Irish EMS Field Guide WInteR 2010. Issue no. 11 and Media/Newsletter/2010... · to Triage Sieve and Sort. The second half is devoted to medications. These are arranged ... Irish EMS

In thIs IssueThe beginning of this new decade sees the publication by PHECC of an EMS Field Guide designed to assist registered practitioners in their practice on the ground.

This is the first PHECC publication of its type and it complements the introduction of the 3rd Edition Clinical Practice Guidelines (CPGs). The format is pocket sized in order to be easily carried and consulted by practitioners in the field.

The first half of the guide covers subjects ranging from items such as MEWS, Glasgow Coma Scale, ECG interpretation, Peak Flow Rates, Paediatric assessments - values - Wong Baker faces - analgesia options and Burns to Triage Sieve and Sort. The second half is devoted to medications. These are arranged alphabetically and details indications, dosage, contra-indications, side effects and additional information. Paediatric doses are included where appropriate.

The concept for this publication originated with Sean Creamer when on secondment with PHECC a number of years ago. Since then 3 practitioner levels, advanced practice and increases in medications at all levels have been introduced. These advances combined with the 3rd Edition of the CPGs and enquiries from other practitioners have prompted this publication.

The Field Guide is not a substitute for the published CPGs and does not authorise interventions or medication administration. Practitioners are reminded that they may only practice in keeping with their status on the Register and their current scope of practice. This

is a quick reference tool to assist practitioners particularly with medication calculations, infrequent clinical encounters in addition to giving values for clinical measurements.

This Field Guide has a limited life span. Please note the caution at the beginning of the guide. It will expire on 30 Sept 2011, when it will be replaced by a new revised edition which will be based on recommendations and incorporate suggestions from practitioners. A consultation process will be established early in 2011 to facilitate the creation of a revised publication to more accurately reflect practitioner’s needs. You are strongly encouraged to participate in and contribute to this process, details of which will be circulated following distribution of the Guide in the new year.

WInteR 2010. Issue no. 11

Quarterly newsletter published by the Pre-hospital emergency Care Council

www.phecc.ie

• EMS Field Guide

• Paramedic Upskilling - eLearning

• Continuous Professional Competence (CPC)

• CFR Training Resources

• 2011 Education and Training Standards

• Emergency Driving Course

• Citizen CPRA Winning Campaign

Irish EMS Field Guide

01

Sonas agus síocháin oraibh uiligum Nollaig ó fhoireann PHECC.

Happiness and peace to you allthis Christmas

from the PHECC team.

Clinical Practice Guidelines – 3rd Edition

Field Guide for Pre-Hospital Emergency Care

Pre-Hospital Emergency Care Council, Abbey Moat House, Abbey Street, Naas, Co Kildare, Ireland.Tel: (045) 882042 Fax: (045) 882089Email: [email protected] www.phecc.ie

‘Very enjoyable’.

‘Very good, an easy way to learn, Thanks’.

‘Should focus more on individual changes and less on “request ALS” being stated 3 times for almost every CPG’.

‘Enjoyed it’

02

Paramedic Upskilling - eLearning The table below lists the CPGs (Name, CPG number and Paramedic CPG manual - page number) of the CPGs that will be made available to practitioners once they have successfully the eLearning package.

