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Laredo Community CollegeEmergency Medical Services Program

Clinical Handbook

Introduction:

The clinical rotations are perhaps the most exciting and the most challenging part of a student's training. To make this experience positive and rewarding, the student must be well prepared. The clinical handbook is designed to keep the student focused on the clinical portion of the Emergency Medical Services Program. This manual provides the student with a means of reporting and monitoring each experience. The Clinical Coordinator will be available by telephone or by pager.

Enjoy your clinical and field internship rotations!

Revised 8/06,7/08,6/080

TABLE OF CONTENTS

Introduction………………….………………………….………1Table of Content………………………………………………..2EMT-Basic Clinical Hours……………………………………..3EMT-Intermediate Clinical Hours……………………………...3EMT-Paramedic Clinical Hours………......................................4Professional Behavior…………………………………………..5Confidentiality……………………………………………….....5Clinical Scheduling……………………………………………..5Attendance Policy……………………………………………....6Personal Emergencies…………………………………………..6Clinical Equipment…………………………………………......7Clinical Grading…………………………………………...……7Inclement Weather…………………………………………...…7Meal Breaks………………………………………………….....8Parking………………………………………………………….8Specifics Relating to Hosp. Rotation…...................................8-9Specifics Relating to Amb. Rotation……………………….......9Dress Code…………………………………………………….10Skills & Objectives………………………………………...11-24Medical Abbreviations…………………………………….25-31Fire Station Locations…………………………………………32Hospital Location…………………………………………...…33Clinical Time Tracing Form…………………………...……...34Clinical Grading Form………………………………………...35Clinical Agreement……………………………………………36

Revised 8/06,7/08,6/081

EMT - BasicClinical Requirements

Hospital Rotation:48 Hours Emergency Room documentation at least three (3) patients per shift16 Hours Obstetrics 64 Subtotal Hours

Ambulance Rotation:64 Hours - Document at least three (10) Basic Life Support transports to a hospital facility

128 Total HoursThe student must complete all the stated clinical requirements before they will be allowed to take the National Registry EMT Basic Exam.

EMT – IntermediateClinical Requirements

Hospital Rotations:40 Hours Emergency Room documentation at least three (3) patients per shift16 Hours Operating Room and Recovery 8 Hours Obstetric 8 Hours Respiratory 8 Hours Phlebotomy 80 Subtotal Hours

Ambulance Rotations:50 Hours- Document at least five (10) Advance Life Support transports to a hospital facility

130 Total HoursThe EMSP student must document at least five (10) successful Intravenous Therapy that the student has initiated in the hospital or ambulance rotation.Student must be eligible to take National Registry EMT Basic Exam to continue into the EMT-Intermediate and must be EMT Basic certification to attend clinical rotations. The student who does not complete Laredo Community College requirements will not be eligible to set for the National Registry Intermediate Exam. All course and clinical requirements must be completed prior to the National Registry Exam.

Revised 8/06,7/08,6/082

EMT - ParamedicClinical Requirements

Hospital Rotations:96 Hours Emergency Room documentations at least three (3) patients per shift 48 Hours Intensive Care Unit/Telemetry 40 Hours Operating Room and Recovery 16 Hours Obstetric 16 Hours Respiratory 8 Hours Cath Lab 224 Subtotal hours

Ambulance Rotations:100 Hours-Document at least five (10) MICU transports to hospital facility with ECG strips.

324 Total Hours

The EMSP student must document at least ten (20) successful Intravenous Therapies that the student has initiated in the hospital or ambulance rotations.

All Laredo Community College EMSP courses and clinical requirements must be completed prior to the taking the National Registry Paramedic Exam. The student who does not complete Laredo Community College requirements will not be eligible to set for the National Registry Paramedic Exam.

Revised 8/06,7/08,6/083

Professional Behavior

The student must maintain a professional demeanor at all times and respect the client, his/her family, and the medical personnel with whom he/she will be working. Failure to act in a professional manner may result in dismissal from the clinical area and/or a delay in testing for certification. Please be aware that other students will follow you into these training sites and they may be judged by the impressions you leave behind. Remember you are a guest in a sensitive environment, please maintain the welcome.

Confidentiality

While at any training site or while participating in any training activity strict patient confidentiality must be maintained. Do not discuss a patient's condition with the family, with bystanders, with the media, or any other non-medical personnel. Do not discuss a patient's condition or prognosis outside of class. Violation of confidentiality rules will result in the student's withdrawal from the course.

All Clinical Rotations

The student must be prompt for all clinical rotations. The student may only be in the clinical setting at the times assigned.

Clinical Scheduling1. The liability insurance ONLY covers the student during scheduled rotations.

2. Students attending any shift that is not scheduled with the clinical coordinator will be counseled and may be dropped from the program.

3. The student must have on file a current American Heart Association Healthcare Provider CPR card, current immunization record and physical examination, negative criminal background, negative drug test and completed HBV series prior to attending any clinical rotation.

4. Once a clinical rotation schedule on FISDAP, the student cannot alter his/her assignments. The student must comply with the clinical rotation as posted on the clinical schedule.

