bartowhighschoolmedicalandfireacademy.files.wordpress.com · Web viewJul 18, 2018 · 2-0.5 _____ the outermost layer of clothing worn by all students must identify them as EMR Program

Bartow Medical and Fire Academy EKG Course 18 19 SY

18/19 SY Electrocardiography

TechnicianRequired Paperwork

Please return this packet to the instructor with all required signatures.

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Bartow Medical and Fire Academy EKG Program

Required Paperwork

Student Name (please print): ___________________________________________________

ITEMS ON THIS PAGE ARE FOR CLINICAL EDUCATION OFFICE USE ONLY

Item # 1 _______ Student Contact Information Form

Item # 2 _______ Free From Addiction and/or Disease or Defect Ability

Item # 3 _______ Compliance Agreement

Item # 4 _______ Copy of Government Issued I.D. / Health Insurance

Item # 5 _______ Physical Examination Form

Item # 6 _______ Immunization Schedule

Item # 7 _______ Affidavit of Good Moral Character

Item # 8 _______ Background / Drug Screen Notice

Item # 9._______ Blanket Field Trip Form

Item # 10 _______ Medical Treatment Authorization

Item # 11 _______ Classroom/Clinical/Skills/High Fidelity Simulation Labs SOP

This will be entered by instructor when received after testing at the academy.

Item # 12. _______ Background Check Results received

Item # 13. _______ Drug Screen Results received

Item # 14. _______ HOSA App.

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Required Paperwork

Item # 1

Please print neatly!!!

Student

Last Name: __________________________________ First Name: __________________________________

Street Address: _____________________________________________________________________________

City: ________________________________________ State: ________________ Zip Code: _____________

Cell Phone: __________________________________ Home Phone: ________________________________

Date of Birth: _________________ Gender (circle one): M / F Age: ________________________

E-Mail address: ______________________________________________________________________

EKG Program Instructor: ___________________________________________ Period: _______________

Parent or Guardian


Street Address: _____________________________________________________________________________




Street Address: _____________________________________________________________________________



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Required Paperwork

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Item # 2

STATEMENT AFFIRMING FREEDOM FROM ADDICTION AND/OR DISEASE

I, ______________________________________________, hereby attest that I am free from addiction to alcoholic

beverages and/or any controlled substances. Furthermore, I hereby attest that I am free from physical and/or mental defects or disease, which may impair my ability to perform as an EKG Program student.

____________________________________________ Student Signature

____________________________________________ Parent Signature

________________Date ____________________________________________ Notary Signature

____________________________________________ Date

Affix Notary Seal

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Required Paperwork

Item # 3

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COMPLIANCE AGREEMENT

This agreement is required so as to ensure that all students have been informed of certain rights that the student is entitled according to the standard college policy.

I, ______________________________________________, have read the EKG Program policies manual, have obtained a current Student Handbook, and have read the sections entitled:

Students Rights and Responsibilities

Due Process

Health Services

Class Attendance and Absences

Student Conduct

Discipline and Due Process

I understand and agree to comply with the policies, rules, and regulations in both publications.

______________________________________________________________________________ Applicant Signature Date

______________________________________________________________________________ Parent Signature Date

____________________________________________ Notary Signature

____________________________________________ Date

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Required Paperwork Item # 4

VERIFICATION OF HEALTH INSURANCE AND I.D.:

Those currently covered by a health insurance plan; please attach a copy of your current health insurance card and initial the first selection below. Those who do NOT have any health insurance coverage at present; please initial the second selection below. Polk County School Board is not financially liable for any injuries that may occur while a participant of the EKG training program.

Also, please attach a copy of your Driver’s License, Florida ID or Passport to this sheet.

I, ______________________________________________, understand that I shall be financially responsible for the treatment of any injury and/or illness that occurs while I am engaged in any type of program activity, whether on or off-campus.

PLEASE INITIAL ONE OF THE FOLLOWING:

_____ I have a current health insurance policy, which I agree to keep current throughout the duration of the EMS program. Said company’s name, policy number, and/or other claims related information, is listed on the card which I have provided a copy of.

_____ I DO NOT have a current health insurance policy. Thus, I understand that, Polk County School Board affords students minimal accidental injury coverage. Moreover, I understand and agree that I am liable for any remaining financial liability resulting from an accident, injury, illness and/or death incurred by me while partaking in any EKG program activity.

_________________________________________________________ Applicant Signature


___________________________Date

____________________________________________ Notary Signature

____________________________________________ Date

ATTACH A COPY OF YOUR HEALTH INSURANCE CARD AND I.D. BELOW

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PRE-ENTRANCE PHYSICAL EXAMINATION

The medical examiner is required to make a careful physical examination. Impairments found after admission may lead to the rejection of the applicant due to the inability of the applicant to meet patient care responsibilities. According to Florida Law, General Authority Section 15; Chapter 73-125: An applicant must be free from any physical or mental defect or disease, which might impair the applicant’s ability to attend clinical.

- STUDENT INFORMATION -

Name: ___________________________________________________ DOB: _______________ Sex: M F

Past Medical History: ____________________________________________________________________________

Medications: __________________________________________________________________________________

Allergies: _____________________________________________________________________________________

- FINDINGS OF PHYSICAL EVALUATION –

Height: _________ Weight: _________ Blood Pressure: _________ Pulse: _________

Vision: R 20/_____ L 20/_____ Corrected: Y / N Contacts: Y / N Glasses: Y / N

INDICATORS NORMAL? ABNORMAL FINDINGS / COMMENTS

General Appearance YES Head/Neck YES Eyes/Sclera/Pupils YES Ears: YES Ear Drums YES Gross Hearing YES Nose/Mouth/Throat YES Lymph Glands YES Cardiovascular: YES Heart Rate YES Rhythm YES Murmur ABSENT If murmur present Standing makes it: Louder Softer No change

Squatting makes it: Louder Softer No change Valsalva makes it: Louder Softer No change Femoral Pulses YES Lungs: Auscultation/Percussion YES Chest Contour YES Skin YES Abdomen (liver, spleen, masses) YES Neck/Back/Spine: YES INDICATORS NORMAL? ABNORMAL FINDINGS / COMMENTS

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Range of Motion YES Scoliosis ABSENT Upper Extremities: YES Range of Motion YES Strength YES Stability YES Lower Extremities: YES Range of Motion YES Strength YES Stability YES Neurological: YES Balance YES Coordination YES Reflexes YES Additional Observations: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Physician/ARNP Certification Statement

After a complete and thorough physical examination, it is my opinion that the person whose name is listed on the front of this form is in good health. In addition, this person is able to participate in any physical activity associated with any facet of Bartow Medical and Fire Academies Program without any restrictions.

Please print or stamp the facility or physician’s name and address below.

