advanced paramedic standard 2008

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____________________________________________________________________________________________PHECC Education and Training Standards Section G- Advanced Paramedic

1

Advanced Paramedic

Education and Training Standard

Version 1- Council approved 16th June 2008


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1. INTRODUCTIONTOPREHOSPITALEMERGENCYCARE......................................................................4

1.1 GOVERNANCE,PROFESSIONALISM,ETHICSANDPHECCREGISTRATION..........................................................4

1.2 LEGALASPECTSOFPREHOSPITALEMERGENCYCARE...................................................................................5

1.3 INFORMATIONMANAGEMENTANDTHEPHECCCLINICALHANDBOOK...........................................................6

1.4

HEALTH,SAFETYANDWELFARE.............................................................................................................

7

1.5 ANATOMYANDPHYSIOLOGY..................................................................................................................8

2. PATIENTASSESSMENT...................................................................................................................12

2.1 CLINICALDECISIONMAKING.................................................................................................................12

2.2 HISTORYTAKING,DIFFERENTIALDIAGNOSISANDCLINICALIMPRESSION.........................................................13

2.3 CLINICALEXAMINATIONOFTHEABDOMEN,ANDRESPIRATORY,CARDIOVASCULARANDNEUROLOGICALSYSTEMS..14

2.4 PRIMARYSURVEY,IMMEDIATECAREANDTRANSPORTPRIORITISATION.........................................................15

2.5 SECONDARYSURVEY...........................................................................................................................16

3. RESPIRATORYEMERGENCIES.........................................................................................................17

3.1 AIRWAYANDVENTILATORYSUPPORT.....................................................................................................17

3.2 PERSISTENTFOREIGNBODYAIRWAYOBSTRUCTION...................................................................................19

3.3

INADEQUATERESPIRATION,APNOEAANDOTHERRESPIRATORYEMERGENCIES................................................20

4. MEDICALEMERGENCIES................................................................................................................21

4.1 ADVANCEDCARDIACRESPONSE............................................................................................................21

4.2 ABNORMALCARDIACCONDITIONS.........................................................................................................22

4.3 CARDIACARRHYTHMIAS......................................................................................................................24

4.4 NEUROLOGICALDISORDERS.................................................................................................................26

4.5 ABDOMINALEMERGENCIES..................................................................................................................28

4.6 PAINMANAGEMENT...........................................................................................................................29

4.7 DIABETICANDENDOCRINEEMERGENCIES...............................................................................................30

4.8 ALLERGIESANDANAPHYLAXIS...............................................................................................................31

4.9 POISONING/OVERDOSEEMERGENCIES...................................................................................................32

4.10

ENVIRONMENTALEMERGENCIES...........................................................................................................

33

4.11 BEHAVIOURALEMERGENCIES...............................................................................................................34

4.12 SPECIALPATIENTGROUPS....................................................................................................................35

4.13 SEPTICAEMIAANDMENINGITIS.............................................................................................................36

4.14 VIRALANDNONVIRALINFLUENZATYPEILLNESS.......................................................................................37

5. OBSTETRICS&GYNAECOLOGY.......................................................................................................38

5.1 PREGNANCYANDPREANDPOSTDELIVERYEMERGENCIES..........................................................................38

5.2 CHILDBIRTHANDNEONATALRESUSCITATION...........................................................................................39

5.3 GYNAECOLOGICALEMERGENCIES..........................................................................................................41

6. TRAUMA.......................................................................................................................................42

6.1 OVERVIEWOFTHEMECHANISMSANDKINEMATICSOFTRAUMA..................................................................42

6.2

HAEMORRHAGEANDHYPOVOLAEMICSHOCK..........................................................................................

43

6.3 SOFTTISSUEANDMUSCULOSKELETALINJURIESINCLUDINGCRUSHINJURIES...................................................44

6.4 HEAD,BRAINANDSPINALINJURIES........................................................................................................46

6.5 BURNINJURIES..................................................................................................................................48

7. PAEDIATRICEMERGENCIES............................................................................................................49

7.1 PAEDIATRICGENERAL.........................................................................................................................49

7.2 PAEDIATRICMEDICAL..........................................................................................................................50

7.3 PAEDIATRICTRAUMA..........................................................................................................................52


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8.PREHOSPITALEMERGENCYCAREOPERATIONS..................................................................................53

8.1 MAJORINCIDENTMEDICALMANAGEMENTANDSUPPORT........................................................................53

9. PROFESSIONALDEVELOPMENT......................................................................................................54

9.1 COMMUNICATION.............................................................................................................................54

9.2 MANAGEPERSONALWORKPRIORITIESANDPROFESSIONALDEVELOPMENT....................................................54

9.3

WORKEFFECTIVELYWITHOTHERS.........................................................................................................

54

9.4 MENTORSHIP....................................................................................................................................54

9.5 LEADANDPARTICIPATEINWORKTEAMS.................................................................................................54

9.6 CLINICALQUALITYIMPROVEMENT.........................................................................................................56

9.7 CHANGEMANAGEMENT......................................................................................................................58

9.8 EXPERIENTIALLEARNINGANDREFLECTIVEPRACTICE..................................................................................60

10.CLINICALPROCEDURES.....................................................................................................................62

10.1 PHARMACOLOGY...............................................................................................................................62

10.2 INFECTIONPREVENTIONANDCONTROL..................................................................................................64

10.3 MEDICATIONADMINISTRATION............................................................................................................65

The standard for the Advanced Paramedic builds substantially on the knowledge andcompetencies of an experienced Paramedic, therefore this standard does not repeat butfrequently refers to the relevant units of the 2007 Education and Training Standard- Paramediclevel.


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1. INTRODUCTION TO PRE-HOSPITAL EMERGENCY CARE

1.1 Governance, Professionalism, Ethics and PHECC registration

Objectives

Refer also to the relevant units of the 2007 Education and Training Standard- Paramedic

level and the PHECC Code of Professional Conduct and Ethics

Knowledge ObjectivesDemonstrate adequate working knowledge and comprehension of:

1.1.1 Self-regulation as a professional and as a profession1.1.2 Legislation underpinning the ability and licensing of practitioners on the

PHECC Register1.1.3 The concepts of good governance1.1.4 The mechanism and maintenance of PHECC registration1.1.5 The PHECC Code of Professional Conduct and Ethics1.1.6 The nature of professionalism and the commitment to continuing

professional development (CPD) and lifelong learning and the concepts ofprofessionalism outlined therein

1.1.7 The principles of ethical clinical practice1.1.8 Clinical indemnity as it relates to the Advanced Paramedic1.1.9 The difference between an ethical and a moral decision1.1.10 The appropriate action the Advanced Paramedic should take when faced

with the situation that another Advanced Paramedic or a Doctor on sceneorders a course of action, which may be detrimental to the care of thepatient