Revised 8/06,7/08,6/084

Attendance

A. Classroom attendance follows the policy as stated in the LAREDO COMMUNITY COLLEGE catalog.

B. Clinical Rotation:a) Requires 100% attendance. Tardiness and leaving before the end of the assigned time

is equivalent to an absence. Students must remember that completion of required objectives and competencies must be met while the assigned clinical preceptors or clinical instructor is on duty. Failure to make up missed time or complete the assigned requirements will result in an “F” (Failure) for clinical rotation.

b) Cancellation of clinical rotation regardless of the reason the student must notify the clinical coordinator before the scheduled shift.

c) Any student that fails to notify clinical coordinator of a cancellation of their scheduled clinical rotation will result in counseling with possible student dismissal from the EMS program.

d) Student may not sleep during their clinical rotation nor should the student enter any sleeping area of clinical facility.

e) Student must have at least 8 hours of rest before entering the clinical rotation. f) Maximum hospital hours will be 16 hours (Two 8 hour shifts)g) Maximum ambulance hours will be 14 hours (Two 7 hour shifts) h) Prompt arrival at the designated clinical site and in the prescribed attire is

required. If the student arrives late this is grounds for the student to be sent home. The student will have to make up the hours at the discretion of the EMS Instructor.

C. Clinical1. Clinical practicum grades will be withheld until all sections of the practicum have been

completed satisfactorily.

2. The student needing more training in a specific clinical area will reenter that area for a specified length of time to be determined in consultation with the clinical coordinator, program coordinator and student. The student will receive a grade of incomplete (I*) at the end of the semester until the training is complete. The student must complete the training as soon as possible, but no later than four months. If the time exceeds four months, a grade of incomplete (I*) will changed to an “F” by the instructor.

3. The student failing to achieve a satisfactory evaluation after more training will be asked to take the corresponding semester length course remediation. Remediation will also include more time at the clinical site.

4. The student can make copies of their completed clinical documentation for their personal records. Student must submit the original clinical documentation with the original signature of clinical preceptor. It is the student’s responsibility to make sure they are signed up for the adequate amount of clinical hours.

Revised: 6/08, 7/07, 8/065

Personal EmergenciesShould a personal emergency arise that would require the student to leave a clinical site, the student must notify the Clinical Instructor, or EMSP Coordinator.

Clinical Equipment

The student will need the following items for each clinical rotation.

Stethoscope Watch with a second hand Trauma scissors Penlight Pen (Black Ink) Note pad Clinical Notebook with required Texas Department of State Health Services

paperwork

Clinical Grading

Clinical grades will be based on the Clinical Report Grading Form.Refer to page 35 to view a copy of the clinical report grading form.

If the student does not demonstrate satisfactory performance in the clinical areas, the student will be counseled and additional clinical time will be required. If there is no improvement demonstrated the student will receive a failing grade for the clinical course and dismissal from the EMS Program.

If the student does not turn in their clinical documentation by the due date and time the student will receive an “F” for the clinical class.

If the student misplaces their clinical paper work they must redo all the hours and turn in the clinical documentation by the due date and time.

Inclement Weather

If inclement weather conditions arise that would make it dangerous for a student to travel, notify the Clinical Instructor as soon as possible. The Clinical Instructor will reschedule the student at a time and date convenient for the clinical site.

Revised: 6/08, 7/07, 8/066

Meals

Hospital: The student may eat in the hospital cafeteria or bring food to the cafeteria or designated lounge area. Student must plan meal breaks in the cafeteria based on operational hours of dining facility with the approval of the Clinical Instructor. (Meal breaks are 30 minutes).

Ambulance: If you intend to prepare food at the station ask permission to use the kitchen. Be sure to clean up when finished. If the station personnel invite the student to join them at their meals, be sure to compensate the staff. The student may also bring food from home.

For safety reasons the student is encouraged to remain at the clinical site during meal times.

Under no circumstances may a student borrow anyone's car at a clinical site to go and purchase food. Should the student need to leave the clinical site, he/she must request and be granted permission from the assigned preceptor and their clinical instructor. The student must notify the preceptor and clinical instructors upon his/her return to the clinical site.

Parking

Follow the parking guidelines set forth by the hospital and fire station.

Clinical Supervision

Specifics Relating to Hospital Rotation

Hospital:The student must report to the in-charge nurse for that designated department. At that

time, the student will be assigned a preceptor for that clinical site. The student will remain with the assigned clinical preceptor for the specified rotation period. The student cannot leave the clinical area without permission or instructions from the assigned preceptor. The student must notify the assigned preceptor when leaving for or returning from breaks and meals. The preceptor or clinical coordinator will make daily rounds of the clinical sites.

Hospital Documentation form Each student is required to complete at least three (3) written patient assessments per shift

in the Emergency Department. Clinical rotations in other department of the hospital will need at least one or more patient assessment per shift, if possible. The student may gather information from a variety of sources, but cannot copy information word for word from the patient's chart. The written assessments should reflect only the student's observations. The student can use one sheet or multiple sheets for the patient assessments. Follow the format in the example found in this handbook. Use black ink, write legibly, and complete the entire form. You must have one set of vital signs in your patient report and your clinical preceptor must sign your patient documentation form before you leave that rotation. DO NOT LEAVE BLANKS. DO NOT

Revised: 6/08, 7/07, 8/067

use patient names on any documentations, all information gained about your patient must be kept confidential.Evaluation Forms:

The student will provide the evaluation form to their clinical preceptor who will complete and sign the evaluation form. The student is responsible for returning the signed evaluation form and all descriptive documentation to the Clinical Coordinator. All evaluation forms in clinical documentation packet must be completed by their clinical preceptor. (Refer to student documentation packet)

Clinical Supervision

Specifics Relating to Ambulance Rotations

Ambulance:The EMSP student must notify the in-charge captain of that station as to his/her assignment. The student will be assigned to an in-charge EMT or PARAMEDIC for the specified ambulance. At this time the in-charge medic may want to orient you to the station rules and to the equipment on the ambulance.