_____________________________________________________________________________________________________________________ X________________________________________________

Physician/ARNP Signature Please sign and date

THE PHYSICAL ACTIVITY REFERENCED ON THE CERTIFICATION STATEMENT ABOVE INCLUDES, BUT IS NOT LIMITED TO; HEAVY LIFTING, TWISTING, BENDING, AND PROLONGED PERIODS OF PHYSICAL EXERTION. IN ADDITION, EKG PROGRAMS PARTICIPANTS HAVE AN ELEVATED RISK OF BEING EXPOSED TO COMMUNICABLE AND/OR INFECTIOUS DISEASES.

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Please PRINT student’s name HERE: _______________________________________________________

Complete this form in its ENTIRETY. Include all NAMES, SIGNATURES, and ADDRESSES.

T-DAP within the last 10 years Name/Title of Agency (print or stamp) Date administered ________________________ ____________________________________ By: _______________________________ ____________________________________ Signature: _________________________ ____________________________________

Measles, Mumps, and Rubella (MMR) Name/Title of Agency (print or stamp) Date administered ________________________ ____________________________________ By: _______________________________ ____________________________________ Signature: _________________________ ____________________________________

Varicella (TITER is required) Name/Title of Agency (print or stamp) Date drawn: ________________________ ____________________________________ By: _______________________________ ____________________________________ Signature: _________________________ ____________________________________

Report: Positive _____ Negative _____ All students MUST have the above blood test (TITER) drawn regardless of how many times you may have experienced the disease or who can attest to your medical history.

PPD (TB skin test within the last 3 months) Name/Title of Agency (print or stamp) Date administered ________________________ ____________________________________ By: _______________________________ ____________________________________ Signature: _________________________ ____________________________________

Report: Positive _____ Negative _____

Positive results of PPD require a chest x-rayDate of chest x-ray: _________________ By: _______________________________ Assessed by: _________________________ Signature: _________________________ Signature: ___________________________


Hepatitis C TITER (antibody testing within the last 6 months) Name / Title of Agency (print of stamp) Date drawn: _________________ ____________________________________ By: _______________________________ ____________________________________ Signature: _________________________ ____________________________________


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Heptovax Series

If the applicant chooses not to receive this immunization, the waiver at the bottom of this form must be signed.

Name / Title of Agency (print of stamp) Date Administered ________________________ ____________________________________ By: _______________________________ ____________________________________ Signature: _________________________ ____________________________________



Rejection of Immunization

This will certify that I, the undersigned, understand the risk of exposure and possible complications that may occur because of contact with patients who have Hepatitis B. Should I contact Hepatitis B while on hospital or field affiliation as an EKG Program student, I will not hold Polk County Public Safety, the hospital, nursing home, or Polk County School Board responsible.

_________________________________________________ _____________________________ Program Participant’s Signature Date



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Exhibit “A”

Affidavit of Good Moral Character

I hereby attest that I am of good moral character, that I have not been found guilty of, regardless of adjudication, or entered a plea of nolo contendere or guilty to, any offense prohibited under any of the following provisions of the Florida Statutes or under any similar statute of another jurisdiction:

1. Section 415.111 relating to adult abuse, neglect, or exploitation of aged persons or disabled adults 2. Section 782.04 relating to murder 3. Section 782.07 relating to manslaughter 4. Section 782.071 related to vehicle homicide 5. Section 782.09 relating to killing an unborn child by injury to the mother 6. Section 784.011 relating to assault, if the victim of the offense was a minor 7. Section 784.021 relating to aggravated assault 8. Section 784.03 relating to battery, if the victim of the offense was a minor 9. Section 784.045 relating to aggravated battery 10. Section 787.01 relating to kidnapping 11. Section 787.02 relating to false imprisonment 12. Section 794.011 relating to sexual battery 13. Chapter 796 relating to prostitution 14. Section 798.02 relating to lewd and lascivious behavior 15. Chapter 800 relating to lewdness and indecent exposure 16. Section 806.01 relating to arson 17. Chapter 812 relating to theft, robbery, and relating crimes if the offense is a felony (See 812.014, 812.016, 812.019, 812.081, 812.13, 812.133, 812.135, 812.14, and 812.16) 18. Section 817.563 relating to fraudulent sale of controlled substances, only if the offense was a felony 19. Section 826.04 relating to incest 20. Section 827.03 relating to aggravated child abuse 21. Section 827.04 relating to child abuse 22. Section 827.05 relating to negligent treatment of children 23. Section 827.071 relating to sexual performance by a child 24. Chapter 847 relating to obscene literature 25. Chapter 893 relating to drug abuse prevention and control, only if the offense was a felony or if any other person involved in the offense was a minor.

I further attest that I have not been judicially determined to have committed abuse or neglect against a child as defined in s.3901 (2) and (36), Florida Statutes; nor do I have a confirmed report of abuse, neglect, or exploitation as defined in s.415.102, or abuse or neglect as defined in s.415.503 (3), which has been uncontested or upheld under s.415.103 or s.415.504, Florida Statues; nor have I committed an act which constitutes domestic violence as defined in s.741.28, Florida Statutes.

BEFORE ME this day personally appeared, ______________________________________, who, being duly sworn, deposes and says: Under the penalties of perjury, I declare that I have read the foregoing, and the facts alleged are true to the best of my knowledge and belief.

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____________________________________ Applicant

___________________________________ Parent Signature Date

OR

To the best of my knowledge and belief, my record may contain one of the foregoing disqualifying acts or offenses.

____________________________________ Applicant

____________________________________ Parent Signature Date

SWORN TO AND SUBSCRIBED before me this ______ day of _______________________, 20___, by

_______________________________________________, who is personally known to me or has produced

______________________________________, as identification, and who did take an oath.

____________________________________ Signature of Notary Public – State of Florida

____________________________________ Notary Seal

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Background Check / Drug Screen Notice

All students enrolled in the course listed above are hereby advised; continued enrollment in this course is contingent upon a satisfactory result on a seven-year criminal background history check and negative results on a ten-panel drug screen. Failure to comply with one or both of these requirements will result in your immediate dismissal from EKG without any refund of uniform, dues and/or lab fees.

For a sample list of criminal and/or felony offenses, which will yield an unsatisfactory result on the seven-year criminal background history, refer to Item # 8; which is the previous page. However, anyone who has been convicted, or plead guilty, or nolo contendre to a felony violation, regardless of adjudication, is strongly urged to consult with a Program Director – EKG prior to the start of classes.

The ten-panel drug screen will check for the presence of: Amphetamines Cannabinoids Cocaine Phencyclidine Methaqualone

Opiates Barbiturates Benzodiazepines Methamphetamine Propoxyphene

A positive result for any of the above substances will disqualify a student from participation in the Electrocardiography Tech. Program. Thus, dismissal from Bartow Medical and Fire Academy will ensue without any refund of uniform, dues and/or lab fees.

