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STUDENT CLINICAL BOOK
2012-2013
Palm Beach State College – Paramedic Program Student Clinical Book
Table of Contents
STUDENT CLINICAL BOOK REQUIREMENTS: .............................................................................. 1
BOOK ATTESTATION PAGE ....................................................................................................... 3
STUDENT CLINICAL MANUAL .................................................................................................... 4
CLINICAL SIGN IN SHEET .......................................................................................................... 5
CLINICAL EVALUATION – PROGRESS REPORT ........................................................................... 6
CLINICAL EVALUATION - COVER FOR LONG FORM ..................................................................... 7
MANDATORY PARAMEDIC DRUGS ............................................................................................. 8
REPORT WRITING NARRATIVE REQUIREMENTS .......................................................................... 9
PATIENT CARE REPORT ..........................................................................................................10
SKILLS SIGN OFF ....................................................................................................................13
STUDENT EQUIPMENT COMPETENCY CHECK LIST - LP .............................................................14
STUDENT EQUIPMENT COMPETENCY CHECK LIST – MED BAG ..................................................15
STUDENT EQUIPMENT COMPETENCY CHECK LIST - STRETCHER ................................................16
Palm Beach State College – Paramedic Program 1 Student Clinical Book
Palm Beach State College
Paramedic Program
STUDENT CLINICAL BOOK REQUIREMENTS:
To be assembled with tabs
If clinical rotation has not happened yet – keep blank forms out of book.
** Outside Cover is the Attestation Page**
1. Front Page – Name Page
2. Clinical Sign In Sheet
3. Drug Card Check Off Sheet (EMS 2664 ONLY)
4. Medical Director Rotation
5. Sim Lab
6. Pediatric Partners
7. ECT Lab
8. Trauma Surgeon Documentation Forms
9. Healey Rehab
10. Humane Society Form
11. O.R. Intubation rotation
12. Midterm and Final Evaluation, Cover Sheet for Long Form
13. Preceptor Objective Worksheet
14. Preceptor Feedback Tool
15. Patient Care Reports Hospital
16. Patient Care Reports Fire Rescue
17. Skills Sheet
Palm Beach State College – Paramedic Program 2 Student Clinical Book
**Binder clipped when turned in with labeled tabs.
Palm Beach State College – Paramedic Program 3 Student Clinical Book
Paramedic Clinical BOOK ATTESTATION PAGE
CLASS SHIFT: ____________
I hereby attest that the reports and documentation contained
within this Student Clinical Book for:
Are complete, accurate, have been reviewed by the student and
myself, verified with our signatures, and reflect the student’s
TYPHON entries.
Clinical Instructor Printed Name:
_______________________________________________
Clinical Instructor Signature:
_______________________________________________
Date of Submission:
_______________________________________________
□ EMS 2664 – CLINICAL 1 □ EMS 2658 – CLINICAL 3
□ EMS 2665 – CLINICAL 2 □ EMS 2659 – Internship
Palm Beach State College – Paramedic Program 4 Student Clinical Book
Palm Beach State College
PARAMEDIC PROGRAM
STUDENT CLINICAL MANUAL
EMS 2664, 2665, 2658, 2659
STUDENT NAME________________________________
CLINICAL INSTRUCTOR__________________________
FIRE RESCUE INSTRUCTOR______________________
CLASSROOM INSTRUCTOR______________________
Palm Beach State College – Paramedic Program 5 Paramedic Book
CLINICAL INSTRUCTOR_______________________________ FIRE RESCUE INSTRUCTOR____________________________ INSTRUCTOR PHONE # ________________________________
PALM BEACH STATE COLLEGE PARAMEDIC STUDENT
CLINICAL SIGN IN SHEET STUDENT: Fill out this sheet every time you attend a clinical function. Fill out the dates you are absent also. Keep this sheet in your Clinical Handbook.