The student is required to spend the specified number of hours on the ambulance and participate in the specified number and type of transports delineated by TDH. A transport is considered a case in which the ambulance transports a patient while providing treatment in route to the hospital regardless of the code status. If the student does not complete the required number of transports, the student must contact the Clinical Coordinator and schedule additional ambulance rotations until all requirements are met.

No student may be in the fire station after 22:00 hours to perform ambulance calls. If the student is on a call at 22:00 hours, the student will leave the station when the ambulance returns to the station. NO EXCEPTIONS

Ambulance Documentation formsThe EMT student must complete and document at least three (3) BLS transports. The

EMT-I student must complete and document at least three (3) ALS transports. The EMT-P student must complete and document at least five (5) MICU transports. The student will be precepted by the in-charge EMT-P on the ambulance with unscheduled site visits by the Clinical Coordinator. You must have your preceptor sign your patient documentation form before you leave that rotation. Attentiveness to the rotation requirements and involvement in the rotation activities is highly recommended. DO NOT use patient names on any documentations, all information gained about your patient must be kept confidential.

Evaluation Forms:The student will provide the evaluation to their clinical preceptor who will complete and

sign the evaluation form. The student is responsible for returning the signed evaluation form and all descriptive documentation to the Clinical Coordinator. All evaluation forms in clinical

Revised: 6/08, 7/07, 8/068

documentation packet must be completed by their clinical preceptor. (Refer to student documentation packet)

(The student is expected to review all skills and required competencies prior to the ambulance rotations.)

Professional Dress Code

The student who is enrolled in the Laredo Community College EMS Program will adhere to the following dress code.

Hair: Clean and neat. Hair must be worn off shoulder. Hair carries bacteria, which can initiate a disease process in a patient.

Clothes: Clean, neat, and unwrinkled uniform. Name Badge / LCC Patch: The student's LCC official name badge will be worn on

the upper left side of the lab jacket. The LAREDO COMMUNITY COLLEGE Patch must be worn on the left sleeve of lab jacket or shirt and be visible at all times.

Shirt: White Polo shirts with star of life logol on left chest, and LCC patch on left shoulder. Students name on right chest. No other logo can on any clinical shirt are allowed. Students are allowed to wear a dark colored shirt under the polo shirt.

Slacks: Black or Navy Blue BDU’s or EMS Pants are allowed. JEANS are not acceptable.

Shoes: Black shoes acceptable. Black leather tennis shoes are acceptable. Open-toe or high heel shoes are not acceptable. Shoes must be clean.

Headwear: The student is not allowed to wear any type of headwear ex. Caps, etc Jewelry: Wearing excessive amount of jewelry is unacceptable. Small stud earrings

may be worn. Multi-rings on fingers are not allowed. No Body piercing rings are to be worn, (i.e. tongue, eyebrows, nose, etc.) at clinical training sites.

Eye Glasses: No sunglasses or dark lenses are to be worn in the hospital setting. Sunglasses may be worn in the daytime only on ambulance runs but not while performing patient care.

Make-up: Light use is acceptable. Perfume: Very light use is acceptable. Heavy use may cause nausea and/or

vomiting in some patients. Personal hygiene: Due to the nature of the clinical settings, all students are expected

to comply with good, daily, personal hygiene habits. Nails must be short. Pager and Cellular Phones: Are to be left outside the clinical environment.

Remember: ALWAYS FOLLOW OSHA UNIVERSAL PRECAUTION GUIDELINES

If a student fails to meet the stated dress code criteria, the student will be asked, at the discretion of clinical coordinator, the preceptor or staff nurse to leave the clinical site. The student will be required make up the deficient clinical hours.

Revised: 6/08, 7/07, 8/069

Approved Skills

The student is to render care, as directed by the medical personnel with whom he/she is working, in the manner and at the level it has been taught in EMTB, EMT-1, and/or EMT-P classes. DO NOT UNDER ANY CIRCUMSTANCE ATTEMPT TO PERFORM ANY SKILL THAT YOU HAVE NOT BEEN TRAINED TO PERFORM IN CLASS!! If you are asked to perform a skill that you have not been trained to do, immediately inform the medical personnel or your preceptor that this is a skill beyond the scope of your knowledge and/or practice. The student is only allowed to practice at the level delineated by his/her level of education.

Standard Operating ProceduresAs listed by the Texas Department of State Health Services

EMT-Basic Procedures:The EMT-Basic student has the ability to perform the following:

Administer Nitroglycerine—Spray or TabletAdminister Oral Glucose TherapyAdministration of Activated CharcoalAutomatic External DefibrillatorBandagingControl BleedingCPR Adult, Child, and InfantEpi-PenLifting and Moving of PatientsNebulizer TreatmentsOxygen AdministrationPatient AssessmentPneumatic Anti-Shock GarmentProper safety proceduresRadio CommunicationsSpinal ImmobilizationSplintingVital Signs

EMT-Intermediate ProceduresThe EMT-Intermediate student has the ability to perform all of the EMT-Basic requirements in addition to the following:

Endotracheal IntubationEsophageal Gastric Tube AirwayEsophageal Obturator AirwayI V Therapy/Fluid Replacement

Draw BloodEMT-Paramedic Procedures

The EMT Paramedic student has the ability to perform all of the EMT-Basic and EMT-Intermediate requirements in addition to the following:

DefibrillationDrug Administration including Cardiac MedicationsDrug Administration through IV push, IV piggyback, ET, IM and SubQEKG Interpretations

Revised: 6/08, 7/07, 8/0610

Recognition of abnormal cardiac rhythmsSynchronized Cardiovert

Laredo Community College OBJECTIVES: EMERGENCY DEPARTMENT

The EMT-Basic student has the ability to perform the following:

Patient Assessment The assessment should include, at a minimum, taking and

recording vital signs, and auscultation of breath sounds Administer—Oxygen; Nitroglycerine (Spray or Tablet); Oral Glucose

Therapy; Nebulizer Treatments; Epi-Pen; Activated Charcoal CPR Adult, Child, and Infant Automatic External Defibrillator (AED) Splinting Traction Splint Bandaging-Control Bleeding Airway Management PASG Spinal Immobilization—Sitting and Supine Lifting and Moving of Patients Follow safety procedures

During the experience in the Emergency Department, the student should have the opportunity to practice and demonstrate proficiency under direct supervision for each of the following:

Perform initial assessment—ABC’s Develop relevant medical history, Perform patient assessment, Perform physical examinations.