CPG 3rd Edition Name CPG Number Page Number

3 Respiratory Emergencies

Advanced Airway Management - adult 5/6.3.1 25

4 Medical

Basic Life Support - adult 4/5/6.4.1 28

Basic Life Support - infant (4 weeks to 1 year) 4/5/6.4.3 30

VF or Pulseless VT - adult 4/5/6.4.7 33

Symptomatic Bradycardia - paediatric 4/5/6.4.9 35

Asystole - adult 5/6.4.10 36

PEA - adult 4/5/6.4.11 37

Asystole / PEA Paediatric 4/5/6.4.12 38

Asystole decision tree 5/6.4.13 39

Symptomatic Bradycardia - adult 4/5/6.4.17 43

Glycaemic Emergency - adult 5/6.4.19 45

Seizure/ convulsions - adult 5/6.4.20 46

Septic Shock - adult 5/6.4.21 47

Poisons - Adult 4/5.4.23 49

Epistaxis 4/5/6.4.25 51

Decompression Illness 4/5/6.4.26 52

Altered Level of Consciousness (L 5&6) 5/6.4.27 53

5 Obstretic Emergencies

Pre-Hospital Emergency Childbirth 5/6.5.1 56

Basic & Advanced Life Support - neonate 5/6.5.2 57

Haemorrhage in Pregnancy prior to delivery 5/6.5.3 58

Postpartium Haemorrhage 5/6.5.4 59

Umbilical cord complictions 5/6.5.5 60

Breech Birth 5/6.5.6 61

6 Trauma

Shock from blood loss - adult 5/6.6.2 63

Limb fractures - Adult 5/6.6.5 66

Head Injury - Adult 5/6.6.6 67

Submersion incident 4/5/6.6.7 68

Chrush injury 5/6.6.8 69

7 Paediatric Emergencies

Glycaemic Emergency - Paediatric 5/6.7.9 77

Septic Shock - Paediatric 5/6.7.12 80

Shock from blood loss - Paediatric 5/6.7.13 81

8 Pre-Hospital Emergency Care Operations

Major Emergency - First Practitioners on site 4/5/6.8.1 85

Major Emergency - Operational Control 4/5/6.8.2 86

Triage sieve 4/5/6.8.3 87

‘Excellent programme of training, keep it coming’.

‘Very well constructed, highly interactive approach. I would like to see additional training materials being made available through this medium. The pdf files associated with the different CPGs are very useful. Thanks to all concerned’.

‘Excellent medium for training, I would be interested in seeing individual updates in operations and CPGs posted this way as they are available as it would be published to a greater audience at the same time’.

‘Too repetitive’.

‘CPG not the same layout as the book’.

‘Very good on-line training. I would love to see more in the near future, great way of upskilling and refreshing certain CPGs’.

‘Good training but a bit repetitive’.

‘Interactive elements meant that you never switched off during the course’.

‘Slides take too long to load. No guidance given in calculating paediatric drug doses for Ibuprofen or Paracetamol’.

‘As a new way of training, it may take time to get used to. Overall I like the new system’.

‘Very well laid out and easy to understand, well done to all involved in putting this together’

‘Any training is better then no training’.

‘Good method of revision’.

‘Easy enough to navigate, videos repititious’.

‘I had a bit of difficulty trying to log on to this site due to pop up blockers having to be switched off’.

03

‘I think it has huge potiental to bring many more courses and training to our lives, such as pre-learning for the advanced paramedic course’.

Paramedic Upskilling - eLearning The table below lists the CPGs (Name, CPG number and Paramedic CPG manual - page number) of the CPGs that will be made available to practitioners once they have successfully the eLearning package.