I understand that my continued enrolment in Bartow Medical and Fire Academy is contingent upon meeting the above requirement. As such, I agree to be dismissed from the program if I should fail to meet the minimum accepted standards as outlined. Furthermore, I agree to be bound by the terms listed above, specifically those parts, which state no refund will be issued if I am dismissed from the course.

The Medical and Fire Academy has made arrangements to have this testing done on campus for a $120 fee. This is a onetime only deal. If you do not get the testing done at this time it will be up to you to have the testing done by the deadline given. Students are not allowed to go to clinical without this testing. Students need to bring this paper signed by a parent or guardian and a driver’s license, Florida ID card or Passport when testing in the Nursing Lab.

I am giving the Polk County School Board permission to test my student.

Parent Name:_______________________________________________________

Parent Signature:____________________________________________________

Please declare if you are taking any prescribed or over the counter Medications:____________________________

_____________________________________________________________________________________________

_____________________________________________________ _________________Student Signature Date _____________________________________________________ _________________________Printed Student Name Student Identification Number

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Item # 09

Form No. TRNS 0082 Appendix A

THE SCHOOL BOARD OF POLK COUNTY, FLORIDA BLANKET FIELD TRIP PERMISSION FORM

TO WHOM IT MAY CONCERN:

_____ _____________________________ has my permission to participate in all Name of student

field trips to be taken by __Bartow Senior Medical & Fire Academy/ HOSA/FPSA____ Name of organization/group during the __2018 - 2019__ school year. As parent/guardian I acknowledge the following:

1.School officials are authorized to obtain emergency medical treatment for this student as necessary.

2.The School Board has made available to this student the opportunity to purchase student accident insurance.

3.During this field trip, that the School Board will not be liable for injury to this student as result of the negligence, errors, and omissions of others (i.e., charter bus owners and drivers, or amusement park owners or workers), their agents, heirs, employees or assigns either through their action or inaction.

4.If your child takes personal belongings on this field trip, he or she will be responsible for them. The School Board accepts no responsibility for personal items, such as watches, purses, money, cameras, and wallets, etc. If a student stores personal items in a locker at an amusement park, that entity may be responsible for any loss or damage.

______________________________________ _________________ Signature of parent/guardian Date NOTES:

1. THIS BLANKET FORM MAY BE USED FOR TRIPS OF A SIMILAR NATURE, WHICH ARE REPEATED DURING THE SCHOOL YEAR.

2. FOR ALL OUT-OF-COUNTY TRIPS, A NOTARIZED MEDICAL TREATMENT AUTHORIZATION FORM MUST ALSO BE AVAILABLE. THE MEDICAL FORM MUST BE COMPLETED PRIOR TO THE STUDENT'S FIRST OUT-OF-COUNTY TRIP AND SHOULD BE RETAINED FOR USE DURING THE REMAINDER OF THE SCHOOL YEAR.

All students must provide transportation to and from all functions. Students are required to stay for the entire function and are not permitted to leave unless the instructor in charge of the function has been notified and the parent has given permission for the student to leave. Please sign below if you will allow your student to drive to and from all functions and leave only when the function is over.

_____________________________________________ Parent Signature

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Item # 10 Form No. TRNS 00797 Appendix D

THE SCHOOL BOARD OF POLK COUNTY, FLORIDAMEDICAL TREATMENT AUTHORIZATION FORM

TO WHOM IT MAY CONCERN:

I the undersigned parent/guardian of ________________________________________ hereby authorize any necessary medical treatment for this student while participating in field trips conducted under the sponsorship of Bartow Medical & Fire Academy ALL HOSA/FPSA Events_ during the 2018-2019_school year and guarantee payment of all charges incurred as a result of this medical treatment.

INFORMATION: Please Print

ALLERGIES TO FOOD, MEDICATION, ETC. (If none, so state.) _______________________

SPECIAL MEDICAL CONDITIONS (If none, so state.)________________________________FAMILY PHYSICIAN __________________________________________________________OFFICE ADDRESS ______________________________PHONE NO____________________PARENT/GUARDIAN NAME____________________________________________________PARENT/GUARDIAN HOME ADDRESS__________________________________________

HOME PHONE___________________________WORK PHONE________________________

______________________________ _______________________________________________Insurance Company Policy No. or Group No.______________________________________________________________________________PARENT/GUARDIAN SIGNATURE DATE

STATE OF FLORIDA, COUNTY OF ______________________________

I hereby certify that the foregoing was executed before me this ____________ day of_________,

by________________________________________, who is personally known to me or who has produced _______________________as identification and who did (did not) take an oath.

____________________________________

Notary Public, State of Florida

THIS FORM IS TO BE USED FOR ALL OUT-OF-COUNTY FIELD TRIPS EXCEPT ATHLETIC ACTIVITIES. THE FORM SHOULD BE COMPLETED PRIOR TO THE STUDENT’S FIRST OUT-OF-COUNTY TRIP AND RETAINED ON FILE FOR THE REMAINDER OF THE SCHOOL YEAR. English Version 8/00

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Item 11.Throughout the remainder of this syllabus: Print your initials on the blank lines to the left to acknowledge that you have read, reviewed, comprehend, and agree to be bound by the statements on the right.

Classroom/Clinical/Skills/High Fidelity Simulation Labs SOP

2-0.1 ______ Uniforms identify you as an EKG-Intern and are to be worn while attending all program functions; unless you are otherwise informed. The uniform policy will be strictly enforced. Failure to adhere to the uniform policy will result in a reprimand, which is the first in a series of steps to dismiss said student from class. Nothing will excuse a student from adhering to this policy.

2-0.2 ______ all students are expected to be well groomed and clean. Hair must be kept above the collar. In addition, uniforms must be kept neat and free of wrinkles while shoes should be polished as needed.

2-0.3 ______ the use of jewelry is limited to one (1) ring per hand, only. Students are not to wear any kind of jewelry above the collar during clinical rotations, regardless of gender and/or clinical site.

2-0.4 ______ there are no hats of any kind, which may be worn.

2-0.5 ______ the outermost layer of clothing worn by all students must identify them as EMR Program participants. Thus, regardless of whether students decide to wear the EKG-Intern polo, EKG Program t-shirt, or an EKG Program sweatshirt, any additional layers of clothing must be worn under the EKG Program attire.

2-0.6 ______ most uniform components are available for purchase at any other medical uniform retailer. However, uniform shirts must be purchased from the program classroom.

2-0.7 ______ Students may NOT use any non-prescribed eyewear (i.e. sunglasses) or hats of any kind while class is in session or while participating in the skills and/or simulation labs.

2-0.8 _______ Due to the potential for injury, all types of open style footwear are prohibited in all areas of the EMS building. This includes “flip-flops”, “crocs”, and all other similar style shoes. Anyone found to be in violation of this code will be asked to leave and return once proper footwear is being worn. Any time missed from class will be counted as outlined in the Course Attendance Policy.