1.1.11 The appropriate action the Advanced Paramedic should take when facedwith the situation that a Doctor on scene orders a course of action thatwould not under normal conditions be part of the Advanced Paramedics

scope of practice

Attitudinal ObjectivesDemonstrate ability to:

1.1.12 Accept and uphold the professional responsibilities of an AdvancedParamedic in accordance with the standards of the PHECC Register

1.1.13 Limit practice to that within the Advanced Paramedic responsibilitiesoutlined by the PHECC CPGs

1.1.14 Advocate for the resuscitation of patients who may be potential organdonors

1.1.15 Strive to apply the highest standards of professionalism

Skills ObjectivesDemonstrate ability to:

1.1.16 Apply the principles of good governance to practice1.1.17 Work in a patient-centred way applying the principles of ethical clinical

practice1.1.18 Apply the principles contained with the PHECC codes and standards1.1.19 Work seamlessly with other healthcare and emergency professionals


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1.2 Legal aspects of pre-hospital emergency care

Objectives


level


1.2.1 The concepts of trespass to the person and assault1.2.2 The tort of negligence1.2.3 Valid, explicit and implicit consent1.2.4 The three types of evidence1.2.5 The four sources of legal rules in Ireland1.2.6 The Irish court system

1.2.7 The role of the Coroners court1.2.8 The differences between evidence and hearsay1.2.9 The role of an expert witness1.2.10 The concept of Duty of Care1.2.11 The potential conflict between professional standards and the law1.2.12 The basic assessment of patient capacity/ competence1.2.13 The issues around pre-hospital consent1.2.14 The issues surrounding patient refusal1.2.15 The legal status of DNR or DNAR and advance directives in Ireland1.2.16 The issues around managing minors1.2.17 Writing reports or statements, appropriate content, difference between

objective and subjective statements

1.2.18 The process of detention of mental health patients1.2.19 The legislation underpinning controlled drugs


1.2.20 Accept and uphold the legal responsibilities of an Advanced Paramedic inaccordance with the standards of the PHECC Register

Skills Objectives

Demonstrate ability to:

1.2.21 Prepare a statement from a simulated case in a manner that meetslegislative requirements

1.2.22 Demonstrate how to check the relevant sections of an involuntaryadmission form for a mental health patient


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1.3 Information management and the PHECC Clinical Handbook

Objectives


level


1.3.1 The benefits of clinical record keeping in pre- hospital emergency care1.3.2 How to maintain the security and confidentiality of clinical and other

services files while facilitating access as appropriate1.3.3 The importance of accurate, timely legible and attributable patient clinical

records1.3.4 The role of such records in clinical audit and research and the importance

of these in improving patient care

1.3.5 The PHECC Clinical Handbook (PHECC CPGs, Formulary and similar)1.3.6 The implications of the Data Protection Acts and Freedom of Information

Acts on patient records


1.3.7 Apply PHECC guidance regarding information management reliably1.3.8 Use knowledge to support others so that they are competent to fulfil

workplace requirements

Skills Objectives

Demonstrate ability to:

1.3.9 Use CPGs as a guide for pre-hospital emergency care practice1.3.10 Complete a PHECC PCR for a given patient scenario in a timely and

relevant manner in accordance with organisational requirements1.3.11 Evaluate a PCR for accuracy and efficacy1.3.12 Collect, record, process and organise information including from PCRs,

accurately using business equipment/ technology as appropriate1.3.13 Maintain an established records system to ensure its integrity1.3.14 Communicate with other team members, colleagues and fellow

professionals effectively and constructively regarding information

management1.3.15 Access data from the Reporting Module via the PHECC website1.3.16 Prepare an individual care management report based on individual skills

and medication provided within a given time period


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1.4 Health, Safety and Welfare

Objectives


level


1.4.1 The function of an organisations Safety Statement1.4.2 The difference between hazard, risk and controls1.4.3 How a hazard, risk and control assessment is carried out1.4.4 The risk control hierarchy1.4.5 The benefits of an occupational health and safety programme in the

workplace1.4.6 The term contributory negligence

1.4.7 The differences between a near miss and an incident1.4.8 The benefits of incident and near miss reporting1.4.9 Risk reduction approaches related to Advanced Paramedic practice


1.4.10 Help develop and promote a workplace safety culture1.4.11 Openly report risks and errors


1.4.12 Conduct a basic hazard, risk and control assessment of a workplace1.4.13 Analyse relevant workplaces in order to identify, assess and control risks1.4.14 Analyse relevant workplaces/ data in order to evaluate the effectiveness of

a health and safety programme


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1.5 Anatomy and physiology

Objectives


level


Fluids and electrolytes

1.5.1 Why electrolytes are important body constituents1.5.2 The importance of buffers in the maintenance of body pH1.5.3 Homeostasis1.5.4 The function of the pH scale

1.5.5 Why different body fluids have varying pH values1.5.6 The difference between isotonic, hypotonic and hypertonic1.5.7 The difference between acidosis and alkalosis1.5.8 The basic chemical nature of sugars, protein, lipids, nucleotides and

enzymes1.5.9 The difference between the processes of osmosis and diffusion1.5.10 How molecules move within and between body compartments1.5.11 The difference between intra- and extra-cellular fluid1.5.12 Why homeostatic control of intra- and extra-cellular fluids is vital to body

function

The cells, tissues and organisation of life

1.5.13 How substances are transported across cell membranes1.5.14 The difference between the structures of epithelial, connective, muscle

and nervous tissue1.5.15 How different types of tissues regenerate1.5.16 The structure and function of mucous, serous and synovial membranes1.5.17 The structure and functions of endocrine and exocrine glands

The respiratory system

1.5.18 The outline of the physiology of respiration1.5.19 The difference between external and internal respiration

1.5.20 The nervous and chemical mechanism that regulate respiration includingthe hypoxic drive and the role of CO2

1.5.21 The pulmonary and systemic gaseous exchange1.5.22 How respiration affects the pH of certain body fluids1.5.23 The partial pressures in relation to the respiratory gases1.5.24 The physiological variables affecting respiration1.5.25 The function of smooth muscle in the pulmonary system


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The cardiovascular system

1.5.26 The structure and functions of arteries, veins and capillaries1.5.27 The relationship between the different types of blood vessels1.5.28 The difference between vasodilatation and vasoconstriction of blood

vessels1.5.29 The mechanism by which the exchange of gases occurs in internal

respiration1.5.30 The mechanism by which nutrients, water and waste occurs1.5.31 The circulation of blood to the pelvis and lower limbs1.5.32 The physiology of heart sounds1.5.33 The factors affecting cardiac output1.5.34 The main control mechanism for the regulation of blood pressure1.5.35 The electrical conducting system of the heart