CPG 3rd Edition Name CPG Number Page Number

3 Respiratory Emergencies

Advanced Airway Management - adult 5/6.3.1 25

4 Medical

Basic Life Support - adult 4/5/6.4.1 28

Basic Life Support - infant (4 weeks to 1 year) 4/5/6.4.3 30

VF or Pulseless VT - adult 4/5/6.4.7 33

Symptomatic Bradycardia - paediatric 4/5/6.4.9 35

Asystole - adult 5/6.4.10 36

PEA - adult 4/5/6.4.11 37

Asystole / PEA Paediatric 4/5/6.4.12 38

Asystole decision tree 5/6.4.13 39

Symptomatic Bradycardia - adult 4/5/6.4.17 43

Glycaemic Emergency - adult 5/6.4.19 45

Seizure/ convulsions - adult 5/6.4.20 46

Septic Shock - adult 5/6.4.21 47

Poisons - Adult 4/5.4.23 49

Epistaxis 4/5/6.4.25 51

Decompression Illness 4/5/6.4.26 52

Altered Level of Consciousness (L 5&6) 5/6.4.27 53

5 Obstretic Emergencies

Pre-Hospital Emergency Childbirth 5/6.5.1 56

Basic & Advanced Life Support - neonate 5/6.5.2 57

Haemorrhage in Pregnancy prior to delivery 5/6.5.3 58

Postpartium Haemorrhage 5/6.5.4 59

Umbilical cord complictions 5/6.5.5 60

Breech Birth 5/6.5.6 61

6 Trauma

Shock from blood loss - adult 5/6.6.2 63

Limb fractures - Adult 5/6.6.5 66

Head Injury - Adult 5/6.6.6 67

Submersion incident 4/5/6.6.7 68

Chrush injury 5/6.6.8 69

7 Paediatric Emergencies

Glycaemic Emergency - Paediatric 5/6.7.9 77

Septic Shock - Paediatric 5/6.7.12 80

Shock from blood loss - Paediatric 5/6.7.13 81

8 Pre-Hospital Emergency Care Operations

Major Emergency - First Practitioners on site 4/5/6.8.1 85

Major Emergency - Operational Control 4/5/6.8.2 86

Triage sieve 4/5/6.8.3 87

Paramedic Upskilling – CPG 3rd EditionNASC have clarified the situation regarding paramedic upskilling to the 3rd Edition CPGs for HSE personnel.

• There are 2 parts to the 3rd edition CPG upskilling; a knowledgeelement and a skills element.

• Thee-learningpackage(1stpart)coverstheknowledgeelementonly;there are some CPGs that will require a skills session (2nd part) before upskilling will be completed.

• Practitionerswhocompletethee-learningupskilling,onsubmissionof their completion certificate to their T&D, will be issued with a letter authorising a change in their scope of practice.

• PHECCwillpublishanagreedlistofthenewmedicationsandCPGswhich will comprise this 1st part increase in scope of practice.

• NASCtrainingstaffareatanadvancedstageindevelopinganational2-day skills (2nd part) programme to complement the e-learning package.

• Thisfinalpartoftheupskillingprogrammewillbereadyfordeliveryto all NAS staff early in 2011.

• Oncepractitionerssuccessfullycomplete this2ndpart theywillbeauthorised to fully implement the 3rd edition CPGs.

PHECC anticipate that other service providers will adopt a similar approach and will notify developments as they occur.

‘This was very “dry” and a bit monotonous to complete. How about integrating actual “case studies” which would better illustrate the relevance of the material, or lectures on specific topics (e.g. trauma, cardiology, paediatrics, etc.) and integrating the CPGs into the assessment and treatment plans for such patients?’

‘Due to poor internet connection at home, I feel it would have helped me if I was able to down load or print off more of the course’.

‘Found that there was a lot of repetition. Think this is a great medium to teach further modules to ambulance personnel in the future’.

‘I found some of it very repetitive to a point where I found myself almost getting bored with it. Apart from that it was very well put together’.

‘Very well done. A bit repetitive but consistent and necessary. Would love to see PHECC continue to use this medium as a means of any future upskilling or continuing education projects. Good job guys!’

‘I found the programme of excellent value, it is great to be able to sign in/out when suitable, rather than having to sit down for hours trying to complete. Also much better than sitting flicking through paper exams’.

‘Due to no down-time in my station I had to do the course at home which was not a big problem, I was happy to do it while having a cup and in my own time no pressure which is also good. Yes I would look at other courses and if it suits me I would consider what’s on offer. I want keep up my CPD’.‘As a new way of training, it may take time to get used to. Overall I like the new system’.

‘I found this course to be really beneficial and a great way of revision, but it would be impossible to do at home if like me you had a slow broadband’.

04

The progress of pre-hospital emergency care services in Ireland is continuing to develop in line with international best practice over the last number of years. The introduction and implementation of clinical practice guidelines, including the associated medications that can now be used by registered practitioners, and the introduction of a statutory register for pre-hospital practitioners, are just some of the initiatives that have assisted in elevating the role of the practitioner, and indeed the profession, both nationally and internationally.

The need to maintain this professionalisation and to advance pre-hospital practitioner development is essential, if the profession is to continue to develop in line with other professions generally and healthcare professions specifically. Other regulated professions including the legal, pharmaceutical, medical and nursing professions have already developed, or are in the process of developing, models of Continuous Professional Development (CPD) within their own professions.