Student Name Date Time In Time Out Site Instructor Printed Name Instructor Signature
Palm Beach State College – Paramedic Program 6 Student Clinical Book
Palm Beach State College – Paramedic Program
CLINICAL EVALUATION – PROGRESS REPORT
□ EMS 2664 – CLINICAL 1 □ EMS 2658 – CLINICAL 3
□ EMS 2665 – CLINICAL 2 □ EMS 2659 – Internship
Class:
Date Student Name
Instructor Name Instructor Signature
Indicate how the student is progressing toward competency by rating the student on a scale of 1-5. A “1” or “2” rating indicates that immediate remedial work is indicated. A “5” indicates superior performance.
Cognitive Domain (Knowledge Base) 5 4 3 2* 1*
Psychomotor Domain (Clinical Proficiency) 5 4 3 2* 1*
Affective Domain (Behavioral Skills) 5 4 3 2* 1*
Documentation (FISDAP/Typhon) 5 4 3 2* 1*
Comments:
*Grades of 1 or 2 require comments, an Assistance Lab referral form, and Clinical Coordinator notification.
Student Signature:
Palm Beach State College – Paramedic Program 7 Student Clinical Book
Palm Beach State College – Paramedic Program
CLINICAL EVALUATION - COVER FOR LONG FORM
□ EMS 2664 – CLINICAL 1 □ EMS 2658 – CLINICAL 3
□ EMS 2665 – CLINICAL 2 □ EMS 2659 – Internship
CLASS: _______________
Date Student Name
Instructor Name Instructor Signature
Competent Not Competent
Cognitive Domain (Knowledge Base) Minimum Score: 24
Psychomotor Domain (Clinical Proficiency) Minimum Score: 16
Affective Domain (Behavioral Skills) Minimum Score: 36
Documentation (Typhon) Minimum Score: 12
Comments:
In any given semester, a Competent score is required in the Psychomotor domain in order to receive a course satisfactory grade (S). In EMS2664, EMS2665 and EMS2658, other than the above mentioned requirement, the student may receive only one Not Competent and still receive a course grade of satisfactory (S). In EMS2659, a Final Evaluation of Competent must be received in ALL categories to earn a satisfactory grade (S).
CURRENT GRADE: Satisfactory Unsatisfactory*
*Requires immediate Clinical Coordinator notification
Student Signature:
Palm Beach State College – Paramedic Program 8 Student Clinical Book
MANDATORY PARAMEDIC DRUGS 1. These are mandatory for student drug cards. Instructors may also add additional drugs
as they see fit. 2. All drug cards are to be turned into the Clinical Lead Instructor by the end of EMS 2664. 3. YOU ARE REQUIRED TO KNOW THE HIGHLIGHTED DRUGS FOR THIS PROGRAM.
THE OTHERS ARE FOR YOUR REFERENCE AS YOU WILL SEE THEM IN SOME DEPARTMENTS AND/OR HOSPITALS.
1. ADENOCARD
2. ALBUTEROL
3. AMIODARONE
4. ASPIRIN
5. ATROPINE
6. CALCIUM CHLORIDE
7. DEXTROSE 50%
8. DIAZEPAM
9. DILTIAZEM
10. DIPHENHYDRAMINE
11. DOPAMINE
12. EPINEPHRINE 1:1000
13. EPINEPHRINE 1:10000
14. ETOMIDATE
15. FENTANYL
16. FLUMAZENIL
17. FUROSEMIDE
18. GLUCAGON
19. IPRATROPRIUM BROMIDE
20. KETAMINE
21. KETORLAC
22. LABETALOL
23. LEVALBUTEROL
24. LIDOCAINE
25. LORAZEPAM
26. MAGNESIUM SULFATE
27. METHYLPREDNISONE
28. MIDAZOLAM
29. MORPHINE
30. NALOXONE
31. NITROGLYCERINE
32. NOREPINEPHRINE
33. NORCURON
34. ONDANSETRON
35. OXYGEN
36. PROCAINAMIDE
37. PROCHLORPERAZINE
38. PROMETHAZINE
39. SODIUM BICARBONATE
40. SUCCINYLCHOLINE
41. TETRACAINE
42. THIAMINE
Student Printed Name: _____________________________________ Student Signature: _________________________________________ Clinical Instructor Signature: _________________________________ Date Completed: ___________________________________________
Palm Beach State College – Paramedic Program 9 Student Clinical Book
PALM BEACH STATE COLLEGE
EMS Academy - Paramedic Program
DATE: August 2010
PATH: REPORT WRITING NARRATIVE REQUIREMENTS
