Clinical Handbook_2024_rev.docx

2024 Cincinnati Fire Department Clinical Handbook for Field Internship and Hospital Clinical Requirements 1/8/2024 – 11/2/2024 Table of Contents Overview Key Terms Approval Field Experience and Clinical Specifics Schedule Student Attire Required Skills Team Leads Submission Requirements Bloodborn...

2024 Cincinnati Fire Department Clinical Handbook for Field Internship and Hospital Clinical Requirements 1/8/2024 – 11/2/2024 Table of Contents Overview Key Terms Approval Field Experience and Clinical Specifics Schedule Student Attire Required Skills Team Leads Submission Requirements Bloodborne Pathogens Attendance Affective Domain Grade Overview Paramedic programs are designed to be a continuous course of study and facilitating a smooth transition through the clinical and field internship phases is crucial. The didactic classroom portion is amplified by the hands-on clinical experience. The CFD paramedic program includes specific EMS field internship, hospital clinical, and other clinical experiences. These shifts are designed to allow students to practice and perfect psychomotor skills learned in class, gain applicable field experience, understand the role of a lead paramedic, and enhance each student’s overall skills and competent performance. Key Terms Formative An activity in which the student performance is assessed to provide feedback to the student during the educational experience and expose the student to a variety of patients and conditions. The student is learning how to effectively perform an ALS level skill or assessment under the direct supervision of a verified preceptor. Think of Formative as a rookie fire fighter (FF1) Completed during Term 1 and Term 2 Competency The performance expectation by which the educational program can attest that the student has amassed a portfolio of demonstrated performance of skills and abilities necessary for safe and effective care. The student has mastered the skills and assessment and is learning how to serve in the lead role for patient care with little or no prompting from the preceptor. Think of Competency as a senior fire fighter (FF4) Completed during Term 3 Capstone Capstone refers to a culminating student experience in which students apply the concepts that they have learned to solve real-life problems. It is an opportunity for students to demonstrate that they have achieved the terminal goals for learning established by their educational program and to demonstrate entry level competency in the profession. The student is performing at the highest level with little to no guidance in the wholistic approach to pre-hospital emergency medical care. Activities occurring toward the end of the educational process to allow students to develop and practice high-level decision making by integrating and applying their Paramedic learning. Completed during Term 4 Student Minimum Competencies (SMC) The Committee on Accreditation for the Emergency Medical Services Professional (CoAEMSP) has stated that the primary goal of any Paramedic education program is to assure students are competent at the end of the program of study, both academically and practically. To this end, CoAEMSP has developed the Student Minimum Competency (SMC) requirement to track and report minimum competencies for various age groups, complaints, and skills. The SMC includes Table 1 Ages, Table 2 Pathology/Complaints (Conditions), Table 3 Motor Skill Competency Assessed on Patients During Clinical, Field Experience, or Capstone Field Internship, and Table 4 Capstone Field Internship Team Leads. Table 1 Ages – conducts patient assessment (primary and secondary assessment), performs motor skills if appropriate and available, and assists with development of a management plan in patient exposures for variety of patients aged from neonate to geriatric with appropriate minimum number of patient exposures. Table 2 Pathology/Complaint – the specific medical condition of the patient that has prompted the patient encounter and the specific nuances relative to each pathology Table 3 Motor Skills – assessment of psychomotor skills performed or simulated at an ALS level in either a lab, clinical, or field experience environment. Table 4 Capstone Team Leads – the culmination of clinical experience where the paramedic student successfully manages the scene, performs patient assessment, directs medical care and transport as a Team Leader (Lead Paramedic) with minimal to no assistance. See stand-alone SMC document to review skill requirements per CoAEMSP. Team Member Student serves as part of a team under the guidance and direct supervision of a verified preceptor to develop cognitive, affective, and psychomotor tools to best assess and treat a patient at the paramedic level. Student conducts patient assessment, perform skills, and