One explanatiaon as to the purpose of Continuous Professional Development, as described by the Health Professions Council of South Africa, is:

‘. . . to assist health professionals to maintain and acquire new and updated levels of knowledge, skills and ethical attitudes that will be of measurable benefit in professional practice and to enhance and promote professional integrity. The beneficiary will ultimately be the patient/client’. (HPCSA, 2009)

There are many, and in fact probably too many, definitions and related terms associated with CPD. Some of these terms are profession-specific such as CME (continuous medical education) associated with medicine. In an effort to address the potential confusion over terminology and to give a specific focus on the purpose of continuous improvement PHECC has adopted the term ‘Continuous Professional Competence (CPC)’. This new terminology will also be used in the new Education and Training Standards 2011.

Guided by the principle of ‘beneficence’ regulated healthcare professions recognise the need to update and develop the knowledge, skills and attitudes that underpin professional, competent practice through continuous professional competence. In so doing this protects the public interest while also promoting the individual registrant and the profession.

Similar to other regulated professions there is an onus of responsibility on the practitioner to commit to their own personal and professional development. Section 3.2 of the PHECC Code of Professional Conduct and Ethics states that a registrant shall ‘participate in ongoing CPD (CPC) requirements of the relevant division of the Register’.

The Pre-Hospital Emergency Care Council now wishes to engage with the many stakeholders involved in pre-hospital services and allow practitioners to contribute to the development of a CPC system. As a first step in this initiative PHECC has recently seconded Mr. Shane Knox from the HSE National Ambulance Service to lead the project.

Developing the Profession andContinuous Professional Competence

The purpose of the project is to develop a model of CPC for all registered pre-hospital practitioners in Ireland. Research will be conducted under the auspices of the Centre for Pre-Hospital Research (CPR)/Graduate Entry Medical School at the University of Limerick. This research will include current national and international models of CPD/CPC across many related professions. The implementation of a minimal model of CPC to address current requirements for PHECC registration will be the initial objective. This will ensure consistency for all registered practitioners and provide a platform to expand upon on a national basis.

Anecdotal evidence from international settings suggests that although CPD/CPC has emerged in response to the need for regulation, it has paid less attention to the job specific requirements for professionals in their respective fields of practice. Therefore one of the methodologies proposed is the use of an electronic survey to allow all registrants to input and influence the formulation of an Irish pre-hospital Continuous Professional Competency (CPC)model.

Representative groups will be consulted nationally and focus groups, comprising of registrants, will also be an integral part of the process.

It is extremely important that those who will be directly affected by this initiative, i.e. pre-hopsital registrants, are active in contributing to the process. Registrants at every level are encouraged,therefore, to participate and inform the project through this widespread consultation process.

The development of an appropriate CPC model specifically for pre-hospital professionals will ultimately benefit the public we protect, the patients we treat, and add significantly to the development of the profession itself.

The consultation process will start immediately and if you wish to contribute with any ideas or information from your previous CPC-related experiences, please contact Shane by email at [email protected]. Additionally a new link for CPC will be included on the PHECC website for information purposes.

05

CFR Training ResourcesPHECC proposes to design and produce new training products to assist with the delivery of the CFR Education and Training Standard 2011. These products will be available to recognised institutions and CFR-instructors to deliver the CFR-community, CFR advanced and dual certified IHF/AHA & PHECC courses.

The current CFR levels of responder and practitioner are to be re-titled CFR community and advanced. The advanced level will have the additional components of an airway and breathing module and includes supraglottic airway, suctioning and oxygen administration.

The training products will include:

1. An instructor DVD with 3 course participant options; 1. CFR community, 2. CFR advanced and 3. dual IHF/AHA & PHECC courses (that incorporates adding on the relevant CFR modules to the AHA/IHF courses as required).