Uniform Components

2-0.9 ______ appropriately sized Black waist belt.

2-0.10 ______ Black shoes devoid of any logos and/or any other coloring with matching black socks.

2-0.11 ______ Navy blue pants (standard as set by Fire/Rescue EMS)

2-0.12 ______ EKG-Intern polo style shirt purchased from the vendor listed above or an EKG Program t-shirt.

2-0.13 ______ Stethoscope.

2-0.14 ______ working watch. If using a traditional style watch then it must be equipped with a sweeping second hand; if using a digital watch, then it must include a display for seconds.

2-0.15 ______ EKG Program Sweatshirts if necessary (review rule 2-0.5 to determine if you will need this component)

2-0.16 ______ Royal Blue Scrub Top and Bottom

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Skills and High Fidelity Simulation Labs

Procedures and Conduct Guidelines

2-1.0 _____ generally, the EKG Skills and High Fidelity Simulations labs are open every class period and from 0630 till 1500 every day. In the event that the BHS campus is closed due to school wide closure the program will do make up time on designated make up days.

2-1.1 _____ since the schedule listed above is subject to change, students bear responsibility to verify with an EKG Program Director whether there has been any change during the current semester.

2-1.2 _____ the purpose of the EKG Program’s Skills and High Fidelity Simulation Labs is to provide ALL course participants with a place to practice the skills necessary to complete the course objectives in order to develop competency in skill performance. ALL course participants are encouraged to visit the lab facilities prior to testing in order to practice sufficiently. EKG Program instructor/preceptors are always present to assist you with any particular skill.

2-1.3 _____ Students must attend the Skills and High Fidelity Simulation labs during regular scheduled classroom time to complete several practical skills and scenarios. Failure to do so will result in a failing grade being issued for and student will not be eligible to receive a certificate of completion until he or she completes the skills and practical exams the amount of time required to complete these various tasks will vary amongst all students. Thus, the student bears all responsibility for ensuring that all course deadlines are met.

2-1.4 _____ frequently students will have to perform skills in the presence of other students. It is expected that all students maintain a professional attitude and be courteous to the student testing.

2-1.5 _____ the consumption and/or possession of any alcoholic beverage and/or controlled substances, is strictly prohibited, not only on every campus, but at all clinical rotation locations as well. In addition, students must NOT be under the influence of alcohol or other controlled substances at any time during which they are representing the EMR Program. This includes on and off campus locations. Violation of this rule will result in disciplinary action up to and including immediate dismissal from the program.

2-1.6 _____ the use of electronic devices such as pagers, cell phones, and laptops; is strictly prohibited within the EMR Skills and High Fidelity Simulation labs. Furthermore, any electronic device in your possession while inside either the lab; must be turned off and kept out of sight. In the event, that a student or group of students desires to use such devices for a study session they are instructed to speak with an instructor so that if another area is available for use, the students can be granted access.

2-1.7 _____ Failure to comply with the electronic device policy will result in the following:

1st infraction will result in a one-point (1) drop on the grading rubric used for EKG.

2nd infraction will result in a five-point (5) drop in grade on the grading rubric used for EKG.

3rd infraction will result in dismissal from EKG Tech.

*An infraction is described as; any time the device is visible to a staff member in plain sight.

2-1.8 _____ every student will receive an EKG Skills Check-off form as part of the course syllabus. This form not only outlines every skill which students are expected to develop proficiency on, but will also serves as a record of said development. Therefore, all students are advised to have this form in their possession every time they visit either of the labs. This form documents the dates of completion and the instructor initials every time a student demonstrates competency with the skill at hand.

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2-1.9 _____ Instructors working in the labs when a student successfully demonstrates competency on any skill will date and initial the individual skill sheet and the skills check-off form. However, the student is responsible for ensuring that they have not only brought the appropriate paperwork to the lab, but that an instructor has signed and dated the forms as well. Failure to follow this procedure could result in a student having to repeat all the work done up to that point.

2-1.10 _____ upon entering the skills lab, all students are expected to sign-in on the EKG Lab Attendance book located just left of the entryway. In addition, to entering their own name, students must obtain and record another student’s vital signs on to this book as well.

2-1.11 _____ during the course of a semester, students may “test” on any given skill as many times as necessary to demonstrate competency. However, students will be limited to no more than two (2) testing attempts on any one skill during the same lab date on the same skill, which they have failed. In addition, students may not re-test on any skill, which was successfully completed during the same day.

2-1.12 _____ In order to record competency on all practical skills, the EKG Skills Check-off form is composed of four (4) columns; the first column identifies each particular skill while the remaining columns must be dated and initialed by either an EKG Program Instructor or an approved EKG Program Preceptor on three (3) separate occasions as outlined below:

2-1.12a _____ First or initial check-off is completed in the skills lab prior to any clinical attendance.

2-1.12b _____ Second check-off; completed during the first three (3) field clinical in a mostly discussion type scenario between the student and their assigned preceptor.

2-1.12c _____ Third or final check-off; completed once the student performs a skill on a “live” patient during clinical rotations. *Since the opportunity to perform some skills on a “live” patient may not be available, students may visit the skills lab and request to be checked-off for the third column using during a simulated scenario.

2-1.13 _____ any act of dishonesty, including but not limited to forgery, alteration, or misuse of any college document, record or instrument of identification will result in dismissal from the program. In addition, infractions of this rule; may, at the discretion of the EMR program director, result in a permanent ban from participation in any future Bartow Medical and Fire Academy programs course.

Clinical Rotation Standard Operating Policies and Procedures

Clinical Uniform Policy

2-2.0 ______ Uniforms not only identify you to the patient as an EKG-Intern, but to anyone else you may meet, as well. Additionally, the uniform presents a more professional appearance while assisting in the prevention of cross contamination by separating everyday clothes from “work” clothes.

2-2.1 ______ Uniforms are to be worn while attending all program functions; unless you are otherwise informed. The uniform policy will be strictly enforced. Failure to adhere to the uniform policy may result in your dismissal from the assigned clinical area, which will result in a reprimand and the time not counting to toward course completion. Nothing will excuse a student from adhering to this policy during clinical rotations.



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2-2.4 ______ any, and ALL tattoos must be kept covered, thus out of sight, during all hospital clinical rotations.

2-2.5 ______ there are no hats of any kind, which may be worn during any clinical; regardless of location.

2-2.6 ______ the outermost layer of clothing worn by all students must identify them as EKG Program participants. Thus, regardless of whether students decide to wear the EKG-Intern polo, EKG Program t-shirt, or an EKG Program sweatshirt, any additional layers of clothing must be worn under the EKG Program attire.

2-2.7 ______ most uniform components are available for purchase at any other medical uniform retailer. However, uniform shirts must be purchased from the Instructor in the classroom:




2-2.11 ______ EKG-Intern polo style shirt purchased from the vendor listed above. DO NOT WEAR THE EKG PROGRAM T-SHIRT TO CLINICAL SITES unless it is being used as an undershirt to the EKG-Intern polo style shirt.