1.5.36 The relationship of the electrical activity of the conduction system to thecardiac cycle

1.5.37 The properties of cardiac cells1.5.38 The role of sodium and potassium in cardiac muscle contraction1.5.39 The phases of cardiac potential1.5.40 The effect that circulating catecholamine have on the heart1.5.41 Typical venous pathways in the hand and arm1.5.42 Main arterial circulation1.5.43 Mechanism for venous blood flow

The musculoskeletal system

1.5.44 The functions of the main muscles in the face and neck, back, abdominalwall and pelvic floor

1.5.45 The relationship of the function of muscles in the limbs to movement1.5.46 The relationship of the structure of each type of bone to their functions1.5.47 The relationship of the structure of the vertebral column with movement

and other functions1.5.48 The characteristics of the bones of the appendicular skeleton1.5.49 The relationship of the characteristics of the types of joints with their

functions1.5.50 The difference between the functions of muscles, ligaments and tendons1.5.51 The importance of the growth plate to bone development1.5.52 The neuromuscular junction

The digestive system

1.5.53 How peristalsis occurs1.5.54 The functions of the liver, pancreas and gallbladder


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The blood

1.5.55 The structure, function and formation of erythrocytes, leucocytes andthrombocytes

1.5.56 The function of the constituent parts of plasma1.5.57 The relationship between intracellular and extra-cellular fluids and their

effects on haemostasis1.5.58 How coagulation is controlled1.5.59 How the clotting process controls blood loss

The skin

1.5.60 The functions of the skin1.5.61 The difference between primary and secondary healing1.5.62 The layers of the skin, dermis, epidermis, superficial facia, deep facia1.5.63 How blood vessels in the skin respond to heat, cold and to the stress

response

The nervous system

1.5.64 The physiology of nerve impulse transmission including the role ofneurotransmitters

1.5.65 The difference between the functions of sensory and motor nerves1.5.66 How pain is perceived and the rational for referred pain1.5.67 The relationship between the structures of the meninges to its functions1.5.68 The composition cerebrospinal fluid (CSF) in the brain1.5.69 The difference between the functions of white and grey matter1.5.70 The origins of the 31 pairs of spinal nerves1.5.71 The areas innervated by the 8 cervical nerves

1.5.72 The functions of the 12 cranial nerves1.5.73 The difference between the sympathetic and parasympathetic nervous

system, comparing the structures and neurotransmitters of the 2 divisions

The urinary system

1.5.74 The structure of a nephron1.5.75 The processes involved in the formation of urine1.5.76 How body water and electrolyte balance is maintained1.5.77 The role of kidneys in blood pressure control1.5.78 The storage and passage of urine

The female reproductive system and labour

1.5.79 The main structures comprising the external genitalia1.5.80 The location, structure and function of the uterus1.5.81 How the placenta develops and list its functions1.5.82 The location, structure and function of the umbilical cord1.5.83 The pregnancy induced changes in maternal physiology1.5.84 Foetal circulation and the physiological changes that occur at birth


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The endocrine system

1.5.85 The actions of the hormone aldosterone on the renin-angiotensin-aldosterone system in maintaining the water and electrolyte balance in thebody.

1.5.86 The functions of the hormones adrenaline and noradrenaline and outline

their relationship to the sympathetic nervous system1.5.87 The actions of insulin and glucagon


1.5.88 Apply anatomy and physiology knowledge to Advanced Paramedicpractice


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2. PATIENT ASSESSMENT

2.1 Clinical decision making

Objectives

Refer also to the relevant units of the 2007 Education and Training Standard- Paramediclevel


2.1.1 The benefits of using a clinical problem solving model2.1.2 The factors that may influence clinical judgement2.1.3 Forming a clinical impression2.1.4 The strengths and weaknesses of CPGs in decision making2.1.5 Preparation of strategies for effective clinical decision making under

pressure2.1.6 The fundamental elements of critical thinking2.1.7 The importance of post intervention reassessment2.1.8 How effective assessment is critical to clinical decision making2.1.9 How Advanced Paramedics attitudes affect assessment and decision

making2.1.10 How uncooperative patients affect assessment and decision making2.1.11 The principles of medical direction/ advice2.1.12 The different strategies of medical direction/ advice2.1.13 The principles underpinning treat and discharge decisions


2.1.14 Uphold clinical decisions made based on best practice and anticipateincidents when exceptions may arise

2.1.15 Advocate and practice the process of complete patient assessment on allpatients


2.1.16 Develop and implement appropriate care management plans for given

scenarios2.1.17 Practice effective clinical decision making during clinical practice2.1.18 Practice implementing effective care management plans including

evaluation for patients during clinical practice2.1.19 Implement treat and discharge procedures for patients as per PHECC

CPGs2.1.20 Apply strategies to prevent patient labelling and tunnel vision2.1.21 Apply strategies to reduce scene distractions


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2.2 History taking, differential diagnosis and clinical impression

Objectives



2.2.1 The purposes of obtaining a detailed medical history2.2.2 The techniques of history taking2.2.3 The importance of open ended questions and the role of closed questions2.2.4 How the skills of communication are employed to facilitate, clarify and

interpret a patients medical history2.2.5 Breaking bad news2.2.6 The difference between the past medical and presenting medical history

and outline how they often interrelate2.2.7 How a medical history can be gathered concurrently with patient

assessment2.2.8 The concepts of differential diagnosis and clinical impression2.2.9 The methods and main terms used in recording medical examinations


2.2.10 Advocate and practice the process of complete history taking on all

patients2.2.11 Strive to develop empathetic and therapeutic trusting relationships with

patients2.2.12 Value the requirements for confidentiality when obtaining a medical history


2.2.13 Obtain a detailed medical history pertaining to the patients presentingillness/ injury using interviewing skills and techniques

2.2.14 Obtain information regarding the patients past medical history2.2.15 How to form a clinical impression and consider differential diagnosis


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2.3 Clinical examination of the abdomen, and respiratory, cardiovascular andneurological systems

Objectives



2.3.1 The techniques of general and focussed clinical examination2.3.2 Advanced Paramedic level examination techniques of the abdomen and

respiratory, cardiovascular, neurological systems; including a Face, Arm,Speech and Time (FAST) assessment

2.3.3 The implications of typical abnormal findings in each of these systems


2.3.4 Deal sensitively and respectfully with examination of patients recognisingthe need to keep patients dignity wherever possible


2.3.5 Make some general physical assessments of the patient from nearby/during approach

2.3.6 Focus the clinical examination based upon the presentation and history,as well as the clinical impression

2.3.7 Examine the respiratory system using inspection, auscultation, palpationand percussion of the patient generally, the chest and the neck

