fri book - palm beach state college · fri book 10/24/2013 ... student equipment competency check...

FRI BOOK

10/24/2013

Palm Beach State College – Paramedic Program 1 FRI

Table of Contents

PARAMEDIC CLINICAL .............................................................................................................. 1

STUDENT CLINICAL BOOK ........................................................................................................ 2

Typhon – Non-Compliance ................................................................................................. 3

CLINICAL DO’S AND DON’TS .................................................................................................... 4

SEMESTER SKILLS ................................................................................................................... 5

CARDIO-PULMONARY / ICU DEPARTMENT OBJECTIVES ............................................................. 6

ALS UNIT OBJECTIVES ............................................................................................................. 7

EMERGENCY DEPARTMENT OBJECTIVES ................................................................................... 8

PEDIATRIC DEPARTMENT OBJECTIVES ...................................................................................... 9

CODE OF CONDUCT OFFENSE .................................................................................................10

REQUIRED SKILLS / CLINICALS - 2ND SEMESTER ........................................................................11

REQUIRED SKILLS / CLINICALS - GRADUATION .........................................................................12

SIGNIFICANT EXPOSURE OR INJURY IN A CLINICAL/LAB SETTING: .............................................15

DECLINATION OF POST-EXPOSURE EVALUATION .....................................................................16

PHYSICIAN NOTIFICATION OF SIGNIFICANT EXPOSURE ..............................................................17

PARAMEDIC STUDENT CLINICAL OBJECTIVE WORKSHEET ........................................................19

ONGOING PRECEPTOR TRAINING PROGRAM .............................................................................20

PRECEPTOR EVALUATION OF STUDENT CLINICAL EXPERIENCE .................................................21

PRECEPTOR FEEDBACK TOOL .................................................................................................22

CLINICAL SIGN IN SHEET .........................................................................................................23

STUDENT SHIFT LOG ...............................................................................................................24

PATIENT CARE REPORT ..........................................................................................................25

STUDENT EQUIPMENT COMPETENCY CHECK LIST - LP .............................................................28

STUDENT EQUIPMENT COMPETENCY CHECK LIST – MED BAG ..................................................29

PAYROLL REPORT – CLINICAL .................................................................................................30

PARAMEDIC ASSISTANCE LAB REFERRAL ....................................................................31

Paramedic Student Assistance Lab Referral Guidelines .................................................33

CLINICAL EVALUATION - PROGRESS REPORT .....................................................................34

CLINICAL EVALUATION - COVER FOR LONG FORM ....................................................................35

CLINICAL EVALUATION - LONG FORM ......................................................................................36

Team Leadership ........................................................................................................39

Palm Beach State College – Paramedic Program FRI

PARAMEDIC CLINICAL

Book Attestation Page

I hereby attest that the reports and documentation contained within this Student Clinical Book for:

Are complete, accurate and reflect the student’s Typhon entries.

Fire Rescue Instructor Printed Name: _______________________________________________

Fire Rescue Instructor Signature: _______________________________________________

Date of Submission: _______________________________________________

CLASS SHIFT: ____________


PALM BEACH STATE COLLEGE

PARAMEDIC PROGRAM

STUDENT CLINICAL BOOK

□ EMS 2664 – CLINICAL 1



□ EMS 2659 – Internship

STUDENT NAME________________________________

HOSPITAL INSTRUCTOR_________________________

FIRE RESCUE INSTRUCTOR______________________

CLASSROOM INSTRUCTOR______________________


PALM BEACH COMMUNITY COLLEGE

EMS Academy - Paramedic Program

Typhon – Non-Compliance □ EMS 2664 – CLINICAL 1



□ EMS 2659 – Internship

Class Shift: ______ Clinical Shift: ______ Date of Non-compliance: Clinical instructor: Student Name (Print): I am aware that skills tracking and documentation are integral components of my paramedic training and is used for recording and verification of skills observed and performed while at clinicals. Entries must be made within 72 hours of occurrence. Non-compliance will affect the Documentation section of my Clinical long-form evaluation and may result in receiving an Unsatisfactory grade for that given semester. Entries not made within 72 hours

Narrative deficiency

Student Acknowledgement (signature):


Palm Beach State College EMS Academy

CLINICAL DO’S AND DON’TS

√ Use good hygiene √ Study textbook during slow time √ Be part of the team √ Help with patient lifting √ Help with truck washing √ Help with station chores √ Ask questions √ Show enthusiasm √ Be professional √ Thank the crew √ Contribute $$ for food √ Offer to cook & clean √ Ask for help √ Participate in truck checks √ Clean up your mess √ Have safety goggles, HEPA mask, vest

× Sit in a recliner × Adjust the AC × Leave work area early × Be unprofessional × Use TV remote control × Use cell phone × Eat what is not yours × Go into bunkroom or offices × Perform medical procedures

without × Preceptor approval × Falsify any documents or

evaluations × Be Late!!

The following is provided to you with the intent of making your clinical experiences amiable. Remember: you are a guest at Fire

Rescue and the Hospital. This is your Clinical Code of Conduct


SEMESTER SKILLS PARAMEDIC STUDENT FIRST SEMESTER SKILLS:

• All EMT-B Skills

• IV Set Up and Insertion

• Ventilation of Unintubated Patients

• Encoding

• Medication Administration, IV, IM, SQ, PO

• Endotracheal Intubation

• Student must demonstrate the ability to serve as the Team Leader in a variety of prehospital emergency situations. The student should serve as the Team Leader for at least 35 prehospital emergency responses.