Excellent report writing and documentation skills are paramount for paramedic students to master. These skills require much diligence and patience in order to achieve excellence. Therefore, all paramedic students are required to use the following narrative styles in each subsequent semester. Templates and examples for each can be found on Typhon. Semester 1: Students will write narratives in the CHARTE format. Semester 2: Students will write narratives in the SOAP format. Semester 3 and Internship: Students will write narratives in the Descriptive Narrative format
Palm Beach State College – Paramedic Program 10 Student Clinical Book
PALM BEACH STATE COLLEGE EMT/Paramedic Program
PATIENT CARE REPORT
Student:
_________________________
EMT Paramedic Date:
____/____/_____
Time of Call: _______________ Hospital/Agency: ____________
Age:____
Unit: ____________
□ I accompanied this patient to the hospital during transport.
Instructor/Preceptor Name:
______________________
Instructor/Preceptor Signature:
______________________
ETHNICITY M F
African American
American Indian
Asian
Caucasian
Hispanic
Other:
___________________
Chief MEDICAL COMPLAINT
Abdominal OD-Poison Cardiac Psychiatric CVA Respiratory Diabetic Seizure OB/GYN Sepsis
Other ___________________
Chief TRAUMA COMPLAINT
Abdomen Neck/Back Chest Pelvic Extrem. Head/Face
Muscular Multi-
system
Other ___________________
MECHANISM OF INJURY None Driver MVA Passenger MVA Auto-Pedestrian
Motorcycle Fall/Jump
Airbag Seatbelt Entrapment Ejection
Rollover Blunt Penetrating Injury – Type: _____________________ Other: ______________________________________
ALLERGIES:
MEDICATIONS:
PAST MEDICAL HX:
Time BP Pulse Resp AVPU Pupils Lungs Drug/Tx Dose Route
Palm Beach State College – Paramedic Program 11 Student Clinical Book
Eyes Open→ Spontaneous 4 To Voice 3 To Pain 2 None 1 Glasgow Score =
_________ Verbal→ Orient 5 Confused 4 Inappropriate 3 Garbled 2 None
1
Motor→ Obey Com. 6 Pain/Local 5 Pain/Withdraw 4 Pain/Flexion 3 Pain/Ext 2
None 1
BLS AIRWAY NC NRB Nasal airway Oral airway
BVM @ ______L/Min
ALS AIRWAY Surgical Nasal ET Oral ET Attempts X: ____ Success Y N ET size:
___
Pulse Ox on room air ________ % After O2 ________ % Glucometer __________
IV / IO Attempts X:
_____
Success: Y
N
Site: ________ Gauge: ______ Solution: ______
ELECTRICAL
THERAPY ENERGY
LEVELS
OBS. PERF. EKG INTERPRETATION OBS PERF
MANUAL DEFIBRILLATION Rhythm 1:
SYNCHRONIZED
CARDIOVERSION
Rhythm 2:
TRANSCUTANEOUS
PACING
Rhythm 3:
PHTLS CARE BLS CARE
OBS PERF
OBS PERF
PATIENT INTERVIEW WITNESSED ARREST
VITAL SIGNS SUCTION
02 ADMINISTRATION CHEST COMPRESSIONS
BANDAGING VENTILATIONS
TRACTION SPLINT BLS airway adjunct
C-SPINE
IMMOBILIZATION
AIRWAY ADJUNCT TYPE:
LONG BACKBOARD ALS CARE – OTHER LONG BONE
IMOBILIZATION DESCRIBE # PERFORMED Obs Per
STUDENT PHYSICALLY
INVOLVED IN LIFTING
PATIENT
YES NO CHEST DECOMPRESSION
CRICOTHYROIDOTOMY
12 LEAD ECG
PULSE OXIMETRY
BLOOD GLUCOSE
Palm Beach State College – Paramedic Program 12 Student Clinical Book
SOAP NARRATIVE
Subjective:_____________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Objective:______________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Assessment:____________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Procedures/Response to
Procedures:_____________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Palm Beach State College – Paramedic Program 13 Student Clinical Book
SKILLS SIGN OFF Name: Date: Instructor: Clinical Location: Patient Age: Patient Gender: Skill Performed Successful: Initials: Student Signature: Date: Instructor Signature: Date:
Palm Beach State College – Paramedic Program 14 Student Clinical Book
STUDENT EQUIPMENT COMPETENCY CHECK LIST - LP Student Name: Station/Shift:
School / Institution:
The student will locate and show knowledge of the CPAP
Yes No Preceptor Date