2. An instructor manual which will support CFR instructors to deliver the selected courses.

3. A course participant manual, CFR community and CFR advanced levels.

The proposed CFR course will be DVD led and is based on the watch and practice approach; without the need for additional power point presentations and a high degree of instructor input. Participant practice/test sessions will be built into the DVD, thus eliminating the requirements for a summative skills assessment.

These new training products will eliminate the requirement for recognised institutions to submit a course for approval. Instead the recognised institution will apply to deliver the CFR standard using the PHECC CFR training package. These new products will be available in early 2011 to purchase from the PHECC office in the usual way, using the PHECC website www.phecc.ie and PayPal or alternatively recognised institutions can be invoiced if ordering by email [email protected]

2011 Education and Training StandardsThe closing date for the public consultation project for PHECC’s draft 2011 education and training standards is now closed. PHECC would like to express its gratitude for the many email submissions received during the consultation period. The Medical Advisory Group at their November meeting considered the draft recognised courses and there was consensus that the proposals were comprehensive and meeting service users’ needs.

Of particular note, Cardiac First Response (CFR) responder and practitioner will be replaced with new titles – CFR-community and CFR advanced. CFR-community level is designed for citizens and trained members of volunteer organisations and emergency services such as An Garda Síochána and the Civil Defence who may be dispatched or can respond to someone who has suddenly collapsed. Care management of cardiac arrest, heart attack, choking and stroke will be taught in accordance with PHECC CPGs. The care management will include cardiopulmonary resuscitation for adults, children and infants, AED use (adult & child) and aspirin administration for cardiac chest pain.

In addition to the competencies taught at community level, the advanced level course teaches the use of an oropharyngeal airway, supraglottic airway uncuffed device, bag valve mask (BVM), pulse checks, 2-person CPR, oxygen administration and post resuscitation care. If there is a concern about maintaining competency in all the required CFR-advanced level skills (in particular BVM), Council recommends that individuals consider seriously that CFR-community level is more appropriate.

Successful completion of the CFR standard leads to the award of the joint recognised institution and PHECC award. This award ensures that the responder has fulfilled the educational and training requirements as prescribed by PHECC, thereby attaining the knowledge, skills and professionalism in line with the expectations of the public and the profession. It is recommended that the cardiac first responder ensure their ongoing competency by participation in annual refresher training and certification every two years.

Under its contract with the HSE, EMSTAR has recently completed their first PHECC-accredited emergency driving course at the National Ambulance Service College.

Six candidates undertook the programme in emergency driving in December 2010. Despite the severe adverse weather conditions the candidates received in-depth instruction in a wide range of driving skills. The course also included actual drives under blue light conditions.

The aims and objectives of the PHECC driving course are firmly linked to the provision of high quality patient care. The prevention of deterioration and the ability of clinicians to effectively manage the patient during transport are at the root of the course.

The course was delivered in a range of vehicles and in varying road and traffic conditions. The 6 candidates were all successful and achieved a high standard of driving and theory knowledge. Joint EMSTAR/PHECC certificates were issued by Macartan Hughes, Head of Education and Competency Assurance.

Richard Lane, Director of Training Services for EMSTAR said, “Driving is a key feature of patient care. Getting to the scene quickly yet safely, driving

smoothly to prevent deterioration and assisting clinical staff in the back of the vehicle are fundamental to patient care and comfort. Driving is not just about getting from one point to another as quickly as possible. The safety of staff, patients and other road users will be enhanced with pre-operational driver training. We are delighted at the outcome of this first course and we are looking forward to future courses throughout 2011”.

First Driving Course - Great Success

Pictured: (from left to right) John Dunne, (EMSTAR) John Gaughan, Paul Murray, Tony Fields, Gerry Buckley (EMSTAR), Paul Keane, Bertie Dowling, Paul Doherty, John Kenny (EMSTAR).

06

International Visual Communication Association (IVCA) Clarion Awards 2010PHECC’s Citizen CPR campaign advertisement scooped the winning award for Dene Films (Producer), in the Advertising & Promotions category of the IVCA Clarion Awards.