-Assist and review the treatment of trauma and/or medical emergencies;

-Assist in trauma cases requiring hemorrhage control, bandaging, stabilizing fractures, splinting, and/or traction splinting and spinal immobilization;

-Assist in cardiac arrest cases, including the performance of CPR and airway management.

Revised: 6/08, 7/07, 8/0611

Laredo Community College OBJECTIVES: EMERGENCY DEPARTMENT

(Con’d)

The EMT-Intermediate student has the ability to perform all of the EMT-Basic requirements in addition to the following:

Endotracheal Intubation Esophageal Gastric Tube Airway Esophageal Obturator Airway Intravenous Therapy / Fluid Replacement

During the experience in the Emergency Department, the EMT-I student should have the opportunity to practice and demonstrate proficiency under direct supervision for each of the following:

Starting and discontinuing IV's Preparing IV solutions for administration under the direct supervision of assigned clinical

preceptor. Observing, assisting and/or initiating Endotracheal Intubation Draw Blood


EKG Interpretations Recognition of abnormal cardiac rhythms Drug Administration including Cardiac Medications Drug Administration through IV, IV Piggybacks, ET, IM and SubQ Defibrillation Synchronized Cardioversion Draw Blood

During the experience in the Emergency Department, the EMT-P student should have the opportunity to practice and demonstrate proficiency under direct supervision for each of the following:

Administer IM, IV, IV Piggybacks, E.T. and SUBQ medications Monitor and interpret ECG’s Administer Cardiac medications Synchronized Cardiovert Defibrillation

Revised: 6/08, 7/07, 8/0612

Laredo Community College OBJECTIVES: RESPIRATORY DEPARTMENT

The EMT-Intermediate student has the ability to perform the following:

Patient Assessment The assessment should include, at a minimum, take and

record vital signs, and auscultation of breath sounds Administer—Oxygen; Nitroglycerine (Spray or Tablet); Oral Glucose

Therapy; Nebulizer Treatments; Epi-Pen; Activated Charcoal CPR Adult, Child, and Infant Automatic External Defibrillator Splinting Traction Splint Bandaging-Control Bleeding Airway Management PASG Spinal Immobilization—Sitting and Supine Lifting and Moving of Patients Follow safety procedures

During the experience in the Respiratory Department, the student should have the opportunity to practice and demonstrate proficiency under direct supervision for each of the following:

Perform initial assessment—ABC’s Develop relevant medical history Perform patient assessment Perform physical examinations.

-Assist and review the treatment of trauma and/or medical emergencies,

-Assist and review administration of bronchodilators,

-Assist in cardiac arrest cases, including the performance of CPR and airway management.

Revised: 6/08, 7/07, 8/0613

Laredo Community College OBJECTIVES: RESPIRATORY DEPARTMENT

(Con’d)


Endotracheal Intubation Esophageal Gastric Tube Airway Esophageal Obturator Airway I V Therapy/Fluid Replacement

During the experience in the Respiratory Department, the EMT-I student should have the opportunity to practice and demonstrate proficiency under direct supervision for each of the following:


preceptor. Observing, assisting and/or initiating Endotracheal intubation Draw Blood


EKG Interpretations Recognition of abnormal cardiac rhythms Drug Administration including Cardiac Medications Drug Administration through IV, IV Piggybacks, ET, IM and SubQ Defibrillation Synchronized Cardioversion

During the experience in the Respiratory Department, the EMT-P student should have the opportunity to observe and practice ETT suction, nebulizer treatment via ETT.

Administer IM, IV, IV Piggybacks, E.T. and SUBQ medications Monitor and interpret ECG rhythms Administer Cardiac medications Synchronized Cardioversion Defibrillation

Revised: 6/08, 7/07, 8/0614

Laredo Community College OBJECTIVES: PHLEBOTOMY DEPARTMENT

The EMT - Intermediate student has the ability to perform the following:

Patient Assessment The assessment should include, at a minimum, taking and

recording vital signs, and auscultation of breath sounds Administer—Oxygen; Nitroglycerine (Spray or Tablet); Oral Glucose


During the experience in the Phlebotomy Department, the student should have the opportunity to practice and demonstrate proficiency under direct supervision for each of the following:

Perform initial assessment—ABC’s Develop relevant medical history Perform patient assessment Perform physical examinations.

-Assist and review the treatment of trauma and/or medical emergencies,

-Assist in cardiac arrest cases, including the performance of cardiopulmonary resuscitation and airway management.