2-2.12 ______ one set of bandage scissors, also known as trauma shears.



2-2.14 ______ Eye Protection, which must be worn anytime you are treating a patient.

2-2.15 ______ Gloves, which must be worn during all patient contact (this item is provided to you).

2-2.16 ______ EKG Program Sweatshirts if necessary


Special Detail Policy

2-4.0 ______ Special Details are the result of a carefully orchestrated effort by several people. Despite this fact the number of days available to complete these is very limited. As a result, with regards to special details, the attendance policy in place is strictly adhered to and listed below:

2-4.1 ______ Special Detail dates will not have less than five (5) students scheduled.

2-4.2 ______ once a student has committed to attending on a particular date, they are not to make any changes unless another student is willing to “swap” days. If there is another student willing to do the exchange, a Swap Agreement Form must be completed and turned into the EKG Program Instructor.

2-4.3 ______ Students are expected to arrive on time; on their scheduled special detail day. Failure to arrive on time or failure to attend the detail altogether will result in the student being assigned to a “make-up” special detail work date and a group 2 offense reprimand will be issued. This will consist of working in the main storage room, detailing the ambulance and fire apparatus and also working in the classroom/labs area to make up the time.

2.4.4 ______ A second episode of tardiness or absence will result in an administratively withdrawal from EKG. Thus, said student would have to repeat EKG, during its next available offering.

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Policy on Injury or Illness Incurred During Clinical

2-6.0 ______ it is the intention of the EKG Programs to provide a safe lab and clinical environment to all program participants and visitors. However, due to the nature of the profession it is impossible for The Bartow Medical and Fire Academy or any of its staff to accept any financial liability concerning a student’s accident, injury, illness, and/or death, which is the result of clinical activities. Students are, hereby advised that during the clinical experience they (the students) may be exposed to situations, which could result in an accident, injury, illness, and/or death to the student. Thus, it is imperative that all students comply with any commands given by the preceptor immediately. Furthermore, students must follow all safety procedures instituted by the EKG program, its staff, or any of its educational partners. Lastly, students are, hereby advised that it is the student who bears all financial responsibility for treatment of any accident, injury, illness, and/or death, which occurs while the student is engaged in The Bartow Medical and Fire Academy EKG Program sanctioned activity. This includes but is not limited to needle stick injuries and disease exposure.


Clinical Misconduct Policy

2-7.0 ______ The Bartow Medical and Fire Academies’ partnership with local agencies depends a mutual understanding of each other’s roles. However, both parties reserve the right to discontinue this partnership at any time. As a result, anytime staff from either party feels that a particular student’s actions, attitude, and/or ability as an EKG Intern may, in any way, compromise patient care and/or the safety of the team; said student shall be immediately dismissed from the clinical site.

2-7.1 ______ any student asked to leave a clinical site, and does not agree with such action may follow established grievance procedures as outlined in the most current Student Handbook. However, students who opt to begin the grievance process may not return to any clinical site and/or any EKG Program detail until the matter has been resolved. In addition, there will be no credit awarded during that period.

2-7.2 ______ lastly, the following individuals may ask a student to leave a clinical site and/or classroom, if they deem it to be necessary:

EKG Program Medical Director - Dr. Joe Nelson

EKG Program Director – Kozette Hubbard

EKG Program Preceptors – TBA.

EKG Program Class and Lab Instructors

Student Counseling Documentation Policy

2-8.0 ______ Student Counseling Report: Also known as a reprimand and informational report, this form is to be used as a means to document any violations of policy as well as any tardiness and/or absenteeism. The form is composed of two (2) groups which are separated by the penalty which will be applied:

2-8.1 ______ Group one (1) infractions are serious offenses, which come along with the potential for adverse criminal consequences. Any group one (1) infraction will result in an immediate removal from the clinical site and/or campus; followed by dismissal from the Electrocardiography Tech. course. *Subsequently, re-admission to the EKG Program may not be an option.

2-8.2 ______ Group two (2) infractions most often relate to procedural infractions and follow a three (3) “strike” rule as follows:

First infraction = Verbal reprimand detention given to be served with academy instructor

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Second infraction = Written reprimand detention given to be served with academy instructor

Third infraction = Referral given and possible dismissal from Emergency Medical program course.

2-8.3 ______ Group 2 offenses signify a reprimand in steps for dismissal. You in fact may receive 1, 2 or all-3 reprimands at one time depending upon the infraction/s disclosed.


Clinical Documentation Policy

2-9.0 ______ Clinical Evaluation Form (Includes Field, Special Detail): This form documents clinical attendance at the various clinical internship sites in use by the EKG Program. The form is to be completed, and signed, by the clinical preceptor or instructor upon conclusion of each and every clinical. The preceptor will evaluate student performance throughout the clinical and document his or her observations accordingly on this form.

2-9.0a ______ Value System: The Clinical Evaluation Form allows preceptors to rate student performance based upon several categories. Each of these categories rates whether student performance was “Satisfactory”, “Unsatisfactory”, or “Remedial”. The instructor will then input the information from the Clinical Evaluation Form unto a computer database which assigns a numerical value to each rating as follows: Satisfactory +1, Unsatisfactory (-1), and Remedial (-2). This numerical value is collected following every clinical and averaged over the course of all clinical. Subsequently, this average is reported on both the EMR Clinical Progress Report and the EKG Terminal Clinical Evaluation Report. If this value is a negative integer; the student will have continue attending clinical until a value above zero is achieved. In the event that the deadline to complete clinical has passed, an incomplete grade will be issued and the student will be afforded an additional two (2) weeks to schedule additional field clinical in an attempt to earn a value above zero on the Terminal Clinical Evaluation Report. Failure to achieve this benchmark will result in a failing grade in EKG.

2-9.0b ______ Remedial Training: Any student who receives a REMEDIAL mark on any clinical evaluation form will be required to discontinue clinical rotations and meet with instructor. During this meeting, the instructor will make a decision as to when said student may continue clinical rotations. Typically, the issue is often resolved at this point. However, on occasion the student is asked to come back into the skills lab in order to be re-trained in those area(s) marked as remedial on the evaluation prior to continuing with clinical.

2-9.1 ______ Preceptor Evaluation Form: Completed by the student upon completion of the clinical. Students are to evaluate and rate their experience with the preceptor with whom they completed the clinical on that day (you will remain anonymous).

2-9.2 ______ Patient Care Report: PCRs are required anytime students encounter any type of patient contact. Regardless of the number of patient contacts completed previously. This rule is pursuant to State of Florida Administrative Code 64J-1.014.

2-9.3 ______ Clinical Swap Agreement Form: Used when two (2) students agree to swap their scheduled hospital clinical days. Both parties must sign the form in the presence of the instructor who will also sign it.