assists with development of a management plan for the patient with assistance from a verified preceptor. Team Lead Student conducts a comprehensive assessment (not necessary to perform the entire interview or physical exam, but rather been in charge-of the assessment), as well as formulated and implemented a treatment plan for the patient. This means that most (if not all) of the decisions have been made by the student, especially formulating a field impression, directing the treatment, determining patient acuity, disposition and packaging and moving the patient (if applicable). Minimal to no prompting was needed by the preceptor. No action was initiated/performed that endangered the physical or psychological safety of the patient, bystanders, first responders or crew. To be counted as a Team Lead during the Formative stage, the paramedic student MUST accompany the transport team AS A THIRD MEMBER (non-staffing/extra assignment) to a higher level of care or termination of resuscitation in the field (cardiac arrest) and function as Team Leader under the guidance of a verified preceptor. Approval A student must receive program approval by the Clinical Coordinator prior to being scheduled for field internship or clinical shifts. The student must: Complete the appropriate Health Screening Form. Complete the appropriate General Health and Safety Information Form. Completely the appropriate Student Requirements for Shot Records Form to document all required and current immunizations have been completed within the appropriate time period or submission of titer results with appropriate levels of protection. Complete the appropriate COVID Attestation form. Complete the appropriate Student Confidentiality agreement. Submit copy of COVID-19 Vaccination records OR approved COVID-19 Vaccination Exemption Process form Completion of other appropriate forms deemed necessary by the Clinical Coordinator. Must have a 75% class academic average. Must complete the core didactic topics relative to each Term and Clinical. Must demonstrate skill competency during the appropriate lab sessions. Field Internship and Hospital Clinical Specifics Ohio Department of Public Safety and OAC §4765-17-04 Paramedic Curriculum state that EMS training programs must devote at least four hundred hours to clinical and field training, including minimum skills set competency. Accordingly, and consistent with CoAEMSP requirements, the CFD Paramedic Program requires 414 hours of Field Internship and Hospital Clinical training. Clinical rotations will occur at scheduled times and durations throughout the course. It is the student’s responsibility to schedule and log a completed clinical shift through Platinum Planner. Once a field internship or hospital clinical begins, it can be continued until the class final exam is administered. However, ALL clinical and SMC category requirements must be completed prior to sitting for the class final exam. Term 1 No EMS Field Internship Clinical Will be conducting lab skills to prepare for Term II UCMC Cadaver Lab Planned, scheduled, educational student experience with patient contact activities in a hospital educational cadaver lab setting to closely examine, evaluate, and understand the detailed structure of the human body and psychomotor advanced airway management and interosseous access skills in preparation for Field Internship and Hospital Clinicals. 5 hours in Formative stage Clinical conducted with staff and/or UCMC Office of Medical Director Fellows for a five (5) hour time block. Term 2 EMS Field Internship Planned, scheduled, educational student time on an advanced life support (ALS) unit responsible for responding to critical and emergent patients who access the emergency medical system to develop and evaluate team skills in the cognitive, psychomotor and affective domains. Clinical conducted with trained and verified paramedic preceptor at an approved field internship location (must have a current approved field internship fire department agreement on file) for a maximum of a twelve (12) hour time block per clinical. Phase I – 36 hours in Formative stage Begins 3/28/2024 and ends 4/27/2024 No Skill shall be permitted in the field internship or hospital clinical setting until didactic education and lab training have been completed and documented, Motor Skills Permitted Establish IV access Establish IO access Administer IV bolus medication Administer IV infusion medication Administer IM injection Administer Sub-Q injection Perform PPV w/ BVM Perform Endotracheal intubation adult Perform Endotracheal suctioning adult Perform foreign body airway obstruction (FBAO) removal with Magill forceps Perform surgical cricothyrotomy Insert supraglottic airway Perform needle decompression of the chest Perform chest compressions Perform defibrillation For external