Revised: 6/08, 7/07, 8/0615

Laredo Community College OBJECTIVES: PHLEBOTOMY DEPARTMENT

(Con’d)


Endotracheal IntubationEsophageal Gastric Tube AirwayEsophageal Obturator AirwayI V Therapy/Fluid Replacement

Draw BloodDuring the experience in the phlebotomy department, the EMT-I student should have the opportunity to practice and demonstrate proficiency under direct supervision for each of the following:


preceptor. Observing, assisting and/or initiating Endotracheal Intubation Draw Blood


EKG Interpretations Recognition of abnormal cardiac rhythms Drug Administration including Cardiac Medications Drug Administration through IV, IV Piggybacks, ETT, IM and SubQ Defibrillation Synchronized Cardioversion

During the experience in the Phlebotomy Department, the EMT-P student should have the opportunity to practice and demonstrate proficiency under direct supervision for each of the following:


Revised: 6/08, 7/07, 8/0616

Laredo Community CollegeOBJECTIVES: CATH LAB DEPARTMENT

The EMT-Paramedic student should have the opportunity to observe under direction supervision heart catheterization.

The EMT-Paramedic student has the ability to perform all of the EMT-Basic requirements in addition to the following:

Endotracheal Intubation (ETT) Esophageal Gastric Tube Airway (EGTA) Esophageal Obturator Airway (EOA) IV Therapy/Fluid Replacement

During the experience in the catheterization lab department, the EMT-Paramedic student has the ability to practice and demonstrate proficiency under direct supervision for each of the following:

Starting and discontinuing IV's Preparing IV solutions for administration under the direct supervision of assigned

clinical preceptor. Observing, assisting and/or initiating Endotracheal Intubation


EKG Interpretations Recognition of abnormal cardiac rhythms Drug Administration including Cardiac Medications Drug Administration through IV, IV Piggybacks, ET, IM and SubQ Defibrillation Synchronized Cardioversion

During the experience in the catheterization lab department, the EMT-Paramedic student has the ability to practice and demonstrate proficiency under direct supervision for each of the following:


.

Revised: 6/08, 7/07, 8/0617

Laredo Community College OBJECTIVES: LABOR AND DELIVERY

During the experience in the labor and delivery unit, the EMT-B student should have the opportunity, under direct supervision, to practice and demonstrate proficiency for each of the following:

Perform patient assessment and physical examination. At minimum, the patient assessment should include a review of the patient's chart, take and record vital signs, and auscultation of chest and abdominal sounds;

Identify and describe the three stages of labor and common complications in abnormal deliveries;

Observe, where possible, normal deliveries; Observe, where possible, abnormal deliveries; Observe, where possible, the resuscitation of the newborn Assist with handling, with feeding, and the general care of the nursery patients if you

rotate through the nursery.

During the experience in the Labor and Delivery, the EMT-I student should have the opportunity to practice at the EMT-B level plus have the additional opportunity to practice and demonstrate proficiency under direct supervision for each of the following:


clinical preceptor. Observing, assisting and/or initiating Endotracheal intubation

During the experience in the Labor and Delivery, the EMT-P student should have the additional opportunity to practice at the EMT-B and EMT-I level and demonstrate proficiency under direct supervision for each of the following:

Administer IM, IV push, IV Piggyback, E.T.T. and SUBQ medications Monitor the drugs being administered and observe patient reactions Monitor and interpret ECG rhythms

Revised: 6/08, 7/07, 8/0618

Laredo Community College OBJECTIVES: OR AND RECOVERY

While in the operating room, the EMT-I and EMT-P student should have the opportunity to practice intubating a patient under the direct supervision of an anesthesiologist or nurse anesthetists.

The EMT-P student should monitor the drugs being administered and observe patient reactions.

The student will assist the nurses in any way possible including obtaining warm blankets, changing IV's, suctioning the patients and performing assessment of vital signs.

During the experience in the OR and Recovery, the EMT-I student should have the opportunity to practice and demonstrate proficiency under direct supervision for each of the following:



During the experience in the OR and Recovery Department, the EMT-P student should have the opportunity to practice and demonstrate proficiency under direct supervision for each of the following:


In recovery, the EMT-I and EMT-P student should observe and participate in extubating a patient. The student should observe the steps to maintain an open airway of an unresponsive patient.

Revised: 6/08, 7/07, 8/0619

Laredo Community College OBJECTIVES: ICU

The student should observe and assist in the care of patients that are experiencing assisted ventilation, are unresponsive or that need special attention.

During the experience in ICU the EMT-I student should have the opportunity to practice and demonstrate proficiency under direct supervision for each of the following:



During the experience in ICU, the EMT-P student should have the opportunity to practice and demonstrate proficiency under direct supervision for each of the following:


The EMT-P student should monitor ECG strips and immediately notify the Clinical Preceptor of changes or abnormal rhythm patterns.

Revised: 6/08, 7/07, 8/0620

Laredo Community College OBJECTIVES: AMBULANCE

The EMT-Basic student has the ability to perform the following:

Patient Assessment should include, at a minimum, taking and recording vital signs, and auscultation of breath sounds Administer—Oxygen; Nitroglycerine (Spray or Tablet); Oral Glucose


During the experience in the pre-hospital setting, the student should have the opportunity to practice and demonstrate proficiency under direct supervision for each of the following:

Perform initial assessment—ABC’s Develop relevant medical history, Perform patient assessment, Perform physical examinations.

-Assist and review the treatment of trauma and/or medical emergencies;

-Assist in trauma cases requiring hemorrhage control, bandaging, stabilizing fractures, splinting, and/or traction splinting and spinal immobilization;

-Assist in cardiac arrest cases, including the performance of cardiopulmonary resuscitation and airway management.