2-9.4 ______ Field Clinical Sign-in Form: The purpose of this form is to provide students a means to have a backup record, which documents the student’s clinical attendance. This form is not required; however, in the event that other documentation means is lost this form will serve proof of your total hours and patient contacts. Lastly, in order for this form to be valid it must have the signature of every preceptor with whom the student has completed clinical. *Responsibility to provide documentation of attendance, which fulfills the required clinical time, lies solely with the student.

2-9.5 ______ all paperwork relating to clinical completion MUST be turned into the instructor within 5 days of the date of said clinical. If you are having issues with fulfilling this requirement, contact instructor prior to the 5th day.

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2-9.6 ______ Students are not to remove any confidential paperwork from their clinical locations.

EKG Lab/Clinical Grading Policy

2-10.0 ______ Letter grades for EKG are determined by using a rubric composed of a point system which is dependent on several course completion benchmarks and their respective deadlines for completion. Students will earn five (5), three (3), zero (0), or up to negative six (-6) points in six (6) categories depending on when the tasks are completed. The six (6) categories are as follows: • Completion of the 1st column on the EKG Skills Check-off form and ALL clinical prerequisite paperwork (i.e. physical exam, immunizations, drug screen, background check, HIPAA) • Completion of the 2nd column on the EKG Skills Check-off form with clinical preceptor • Completion of the Special Detail clinical • Completion of the EKG Skills Check-off Form in its entirety • Completion of all field clinical time requirements

Completion of Capstone Project to be presented senior year.

2-10.1 ______ Grading Scale:

Total Points Earned Associated Letter Grade 25 – 21 A 20 – 14 B 13 – 0 C Below ZERO F (In other words, the cumulative total number of Points earned upon completion of course equals a Negative number)

EKG LAB

Completion RequirementsField Clinical Rotation Requirement

3-1.0 ______ Complete a minimum of 25 12 lead ekg’ s.

Practical Skill Lab Requirement

3-1.3 ______ all practical skills will be reviewed and/or performed on a minimum of three separate dates which are documented with an approved EKG instructor/preceptor on the Skills Check-Off form by

Electrocardiography Technician

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Completion Requirements to sit for National Certification.

3-2.0 ______ Obtain, maintain, and/or possess the Basic Life Support for Healthcare Provider certification, or a State of Florida approved equivalent, according to the standards set forth by the American Safety and Health Association.

3-2.1 ______ Complete a minimum of four (4) hours training on HIV / AIDS awareness and safety pursuant to: FS 401.2701(1) (a) 5c

3-2.2 ______ Achieve a minimum average exam grade of eighty percent (70%) overall.

3-2.3 ______ Achieve a minimum grade of eighty percent (80%) on the comprehensive final examination.

3-2.4 ______ Complete all the requirements for EKG Clinical with a minimum letter grade of “C”.

3-2.5 ______ Achieve a minimum of 25 12 lead EKG’s.

3-2.6 ______ Completion of Capstone Project to be presented senior year. Classroom Uniform Policy

1-0.1______ Uniforms identify you as an EKG-Intern and are to be worn while attending all program functions; unless you are otherwise informed. The uniform policy will be strictly enforced. Failure to adhere to the uniform policy will result in a reprimand, which is the first in a series of steps to dismiss said student from class. Nothing will excuse a student from adhering to this policy.



1-0.4 ______ there are no hats of any kind, which may be worn.

1-0.5 ______The outermost layer of clothing worn by all students must identify them as EKG Program participants. Thus, regardless of whether students decide to wear the EKG-Intern polo, EKG Program t-shirt, or an EKG Program sweatshirt, any additional layers of clothing must be worn under the EKG Program attire.

1-0.6 ______ most uniform components are available for purchase at the EKG classroom and/or any other medical uniform retailer.

1-0.7 ______ Students may NOT use any non-prescribed eyewear (i.e. sunglasses) or hats of any kind while class is in session or while participating in the skills and/or simulation labs.

1-0.8 _______ Due to the potential for injury, all types of open style footwear are prohibited in all areas of the EMS building. This includes “flip-flops”, “crocs”, and all other similar style shoes. Anyone found to be in violation of this code will be asked to leave and return once proper footwear is being worn. Any time missed from class will be counted as outlined in the Course Attendance Policy.

Uniform Components

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1-0.12 ______ EMR-Intern polo style shirt purchased from the instructor listed above or an EKG Program t-shirt.



1-0.15 ______ EKG Program Sweatshirts if necessary (review rule 1-0.5 to determine if you will need this component)

1-0.16 ______ Royal Blue Scrubs top and bottom.

Grading Scale

1-1.0 ______ Letter grades are based on the following scale.

100% - 90% = A 90.9% - 80% = B 80.9% - 70% = C 70.9% - 60% = D (Student will be put on academic probation with 2 weeks to improve) 60.9% - 0% = F (class must be repeated)

Grade Weighting

1-2.0 ______ all course work is assigned to one of the categories listed below. In addition, the overall final grade is derived based upon the weight of each category, as listed below.

Workbook and Objectives: 10% Chapter Quizzes: 10% Practical Exams: 10% Final Practical Scenario: 10% Exams: 15% Comprehensive Final Exam: 15% Clinical /Special Detail: 20%Capstone Project: 10%

Withdrawal Policy

1-3.0 ______ any student who wishes to withdraw from this course without influencing their grade point average must follow Polk School Board policy as outlined in the student catalog. 1-3.1 ______ all students who fail to meet the minimum attendance as outlined in the Course are subject to dismissal from the academy.

Attendance Policy(BMFA Rule 1 – 4) are subject to dismissal from the Electrocardiography program.

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1-3.2 ______ Students must not miss more than 20% of class time. Students must also be in class the whole period. Time is counted in 1 hour increments.

Course Attendance Policy

1-4.0 ______ Students are expected to attend all class meetings. However, in the event that attending class is not possible; the responsibility to obtain any information and/or assignments, which were missed, lies solely with the student.

1-4.1 ______ Attendance is checked at the start of each of class. Any student not physically present in the classroom at that time will be marked as being absent unless they ensure the instructor is aware that they arrived late and has corrected the attendance log.

1-4.2 ______Any time missed from class, whether caused by arriving late or leaving early, will be counted in hour-long increments only.

1-4.3 ______ any student who exceeds the maximum amount of missed time allowed will be subject to withdrawal from the program.

1-4.4 ______ the maximum amount of hours, which students may miss from class, is not to exceed the equivalent of 20% of time in class

1-4.5 ______ In the event that Polk School Board officials have temporarily closed the campus affecting a normally scheduled class date the following policy will be adhered to:

I. Once the campus is re-opened students are expected to arrive no later than the scheduled Start time and policies affecting tardiness will be strictly adhered to. II. If the scheduled start time is rescheduled for another day classes will be scheduled during the normal breaks as a makeup day students will be notified as to when that class will be scheduled for a “make-up day”.