PARAMEDIC STUDENT SECOND SEMESTER SKILLS:

• ACLS, PHTLS

• Comprehensive Assessments on all patient types including: OB, Trauma, Psychiatric, Cardiac, Geriatric, etc.

• Formulate and Implement Treatment Plans on Chest Pain, Dyspnea, Syncope,

Abdominal, and Altered Mental Status Patients.


PARAMEDIC STUDENT THIRD SEMESTER SKILLS:


• PALS


Revised Fall 2010

Paramedic Student Clinical Rotations:

CARDIO-PULMONARY / ICU DEPARTMENT OBJECTIVES

During clinical rotations in this area, the paramedic student should have the opportunity to gain experience and develop proficiency in the following skills:

1. Perform oral and sterile endotracheal suctioning. (2-1.89)

2. Using bag-valve-mask device to ventilate patients. (2-1.43d)

3. Apply and/or monitor oxygen therapy devices such as mask and cannula. (2-1.100)

4. Identify uses and side effects of the various respiratory treatment drugs. (5-1.7, 5-1.8)

5. Identify uses and side effects of the various respiratory treatment drugs. (5-1.7, 5-1.8)

6. Identify lung sounds including: wheezing, rales, rhonchi. (3-2.28, 5-1.10)

7. Identify sounds and symptoms of respiratory distress. (2-1.26, 5.15)

8. Observe ABG procurement and use of blood gas machine (intern will not perform arterial punctures) Interpret ABG’s and relate to specific signs and symptoms and treatment. (2.1.9, 2-1.10, 2-1.12, 2.1.13)

9. Assist in respiratory treatments and use of mechanical ventilators. (1.8.38, 2-1.95f, 5-1.7)

10. Use a pulse oximetry device. (2-1.81)

11. Define, identify and describe a tracheostomy, stoma, and tracheostomy tube. (2-1.52.

12. Maintains a professional demeanor throughout this clinical rotation. (1-1.39, 1-1.46)

13. Paramedic Student will be under direct supervision during clinical rotations.

**Detailed documentation must accompany this referral


Revised Fall 2010

Paramedic Intern Clinical Rotations: ALS UNIT OBJECTIVES

During this rotation, as experience, exposure, and knowledge level permits, the paramedic intern: 1. Determines safety for self and adequacy of work environment and intakes appropriate

action (1*1.38, 3-3.64) 2. Initiates appropriate crowd control maneuvers. (3-3.64) 3. Establishes and maintains rapport while providing emotional support to patients, family,

and bystanders. (1-9.3) 4. Performs primary assessment and intervenes as indicated. (3-3) 5. Obtains relevant and accurate patient history in a systematic manner. (3.1.1, 3-1.2, 3-1.5,

3-1.6 0 6. Performs an appropriate physical exam. (3-3.81) 7. Recognizes patients that need further attention and transports at appropriate point in run.

(3-3.28, 3-3.29) 8. Recognizes the need to make hospital contact. (1-1.24, 1-4.28, 3-5.23) 9. Obtains vital signs quickly and accurately. (2-1.19, 3-2.32, 3-2.81) 10. Recognizes arrhythmias. (5-2.35) 11. Interprets assessment information clearly and takes appropriate action. (3-4, 7-1.1) 12. Accurately reports all pertinent information in a systematic manner. (1-4.28, 3-5.29, 7-

1.13) 13. Speaks clearly and concisely and is easily understood. (3-5.5, 7-1.13) 14. Repeats all orders and reports patient response to therapy. (1-4.28, 3-6.18) 15. Keeps accurate, complete and legible written records. (1-4.28, 1-4.29, 7-1.13) 16. Anticipates orders, and the needs of other team members. (1-1.16) 17. Establishes appropriate working relationships with all team members. (1-1.16) 18. Assumes leadership role and directs team members appropriately. (1-1.16, 7-1.8, 7-1.18,

7-1.19) 19. Communicates information appropriately to all team members. (1-1.6,7-1.13) 20. Performs well under stress, uses good judgment. (1-1.46, 1-2.26, 3-4.9) 21. Is able to accept constructive criticism and guidance. (1-1.1L, 3-4.7) 22. Maintains adequate airway control. (2-1.1, 2-1.29.2-1.42, 2-1.43d, 2-1.58) 23. Properly uses the antishock trousers. (4-2.40) 24. Applies splints and bandages appropriately. (4-3.35a & b, 4-9.44) 25. Provides proper care to burn patient. (4-4.80-.84) 26. Performs CPR correctly and effectively. (5-2.125, 5-2.205a) 27. Safely and effectively performs defibrillation/cardioversion. ( 5-2.205b, 5-2.205c) 28. Displays proper knowledge and skill level when using drug therapy. (1-7.24, 1-8.20, 1-

8.21, 1-8.41) 29. Demonstrates knowledge and ability in emergency Childbirth. (5-14.13) 30. Efficiently performs ET, Nasal Tracheal and EOA procedures. (2-1.58, 2-1.69, 2-1.104a-c) 31. Initiates or directs extrication of patient. (8-3.34) 32. Aseptic and proficient insertion of IV and monitoring IV therapy. (1-8.8, 1-8.34) 33. Performs needle thoracostomy. (4-7.50A) 34. Proficiently administers oxygen therapy. (2-1.43d, 2-1.51) 35. Spinal immobilizes patient correctly. (4-6.15, 4-6.31) 36. Demonstrates ability to suction patient. (2-1.88, 2-1.89) 37. Maintains assigned ambulance inventory. (8-1.2) 38. Demonstrates the ability to correctly operate all electronic equipment. (3-5.29, 2-1.31, 2-