Revised: 6/08, 7/07, 8/0621

Laredo Community College OBJECTIVES: AMBULANCE

(Con’d)


Endotracheal Intubation Esophageal Gastric Tube Airway Esophageal Obturator Airway I V Therapy/Fluid Replacement

During the experience in the pre-hospital setting, the EMT-I student should have the opportunity to practice and demonstrate proficiency under direct supervision for each of the following:


preceptor. Observing, assisting and/or initiating Endotracheal intubation


EKG Interpretations Recognition of abnormal cardiac rhythms Drug Administration including Cardiac Medications Drug Administration through IV, IV Piggybacks, ET, IM and SubQ Defibrillation Cardioversion

During the experience in the pre-hospital setting, the EMT-P student should have the opportunity to practice and demonstrate proficiency under direct supervision for each of the following:

Administer IM, IV, IV Piggybacks, E.T. and SUBQ medications Monitor and interpret ECG rhythms Administer Cardiac medications Cardioversion Defibrillation

Revised: 6/08, 7/07, 8/0622

MEDICAL ABBREVIATIONS

Laredo Community College Emergency Medical Services

Revised: 6/08, 7/07, 8/0623

ACCEPTED MEDICAL ABBREVIATIONS

_a beforeAAA abdominal aortic aneurysmabd. abdomenA/C, A-C acromioclaviculara.c. before mealsAcc. accessoryact. ActiveA.D. right earA/E above the elbowAEA above the elbow amputationA & E active and equalA. Fib. atrial fibrillationA. Fl. atrial flutterAIDS acquired immune deficiency syndromeAK above the kneeAKA above the knee amputationA.M., a.m. from 12 midnight to 12 noon, morningAMI acute myocardial infarctionamp. ampuleamt. amountaneu. aneurysmant. anteriorA/O x- alert and oriented times ---(state degree of orientation)A & P anterior and posteriorapprox. approximatelyAROM artificial rupture of membraneart. artery, arterialarth. arthritisA.S. left earASA acetylsalicylic acid (aspirin)ASAP as soon as possibleASCVD arteriosclerotic cardiovascular diseaseASHD arteriosclerotic heart diseaseassist. assistanceassoc. associatedas tol. as toleratedA-V arteriovenousax. axillary

BBB bundle branch block21

Revised: 6/08, 7/07, 8/06

BBSCTA bilateral breath sounds clear to auscultationB/E below the elbowBEA below the elbow amputationBF black femalebicarb. sodium bicarbonateb.i.d. twice a dayBIGM bigeminybilat. bilateralBK below the kneeBKA below the knee amputationBM black maleb.m. bowel movementBOW bag of watersB/P, B.P. blood pressurebpm beats per minuteBRB bright red bloodBr. S breath soundsBS bowel soundsBVM bag-valve-mask

C. centigradeC-(1-7) cervical vertebra (specify 1 thru 7 or range)c withCA carcinomaCa, Ca² calciumCAB coronary artery bypassCAD coronary artery diseasecalc. CalculatedCAO conscious alert orientatedcap. capillarycaps. capsulecath. catheter, catheterizeC.C. chief complaintcc. cubic centiliters (milliliter)cerv. cervicalCHB complete heart blockCHD coronary heart diseaseCHF congestive heart failureCHI closed head injurychr. chroniccirc. CirculationCl- Chloridecm. centimeterCNS central nervous systemCO Carbon MonoxideCO2 Carbon DioxideC O complains ofcomp. compoundconc. concentration

22Revised: 6/08, 7/07, 8/06

cong. congenitalcons. consultationcont. continuecontr. contracture/contractionCOPD chronic obstructive pulmonary diseasecor heartC-P cerebral palsycrych. crycothyrotomyC-section cesarean sectionCSF cerebrospinal fluidCSM Carotid Sinus MassageCVA cerebrovascular accidentC-VA costovertebral angle

D5W 5% dextrose in waterD10W 10% dextrose in waterD50W 50% dextroseD.C., d/c discontinuedefib. defibrillation, defibrillatedep. depressed (as in a skull fracture)1OHB first degree heart block2OHB second degree heart block type---(specify I or II)3OHB third degree heart blockDIA diastolic pressurediab. diabeticdiag. diagnosisdig. digoxindil. dilutedisc. dischargeD M diabetes mellitusIDDM insulin dependant diabetes mellitisNIDDM non-insulin dependant diabetes mellitisD.O. Doctor of OsteopathyD O A dead on arrivalD O B date of birthD O E dyspnea on exertionD O S dead on sceneDP dorsalis pedisDr. DoctorDsg dressingDT delirium tremensDx diagnosis

EBL estimated blood lossECF extracellular fluidECG/EKG electrocardiogram

23Revised: 6/08, 7/07, 8/06

ED/EC/ER emergency department/center/roomEDC estimated date of confinementEDD estimated date of deliveryEEG electroencephalogramEENT eyes, ears, nose, throatEGTA esophageal gastric tube airwayelix. elixirENT ears, nose, throatEOA esophageal obturator airwayEOM extraocular movementEOMI extraocular movements intactepi. epinephrineETOH ethyl alcoholETT endotracheal tubeexam examinationexp. expireext. externalextr. extremity

F femaleF. FahrenheitF A female arteryF B foreign bodyF B A O foreign body airway obstructionF&D fixed and dilatedfem. femur, femoralF.Hx. family historyFHT fetal heart tonefib. fibulafl. fluidflex flexion, flexorfrag. fragmentfwd forwardFx., fx fracture

G gravidag gaugeGO gonorrhea (gonococcus)GI gastrointestinalgm. gramgr. grainG S W gun shot woundgtt., gtts. drop, dropsGU genitourinary

h, hr. hourHCO3 - bicarbonateH2O waterH2CO3 carbonic acid

24Revised: 6/08, 7/07, 8/06

HA headacheHb hemoglobinhx/o history ofHPB high blood pressureHCT, hct hematocritHCVD hypertensive cardiovascular diseaseHEENT head, eyes, ears, nose, throatHOB head of bedHPI history of present illnessHR heart ratehr. hourh.s. hours of sleep/bedtimeht. heightHTN hypertensionHum. HumerusHVD hypertensive vascular diseaseHx historyhypo hypodermic