students, a recommended minimum of 12 hours of EMS Field Internship Phase I must be completed on a Cincinnati Fire Department (CFD) Medic Unit Phase II – 72 hours in Formative stage Begins 4/28/2024 and ends 6/05/24 A recommended minimum of 36 hours of EMS Field Internship Phase II must be completed on a Cincinnati Fire Department (CFD) Medic Unit For external students, a mandatory minimum of 48 hours of EMS Field Internship during Phase I and Phase II shall be conducted on Cincinnati Fire Department (CFD) Medic Units A total of 10 Formative Team Member roles, 30 Formative Team Lead roles, and all applicable Age and Pathology requirements in the Formative stage must be completed prior to entry into the Competency Field Internship stage. University of Cincinnati Medic Center (UCMC) Emergency Department (ED) Clinical Planned, scheduled, educational student experience with patient contact activities in a hospital emergency department setting. Phase I – 20 hours in Formative stage Clinical conducted with verified and compensated nurse preceptor with three (3) students for a five (5) hour time block. Student must document five (5) Live Patient Blood Draws as mandated by the Ohio Department of Public Safety and OAC §4765-17-04 Paramedic Curriculum UCMC Operating Room (OR) Outpatient Clinical Planned, scheduled, educational student experience with patient contact activities in a hospital operating room (outpatient) setting to acquire advanced airway management skills, including endotracheal intubation and insertion of supraglottic airways. 12 hours in Formative and Competency stage Clinical conducted with verified nurse preceptor for a six (6) hour time block. Student must document three (3) Live Patient Intubations as mandated by the Ohio Department of Public Safety and OAC §4765-17-04 Paramedic Curriculum Term 3 EMS Field Internship Phase III – 120 hours in the Competency Stage (when approved and applicable) Begins 6/6/2024 and ends 8/21/2024. Additional Motor Skills Permitted Administer bronchodilator medication Perform endotracheal intubation pediatric Perform synchronized cardioversion Perform transcutaneous pacing For external students, a minimum of 60 hours of EMS Field Internship during Phase III shall be conducted on CFD Medic Units. UCMC ED Clinical Planned, scheduled, educational student experience with patient contact activities in a hospital emergency department setting. Phase II – 10 hours in the Competency stage (when approved and applicable) Cincinnati Childrens Hospital Medical Center (CCHMC) Emergency Department (ED) Clinical Planned, scheduled, educational student experience with patient contact activities in a pediatric hospital emergency department setting. 20 hours in Formative and Competency stages Clinical conducted with verified paramedic or nurse preceptor for a four (4) hour time block. Psychiatric/Behavioral Clinical Planned, scheduled, educational student experience with patient contact activities in a hospital behavioral department setting. 3 hours in Formative and Competency stages Clinical conducted with verified nurse preceptor for a three (3) hour time block. CCHMC Recovery Room/Post-Anesthesia Care Unit (PACU) Clinical Planned, scheduled, educational student experience with patient contact activities in a pediatric hospital PACU setting for advanced airway management in a pediatric patient. 4 hours in Formative and Competency stages Clinical conducted with verified nurse preceptor for a four (4) hour time block CCHMC Trauma Round Clinical Monthly, planned, scheduled, educational student experience with patient contact activities in a pediatric hospital review of pertinent trauma round case(s). 2 hours in the Competency Stage [attendance at one (1) session]. Clinical conducted with verified nurse or physician preceptor for a two (2) hour time block IN CLASS in a group setting upon approval from CCHMC UCMC Obstetric (OB)/Labor and Delivery (L&D) Clinical Planned, scheduled, educational student experience with patient contact activities in a hospital OB/L&D department setting. 8 hours in the Formative and Competency stages Clinical conducted with verified nurse preceptor for a four (4) hour time block Student must document three (3) Live Birth patients as mandated by the Ohio Department of Public Safety and OAC §4765-17-04 Paramedic Curriculum UCMC Neonatal Intensive Care Unit (NICU) Clinical Planned, scheduled, educational student experience with patient contact activities in a hospital NICU department setting. 4 hours in the Formative and Competency stages Clinical conducted with verified nurse preceptor for a four (4) hour time block. UCMC Cardiology Cath Lab Clinical Planned, scheduled, educational student experience with patient contact activities in a hospital Cardiac Catheterization Unit/Percutaneous Coronary Intervention Unit/Cath Lab department setting. 