1.46, 5-1.15, 5-2.199, 5-4.12 39. Critiques runs with preceptor. (1-1.1L, 3-4.7) 40. Maintains a professional demeanor throughout this clinical rotation. (1-1.16, 1-1.17, 1-

1.39)


Revised Fall 2010

Paramedic Student Clinical Rotations:

EMERGENCY DEPARTMENT OBJECTIVES

During clinical rotations in this area, the paramedic student should have the opportunity to gain experience and develop proficiency in the following skills:

1. Triage (8-2.17, 8-2.20, 8-2.21)

2. Vital and diagnostic signs-recognition and significance. (3-2.6, 3-2.28, 3-281)

3. Physical assessment, patient history, documentation in compliance with hospital policy for all age groups. (3.3, 3-1.1, 3-6.1)

4. Peripheral IV insertion and drip rate calculation. (1-8.16, 1-8.17, 1-8.19, 1-8.21)

5. Drug therapy-IM,IV,SQ,PO,SL,ET, dosage calculation. (1-8.16, 1-8.17, 1-8.19, 1-8.21)

6. Aseptic techniques and universal precautions. (1-8.28, 1-8.30)

7. Cardiac arrest procedures. (5-2.124, 5-2.125, 5-2.129, 5-2.2056).

8. NG tube and urinary catheter insertion (2-1.40, 6-6.29).

9. Airway management including insertion of airways, suctioning, oxygen therapy, intubation (under direct physician supervision). (2-1.100, 2-1.104a, 2-1.37, 2-1.88)

10. Use of cardiac monitors and interpretation of rhythms. (5-2.35, 5-2.200)

11. Venipunture for blood specimens. (1-8.23, 1-8.42)

12. Emotional support of patient and families. (1-1.44)

13. Use of IV pumps. (1-8.21)

14. Recognition of safety hazards to patients; implementation of safety procedures including side rail use and needle safety. (12.45, 1-2.46)

15. Interpretation of ABG’s. (2-1.9, 2-1.10)

16. Wound care and bandaging. (4-3.31)

17. Maintains a professional demeanor throughout this rotation. (1-1.39, 1-1.46)

18. Paramedic Student will be under direct supervision during clinical rotations


Revised Fall 2010

Paramedic Student Clinical Rotation:

PEDIATRIC DEPARTMENT OBJECTIVES During clinical rotations in this area, the paramedic student should have the opportunity to experience and develop proficiency in the following skills:

1. Perform pediatric patient assessment including, at a minimum, a review of the patient’s chart, taking vital signs, and auscultation of lung and bowel sounds. (6-2.8, 6-2.94).

2. Prepare and administer IM and IV medications, if allowed by the department. (6-2.107).

3. Monitor IV infusions; assist with IV insertions (some pediatric departments will allow intern IV insertion in selected cases, check with instructor or charge nurse) (6-2.50, 6-2.106).

4. Estimate pediatric ages, and weights in kilograms and verify with documented measurements. (6.2.95).

5. Perform history-taking using information from patient and parents. (3-1.1).

6. Relate history and assessment to pathological conditions, treatments, and medications. (6-2.1).

7. Perform isolation procedures. (1.2.30, 5-11.59).

8. Provide emotional support to patients and families. (6-2.90).

9. Assist with nursing care and treatments (including feeding and changing diapers). (6-2.91, 6-2.9).

10. Maintains a professional demeanor throughout this clinical rotation. (1-139, 1.1-46).

11. Observe the following procedures as they occur

• Spinal tap • Oxygen therapy using tents, etc. • Intraosseous infusions • Other procedures performed on pediatric patients

Please bring any problem to the attention of the clinical instructor\

Paramedic Students will be under direct supervision during clinical rotations


Revised Fall 2010


Paramedic Program - Clinicals CODE OF CONDUCT OFFENSE

Please refer to PBSC Health Sciences/EMS Disciplinary Procedures for a complete listing of offenses Date: Instructor: Student Print Name: Class Shift Signature:

Group 1 Offense** Inappropriate language Dress Code Violation Failure to follow chain of command Failure to act in a professional manner Absence Non-Notification Arrive late without notification Smoke or chew tobacco at hospital or fire rescue setting Conduct inconsistent to good order and discipline Other:

Group 2 Offense** Commit academic dishonesty. “Any student who knowingly helps or is present when another student violates

academic behavior standards is also in violation.” Behave with intent to detract from the education of another student. Leave assigned area (hospital or fire rescue setting) without notifying instructor. Perform duties outside the scope of practice. Perform as a firefighter while participating in a paramedic student capacity. Respond to a fire/rescue call while in a PBSC lecture/lab/hospital setting. Examine a patient without an instructor or preceptor present. Not properly maintaining BSI and/ or properly utilizing PPE. Show disrespect or be abusive to any instructor, hospital or fire rescue personnel. Use a cellular telephone without the consent on an instructor. Other:

Group 3 Offense** Immediate phone call to Clinical Coordinator required Possess or be under the influence of controlled substance or alcohol Perform skills on which s/he has not yet been signed-off in lab Failure to comply with HIPAA Conduct perceived to be sexual harassment Conduct which threatens the health or safety of others Other:



Paramedic Program

DATE: August 2011

PATH: REQUIRED SKILLS / CLINICALS - 2ND SEMESTER

Evidence of progression of clinical skills is required for success in the paramedic program. In order to receive a Satisfactory grade in EMS2665 Paramedic Clinical II, the student must have the following minimum skills accurately reflected in Typhon:

Skill Minimum # LIVE Skills Required Med Administration 10

ET Intubation 2 IV Success 15

Bag-Valve-Mask 4 Team Lead 10

The numbers utilized for this benchmark will be the accumulation of Typhon numbers from EMS2664 and EMS2665, Paramedic Clinicals I & II. Regardless of any other evaluations in clinicals, the student will not be allowed to progress to EMS2658 Paramedic Clinical III without the accomplishment of the above live skills. These minimum goals are not meant as your target goals; they are at the lowest end of the acceptable spectrum. We recommend that the students get as much possible experience while in the program to be best prepared to enter their chosen field of EMS.


https://www.typhongroup.net/ahst/data/cpsdetail.asp?facility=9027&userid=1148oSj7MYx44GN35MC2OAkv4HytSNn36Ud25Br1UHg7&FacToken=oujsdf8723nv9anyav389ASOjC98usag89jah978hdfg&arch=&rangestart=&rangeend=&semester=&course=&location=&preceptor=&myitem=&itemcustomlabel=&itemcustomcode=&cattype=2




Paramedic Program DATE: August 2011

PATH: REQUIRED SKILLS / CLINICALS - GRADUATION

Evidence of progression of clinical skills is required for success in the paramedic program. In order to receive a satisfactory grade in EMS2659 Paramedic Internship, and therefore graduate, the student must have met all of the required minimum clinical goals in each category:

• Mandatory Skills • Assessments by Patient Age • Assessments and Plans • Assessments by Patient Type

The numbers utilized for this benchmark will be the accumulation of Typhon numbers from EMS2664, EMS2665, EMS2658 (Paramedic Clinicals I, II, & III) and EMS2659 Paramedic Internship. Students MUST obtain, and accurately document, 15 Team Leads solely within EMS2659 Paramedic Field Internship, with a total of 35 to graduate. These minimum goals are not meant as your target goals; they are at the lowest end of the acceptable spectrum. We recommend that the students get as much possible experience while in the program to be best prepared to enter their chosen field of EMS.

Students will utilize the current paramedic

Required Clinical Goals (see policies).


Mandatory LIVE Skills Assessments by Patient AgeMinimum Category Minimum Age

15 *Med Administration 1 Newborn 0-1mo5 *ET 1 Infant 1m -1yr

25 *IV Success 3:1 Make-up Ratio (SimMan) 5 Toddler 1-3yr20 *Bag-Valve-Mask 5:1 Make-up Ratio (SimMan) 5 Pre School 4-5yr35 *Team Lead 1:1 Make-up Ratio 2 School Age 6-12yr

15 Live MUST be during EMS2659 2 Adolescent 13-17yr35 Adult 18-65yr35 Geriatric >65yr

Assessment and Plan Assessment by Patient TypeMinimum Encounter Minimum Encounter

15 Cardiac 1 Obstetric5 Respiratory 10 Trauma5 Syncope 35 Medical

10 Abdominal 2 Psychiatric5 AMS / Neuro


Medication Administration 15

Live ET Intubations 5

Successful IV's 25

Ventillation with BVM 20

Assessment of Newborn (0-1mo) 1

Assessment of Infant (1mo-1yr 1

Assessment of Toddler (1-3yr) 5

Assessment of Preschooler (4-5yr) 5

Assessment of School Age (6-12yr) 2

Assessment of Adolescents (13-17yr 2

Assessment of Adults (18-65yr) 35

Assessment of Geriatrics (>65yr) 35

Assessment of Obstetric Patients 1

Assessment of Trauma Patients 10

Assessment of Medical Patients 35

Assessment of Psychiatric Patients 2

Assessment and Plan of Cardiac Patients 15

Assessment and Plan of Respiratory Patients 5

Assessment and Plan of Syncope Patients 5

Assessment and Plan of Abdominal Patients 10

Assessment and Plan of AMS/Neuro Patients 5

Total Field Team Leads 35

Field Internship Team Leads in EMS2659 15


SIGNIFICANT EXPOSURE OR INJURY IN A CLINICAL/LAB SETTING:

An exposure can be defined as a percutaneous injury (e.g., needlestick or cut with a sharp object) or contact of mucous membrane or nonintact skin (e.g., exposed skin that is chapped, abraded, or with dermatitis) with blood, saliva, tissue, or other body fluids that are potentially infectious. Exposure incidents might place health care personnel at risk for hepatitis B virus (HBV), hepatitis C virus (HCV), or human immunodeficiency virus (HIV) infection, and therefore should be evaluated immediately following treatment of the exposure site by a qualified health care professional. (Centers for Disease Control and Prevention) The following is a recommended approach for student reporting and instructor action should a significant exposure or injury occur during a clinical setting.

1. Student shall notify Clinical/Lab instructor.

2. Clinical instructor to notify Infection Control Nurse (exposures only)

3. Student proceeds to facility’s Emergency Department, signs in as a patient for treatment. If off site, the student should go to nearest hospital emergency department.

4. Clinical/Lab instructor to notify the Clinical Coordinator / Program Manager

via Voice Mail. 868-3418.

5. Clinical/Lab instructor to call Palm Beach State College Security for an incident report to be completed. 561-868-3600, day or night.

6. Clinical Coordinator/Program Manager notifies Safety and Security 868-

3487.

7. (Optional) Clinical instructor to call or page Dr. Landman for student counseling and follow up care for exposures only. 561-969-7900, day or night.