The student can identify the location of the CPAP
The student can identify the location of all accessories for equipment
The student can show and apply the proper procedure for the CPAP
The student will locate and show knowledge of the Carevent
Yes No Preceptor Date
The student can identify the location of the CAREVENT
The student can identify the location of all accessories for equipment
The student can show and apply the proper procedure for the CAREVENT
The student will locate and show knowledge of the Suction Unit
Yes No Preceptor Date
The student can identify the location of the Suction Unit
The student can identify the location of all accessories for equipment
The student can show and apply the proper procedure for the Suction Unit
The student will identify the location of items in the LifePack 15
Yes No Preceptor Date
The student can identify the location of the LifePack 15
The student can identify the location of all accessories for equipment
The student can show and apply the proper procedures for the LifePack 15
Palm Beach State College – Paramedic Program 15 Student Clinical Book
STUDENT EQUIPMENT COMPETENCY CHECK LIST – MED BAG Student Name: Station/Shift:
School / Institution:
The student will identify the location of items in the Blue Med Bag
Yes No Preceptor Date
The student can identify the location of all Medications
The student can identify the location of all IV equipment
The student can identify the location of all Fluids
The student can identify the location of all PPE/BIO bags
The student will identify the location of items in the Airway Bag
Yes No Preceptor Date
The student can identify the Airway Roll and items inside
The student can identify/ knows how to use ALS-BLS Airway equipment
The student can identify the Miscellaneous equipment in Airway bag
The student will identify the location of items in the Trauma Bag
Yes No Preceptor Date
The student can identify the location of all IV equipment
The student can identify the location of all Fluids
The student can identify the location of all PPE
The student can identify the location of BLS/ALS Trauma equipment
The student will identify the location of items in the Pedi Box
Yes No Preceptor Date
The student can identify the location of all Medications
The student can identify the location of all IV equipment
The student can identify the location of all Fluids
The student can identify the location of all PPE/BIO bags
The student can identify the location of BLS/ALS equipment
Palm Beach State College – Paramedic Program 16 Student Clinical Book
STUDENT EQUIPMENT COMPETENCY CHECK LIST - STRETCHER Student Name: Station/Shift:
School / Institution:
The student will display knowledge & demonstrate how to operate the stair chair
Yes No Preceptor Date
The student can identify the location of all handles
The student can identify the location of all levers
The student can identify the location of all straps
The student can demonstrate how to fold and unfold chair
The student will demonstrate correct way to move patient
The student will display knowledge & demonstrate the operation of the either PBCFR stretchers
Yes No Preceptor Date
The student can identify the location of all handles
The student can identify the location of all levers
The student can identify the location of all straps
The student will demonstrate raising and lowering feet/head
The student will identify the location and use of the Pedi, Miller, BackBoards & Scoop stretcher
Yes No Preceptor Date
The student can identify the location of all Boards
The student can identify the location of extra straps
The student can identify the location of the decon spray
The student can demonstrate how to correctly use straps
The student can correctly use above equipment