Policy for Making up Missed Work

1-5.0 ______ Workbooks and other take home assignments are due at the beginning of each class. Students who are late or absent will be issued a grade of ZERO (0) on the material that was due on that class date. No late work will be accepted if the students was not absent or if the absence is not excused.

1-5.1 ______ Students who arrive late may begin the quiz late, however once the last person who arrived on time completes their quiz, the late student’s quiz will be collected and graded “as is”.

1-5.2 ______ any quiz missed due to absence will receive a grade of ZERO (0). Students will make up the quiz the next class day.

1-5.3 ______ Exams not completed during their scheduled date due to student absenteeism, tardiness, or any other reasons not directly caused by Polk County School Board MUST be completed within the five (5) working days, which follow the exam’s date.

1-5.4 ______Students will have to visit the classroom after school in order to complete a different version of the exam missed. It is the student’s responsibility to familiarize themselves with the information for the exam.

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1-5.5 ______ Failure to make-up an exam within five (5) working days will result in a grade of ZERO (0) on that particular exam.

Module Exams/ Comprehensive Final Exam

1-6.0 ______All students are to maintain a minimum average grade of eighty percent (80%) on ALL written and/or computer based examinations.

1-6.1 ______ all students who fail to achieve a minimum of eighty percent (80%) on any three (3) written and/or computer-based exams are subject to academic probation. GPA must maintain at 2.5 or student will be dismissed from the program.

1-6.2 ______ as part of the completion requirements, all participants must complete a comprehensive final exam on the scheduled exam date of class. Students must also be in uniform to take the exam.

1-6.3 ______ the exam is composed of questions, which may be drawn from any and/or all chapters contained within the textbook in use throughout the course. Time allotted for completion will not exceed one and one half (1.5) hours.

1-6.3a ______ the afore mentioned “time allotted” begins once the class instructor advises the class to Begin the exam. Any students, who arrive tardy, may begin their exam upon arrival. However, said students will not be afforded any additional time to complete their examination.

1-6.4 ______ Attendance is mandatory on the date during which the Comprehensive Final Exam is to take place. Failure to attend class on said date will result in a grade of “zero” being issued as the Comprehensive Final Exam grade.

1-6.5 ______ In order to successfully complete the course; students must meet a minimum benchmark of eighty percent (80%) on the comprehensive final exam regardless of their overall class average.

1-6.5a ______ any student who fails to meet the minimum benchmark of eight percent (80%) on the comprehensive final exam and despite that fact, maintains an overall class average grade at or above eighty percent (80%) will afforded the opportunity to re-attempt a different version of the comprehensive final exam.

1-6.5b ______ any student who benefits from the above rule (number 1-6.4a), will be required to meet the minimum of benchmark of eighty percent (80%) on the re-attempt. In addition, if said re-attempt results exceed the minimum benchmark the “official class grade book” will not reflect a grade higher than eighty percent (80%).

1-6.5c ______ The policy outlined above is a privilege intended as a means to assist those students whose class participation and course assignment completion have demonstrated a true desire to succeed in the Emergency Medical Responder program; yet for whatever reason they do not fare well on the final exam.

1-6.5d ______ as stated above, this policy is a privilege to the student. Thus, the classroom instructor And/or the program director reserve the right to discontinue the use of this privilege at any Time and for any reason, regardless of who is affected.

1-6.6 ______ Exam and quiz questions are highly scrutinized by staff prior to deployment. In the event, that a student wishes to challenge the validity of a question deployed in an exam and/or quiz: Students are allotted five

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(5) Academic Calendar days from the date during which the exam and/or quiz took place to provide the lead instructor with evidence, found within the course textbook, to support the allegation.

1-6.6a ______ Regardless of whether or not there is any valid evidence presented. Once the time period Outlined in 1-6.6 expires, no change to grades will be made.

Academic Dishonesty Policy

1-7.0 ______ this policy is intended to enhance Polk County School Boards academic dishonesty policy as outlined in the current student handbook. In the unlikely event that a conflict arises between the policies, the policy listed on the student handbook will supersede.

1-7.1 ______ there is no form of communication permitted amongst students while an exam, quiz, or any other type of academic assessment tool is in use. If the need to speak with an instructor should arise, students may approach the instructor unless told otherwise. However, the student must take extra care to ensure disruptions and/or distractions are, kept to a minimum.

1-7.2 ______ the following outlines the Academic Dishonesty Policy as outlined in the Polk State College student handbook:

Cheating and Plagiarism

Polk County School Board considers academic dishonesty an assault upon the basic integrity and value of an education. Cheating, plagiarism, and collusion in dishonest activities are serious acts that erode the educational role and tarnish the learning experience, not only for the perpetrators but for the entire community. It is expected that all students understand and subscribe to the ideal of academic integrity and that they are willing to bear individual responsibility for their work. Materials (written or otherwise) submitted to fulfill academic requirements must represent a student’s own efforts. The fundamental purpose of this rule is to emphasize that any act of academic dishonesty attempted by any student is unacceptable and shall not be tolerated. Examples of academic dishonesty include:

1. Cheating or plagiarizing on tests, projects, or assignments: Cheating is defined as the giving or taking of any information or material with the intent of wrongfully aiding oneself or another in academic work considered in the determination of a course grade. Plagiarism is defined (Black’s Law Dictionary, Revised Fourth Edition) as “the act of appropriating the literary composition of another, or parts or passages of his writings, or the ideas or language of the same, and passing them off as the product of one’s own mind.” Plagiarism includes failure to use quotation marks or other conventional markings around material quoted from any specific source without citing that source, or paraphrasing a specific passage from a specific source, or using any sequence of material or order of wording without accurately quoting and citing that source. Plagiarism further includes letting another person compose or rewrite a student’s assignment.

The following items have been identified, by the faculty and students, as a partial list of examples of cheating and/or plagiarism:

a. Asking for information from another student before, during, or after a test, quiz, or exam situation. b. Copying answers from another’s paper during a test, quiz, or exam situation. c. Knowingly letting someone copy from one’s paper during a test, quiz, or exam situation. d. Using sources other than what is permitted by the instructor in a test, quiz, or exam situation. e. Copying material exactly, essentially, or in part from outside sources while omitting appropriate documentation. f. Copying or falsifying a laboratory report, clinical project, or assignment without doing the required work. g. Changing answers on a returned graded test, quiz, or exam in order to get the grade revised.

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2. Plagiarism in written assignments: Plagiarism also includes handing in a paper to an instructor that was purchased from a term paper service, created by another student or other individual, or downloaded from the Internet and/or presenting another person’s academic work as one’s own. Individual academic Departments may provide additional examples in writing of what does and does not constitute plagiarism, provided that such examples do not conflict with the intent of this policy.