2.3.8 Examine the cardiovascular system using palpation of pulses, capillaryrefill, examination of the jugular venous pressure, taking a BP,auscultation of the heart

2.3.9 Examine the neurological system checking limb sensation and power, andbasic cranial nerve functions including those relating to raised intracranialpressure and FAST assessment as appropriate

2.3.10 Examine the abdomen to include examination of the abdominal aorta,examination for tenderness, rigidity or rebound tenderness, andauscultation for bowel sounds


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2.4 Primary survey, immediate care and transport prioritisation

Objectives



2.4.1 The purpose of a primary survey2.4.2 The components of a primary survey2.4.3 The types of immediately life-threatening problem which can be found

during the primary survey and how to treat them for both medical andtrauma patients

2.4.4 The differences between a primary survey for a medical and a traumapatient

2.4.5 Categorise a patient using Clinical Status Decision and its impact ontime/ transport criticality

2.4.6 How advanced care and transport requirements of the patient may beprioritised based on the results of the primary survey

2.4.7 The appropriateness of on scene care management versus rapid transportto definitive care

2.4.8 The reasons for reconsideration concerning the mechanism of injury


2.4.9 Advocate and practice the process of completing a primary survey on allpatients

2.4.10 Understand the contribution of on scene care and medicationmanagement to morbidity / comfort


2.4.11 Carry out a primary survey on a medical and trauma patient2.4.12 Continuous assessment, analysis and prioritising the patients immediate

and definitive needs based on the findings of the primary survey

2.4.13 Treat the needs found following the relevant PHECC CPGs


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2.5 Secondary survey

Objectives



2.5.1 The purpose of a secondary survey2.5.2 The components of a secondary survey2.5.3 Categorise a patient using medical early warning system (MEWS)2.5.4 How advanced care and transport requirements of the patient may be

prioritised or revised based on the results of the secondary survey2.5.5 How the finding of the secondary survey contribute to establishing

presenting problems and forming a clinical impression2.5.6 The differences between the physical exam for the trauma and the

medical patient2.5.7 Rapid Physical Exam2.5.8 System- based assessments of the respiratory, cardiovascular,

neurological, gastrointestinal, locomotor and genito-urinary systems asappropriate to Advanced Paramedic practice


2.5.9 Advocate and practice the process of completing a secondary survey on

all patients; time permitting2.5.10 Understand the limitation of the pre-hospital physical examination2.5.11 Value the importance of continuous assessment


2.5.12 Carry out a secondary survey on a medical and a trauma patient2.5.13 Carry out a Rapid Physical Exam2.5.14 Continuously assess, analyse and prioritise the patients immediate and

definitive needs based on the findings of the secondary survey2.5.15 Treat the needs found following the relevant PHECC CPGs


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3. RESPIRATORY EMERGENCIES

3.1 Airway and ventilatory support

Objectives



3.1.1 The measurement of oxygen and carbon dioxide in the blood3.1.2 The pre-hospital emergency assessment findings and evaluation of

respiratory function3.1.3 The gag reflex3.1.4 Tracheostomies, stoma and the tracheostomy tube3.1.5 The management of an occluded stoma or tracheostomy tube with

mucous3.1.6 The risk of infection to pre-hospital emergency care practitioners

associated with ventilation3.1.7 Rigid and soft suction catheters and the conditions when each should be

used3.1.8 The purpose of upper airway suctioning and describe the procedure3.1.9 The purpose and procedure for tracheobronchial suctioning in the

intubated patient3.1.10 The concept of the airway management ladder3.1.11 The indications, contraindications, benefits, limitations, complications,

equipment and procedure of endotrachael intubation, Laryngeal maskairway/ laryngeal tube (LMA/LT) insertion and use of any other PHECC

CPG approved advanced airway devices3.1.12 Gastric distention and the factors that precipitate its occurrence3.1.13 The methods to confirm correct placement of an endotrachael tube (ETT)3.1.14 The methods for securing an endotrachael tube3.1.15 The indications, contraindications, procedure and complications for

extubation3.1.16 The special considerations in airway management and ventilation for

patients with facial injuries


3.1.17 Advocate for the patient who requires airway and ventilatory support3.1.18 Use advanced airway skills appropriately


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3.1.19 Insert and secure an ETT, an LMA/LT and any other advanced airwaydevices as per PHECC CPGs confirming correct placement

3.1.20 Use end-tidal CO2 detection - Colour metric & capnography

3.1.21 Manage an occluded stoma or tracheostomy tube with mucous3.1.22 Perform ETT tracheobronchial suctioning in the intubated patient3.1.23 Remove an advanced airway


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3.2 Persistent foreign body airway obstruction

Objectives



3.2.1 The causes of upper airways obstruction3.2.2 Complete airway obstruction3.2.3 The implications of partial airway obstruction with good and poor air

exchange3.2.4 The pre-hospital emergency care assessment findings and *care

management of the patient with partial airway obstruction and completeairway obstruction

3.2.5 The visual landmarks for direct laryngoscopy3.2.6 Laryngoscopy to remove a foreign body airway obstruction3.2.7 The indications for performing a needle cricothyrotomy3.2.8 The equipment required when performing a needle cricothyrotomy


3.2.9 Empathise with the relatives or bystanders who witness a patient withairway obstruction understanding the acuteness of the condition


3.2.10 Perform a rapid pre-hospital emergency assessment and *caremanagement of the patient with partial airway obstruction and completeairway obstruction

3.2.11 Perform laryngoscopy3.2.12 Retrieve foreign bodies from the upper airway using laryngoscopy and

forceps or suction3.2.13 Perform endotracheal intubation where removal of foreign body

obstruction is not possible with forceps3.2.14 Perform needle cricothyrotomy3.2.15 Perform the pre-hospital emergency assessment and *care management

of the patient with all the conditions listed above

*Care management includes the administration of approved medication(s) as per the PHECCCPGs


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3.3 Inadequate respiration, apnoea and other respiratory emergencies

Objectives



3.3.1 The aetiology and pathophysiology of each of the following conditions

Chronic obstructive airway disease

Asthma

Broncholitis

Pneumonia

Pulmonary embolism

Pulmonary oedema Simple and Tension pneumothoraces

Respiratory arrest

Inhalation injury

Haemothoraces3.3.2 Inadequate respiratory depth and rate associated with narcotic overdose,

allergic reactions, Stroke and traumatic brain injury3.3.3 The pre-hospital emergency assessment findings and *care management

of the patient with the conditions listed above3.3.4 The differences between hypoxia and hypoxemia3.3.5 The time/ transport critical features of respiratory conditions3.3.6 The indication, equipment and procedure for needle thoracocentesis