8. Student shall send a detailed e-mail to Clinical Coordinator / Program

Manager regarding incident specifics.

9. Clinical instructor to provide a copy of the insurance form to emergency registration upon student registration.


PALM BEACH STATE COLLEGE EMS PROGRAM

DECLINATION OF POST-EXPOSURE EVALUATION

On___________________, I experienced an incident while participating in a Palm Beach State College EMS Program, which may have caused my exposure to bloodborne pathogens. An Accident-Incident Report was filed at that time.

I have been advised that I may be evaluated by a physician pursuant to this incident, which may include serologic testing for HIV and HBV, and that there will be no cost to me for this evaluation. However, I choose to decline having the evaluation performed, with the understanding that I may have blood drawn at this time but not tested until a later time of my choosing (up to 90 days following the date of the incident).

_________________________________________ Printed Name _________________________________________ Signature __________________________________________ Date


Palm Beach State College

PHYSICIAN NOTIFICATION OF SIGNIFICANT EXPOSURE To: Emergency Room Physician From: Dr. Ken Scheppke, MD Subject: Significant Exposure to Bloodborne Pathogens The student before you has sustained a significant exposure to a potentially infectious body fluid during the course of medical treatment of ________________________________________ (patient name) Per Florida State Statute 381.004(10), this medical personnel (student) has the right to know the HIV status of this source patient. Florida law allows you to perform a HIV test on this patient either with their consent or without their consent if blood specimens have been obtained for other purposes. In addition, it is not mandated by the state but if the source patient consents, we are also requesting a Hepatitis B and C test be performed. Please have your staff contact the hospitals Infection Control Coordinator and advise them of the incident. They will forward the results to Palm Beach State College, 4200 Congress Avenue, Risk Management Department, Lake Worth Florida, 33461. Thank you for your cooperation. Ken Scheppke, MD Medical Director Palm Beach State College EMS Programs Student Name ______________________________________________________ Date ____________ Student Signature ___________________________________________________ Blood specimen obtained from source patient (check one) □Yes □No Source patient HIV testing (per state statute 381.004) □ With consent □ Without consent □ Refused


PARAMEDIC STUDENT CLINICAL OBJECTIVE WORKSHEET

Date: Shift: Student Name: Course: Fire Department and Station#: Fire Rescue Instructor Name and Contact Number: Goals and objectives to be accomplished today (areas of focus):

• •

•

Preceptor Signature:


F.R.I. __________________ Palm Beach State College

ONGOING PRECEPTOR TRAINING PROGRAM

Preceptor Name Date

Website Was Viewed

Department Name Station

Preceptor Understands what,

where student should be in 1st, 2nd, 3rd

semester Yes Or No

Preceptor Signature

1.

2.

3.

4.

5.

6.

7.

8.

9.


PRECEPTOR EVALUATION OF STUDENT CLINICAL EXPERIENCE AFFECTIVE DOMAIN:

● Preparedness: the student arrived on time with ink pen, stethoscope, eye protection, pen light, and required paper work and identification. ● Professional appearance: the student is dressed in proper uniform and is neat in appearance. ● Initiative: student demonstrates interest in EMS through actions and interactions with evaluator ● Conduct: Student interacts with patients, families & co-workers in a respectful and empathetic manner. Demonstrates respectability and professional ethics. ● Careful Delivery of Service: Student follows policies, procedures & protocols. Uses appropriate safeguards in the performance of duties.

PSYCHOMOTOR DOMAIN:

●Student demonstrates proficiency in skills performed. COGNITIVE DOMAIN:

● Knowledge: The student can recall common terms, facts, principles and basic concepts in EMS. ● Problem Solving: the student uses knowledge to solve a previously unencumbered situation. ● Evaluation: the student can judge the appropriateness of actions and can defend his/her decisions.


Student Name: Clinical Shift Preceptor Name: Class Shift Station: Date:

Palm Beach State Paramedic Student

PRECEPTOR FEEDBACK TOOL

Place an X

Checklist: Yes No Comments:

Student arrives on time and stays entire length of clinical?

Student has clean uniform, PBSC ID, and uses good hygiene?

Student asks questions and studies during down time?

Demonstrates professionalism to patients and crew?

Exercises caution in the performance of duties and policies?

How much prompting was required for student to perform required tasks?

Outstanding recall of principles and theories?

Identifies problems and independently devises a plan to solve problem?

Student can provide a sound rationale for decisions and actions?

What % of the call does student manage without direction of preceptor?

Would you want this student as your partner someday?

Student should receive an “S” or “U” grade for this evaluation period?


CLINICAL INSTRUCTOR_______________________________ FIRE RESCUE INSTRUCTOR____________________________ INSTRUCTOR PHONE # ________________________________ Clinical Shift ___________ Class Shift _____________

PALM BEACH STATE COLLEGE PARAMEDIC STUDENT

CLINICAL SIGN IN SHEET STUDENT: Fill out this sheet every time you attend a clinical function. Fill out the dates you are absent.