4 hours in the Formative and Competency Stage Clinical conducted with verified nurse preceptor for a four (4) hour time block. Term 4 Capstone Field Internship All Formative Team Lead role requirements and Formative Age and Pathology requirements must be completed prior to Capstone Field Internship 72 hours in the Capstone Competency stage Begins 8/22/2024 and ends 10/16/2024. Capstone Field Internship allows students to apply the concepts that they have learned to solve real-life problems and perform at the highest level with little to no guidance in the wholistic approach to pre-hospital emergency medical care. For the capstone field internship to meet the breadth of the paramedic profession, team leads must include transport to a medical facility and may occasionally include calls involving transfer of care to an equal level or higher level of medical authority, termination of care in the field, or patient refusal of care. Capstone field internship team leads cannot be accomplished with simulation. Capstone Preceptors must receive additional training from the educational program and agree to serve as the Capstone Preceptor for each student at their “home” department. Ride time remains for a maximum of a twelve (12) hour time block per clinical. For ALL students, a minimum of 36 hours of EMS Field Internship during Capstone Field Internship shall be conducted on CFD Medic Units and/or ALS Units UCMC ED Clinical Planned, scheduled, educational student experience with patient contact activities in a hospital emergency department setting. Phase III – 10 hours in the Competency Stage UCMC Capstone Physician Round Clinical Planned, scheduled, educational student experience with patient contact activities in a hospital emergency department setting with an emergency department physician to review all facets of adult and geriatric patient care and management in the pre-hospital setting at the Capstone level. 4 hours in the Competency Stage CCHMC Capstone Physician Round Clinical Planned, scheduled, educational student experience with patient contact activities in a hospital emergency department setting with a pediatric emergency department physician to review all facets of pediatric patient care and management in the pre-hospital setting at the Capstone level. 3 hours in the Competency Stage Schedule Each Field Internship shift will be scheduled by the student utilizing Platinum Planner prior to the beginning of the shift. It is the student’s responsibility to appropriately schedule and complete all field internship and hospital clinicals each Term and submit the required clinical documentation and verification in a timely and complete fashion. Field Internship shifts should not be scheduled during assigned didactic or lab time. Each student is required to receive a specific amount of didactic and lab time. Any didactic or lab time missed in lieu of field internship or hospital clinical attendance must be made up consistent with policies set forth in the student handbook, preferably by attendance on an alternate unit day for that didactic or lab session. Scheduling and availability of EMS Field Internship and Capstone Field Internship ride time will be at the sole discretion of the CFD and should be entered into the CFD Rider Master Schedule by the Clinical Coordinator in a timely fashion. Student Attire All students must display a hospital student ID badge (either UCMC or CCHMC) and a CFD Medic School Badge indicating he or she is a paramedic student during all clinicals. Displaying this badge during field internship is an accreditation requirement that must be performed. All students are to immediately report loss of hospital student ID badge or CFD Medic School badge to the Clinical Coordinator. Program clinical polo uniform must be worn during CFD EMS Field Experience, Capstone Field Experience, and all hospital clinicals. During summer months, May, June, July, & August, a program-approved t-shirt may be worn and purchased separately from the online store. Required Skills and Hours Each student is required to complete the minimum number of hours and complete the minimum amount of assessment and individual skills prior to sitting for the course final cognitive exam. Minimum hours spent on an approved ALS Transport Unit All students are required to ride a minimum of 300 hours on an approved ALS transport unit or first responding ALS fire apparatus prior to the course final. All students are required to ride a minimum of 144 hours with a Cincinnati Fire Department paramedic transport unit as delineated above. Team Leads Each student is required to complete 30 Team Leads at the Formative Stage (EMS Field Experience) and 20 Team Leads at the Competency Stage (Capstone Field Experience). A Team Lead is defined as follows: To