3.3.7 The indication, equipment and procedure for continuous positive airwaypressure (CPAP) therapy


3.3.8 Understand the sense of urgency for assessment and care managementin the patient with inadequate respiration

3.3.9 Advocate for the patient who requires airway and ventilatory support3.3.10 Empathise with the patient who has a respiratory emergency


3.3.11 Perform the pre-hospital emergency assessment and *care managementof the patient with all the conditions listed above

3.3.12 Demonstrate CPAP therapy*Care management includes the administration of approved medication(s) as per the PHECCCPGs


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4. MEDICAL EMERGENCIES

4.1 Advanced cardiac response

Objectives



4.1.1 The principles behind the latest International Liaison Committee onResuscitation guidelines

4.1.2 The prime importance of excellent chest compressions in allcardiopulmonary resuscitation (CPR)

4.1.3 Understand why minimal or no interruption to CPR is critical to outcomes4.1.4 The prime importance of quick and safe defibrillation for ventricular

fibrillation (VF)/ pulseless ventricular tachycardia (VT) arrest4.1.5 Methodologies to maximise effective CPR between deliveries of shocks4.1.6 The rationale for the use of Advanced Paramedic medications in cardiac

emergencies and their relevant importance in cardiac arrest compared toCPR and DC shocks

4.1.7 Understand the aetiology and treatment rationale for non-shockablearrests

4.1.8 The complex issues surrounding when not to resuscitate and when tocease resuscitative efforts

4.1.9 The benefits of induced hypothermia post VF arrest4.1.10 The role of AED and ECG in trauma


4.1.11 Understand the sense of urgency for assessment and care managementin the patient with apparent cardiac arrest

4.1.12 Advocate for the patient who has arrested


4.1.13 Perform the pre-hospital emergency assessment and *care management

of the patient with all the conditions listed above4.1.14 Decide which actions are appropriate when treating such patients as a

solo responder or as part of a team



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4.2 Abnormal cardiac conditions

Objectives



4.2.1 The incidence, morbidity and mortality of cardiovascular disease (CVD) inIreland

4.2.2 Prevention strategies that may reduce the morbidity and mortality of CVD4.2.3 The risk factor profile of CVD4.2.4 The zones of ischaemia, injury and infarct and differentiate between a

transmural and subendocardial infarct4.2.5 The aetiology and pathophysiology of:

Atherosclerosis

Arteriosclerosis

Thrombosis

Ischaemia

Angina, stable and unstable

Acute myocardial infarct

Left ventricular failure

Cardiogenic shock4.2.6 The pre-hospital emergency assessment findings and *care management

of the patient with the conditions listed above

4.2.7 The differential diagnosis of chest pain4.2.8 The difference between pain of cardiac and non-cardiac origin4.2.9 The time/ transport critical features of cardiac conditions4.2.10 The role of aspirin, oxygen, nitrates, analgesia, thrombolytic agents and

any other relevant PHECC CPG treatments in treating myocardialinfarction

4.2.11 The role of percutaneous coronary intervention (PCI)4.2.12 The rationale and evidence base for pre-hospital administration of

thrombolytic agents4.2.13 The selection of a patient eligible for thrombolytic therapy4.2.14 The administration of thrombolytics, and their contra-indications and side

effects

4.2.15 The recommendations of the DoHC (2006) Task Force Report on SuddenCardiac Deathas it relates to timely reperfusion (R 5.37 and 5.38, p. 108-111)

4.2.16 The cardiac surfaces or areas represented by the ECG leads4.2.17 The changes to each monitoring lead that occurs as a result of the

following conditions:

ST elevation myocardial infarction

Non-ST elevation myocardial infarction

Ischaemia/ angina


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Right bundle branch block

Left bundle branch block4.2.18 The three abnormal pulses deficit, paradoxus and alternans4.2.19 The timeline window of opportunity as it pertains to reperfusion of a

myocardial injury or infarction4.2.20 The characteristics of a patient who is eligible for thrombolytic therapy

4.2.21 The options available for reperfusion therapy4.2.22 The characteristics of, clinical feature of, interpretation and management

of patients in hypertensive crisis4.2.23 The pathophysiology of vascular disorders4.2.24 Define the terms aneurysm, cardiac tamponade, claudication and phlebitis4.2.25 The signs and symptoms that develop following peripheral artery

occlusion, dissecting thoracic or abdominal aneurysm and the pre-hospital treatment plan for these patients


4.2.26 Understand the sense of urgency for assessment and care managementin the patient with cardiac compromise

4.2.27 Understand the sense of urgency required to protect the reperfusionopportunity in the patient suspected of a myocardial infarct

4.2.28 Understand the decision to possibly discontinue resuscitative efforts incardiac arrest patients



of the patient with all the conditions listed above4.2.30 Using the CPG differentiate between the patient that will be transported to

a facility for PCI verses a patient who will receive pre-hospital thrombolytictherapy

4.2.31 Using a PCR identify a patient who qualifies for thrombolysis4.2.32 Demonstrate the pre-hospital emergency *care management of the patient

with cardiac tamponade, a hypertensive emergency, peripheral arteryocclusion, a dissecting thoracic or abdominal aneurysm

4.2.33 Use semi-automatic and manual defibrillators

*Care management includes the administration of approved medication(s) as per the PHECC

CPGs


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4.3 Cardiac arrhythmias

Objectives



4.3.1 Patient presentations where ECG rhythm analysis is indicated4.3.2 How to identify and correct the various causes of artefact on a 12 lead

ECG4.3.3 The characteristics, description and significance of the ECG waves,

complexes, interval and segments4.3.4 The electrophysiological and haemodynamic events occurring throughout

the entire cardiac cycle with the various ECG waves, segments andintervals

4.3.5 The aetiology and pathophysiology of each of the following conditions:

Ventricular fibrillation and Pulseless ventricular tachycardia

Pulseless electrical activity

Asystole

Symptomatic bradycardia

Supraventricular tachycardia

Atrial Flutter

Atrial Fibrilation4.3.6 The pre-hospital emergency assessment findings and *care management

of the patient with the conditions listed above4.3.7 The features of an automated implantable defibrillator and any special

considerations when caring for a patient with one4.3.8 The ECG characteristics of an implantable pacemaker system and

recognise a malfunctioning internal pacemaker4.3.9 The benefits of early advanced cardiac life support to patients pre-hospital4.3.10 The significance of hypothermia in cardiac arrest


4.3.11 Collaborate with all members of the pre-hospital emergency care team tomaximise the benefits to patients with cardiac compromise


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4.3.13 Perform 12 lead ECG and interpret a wide range of arrhythmias, including:

Normal Sinus rhythm Ventricular fibrillationSinus arrhythmias Idioventricular rhythmAtrial flutter Premature atrial contractionsAtrial fibrillation Premature ventricular contraction