Keep this sheet in your Clinical Book. Student Name Date Time In Time Out Site Instructor Printed Name Instructor Signature Calls Reports


STUDENT SHIFT LOG Class: Student Name: Month: Section: □ EMS 2664

FRI: ______________________________ □ EMS 2665 □ EMS 2658 □ EMS 2659 Date Station Preceptor Call Visit Comments


PALM BEACH STATE COLLEGE EMT/Paramedic Program

PATIENT CARE REPORT Student: _________________________ EMT Paramedic Date: ____/____/_____ Time of Call: _______________ Hospital/Agency: ____________ Unit: ____________ □ I accompanied this patient to the hospital during transport. Instructor/Preceptor Name: ______________________ Instructor/Preceptor Signature: ______________________

ETHNICITY M F

African American American Indian Asian Caucasian Hispanic Other: ___________________

Chief MEDICAL COMPLAINT

Abdominal OD-Poison Cardiac Psychiatric CVA Respiratory Diabetic Seizure OB/GYN Sepsis

Other ___________________

Chief TRAUMA COMPLAINT

Abdomen Neck/Back Chest Pelvic Extrem. Head/Face

Muscular Multi-system

Other ___________________

MECHANISM OF INJURY

None Driver MVA Passenger MVA Auto-Pedestrian Motorcycle Fall/Jump

Airbag Seatbelt Entrapment Ejection Rollover Blunt

Penetrating Injury – Type: _____________________ Other: ______________________________________ ALLERGIES: MEDICATIONS: PAST MEDICAL HX: Time BP Pulse Resp AVPU Pupils Lungs Drug/Tx Dose Route

Eyes Open→ Spontaneous 4 To Voice 3 To Pain 2 None 1 Glasgow Score = _________ Verbal→ Orient 5 Confused 4 Inappropriate 3 Garbled 2 None 1 Motor→ Obey Com. 6 Pain/Local 5 Pain/Withdraw 4 Pain/Flexion 3 Pain/Ext 2

None 1 BLS AIRWAY NC NRB Nasal airway Oral airway BVM @ ______L/Min ALS AIRWAY Surgical Nasal ET Oral ET Attempts X: ____ Success Y N ET size: ___ Pulse Ox on room air ⇒ ________ % After O2 ⇒ ________ % Glucometer ⇒ __________


IV / IO Attempts X: _____ Success: Y N Site: ________ Gauge: ______ Solution: ______

ELECTRICAL

THERAPY ENERGY LEVELS

OBS. PERF.

EKG INTERPRETATION OBS PERF

MANUAL DEFIBRILLATION

Rhythm 1:

SYNCHRONIZED CARDIOVERSION

Rhythm 2:

TRANSCUTANEOUS PACING

Rhythm 3:

PHTLS CARE BLS CARE

OBS PERF

OBS PERF

PATIENT INTERVIEW

WITNESSED ARREST

VITAL SIGNS SUCTION

02 ADMINISTRATION

CHEST COMPRESSIONS

BANDAGING VENTILATIONS

TRACTION SPLINT BLS airway adjunct

C-SPINE IMMOBILIZATION

AIRWAY ADJUNCT TYPE:

LONG BACKBOARD ALS CARE – OTHER

LONG BONE IMOBILIZATION

DESCRIBE # PERFORMED Obs Per

STUDENT PHYSICALLY INVOLVED IN LIFTING PATIENT

YES NO

CHEST DECOMPRESSION

CRICOTHYROIDOTOMY

12 LEAD ECG

PULSE OXIMETRY BLOOD GLUCOSE

Field Diagnosis: CHIEF COMPLAINT: HISTORY OF PRESENT ILLNESS / INJURY: (include pertinent negatives / positives as indicated) ONSET (i.e. slow, sudden, etc.): PROVOCATION: QUALITY: RADIATION: SEVERITY: TIME: LAST ORAL INTAKE: ASSESSMENT: (include pertinent negatives / positives for each area if indicated) SKIN COLOR / CONDITION: CAP REFILL: HEAD: EYES: EARS: NOSE: MOUTH:


NECK: CHEST: LUNGS SOUNDS: ABDOMEN: PELVIS: GENITALIA: EXTREMITIES: BACK: IMPRESSIONS (rule out): RX: TREATMENT, RESPONSE AND REASSESSMENT: TRANSPORT / TRANSFER: Verbal and written report given to: Time of transfer: E: EXCEPTIONS:


STUDENT EQUIPMENT COMPETENCY CHECK LIST - LP Student Name: Station/Shift:

School / Institution:

The student will locate and show knowledge of the CPAP

Yes No Preceptor DateThe student can identify the location of the CPAPThe student can identify the location of all accessories for equipmentThe student can show and apply the proper procedure for the CPAP

The student will locate and show knowledge of the Carevent

Yes No Preceptor DateThe student can identify the location of the CAREVENTThe student can identify the location of all accessories for equipmentThe student can show and apply the proper procedure for the CAREVENT

The student will locate and show knowledge of the Suction Unit

Yes No Preceptor DateThe student can identify the location of the Suction UnitThe student can identify the location of all accessories for equipmentThe student can show and apply the proper procedure for the Suction Unit

The student will identify the location of items in the LifePack 15

Yes No Preceptor DateThe student can identify the location of the LifePack 15The student can identify the location of all accessories for equipmentThe student can show and apply the proper procedures for the LifePack 15


STUDENT EQUIPMENT COMPETENCY CHECK LIST – MED BAG Student Name: Station/Shift:

School / Institution:

The student will identify the location of items in the Blue Med BagYes No Preceptor Date

The student can identify the location of all MedicationsThe student can identify the location of all IV equipment The student can identify the location of all FluidsThe student can identify the location of all PPE/BIO bags

The student will identify the location of items in the Airway Bag

Yes No Preceptor DateThe student can identify the Airway Roll and items insideThe student can identify/ knows how to use ALS-BLS Airway equipment The student can identify the Miscellaneous equipment in Airway bag