ICF intracellular fluidICP intracranial pressureICS intercostal spaceICU intensive care unitIM intramuscularin. inchinc. incompleteinf. Inferioring. inguinalinj. injectioninstab. instabilityIO intraosseousIPPA Inspection, palpation, percussion, auscultationIPPB intermittent positive pressure breathingIPPV intermittent positive pressure ventilationI R internal rotationIUD intrauterine deviceIV intravenousIV bolus intravenous bolus (fluids)I V D A intravenous drug abuseI V P intravenous pylogramIV push intravenous push (drugs)

jt. jointJ tach. junctional tachycardiajuv. juvenileJVD jugular venous distention

25Revised: 6/08, 7/07, 8/06

K+ PotassiumKO keep openKVO keep vein open

L leftL- lumbar (specify 1 thru 5 or range)l. literLA left atriumlac. lacerationLAF Latin American FemaleLAM Latin American Malelap. laparotomylat. laterallat. mal. lateral malleolusLB low (er) backlb. poundL B B B left bundle branch blockL B P low (er) back painLC living childrenLE lower extremitieslido. lidocainelig. ligamentliq. liquidLL lower lobeLLD leg length discrepancyLLE left lower extremityLLL left lower lobeLLQ left lower quadrantLMP last menstrual periodLOC loss of consciousness, level of consciousnessLOM limitation of motionLPM liters per minuteLQ lower quadrantLR lactated ringersL-S lumbosacrallt. leftLUE left upper extremityLUL left upper lobeLUQ left upper quadrantLV left ventricle

M malem. minumMAL midaxillary linemalig. malignantMAST Military Anti-Shock TrousersASG Anti-Shock Garment

26Revised: 6/08, 7/07, 8/06

ASP Anti-Shock PantsAST Anti-Shock TrousersMAST Medical Anti-Shock TrousersPASG Pneumatic Anti-Shock GarmentPCPD Pneumatic Counter Pressure DeviceMCA motorcycle accidentmcgm. MicrogramMCL midclavicular lineM.D. medical doctorM.E. medical examinermech. mechanicalmed. medical doctormed. mal. medial malleolusmen. meningealMF multifocalmg. milligramMI myocardial infarctionml. milliliter (cc)mm. millimetermm Hg millimeters of mercurymod. moderateMOI mechanism of injuryM.S. multiple sclerosisms morphine sulfateMSC motor, sensory, circulatoryMSL midsternal linem v mitral valveM V A motor vehicle accidentM V P motor vehicle pedestrianM V R motor valve replacement

n nauseaN A not applicableN A D no apparent distressN B newbornnc nasal cannulaneb. nebulizerNED no evidence of distressneg. negativeneuro. neurologicN G nasogastric

NGT nasogastric tubeNitro., NTG nitroglycerinNKA no known allergiesNKDA no known drug allergiesNoct. Nocturnal, nightNPO, n.p.o. nothing by mouthN R B non-rebreather (mask)

27Revised: 6/08, 7/07, 8/06

N/S, N.S. normal saline1/2 N.S. half normal saline (.045%)1/4 N.S. quarter normal saline (.0225%)N S R normal sinus rhythmN T T nasotracheal tubeN&V, N/V nausea and vomitingN/V/D nausea, vomiting, and diarrhea

O2 oxygenOB, OBS obstetricsOccas. OccasionalOccip. OccipitalO D right eyeO.D. overdoseO R operating roomO S left eyeOz. Ounce (approx. 30 ml.)

P pulseP afterPA posterioanteriorP&A percussion and auscultationPACE paced rhythmPAC premature atrial complex (contraction)PAF paroxysmal atrial fibrillationPAFl. Paroxysmal atrial flutterPAT paroxysmal atrial tachycardiap.c. after mealsPaCO2 pressure of arterial carbon dioxidePCN penicillinPCP phencyclidinePCV packed cell volumeP.E. physical examinationPEDI pediatricsPEEP positive end expiratory pressurePeriph peripheralPERRLA pupils equal, round and reactive to light and accommodationP.Hx. past historyP.I. present illnessPID pelvic inflammatory disease

PJC paroxysmal junctional complex (contraction)P.M., p.m. from 12 noon to 12 midnight, afternoon, eveningPND paroxysmal nocturnal dyspneap.o. by mouthPaO2 pressure of arterial oxygenpop., popl. poplitealpos. positiveposs. possible

28Revised: 6/08, 7/07, 8/06

post. posteriorP R B parital rebreather (mask)p.r.n. as neededprob. probablyPROM premature rupture of membraneprox. proximalp.s.i. pounds per square inchPSVT paroxysmal supraventricular tachycardiapt. patientPtL pharyngeal tracheal lumenPVC premature ventricular complex (contraction)

q everyq.d. every dayq.h. every hourq.i.d. four times a dayqns quantity not sufficientq.o.d. every other dayqs quantity sufficient

R respirationR rightR A right atriumR B B B right bundle branch blockR B C red blood cells (count)rect. rectalreg. regularresp. respirationRh neg (Rh-) Rhesus factor negativeRh pos (Rh+) Rhesus factor positiveRL ringers lactateRLE right lower extremityRLL right lower lobeRLQ right lower quadrantR.N. registered nurseR O rule outROM range of motionrot. rotationR R R regular rate and rhythm

rt. rightRUE right upper extremityRUL right upper lobeRUQ right upper quadrantR V right ventricleR x prescription, treatment