Junctional rhythm First degree AV-nodal blockSupraventricular tachycardia (SVT) Second degree Wenkebach blockSVT with aberrant conduction Second degree Mobitz II blockVentricular tachycardia Third degree blockTorsades-de-Pointes Junctional escape beats and rhythms

Ventricular escape beats and rhythms Right bundle branch blockLeft bundle branch block



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4.4 Neurological disorders

Objectives

Refer also to the relevant units of the 2007 Education and Training Standard-Paramedic level

Knowledge Objectives

Demonstrate adequate working knowledge and comprehension of:


Stroke

Intracranial haemorrhage

Transient ischemic attack

Meningitis/ meningococcal septicaemia Multiple sclerosis

Parkinsons disease

Neurogenic shock

Seizure disorders/ convulsions

Headache

Intra cerebral mass4.4.2 The aetiology of convulsions to include:

Epilepsy

Hypoxia

Febrile convulsions

Intracerebral insult/ head injury Hypoglycaemia

Hypothermia

Drug related

Eclampsia

Meningitis4.4.3 The pre-hospital emergency assessment findings and *care management

of the patient with the conditions listed above4.4.4 The major types of seizures4.4.5 The phases of a generalised seizure4.4.6 The categories of Stroke4.4.7 Rationale behind stroke thrombolysis AHA guideline

4.4.8 The time/ transport critical features of neurological disorders4.4.9 The protective measures for exposure prone procedures for patients with

confirmed meningococcal disease and outline public health guidelines forfollow up


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4.4.10 Convey empathy to patients whose ability to communicate is limited by

their condition4.4.11 Empathise with the patient who regains consciousness among strangers





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4.5 Abdominal emergencies

Objectives



4.5.1 The common causes of an acute abdomen4.5.2 The typical history and presenting symptoms and signs of an acute abdomen

and of obstruction4.5.3 The pre-hospital emergency assessment findings and *care management

of the patient with the conditions listed above


4.5.4 Understand the need for urgency and analgesia for patients with acuteabdominal emergencies


4.5.5 Perform the pre- hospital assessment and *care management of thepatient with all the conditions listed above



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4.6 Pain management

Objectives

Refer also to the relevant units of the 2007 Education and Training Standard-Paramedic level

Knowledge Objectives4.6.1 Demonstrate adequate working knowledge and comprehension of:

4.6.2 The physiology of pain4.6.3 The various types of pain4.6.4 The pre-hospital emergency assessment findings and *care management

of pain4.6.5 The therapeutic goals of pain relief4.6.6 The non medicinal options for pain relief4.6.7 The benefits and limitations of the interview mnemonic (PQRST)

Provocation, Quality, Region / Referral / Recurrence / Relief, Severity andTime and the analogue scale 0-10

4.6.8 The difference between the descriptors:

Stabbing/ Sharp

Crushing

Acute

Chronic

Pulsating

Burning

Dull Cramps

4.6.9 The time/ transport critical features of pain4.6.10 The medical, pharmacological, physiological and legal aspects of pain

management using the medication within the relevant PHECC CPGs


4.6.11 Respect the feelings that patient with pain, acute or chronic may beexperiencing and support empathetically


4.6.12 Perform the pre-hospital emergency assessment and *care managementof the patient in pain



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4.7 Diabetic and Endocrine emergencies

Objectives



4.7.1 The aetiology and pathophysiology of diabetes mellitus including ketoneformation

4.7.2 The normal range of blood glucose levels and the significance ofvariations to these

4.7.3 The difference between the types of diabetes mellitus4.7.4 The complications of diabetes mellitus4.7.5 How insulin and glucagon work and incidents when they dont4.7.6 The abnormal findings in assessment with clinical significance in the

patient with hypoglycaemia4.7.7 The bodys physiological reaction to hypoglycaemia including

gluconeogenesis4.7.8 The abnormal findings in assessment with clinical significance in the

patient with hyperglycaemia4.7.9 The signs and symptoms of the patient with diabetic ketoacidosis4.7.10 The pre-hospital emergency assessment findings and *care management

of diabetic emergencies4.7.11 The time/ transport critical features of diabetic emergencies4.7.12 Common diabetic medication including insulin

4.7.13 Definition of Addisonian crisis and its appropriate treatment


4.7.14 Empathise with the patient who regains consciousness among strangers





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4.8 Allergies and anaphylaxis

Objectives



4.8.1 The inflammatory response including causes and cardinal signs4.8.2 The benefits and harmful effects of acute inflammation4.8.3 The types of allergic response4.8.4 The risk factors most predisposing to anaphylaxis4.8.5 The pathophysiology of allergy and anaphylaxis including the formation of

antibodies4.8.6 The common antigens most frequently associated with anaphylaxis4.8.7 The common methods of entry of substances into the body4.8.8 The difference between manifestations of an allergic reaction from

anaphylaxis4.8.9 The abnormal findings in assessment with the clinical significance in the

patient with anaphylaxis4.8.10 The aetiology and pathophysiology of anaphylactic shock4.8.11 The pre-hospital emergency assessment findings and *care management

of the patient with anaphylaxis4.8.12 The time/ transport critical features of anaphylaxis


4.8.13 Empathise with the patient, relatives or bystanders who witness a patientwith anaphylaxis understanding the acuteness of the condition





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4.9 Poisoning/ overdose emergencies

Objectives



4.9.1 The time/ transport critical features of poisoning/ overdose emergencies4.9.2 The term antidote4.9.3 The role of the National Poisons Information Centre4.9.4 The assessment findings associated with various toxic groups4.9.5 The treatment and pharmacological interventions including antidotes

available to the Advanced Paramedic in the management of thepoisonings

4.9.6 The term overdose4.9.7 The most common poisonings by overdose4.9.8 The signs and symptoms related to the most common poisonings by

overdose4.9.9 The pre-hospital emergency assessment findings and *care management

of the patient with poisoning and overdose4.9.10 The time/ transport critical features of poisoning and overdose4.9.11 Drug abuse in Ireland4.9.12 The most commonly abused drugs (both by chemical name and street

names)4.9.13 The pathophysiology of commonly used drugs4.9.14 The signs and symptoms related to the most commonly abused drugs

4.9.15 The pathophysiological principles and the assessment findings toformulate a clinical impression and implement a *care management planfor the patient with the most common poisonings and overdose

4.9.16 The unreliable nature of the history in cases of overdose


4.9.17 Empathise with the patient, relatives or bystanders who witness a patientwith poisoning or overdose understanding the acuteness of the condition

4.9.18 Act in a non- judgemental and professional manner when managing self-poisoning and harm cases





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4.10 Environmental emergencies