This is Dene Film’s first full win at this prestigious awards and PHECC are delighted that our worthy campaign helped secure this accolade. To have the creativity and innovation of the PHECC team and Dene Film staff recognised in such a way is indeed an honour. The judges described the commercial as ‘Simple but Brilliant’. IVCA Chief Executive, Marco Forgione, commented ‘This years’ IVCA Clarion Awards winners have once again demonstrated the high levels of creativity, innovation and best practice in ethical and inclusive communications which are a true inspiration to all of us in the visual communications industry. To qualify as a finalist is excellent, to win is a tremendous achievement. Congratulatins to all of those who were short listed and of course many contratulations to DeneFilms Citizen CPR for their excellent and much deserved winning entry.’

Public Service Announcement (PSA) Award 2010PHECC’s Citizen CPR ‘Check, Call, Compress’ campaign has been awarded 1st prize in the public service announcement competition by the Citizen CPR Foundation in the USA during the Emergency Cardiovascular Care Update (ECCU) biannual conference, December 2010.

The Foundation’s mission is ‘to strengthen the Chain of Survival’. One of its primary initiatives in meeting this mission is to host the Emergency Cardiovascular Care Update (ECCU) biannual conference. The purpose of the conference is to present the latest science behind CPR guidelines and provide an inspirational forum for CPR instructors to share their experiences, insights and vision. The ECCU Conference is the only event of its kind, bringing together highly motivated CPR instructors, nurses, physicians, researchers, EMTs, paramedics and others involved in the instruction and practice of resuscitation as well as in research and program administration.to save lives from sudden death by stimulating citizen and community action.

PHECC is delighted to be the first organisation outside the USA to win this prestigious award. This international recognition lays testament to the strength of the message as it transcended a multitude of international issues including ‘calling 999’.

Go to www.citizencpr.org to see the top six PSAs in the competition.

The PHECC nationwide Citizen CPR campaign won a commendation award at the Irish Health Care Awards 2010 in the best public health initiative category. Citizen CPR was pipped at the post by the Irish Examiner initiative. The Examiner project consisted of a two-part supplement on suicide which was published last year, the aim of which was to put a human face on a national crisis. This initiative was also awarded the best overall prize ‘An Duais Mhór’ for 2010, so PHECC was runner up to the best!

The long-established Irish Healthcare Awards are Ireland’s premier awards in the area of health and medicine. They are run on an annual basis by the Irish Medical Times. The awards recognise originality, healthcare excellence and innovation in such areas as patient education, pharmaceutical innovation, healthcare collaboration and patient support. Entries come from individuals and institutions in acute and primary care, public health, the private sector and other sectors who have an interest in healthcare.

PHECC’s Citizen CPR campaign, which was launched in June of this year and ran nationwide during the summer months, www.citizencpr.ie, was nominated in the Best Public Health Initiative category. Other nominees in the category included the Irish Examiner for their Suicide and Ireland campaign; the Department of Community Medicine, Paublic Health Nursing, HSE South PCCC and Cork University Maternity Hospital for the ‘Introduction of a Neonatal BCG vaccination programme in Cork University Maternity Hospital’; and the South Dublin County Sports Partnership for the ‘Link 2B Active’ initiative.

Mr Dara Gantly, Editor, Irish Medical Times, organisers of the Irish Healthcare Awards, said: “The gala event is now in its ninth year, and this year’s awards are the most successful yet, with more entries and a wider selection of groups, organisations and companies represented than ever before, from both the public and private sector. The excellent calibre of winners and highly commended projects reflects the high standard of work carried out in the health service and in the healthcare industry.”

Mr Tom Mooney, PHECC Chair, commenting on PHECC’s award said that ‘This is a great honour for us and we are delighted with the commendation the campaign has received. It not only recognises the importance of the campaign and it’s aims but it also recognises the hard work and dedication of the PHECC team who worked diligently on the campaign. As a small organisation providing a nation-wide service, we are honoured to have this special public awareness initiative recognised among our peers.’

Irish Healthcare Awards 2010

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L->R Deirdre Borland, Dara Gantly, Tom Mooney, Cathal O’Donnell, Valery Small

CITIzEN CPR – A WINNING CAMPAIGN