healthcare and paramedicine, ethical behavior involves upholding professional standards, respecting patient autonomy, maintaining confidentiality, avoiding conflicts of interest, and prioritizing patient welfare. It also involves honesty, transparency, and accountability in all aspects of practice, fostering trust and confidence in healthcare providers. Ethical behavior requires careful consideration of the consequences of one's actions and a commitment to acting in the best interests of patients and the community.  Consent: Consent refers to the voluntary agreement given by an individual to a proposed course of action, such as a medical treatment or procedure. It involves the individual's understanding of the relevant information, their capacity to make decisions, and their willingness to proceed without coercion or undue influence. Key Principles of Consent: Voluntary: Consent must be given willingly by the individual without coercion or pressure from others. Legal and Mental Capacity: The individual must have the legal authority and mental capacity to make decisions about their medical care. Specificity: Consent must be specific to the particular treatment or procedure being proposed and the healthcare provider delivering it. Informed: Consent must be based on clear, comprehensible information about the proposed treatment or procedure, including its purpose, risks, benefits, and alternatives. Nancy Caroline Emergency Care in the Streets 8th Edition (Canadian) Chapter 4; pages 69-70  Consent: get all the details about a treatment, understand it, and agree to it. If you say no, you’re told about the risks Informed Consent: Informed consent involves providing individuals with comprehensive information about a proposed treatment or procedure, including its purpose, risks, benefits, and alternatives. The individual must understand this information and voluntarily agree to undergo the treatment or procedure based on their comprehension. If a patient refuses a treatment, they must be clearly advised of the risks and possible consequences of their choice. clearly say yes, either by speaking, writing, or gestures like nodding Expressed Consent: Expressed consent occurs when individuals explicitly communicate their agreement to a proposed course of action, either verbally, in writing, or through non-verbal cues such as nods or gestures. This clear affirmation indicates their voluntary agreement to proceed. Implied Consent: In emergencies, it’s assumed you agree to treatment if you can’t say yes, based on the idea that you’d want help if you could. Implied consent is inferred from individuals' actions or circumstances, suggesting their agreement to a proposed course of action. It is typically assumed in emergency situations where immediate intervention is necessary to prevent harm, and the individual is unable to provide express consent. Implied consent is grounded in the principle that individuals would consent to necessary medical treatment if they were able to do so. In such cases, it is understood that the paramedic is acting in the patient's best interest, prioritizing their welfare and safety. Nancy Caroline Emergency Care in the Streets 8th Edition (Canadian) Chapter 4; pages 69-70  Capacity: Capacity means being able to understand information, make a decision, and communicate it. If someone’s mind is not working well, they might not be able to decide. Capacity means the ability to use and understand information to make a decision, and communicate any decision made. A person lacks capacity if their mind is impaired or disturbed in some way, which means they're unable to make a decision at that time. This is about understanding information, thinking about options, and clearly saying what you choose. In healthcare, we check if a patient can make informed decisions about their care. Capacity in decision-making refers to an individual's ability to understand and appreciate relevant information, evaluate available options, and communicate their choices in a consistent and rational manner. In healthcare and paramedicine, capacity is assessed to determine if a patient has the cognitive ability to make informed decisions about their medical care, treatment options, and other related matters.This assessment considers factors such as the patient's comprehension of their condition, the risks and benefits of treatment, and their ability to weigh the consequences of their decisions. A person’s ability to decide can change during a call, like if they have a head injury or are very intoxicated. Capacity may change during a call based on the patients condition, such as a progressive head injury or significant toxic impairments. Nancy Caroline Emergency Care in the Streets 8th Edition (Canadian) Chapter 4; pages 70-71  Refusal of Care: At times, patients may refuses treatment or transport, despite the paramedics recommendations. Assessing the patient's capacity to make informed decisions is crucial, evaluating their ability to understand, appreciate, and communicate their decision regarding their care. Informed consent is key, as patients must comprehend the risks, benefits, and alternatives to the proposed treatment or intervention. During capacity assessment, healthcare providers assess patient understanding, confirm voluntary decision-making, and address patient concerns or questions. They must also clearly rule out any medical conditions which could impair a patients capacity in decision making, including hypoxia, hypoglycemia, head injury, strokes, or significant intoxication. Documentation of the refusal process is essential, including details of the capacity assessment, informed consent discussion, and patient rationale for refusal. This documentation ensures transparency, accountability, and continuity of care, while also protecting the patient's autonomy and rights. Nancy Caroline Emergency Care in the Streets 8th Edition (Canadian) Chapter 4; page 71-72 Patient Advocacy: Patient advocacy involves supporting and promoting the rights, interests, and well-being of individuals within the healthcare system. Advocates ensure that patients receive quality care, have access to resources, and are treated with dignity. They empower patients to make informed decisions and navigate healthcare complexities. Healthcare providers and paramedics act as advocates by prioritizing patient needs, respecting autonomy, and ensuring equitable access to care. They communicate effectively, provide education, and address patient concerns. Advocacy also involves identifying and addressing systemic issues affecting patient care, such as disparities or barriers to access. A paramedic encounters a patient with limited English proficiency and uses interpretation services to communicate effectively with them, ensuring they understand their condition and the proposed treatment plan. The paramedic advocates for the patient by advocating for language-appropriate care and involving family members or support persons as needed. Additionally, the paramedic ensures that the patient's cultural and religious beliefs are respected throughout the care process, promoting patient-centered care. Psychosocial Supports: Psychosocial support in healthcare involves addressing the emotional, social, and psychological needs of patients alongside their medical care. For healthcare providers and paramedics, this means recognizing and responding to patients' feelings, concerns, and social circumstances. It involves fostering a compassionate and empathetic patient-provider relationship that acknowledges the patient as a whole person, not just a medical condition. Patient-centered care is an approach that prioritizes the patient's preferences, values, and needs in decision-making and care delivery. It involves actively involving patients in their care, listening to their concerns, and respecting their autonomy and dignity. Extending psychosocial support to the family involves recognizing that illness or injury can affect not only the patient but also their loved ones. Healthcare providers and paramedics can involve family members in discussions about care decisions, provide information and resources to support them, and offer empathy and understanding during difficult times. Effective Communication Effective Communication Skills: Verbal and non-verbal communication, interviewing techniques, and avoiding communication errors. Patient Interaction: Building a compassionate and empathetic relationship, involving family members, and respecting cultural and religious beliefs. Effective Communication – Question Types Nancy Caroline Emergency Care in the Streets 8th Edition (Canadian) Chapter 10 Effective Communication – Interviewing Techniques Nancy Caroline Emergency Care in the Streets 8th Edition (Canadian) Chapter 10 Verbal Communication Skills Nancy Caroline Emergency Care in the Streets 8th Edition (Canadian) Chapter 10 Verbal Communication Skills Nancy Caroline Emergency Care in the Streets 8th Edition (Canadian) Chapter 10 Non-Verbal Communication Skills Nancy Caroline Emergency Care in the Streets 8th Edition (Canadian) Chapter 10 Non-Verbal Communication Skills Nancy Caroline Emergency Care in the Streets 8th Edition (Canadian) Chapter 10 Communication Errors Nancy Caroline Emergency Care in the Streets 8th Edition (Canadian) Chapter 10 Effective Communication - Terms Effective Communication - Terms Chapter References – Study Guide