3. Furnishing false information to any faculty member.

4. Forgery, alteration, or misuse of any document, record, or instrument of identification.

Violations of the s policies pertaining to academic dishonesty may result in academic penalties and/or disciplinary action at the discretion of the professor. Academic penalties may include, but are not limited to, a failing grade for a particular assignment or a failing grade for a particular course. Students charged with violating the Academic Dishonesty portion of this rule are not permitted to withdraw from the course. Additionally, a student in violation of the Student Code of Conduct may be referred to the Dean of Student Services at the campus or center where the offense took place. Any student suspected of violating the Academic Dishonesty section of the Student Code of Conduct is subject to sanctions and provided due process as outlined in the Academic Dishonesty procedure.

1-7.3 ______ any student suspected of cheating will be subject to disciplinary action, which at minimum will result in said person receiving a grade of ZERO on the assignment underway when the alleged incident took place. In addition, the student will receive a written counseling form and a referral to speak with the EKG Program Director who will decide if the student will be subject to dismissal from the Emergency Medical Responder Program.

Classroom Code of Conduct

1-8.0 ______ the responsibility to provide any materials, including text and workbooks, which are required as part of the course curriculum lies solely with the student.

1-8.1 ______ Classroom atmosphere and/or student behavior are determined according to the course instructor’s discretion. In the event that a course instructor determines a student’s conduct is inappropriate; said student will be asked to leave the classroom at once. In addition, the student will have to meet with the EMR Program Director prior to returning to class.

1-8.2 ______ any injury incurred while taking part in a related function must be reported to a Bartow Medical and Fire Academy representative promptly.

1-8.3 ______ Students are not to enter any office area unless there is a staff member present and prior authorization to enter said office has been granted.

1-8.4 ______ Smoking is NOT allowed within any of campus buildings or campus.

1-8.5 ______ the use of the phone system is strictly limited to business related staff use only.

1-8.6 ______ the use of electronic devices such as pagers, cell phones, and laptops is strictly prohibited while classes are in session (this includes skills and simulation labs). Furthermore, any electronic device in your possession must be turned off and kept out of sight.

1-8.7 ______ Failure to comply with the electronic device policy will result in the following:

1st offense will result in a ten (10) point drop in grade on any assignments due that day.

2nd offense will result in a twenty-five (25) point drop in grade on any assignment due that day.

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3rd offense will result in dismissal from the Emergency Medical Responder program.

*In the event an offense occurs while the students is participating in the skills or simulation lab the Above penalties will be enforced on the next scheduled quiz or exam.

(An offense is described as any time the device is visible to a staff member in plain sight.)

1-8.8 ______ All EKG program students are subject to disciplinary action if it is determined, they have in anyway participated in the distribution and/or disclosure of any pictures, videos, and/or any other form of communication deemed to display or disclose immoral, indecent, illegal, unethical or otherwise inappropriate material. If said disclosure relates to, and/or was acquired in conjunction to the students’ course of study while a part of EKG program. 1-8.8a ______All students are asked to respect the rights, privacy and dignity of all those with whom they interact as an EKG program student. All students should conduct themselves appropriately at all times.

1-8.8b ______ Any student/s who, at the sole discretion of the EKG Program Director, violates the above rule (number 1-8.11a), is/are subject to dismissal from the Emergency Medical Responder program.

1-8.9 ______ the consumption and/or possession of any alcoholic beverage and/or controlled substances, whether legal or illegal, is strictly prohibited not only on every campus, but at all clinical rotation locations as well. In addition, students must NOT be under the influence of alcohol or other controlled substances at any time during which they are representing the EKG Programs. This includes on and off campus locations. Violation of this rule will result in disciplinary action up to and including immediate dismissal from the program.

1-8.10 ______ Violations of the EKG Program Code of Conduct will result in a Student Counseling Form being generated. This form is composed of two (2) groups which are separated by the penalty which will be applied:

Group one (1) offenses are serious infractions, which are associated with the potential for adverse Criminal consequences. Any group one (1) infraction will result in an immediate dismissal from the Emergency Medical Responder program. (Re-admission may not be possible)

Group two (2) offenses most often relate to procedural infractions and follow a three (3) “strike” rule as Follows:

First offense = Verbal Reprimand Second offense = Written Reprimand Third offense = Dismissal from the Electrocardiography Tech. Program.

If a student is given detention by an instructor of the Bartow Medical and Fire Academy this detention will be served after school from 14:00 hrs. until 15:30hrs in the academy area and with the instructor who administered the detention. Student’s will be assigned a variety of duties up to and including, washing and waxing the academy vehicles, working in the academy supply room, cleaning the classrooms and lab areas, cleaning equipment and supplies, grounds clean up in and around the academy area. The academy is not responsible for providing transportation to the student who receives detention. Failure to serve the detention or refusal to perform duties assigned during detention will result in a discipline referral being generated and the student being sent to the Discipline Office to be dealt with by administration. Students and Parents need to be aware this could include suspension for failing to follow directions given and constitutes insubordination.

Bartow Medical and Fire Academy

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1-8.11 ______ Group 2 offenses signify a reprimand in steps for dismissal. You in fact may receive 1, 2 or all 3 reprimands at one time depending upon the offenses being disclosed by the EMR Program staff.

1-8.12 ______ lastly, the following persons may ask a student to leave the classroom area at any time they deemed it to be necessary:

EKG Program Medical Director - Dr. Joe Nelson EKG Program Director – Kozette Hubbard EKG Program Visiting Instructors and /or Clinical Instructors

Financial Aid

1-9.0 ______The Bartow Medical and Fire Academy’s objective is to assist students who would otherwise be unable to attend the medical or fire program. Any student who may wonder if there is any such assistance available to them is encouraged to visit the class instructor for more detailed information.

Program Evaluation

1-11.0 ______ periodically, you may be asked to complete an anonymous evaluation of your learning experiences within the EKG Program. Your constructive criticism is welcomed and combined with other measures of success in order to assure the continuous improvement of the EKG programs. Typically, the survey will be completed using Survey monkey.

Classroom/Clinical/Skills/High Fidelity Simulation Labs SOP

I, THE UNDERSIGNED, ACKNOWLEDGE THAT THE EKG LAB/CLINICAL MANUAL WAS READ, AND EXPLAINED TO MY UNDERSTANDING. FURTHERMORE, I ALSO UNDERSTAND THAT FAILURE TO FOLLOW THE GUIDELINES LISTED THROUGHOUT THE MANUAL COULD RESULT IN DISMISSAL FROM EKG Tech AND/OR A FAILING GRADE BEING ISSUED.

Student Name (please print): ________________________________________________________

Student signature: _________________________________________________________________


Date: _____________________ ____________________________________________ Notary Signature

____________________________________________ Date

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bartowhighschoolmedicalandfireacademy.files.wordpress.com · Web viewJul 18, 2018 · 2-0.5 _____ the outermost layer of clothing worn by all students must identify them as EMR Program

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