be counted as a Team Lead in the Formative stage, the Paramedic student must accompany the transport team AS A THIRD MEMBER (non-staffing/extra assignment) and conduct a comprehensive assessment, establish a field impression, determine patient acuity, formulate a treatment plan, direct the treatment, and direct and participate in the transport of the patient to a medical facility, transfer of care to a higher level of medical authority or termination of care in the field (cardiac arrest) under the guidance of a verified preceptor. For the capstone field internship to meet the breadth of the paramedic profession, team leads in the Competency stage (Capstone) must include transport to a medical facility and may occasionally include calls involving transfer of care to an equal level or higher level of medical authority, termination of care in the field, or patient refusal of care. Capstone field internship team leads cannot be accomplished with simulation. Under no circumstances will a student be allowed to solely transport an ALS patient to the hospital without his/her preceptor supervising the delivery of care. Submission Requirements Each clinical session will need to have an accompanying Platinum Planner electronic submission to document patient interactions, skills completed, and time spent. It is the student’s responsibility to complete the form according to instructions and get his or her preceptor to complete the preceptor evaluation with verification of patient contacts, pathologies, and skills performed. Submissions returned without a preceptor evaluation will be returned for proper completion. Preceptor evaluations are provided by the Platinum Planner tracking software provided. A new evaluation should be used for each session. Each evaluation must be completed and signed by the preceptor at the completion of your clinical session. Each clinical submission must be entered into Platinum Planner within seven (7) days of the clinical rotation. It is highly recommended that the paramedic student submit the clinical documentation as close to the clinical date as possible to ensure there is no lost information. The submissions will be reviewed by the Clinical Coordinator and placed in the student’s electronic clinical file. The student can request to review the materials that are in the clinical file at any time. Each patient contact should include a chief complaint, gender, age, brief narrative, overall exposure, team role, exposure pathology, and any successfully performed, attempted, or observed skills. A random 10% (minimum) audit will occur to ensure full compliance with skill completion and attendance. If there is any complaint of any type, the clinical coordinator will fully review all of the respective student’s submissions. Blood Borne Pathogen Exposure See Student Handbook for Infection Control Policy Attendance Prompt and timely attendance at all clinicals is mandatory. Students shall arrive at the clinical meeting point 15 minutes prior to the scheduled beginning of the clinical in order to meet with the preceptor and properly prepare for the clinical prior to the start time. Failure to arrive at the appropriate time may result in progressive discipline. Students not at the clinical site at the start time of the clinical will be refused attendance, marked absent without approval for the clinical, not given credit for the clinical, and be subject to progressive discipline. Students shall remain at the clinical site until the conclusion of the clinical. Unauthorized departure from the clinical prior to the scheduled conclusion may result in penalty of absent without approval and progressive discipline. Unscheduled absence due to unexpected illness or other life event shall require prompt notification to the Clinical Coordinator at the earliest possible convenience to ensure proper notification to the respective preceptor. Cancellation of scheduled clinicals without penalty of absent without approval and progressive discipline shall require at least forty-eight (48) hours notification to the Clinical Coordinator in order to permit rescheduling of the clinical opportunity. Cancellation requests with less than forty-eight (48) hours notice may result in penalty of absent without approval and progressive discipline. Every possible effort should be made to attend clinicals as schedule and avoid cancellation requests to prevent undue hardship on the preceptor or unfilled clinical opportunities. Affective Domain Grade Attendance and completion of required clinicals shall be considered as part of the student’s Affective Domain Grade for each Term. Failure to complete all of the required clinicals each term shall result in a percentage grade decrease relative to the percentage of clinical requirements not completed, including mandatory CFD Ride Time.