Objectives



4.10.1 The time/ transport critical features of environmental emergencies4.10.2 The aetiology and pathophysiology of heat / cold emergencies4.10.3 The role of fluid therapy in the treatment of a heat / cold emergencies4.10.4 The pre-hospital emergency assessment findings and *care management

of the patient with

heat / cold emergencies

a bite or sting

an immersion incident

a diving emergency4.10.5 The time/ transport critical features of the conditions listed above


4.10.6 Empathise with the patient, relatives or bystanders who witness a patientwith an environmental emergency understanding the acuteness of thecondition





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4.11 Behavioural emergencies

Objectives



4.11.1 The time/ transport critical features of behavioural emergencies4.11.2 Behavioural emergencies4.11.3 The medical legal considerations for management of behavioural

emergency4.11.4 The pathophysiology of behavioral disorders4.11.5 The techniques for physical assessment in a patient with behavioral

disorder4.11.6 The pre-hospital emergency assessment findings and *care management

of the patient with a behavioral disorder


4.11.7 Empathise with the relatives or bystanders who witness a patient with abehavioural emergency understanding the acuteness of the condition

4.11.8 Understand that a behavioural disorder may have a complex aetiology



*Care management includes the administration of approved medication(s) as per thePHECC CPGs


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4.12 Special patient groups

Objectives



4.12.1 Brief overview of

Minority ethnic and cultural groups

Hearing impaired

Vision impaired

Life-limiting illness patients

Arthritis patients Psychiatric illness patients

Those with learning disabilities including Downs Syndrome

Multiple Sclerosis patients

Spina Bifida patients

Myaesthenia Gravis patients

Chronic Fatigue patients

4.12.2 Elderly patients, in particular the polypathology and polypharmacyimplications of assessment and treatment of this group

4.12.3 Elder abuse and abuse of any special patient groups, and the role ofpatient advocacy

4.12.4 The common causes of acute and chronic confusion in the elderly, and thekey differences in the history, presentation, findings and managementbetween these two groups


4.12.5 Empathise with the patient who may have communication, sensory,mobility or learning difficulties and make appropriate remediation and/orallowances for these


4.12.6 Perform the pre-hospital emergency assessment and *care managementof a patient within any of the above groups

4.12.7 Differentiate between acute and chronic confusion in the elderly by historyor presentation



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4.13 Septicaemia and meningitis

Objectives



4.13.1 The key causes and presentations of septicaemia and meningitis,including meningococcal disease and toxic shock syndrome

4.13.2 The difference between septicaemia and meningitis4.13.3 The time/ transport critical features of septicaemia and meningitis


4.13.4 Empathise with the relatives or bystanders who witness a patient withsepticaemia or meningitis understanding the acuteness of the condition


4.13.5 Consider septicaemia and meningitis in all appropriate patients4.13.6 Recognise rapid deterioration a critical history finding in meningococcal

disease




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4.14 Viral and non-viral influenza type illness

Objectives



4.14.1 Common routes of spread of flu-type infection and methods to reduce risk4.14.2 Usual history and presentation, signs and symptoms of flu-like illness4.14.3 The currently available tools to prioritise patients with flu-like illness4.14.4 Currently available guidance on case identification, appropriate reporting,

transportation and admission arrangements


4.14.5 Deal sensitively with patients and relatives of patients with flu-like illness


4.14.6 Use currently available guidance in prioritising, transporting and managingpatients with the above types of illness while managing infection control

precautions


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5. OBSTETRICS & GYNAECOLOGY

5.1 Pregnancy and pre and post-delivery emergencies

Objectives



5.1.1 The normal anatomical and physiological changes during pregnancy andlimits beyond which they become pathological

5.1.2 The changes in and resulting from pre-existing disease, including asthma,diabetes, heart disease and hypertension

5.1.3 The significance of trauma during pregnancy including seat belt injury anddomestic violence

5.1.4 The significance of cardiac arrest during pregnancy5.1.5 The pre-hospital emergency care assessment findings of a pregnant

woman and relate these to the gestational period5.1.6 The position of the fundus and gestational age5.1.7 The indications for an inspection of the vulva, taking into account consent

and cultural issues into consideration5.1.8 Gestational diabetes5.1.9 The pre-hospital emergency care assessment findings and *care

management of the patient with the following emergencies:

antepartum haemorrhage

ectopic pregnancy

pre-eclampsia

eclampsia

post-partum haemorrhage5.1.10 The time/ transport critical features of pregnancy related conditions


5.1.11 Value the importance of maintaining a patients modesty and privacy whilebeing able to examine physically and interview as appropriate





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of the patient with all the conditions listed above5.2.16 Demonstrate inserting a urinary catheter



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5. OBSTETRICS & GYNAECOLOGY

5.3 Gynaecological emergencies

Objectives



5.3.1 Toxic shock syndrome5.3.2 Threatened miscarriage5.3.3 Ectopic pregnancy5.3.4 The time/ transport critical features of these conditions5.3.5 Managing sexual assault for males and females


5.3.6 Empathise with the relatives or bystanders who witness a patient with anyof these conditions understanding the acuteness of the condition


5.3.7 Consider pregnancy, threatened miscarriage and toxic shock in allappropriate patients (i.e. any woman of child bearing age)

5.3.8 Take a focussed clinical history5.3.9 Perform the pre-hospital emergency assessment and *care management

of the patient with all the conditions listed above



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6. TRAUMA

6.1 Overview of the mechanisms and kinematics of trauma

Objectives



6.1.1 Energy and force as they relate to trauma6.1.2 The terms; mechanism of injury, down and under, up and over velocity,

acceleration, deceleration, kinetic energy and gravity6.1.3 The pathophysiology of the head, spine, thorax and abdomen that occur

from the result of the above forces6.1.4 How trauma injuries may be predicted based on the mechanism of injury6.1.5 The principles of kinetic energy transfer in relation to the three impacts of

a road traffic accident


6.1.6 Adopt a cautious approach to patients with significant mechanism of injurybut who appear initially stable

6.1.7 Respond to the feelings that the patient or family may be experiencing atthe scene of a traumatic injury


6.1.8 Relate energy and force to possible occult injury6.1.9 Assess and prioritise patients injured in the setting of a traumatic incident


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6. TRAUMA

6.2 Haemorrhage and hypovolaemic shock

Objectives



6.2.1 The various types of and degrees of haemorrhage and shock6.2.2 The pathophysiology of haemorrhage and shock6.2.3 The bodys physiological response to changes in perfusion6.2.4 The difference between controlled and uncontrolled haemorrhage6.2.5 The difference between compensated and uncompensated haemorrhagic

shock6.2.6 The pre-hospital emergency assessment findings and *care management

of the patient with haemorrhage and shock, including tourniquet use6.2.7 The time/ transport critical features of haemorrhage and hypovolaemic

shock6.2.8 The requirement to replace lost blood volume6.2.9 The differences between Crystalloid and Colloid fluid6.2.10 The role of medical direction in fluid replacement therapy6.2.11 The routes of administration of fluid therapy6.2.12 The difference in selecting a cannula and a site for vascular access in the

trauma patient6.2.13 The difference between manual and mechanical intraosseous devices