The student will identify the location of items in the Trauma Bag

Yes No Preceptor DateThe student can identify the location of all IV equipmentThe student can identify the location of all FluidsThe student can identify the location of all PPEThe student can identify the location of BLS/ALS Trauma equipment

The student will identify the location of items in the Pedi Box

Yes No Preceptor DateThe student can identify the location of all MedicationsThe student can identify the location of all IV equipment The student can identify the location of all FluidsThe student can identify the location of all PPE/BIO bagsThe student can identify the location of BLS/ALS equipment


PAYROLL REPORT – CLINICAL

NAME: DEPARTMENT: Paramedic PAYROLL PERIOD: Start Date: End Date:

DATE Course ID: (2664, 2665, 2658, 2659)

Ref#

Shift A B C

Location Hosp, FR,

Other

Start-End Time

DAILY TOTALS

TOTAL HOURS

_____

Timesheets are to be submitted to the Clinical Coordinator by noon of due date. If your time sheet is not submitted on time, the Clinical coordinators signature is required; your hours will not be paid until the following pay date. Name of Hospital must be stated, not just hosp. I certify that the information I have recorded above is accurate. Signature/Date Approved



Paramedic Program

PARAMEDIC ASSISTANCE LAB REFERRAL DIDACTIC LAB CLINICAL (Please fax/scan to Clinical Coordinator @ 868.3419

and keep original) Class Shift: _____ Clinical Shift: _____

Name of Student: ___________________________________ Date ________________ Initiated by: _________________________ Lead Instructor: ________________________ Problem Identified: _____________________________________________________________________________________ __________________________________________________________________________________________________________________________________________________________________________ Test Scores ________ Attendance / Tardy Policies

Suggested Remediation Plan: _____________________________________________________________________________________ _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ I have participated in the development of my remediation plan and agree to the plan as stated. I understand I now have the responsibility to see this plan thru with the assistance of the Occupational Skills Evaluators and my Instructors. Student’s Signature Date Instructor’s Signature Date


Assistance Lab Referral Progress Report

Student______________________ Lead Instructor_______________________________ Date: ________________________ Progress: __________________________________________ _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Student has met expectations for remediation. Additional remediation is recommended.

Instructor’s Signature: _____________________________ Date: ________________________ Progress: __________________________________________ _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Student has met expectations for remediation. Additional remediation is recommended.

Instructor’s Signature: _____________________________ Date: ________________________ Progress: __________________________________________ _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Student has met expectations for remediation. Additional remediation is recommended.

Instructor’s Signature: _____________________________ This page must stay attached to the copy of the Paramedic Student Assistance Lab Referral, as reference to the “problem identified” as well as the “suggested remediation plan”. Place report back in box for additional follow-up.



Paramedic Program

Paramedic Student Assistance Lab Referral Guidelines

• Once the plan is filled out, it should be placed in the top, middle slot of the mail boxes in the office. Clinical Instructors will fax.

• Clinical referrals are to be placed in the clinical referral box. • Any time a student is seen in an Assistance Lab and identifies

themselves as a remediation student, the form is used as reference for the problem identified.

• When a student participates in the remediation process, the Progress Report should be filled out as completely as practical and identified as meeting the expectations for remediation or additional remediation is recommended, by checking one of the associated boxes.

• Paperwork should be returned to the slot to be picked up by either the class Lead, OSE or Clinical coordinator.

• Leads, OSE’s and the Clinical Coordinator originating the paperwork should routinely check the box to follow up on their students’ progress throughout the plan.

• When a student has successfully completed any remediation plan as suggested by our program, the completed paperwork should be placed in their appropriate student file folder.

• Failure to attend a scheduled assistance lab will count as an absence.

• Once a clinical deficiency is identified, and the student has received sufficient remediation in the assistance lab, the student will have to be re-tested on the skill and successfully signed off in order to participate in further clinical rotations.

• Any questions an Instructor may have on any student can be referred to the Lead responsible for that student.


Palm Beach State College – Paramedic Program

CLINICAL EVALUATION - PROGRESS REPORT

□ EMS 2664 – CLINICAL 1 □ EMS 2658 – CLINICAL 3

□ EMS 2665 – CLINICAL 2 □ EMS 2659 – Internship

Date Student Name

Instructor Name Instructor Signature

Indicate how the student is progressing toward competency by rating the student on a scale of 1-5. A “1” or “2” rating indicates that immediate remedial work is indicated. A “5” indicates superior performance. Cognitive Domain (Knowledge Base) 5 4 3 2* 1*

Psychomotor Domain (Clinical Proficiency) 5 4 3 2* 1*

Affective Domain (Behavioral Skills) 5 4 3 2* 1*

Documentation (Typhon) 5 4 3 2* 1* Comments:

*Grades of 1 or 2 require comments, an Assistance Lab referral form, and Clinical Coordinator notification. Student Signature:


Palm Beach State College – Paramedic Program CLINICAL EVALUATION - COVER FOR LONG FORM

□ EMS 2664 – CLINICAL 1 □ EMS 2658 – CLINICAL 3

□ EMS 2665 – CLINICAL 2 □ EMS 2659 – Internship CLASS: _______________

Date Student Name


Competent Not Competent Cognitive Domain (Knowledge Base) Minimum Score: 24

Psychomotor Domain (Clinical Proficiency) Minimum Score: 16

Affective Domain (Behavioral Skills) Minimum Score: 36

Documentation (Typhon) Minimum Score: 12

Comments: In any given semester, a Competent score is required in the Psychomotor domain in order to receive a course satisfactory grade (S). In EMS2664, EMS2665 and EMS2658, other than the above mentioned requirement, the student may receive only one Not Competent and still receive a course grade of satisfactory (S). In EMS2659, a Final Evaluation of Competent must be received in ALL categories to earn a satisfactory grade (S).