S- sacral (specify 1 thru 5 or range)s without

29Revised: 6/08, 7/07, 8/06

S A sinoatrialSB/SH seat belt/shoulder harnessSBP systolic blood pressuresec. secondSFM simple face maskS.Hx. social historysm. smallSOB shortage of breathsol. solutionS/P status postSROM spontaneous rupture of membraness one halfS&S signs and symptomsstat. immediatelysubq subcutaneoussup. superiorsurg. surgery, surgicalS V T supraventricular, tachycardiaS W steering wheel, stab woundSx symptomssync. synchronizedSYS systolic pressure

T temperatureT- thoracic (specify 1 thru 12 or range)T & A tonsillectomy and adenoidectomytab. tablettach tachycardiaTB tuberculosistbsp. tablespoon 15cctemp temperatureTIA transient ischemic attacktib tibiat.i.d. three times a daytinct. tinctureTKO to keep openTMJ temporomandibular jointtol. toleratedtrach tracheotomytsp. teaspoon (5cc)Tx traction

UE upper extremitiesUF unifocalUGI upper gastrointestinalURI upper respiratory infection

V vomitingVALS during Val Salva maneuvers

30Revised: 6/08, 7/07, 8/06

VD venereal diseasevent. ventricleV. fib. ventricular fibrillationV.O. verbal orderV S vital signsV. tach ventricular tachycardia

WBC white blood cells (count)W/C wheel chairW D well developedW F white femaleW M white maleW N well nourishedW N L within normal limitsw/o withoutW P W Wolff-Parkinson-White (syndrome)wt. weighty o years old

above, increased, over

under, decreased, below

standing

sitting

prone

supine

present, positive

absent, negative

male

female

>,<, = greater than, less than, equal

@ at

31Revised: 6/08, 7/07, 8/06

Laredo Community CollegeAllied Health Department

EMS ProgramAmbulance Station Locations

Station 1: #1 Guadalupe 795-2501

Station 2: 2200 Zacatecas (Hwy 83-S. Zapata Hwy) Ciagarroa High School

795-2522

Station 3: 2420 San Bernardo (Civic Center) 795-2523

Station 5: 2600 Bartlett (near Nixon High School) 795-2525

Station 7: 1100 Calton (across SAM's) 795-2527

Station 8: 520 Del Mar (across St. Patrick's Church) 795-2528

Station 9: 1330 Mines Road 795-2529

Station 11: 5210 Highway 359 (near SAC) 728-8164

Station 14:

Quality Care Ambulance Service901 W. Viggie St.Hebbronville, TX (361) 527-3933

Ambulance Service of Laredo, Inc.6502 N. BartlettLaredo, TX 726-1337

Zapata County Fire DepartmentHwy 16 & KennedyZapata, Tx 78076

32Revised: 6/08, 7/07, 8/06

765-9942

Laredo Community CollegeAllied Health Department

EMS ProgramHospital Locations

Doctors Hospital of Laredo 10700 Mcpherson523-2000

Laredo Medical Center1700 E. Saunders796-5000

33Revised: 6/08, 7/07, 8/06

Laredo Community CollegeClinical Time Log a Tracking Form

Name: Social Security Number

EMSP Level: ________________ Semester: __________________ TDH #: ______

Emergency Contact Numbers:

Name of Hospital Area Hours

ER

ICU

OR

OB

Resp

Phle

Cath Lab

Total Hours __________

Name of Ambulance Hours

Total hours_____________

Patient Documentation in ER __________________

BLS or ALS transports __________________

IV’s successful __________________

Coordinator signature____________________________ Date_______________34

Revised: 6/08, 7/07, 8/06

Laredo Community CollegeClinical Report Grading Form

Semester______________________________ DSHS #______________________________

Student Name:

Clinical Site

Type of Clinical (circle one) Ambulance Hospital

(Each worth 10 points)

1. Did the student show up to all clinical rotations as Yes No assigned by Clinical Instructor?

2. Did the student have all evaluation reports signed by preceptor? Yes No

3. Did the student proform all skills assigned by Hosp. staff, Yes No

EMS staff, and Clinical Instructor?

4. Did the student receive low remarks? Yes No _______

5. Did the student ever arrived late, or left early from Yes No clinical site.

6. Did the student have a professional behavior during their Yes No

clinicals?

7. Was at least one complete set of vital signs noted in Yes No each report?

8. Did the student have the clinical preceptor signature on all Yes No

the reports?

9. Was the student wearing the required uniform and have the Yes No required clinical equipment at all times?

10. Was the clinical documentation book completed and submittedYes No

on the due date?

35Revised: 6/08, 7/07, 8/06

Were any items noted as “no” or “needs improvement” in the evaluation section of the form? If so, were these items discussed with the student? Yes or No

Evaluator Comments

Evaluated By Date_________________________

Student Signature _______Date_________________________

Laredo Community CollegeEMSP Student Clinical Agreement

I, __________________________________________ hereby acknowledge that I have and understand

the polices outlined and described in the Emergency Medical Services Program Student Clinical

Handbook. I agree to abide by said agreement and fully understand the implication and consequences of

my failure to do so. I further agree that I shall indemnify and hold harmless any and all agencies,

faculty, staff, and examiners from all suit actions or claim of any type or form brought on, or as the

result to any person, equipment, or property connected with this course. I hereby acknowledge that I am

in receipt of this document prior to the commencement of the aforementioned course.

Student:____________________________________________ Date___/___/___

Coordinator:_________________________________________Date___/___/___

Witness:____________________________________________Date___/___/___

36Revised: 6/08, 7/07, 8/06

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