6.2.14 Understand the importance of a thorough patient assessment6.2.15 Defend why basic life support takes priority over wound closure



6.2.17 Demonstrate tourniquet use



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6. TRAUMA

6.3 Soft tissue and musculoskeletal injuries including crush injuries

Objectives



6.3.1 The assessment, prevention and pre-hospital emergency *caremanagement of wound infection

6.3.2 The time/ transport critical features of soft tissue, musculoskeletal andcrush injuries

6.3.3 The pathophysiology, presentation and pre-hospital emergency *caremanagement of the following:

Fractures

Contusion

Haematoma

Abrasions

Lacerations

Major arterial lacerations

Avulsions

Impaled objects

Amputations

Incisions Blast injuries

Penetrations/ punctures including those from conductedelectrical weapons (Taser guns)

Barotrauma

Chest wall injuriesi. Rib fracturesii. Flail segmentiii. Sternal Fractureiv. Sucking wounds

Lung injuryi. Simple, open, closed and tension pneumothorax

ii. Haemothoraxiii. Pulmonary contusioniv. Traumatic asphyxia

Myocardial injuryi. Cardiac tamponade (pericardiocentesis)ii. Myocardial contusion and rupture

Vascular injury including to major vessels

Visceral injury includingi. Oesophagus, Trachea, Bronchus, Diaphragm


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Pelvic injuryi. Basin effect

Crush syndromei. Renal failureii. Rhabdomyolyosis

Compartment syndrome

Abdominal injuryi. Open injuryii. Closed injuryiii. Solid and hallow organ injuries

6.3.4 The pre-hospital emergency assessment findings and *care managementof the patient with the trauma injuries above according to the mechanismsinvolved

6.3.5 Understand the importance of a thorough patient assessment, with softtissue, and musculoskeletal injuries including crush injuries.

6.3.6 Empathise with the relatives or bystanders who witness a patient with asoft tissue and musculoskeletal injuries understanding the acuteness ofthe condition




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6. TRAUMA

6.4 Head, brain and spinal injuries

Objectives



6.4.1 The motion and energy considerations of mechanisms of injury other thana road traffic accident

6.4.2 The pathophysiology of the following traumatic injuries6.4.3 Head / Brain Injuries

Raised ICP (relationship of O2 & CO2) Diffuse axonal injury

GCS and the classification into mild, moderate and severehead injury

Brain haemorrhagei. Extra duralii. Sub duraliii. Intra cerebraliv. Sub arachnoid

Facial - Including the specific consequences

Eye

Ear

Nose Throat

Mouth

Affects on the airway6.4.4 Spinal- Spinal cord syndromes

Traumatic

Non traumatici. Low back painii. Herniated intervertebral disc


6.4.5 The pre-hospital emergency assessment findings and *care managementof the patient with the trauma injuries above according to the mechanismsinvolved

6.4.6 The principles underlying the PHECC CPG spinal immobilisation decisiontree

6.4.7 The time/ transport critical features of traumatic injuries6.4.8 Respond to the feelings that the patient or family may be experiencing at

the scene and during transport of a traumatic injury


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6.4.10 Practical application of the PHECC CPG spinal immobilisation decisiontree to the trauma patient



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6. TRAUMA

6.5 Burn injuries

Objectives



6.5.1 The pathophysiology of local and systemic responses to burns

Inhalation

Electrical (Based on an understanding of electricalconduction)

Thermal Chemical

Radiation

Cold burns6.5.2 The pre-hospital emergency assessment findings and *care management

of burns6.5.3 Personal safety issues involved in treating patients with chemical and

electrical injury


6.5.4 Understand the importance of a thorough patient assessment, with therealisation that burns are often associated with other significant injuries


Perform the pre-hospital emergency care assessment and *care management of thepatient with burn injury



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7. PAEDIATRIC EMERGENCIES

7.1 Paediatric general

Objectives



7.1.1 The key anatomical, pharmacological and clinical differences betweenchildren at different ages and adults

7.1.2 Assessment of children using the Paediatric Assessment Triangle7.1.3 The signs of a seriously ill or deteriorating child7.1.4 The Advanced Paramedics role in the reduction of infant and childhood

morbidity and mortality from acute illness and injury7.1.5 The importance of obtaining the patients weight for effective care7.1.6 Normal age group related vital signs7.1.7 The care management for sudden infant death syndrome (SIDS) infants7.1.8 The assessment and care management of suspected abuse/ neglect

infant or child and the special considerations


7.1.9 Understand the emotional dependence of the infant/child on their parent/

guardian7.1.10 Interact with the infant/ child that conveys an understanding of their

developmental stage


7.1.11 Use parent / caregiver interviewing techniques and emotional support forinfant and child death situations

7.1.12 Use parent / caregiver interviewing techniques for suspected infant andchild abuse/ neglect situations

7.1.13 Make accurate and detailed records in cases of suspected non-accidentalinjury and neglect

7.1.14 Calculate a paediatric weight using a Braslow tape and age formulae


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7. PAEDIATRIC EMERGENCIES

7.2 Paediatric medical

Objectives




Inadequate respirations

Upper and lower airway obstruction

Foreign body/ Croup/ Epiglottitis/ Stridor

Asthma Bronchiolitis

Tension pneumothorax

Respiratory arrest

Asystole/ Pulseless electrical activity

Ventricular fibrillation and Pulseless VT

Symptomatic bradycardia

External haemorrhage

Hypovolaemic shock

Seizure disorders/ convulsions (febrile and afebrile)

Glycaemic emergencies

Anaphylaxis

Pain

Burns

Septic shock including Meningococcal sepsis

7.2.2 The pre-hospital emergency assessment findings and *care managementof the conditions listed above

7.2.3 The benefits of having a nasogastric tube in place for prolonged airwayand ventilatory support

7.2.4 The indications, contraindications, benefits, limitations, complications,equipment and procedure of endotrachael intubation, Laryngeal maskairway/ laryngeal tube (LMA/LT) insertion and use of any other PHECCCPG approved advanced airway devices for paediatrics

7.2.5 The indications, contraindications, procedure and complications forpaediatric extubation

7.2.6 The time/ transport critical features of infant/ children with illness


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7.2.7 Understand common response of families with acute illness of an infant orchild



advanced paramedic standard 2008

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