CURRENT GRADE: Satisfactory Unsatisfactory*

*Requires immediate Clinical Coordinator notification Student Signature:


Palm Beach State College – Paramedic Program CLINICAL EVALUATION - LONG FORM

CLASS: _____________ □ EMS 2664 – CLINICAL 1 □ EMS 2658 – CLINICAL 3 □ EMS 2665 – CLINICAL 2 □ EMS 2659 – Internship

Date Student Name


Indicate how the student is progressing toward competency by rating the student on a scale of 1-5. A “1” rating indicates that immediate remedial work is indicated. A “5” indicates superior performance.

Comments are required in all categories. Cognitive Domain (Knowledge Base) Has the EMS knowledge necessary to function in a healthcare setting. 5 4 3 2 1

Has the general medical knowledge necessary to function in his/her given semester. 5 4 3 2 1

Is able to collect data from charts and patients. 5 4 3 2 1 Is able to interpret patient data. 5 4 3 2 1 Is able to recommend appropriate diagnostic and therapeutic procedures. 5 4 3 2 1

Uses sound judgment while functioning in a healthcare setting. 5 4 3 2 1 Minimum 24 SCORE _____ / 30

Comments: Psychomotor Domain (Clinical Proficiency) Effectively performs clinical skills for given semester. 5 4 3 2 1

Possesses the skills to perform patient assessment. 5 4 3 2 1 Is able to perform approved therapeutic procedures and modalities. 5 4 3 2 1

Is able to perform and interpret diagnostic procedures. 5 4 3 2 1 Minimum 16 SCORE _____ / 20 Comments:


Affective Domain (Behavioral Skills)

1. INTEGRITY Examples of professional behavior include, but are not limited to: Consistent honesty; being able to be trusted with the property of others; can be trusted with confidential information; complete and accurate documentation of patient care and/or learning activities.

5 4 3 2 1

2. EMPATHY Examples of professional behavior include, but are not limited to: Showing compassion for others; demonstrating respect for others; being supportive and reassuring to others.

5 4 3 2 1

3. SELF – MOTIVATION Examples of professional behavior include, but are not limited to: Taking initiative to complete assignments; taking initiative to improve and/or correct behavior; taking on and following through on tasks without constant supervision; showing enthusiasm for learning and improvement; consistently striving for excellence; accepting constructive feedback in a positive manner; taking advantage of learning opportunities.

5 4 3 2 1

4. APPEARANCE AND PERSONAL HYGIENE Examples of professional behavior include, but are not limited to: Clothing and uniform is appropriate, neat, clean and well maintained; good personal hygiene and grooming.

5 4 3 2 1

5. SELF – CONFIDENCE Examples of professional behavior include, but are not limited to: Demonstrating the ability to trust personal judgment; demonstrating an awareness of strengths and limitations; exercises good personal judgment.

5 4 3 2 1

6. COMMUNICATIONS Examples of professional behavior include, but are not limited to: Speaking clearly; writing legibly; listening actively; adjusting communication strategies to various situations.

5 4 3 2 1

7. TIME MANAGEMENT Examples of professional behavior include, but are not limited to: Consistent punctuality; completing tasks and assignments on time.

5 4 3 2 1

8. TEAMWORK AND DIPLOMACY Examples of professional behavior include, but are not limited to: Placing the success of the team above self interest; not undermining the team; helping and supporting other team members; showing respect for all team members; remaining flexible and open to change; communicating with others to resolve problems.

5 4 3 2 1

9. RESPECT Examples of professional behavior include, but are not limited to: Being polite to others; not using derogatory or demeaning terms; behaving in a manner that brings credit to the profession.

5 4 3 2 1

Minimum 36 SCORE _____ / 45

Comments:


Documentation (Typhon Entries and Narratives)

Typhon reports match paper reports. 5 4 3 2 1 Typhon reports are entered within 72 hours of clinical. 5 4 3 2 1

Typhon narratives completed and well written. 5 4 3 2 1 Minimum 12 SCORE _____ / 15

Comments:

Student Signature:


Team Leadership Student Name: Date: Preceptor Name: Station:

Comments:

Establishes and maintains BSI for self and for crew Communicates roles and responsibilities of each crew member Determines scene safety and uses necessary precautions Acts on prompts given by preceptor and crew Recognizes the need for additional resources Delegates specific tasks to crew members Patient care tasks are performed in a timely manner Is able to multi task Psychomotor skill sets are performed correctly according to institution and departments SOG’s Forms a general impression Determines chief complaint and establishes a rapport with the patient Establishes and maintains communication with patients family, bystanders, and other EMS personnel Is empathetic to patients condition and needs Demonstrates effective and timely critical thinking Implements acceptable patient care Directs the EMS team throughout call Encodes in a succinct and calm manner Performs a thorough patient turnover to hospital personnel Documents activities and pertinent information on the PCR Maintains a high degree of professionalism throughout call Conducts a critique of the emergency call with crew members Understands and accepts constructive criticism well

This form is intended for use during the paramedic students Field Clinical Ride Time component of the Palm Beach State Paramedic Program. Please rate each of the following items as (S) Satisfactory or (U) Unsatisfactory. Add comments as
