Instructor: Arthur M. Brady, Jr.

E-mail: Brady@kcmetro.cc.mo.us

Web Page: http://pages.prodigy.com/ambrady

INTRODUCTION

The guidelines listed below are intended to introduce the student to the clinical classes and procedures of the EMT-Paramedic program at Penn Valley Community College. Outlined below are guidelines for student requirements, dress, documentation, and scheduling, and grading. These guidelines are not intended to replace the Metropolitan Community Colleges policies and procedures as they pertain to student conduct, only to augment those policies and procedures as they pertain to the clinical classes of the EMT-Paramedic program.

The Metropolitan Community Colleges comply with the Americans with Disabilities Act.

If you need any accommodations due to a documented disability, or if you have any emergency medical information to share, please contact the Penn Valley ACCESS Office Coordinator in the Counseling Center, Room 221, or call 759-4152 (voice), or

759-4383 (TDD). All information is strictly confidential and released only upon your permission.

Table of Contents

The requirements listed below MUST be met before the student will be allowed to attend any clinical rotation. These requirement are determined either by the State of Missouri, or the individual clinical sites and therefore no exceptions will be made.

1. The student must have successfully completed the didactic portion paramedic program in order to attend clinical rotations.

2. The student must have a current CPR card either from the American Heart Association or the American Red Cross.

3. The student must show proof of medical liability insurance.

4. The student must have record of a physical examination including a tuberculosis skin test and hepatitis B vaccination or record of hepatitis B vaccination declination on file with the paramedic program Clinical Coordinator. (Physical examination form attached at the rear of this document.)

5. The student must have completed a criminal background check as prescribed by the policies of the Metropolitan Community Colleges. The student must submit to the clinical coordinator a paid receipt as evidence of initiation of the background check.

In order to complete the hospital clinicals in a timely fashion,(e.g. one standard college semester) it is suggested that the student try to average approximately 20-25 hours of clinicals per week. In other words, the student should be completing two (2) clinical shifts each week.

To complete Field Internship clinicals within the final semester of the program, the student should also try to average approximately 20 - 25 hours of field internship clinicals per week. Again, this should equate to two (2) clinical shifts each week.

Students participating in the EMT-Paramedic program must complete the following skills performance requirements as outlined by the Missouri Bureau of Emergency Medical Services.

30 Cardiac rhythm interpretations (covering 10 different rhythms.)

20 Venipuncture

20 Total IV Starts

20 IV direct medications

10 Medication additions to IV solutions

10 Intramuscular medication injections

10 Adult patient assessments

10 Pediatric/neonatal patient assessment (Physical &neurological). Neonates may be healthy patients.

6 Successful endotracheal intubations.

5 Defibrillations on patients or mannequins.

5 Patient profiles.

5 Pharyngeal suctioning procedures.

5 Tracheal suctioning procedures.

2 Subcutaneous medication injections

2 Observations of childbirth.

1 Utilization of Pneumatic Anti-Shock Garment.

1 Observation of autopsy.

10 Cardiac rhythm interpretations.

10 Patient assessments.

10 Management of patient airway to include:

Suctioning

Oral airway

Nasal airway

Esophageal airway

Endotracheal intubation

Positive pressure ventilation

Oxygen administration

4 IV direct medications.

4 Successful IV starts.

20 Documented ALS ambulance runs.

No Field Internship will commence before the start of the LAST semester of the program.

Under no circumstance will the student be allowed to begin Field Internship rotations until the following clinicals have been completed:

Emergency Department ( 90 hours)

Intensive Care Unit ( 60 hours)

All other hospital rotations (131 hours)

Total hosptial clinical hours to be completed by the start of Field Internship: 281

DRESS STANDARDS

Students participating in clinical rotations will STRICTLY adhere to the following standards of dress:

1. Navy blue EMT-Paramedic Program approved scrub suit. No patches or insignia shall be affixed to your scrubs.

2. White blazer length lab coat. No patches or insignia shall be affixed to your lab coat other than an an EMT-Paramedic Program approved name tag.

3. Clean white tennis shoes.

4. PVCC EMT-Paramedic program approved name tag.

5. No long necklaces, or dangling earrings.

6. Beards and longer hairstyles are acceptable as long as

these are kept neat, and trimmed. For safety reasons it may be necessary to tie long hair back into a pony tail.

7. Students will need to supply their own stethoscopes in order to comply with various hospitals and ambulance services infection control standards.

8. Dark color winter jacket. No patches or insignia shall be affixed to the jacket.

Special consideration for ambulance clinicals.

1. EMT-Paramedic Program approved polo or dress shirt. No unauthorized patches or insignia shall be affixed to the shirt.

2. Navy blue dress slacks. Flight, fatigue, or cargo style pants are acceptable. Corduroy or denim are not acceptable.

3. Black polishable shoes or boots.

4. Black polishable belt.

5. Dark color winter jacket. No patches or insignia shall be affixed to the jacket.

Please note: Name tags MUST be worn at all times during clinical rotations. Also, HEPA filtration mask MUST be carried at all times during clinical rotations.

All scheduling of clinical rotations shall be performed by the student in the EMT-Paramedic programs' offices. Working monthly clinical schedules for each of the available clinical sites shall be located in the designated clinical scheduling area. Students are encouraged to schedule clinical rotations as soon as possible. Clinical rotation sites fill-up fast, and all clinical scheduling is on a first come first serve basis.

All clinical scheduling for a given month must be completed by the 15th day of the preceding month. For example, to attend a clinical rotation on March 10, you must have signed up for that clinical by February 15. This is necessary to insure that the hospitals and ambulance services have at least two weeks notice of which students will be attending clinicals that month.

How to schedule a clinical rotation.

1. Check your personal schedule for days that you are free to perform a clinical rotation. Remember that you may not schedule a clinical rotation during times that you are scheduled for class.

2. After determining which days you will be available to

attend clinicals, check the working clinical schedules

located in the designated clinical scheduling area for site availability.

3. If you are available and the clinical rotation you want is open, PRINT your name on the working schedule in the time slot that you desire.

Note: All clinical scheduling must be completed by the

15th day of the preceding month. Working clinical schedules will be removed from the designated clinical scheduling area at the end of the day on the 15th. Should the 15th occur during a weekend or a school holiday, schedules will be picked up on the following Monday or the first school day following the holiday.

Attendance of the clinical rotations that you schedule is mandatory. However, it is understood occasionally you may have to miss a clinical rotation due to circumstances beyond your control. Should you find that you will not be able to attend a clinical you must:

1. Call the clinical site and let them know that you will not be able to attend the clinical.

2. Immediately notify the Clinical Coordinator that you will not be able to attend the clinical rotation, and provide a reason as to why you will not be attending as scheduled.

3. Both the clinical site and the Clinical Coordinator should be notified as soon as possible that you will not be attending a clinical, but defiantly no later than two hours before the start of the clinical rotation that you will be missing.

4. Failure to notify both the clinical site AND the Clinical Coordinator may result in the student being marked as a NO SHOW for that rotation.

5. If a student will be more than fifteen (15) minutes late for a clinical rotation, the student must check with the clinical site to see if they can still attend the rotation that day. If the clinical site chooses not to allow the student to attend, the student must reschedule the clinical rotation as stated above.

It is the student's responsibility to reschedule any missed clinical rotations. If the current month's clinical schedule has been submitted to the hospital or ambulance service, then the rescheduled rotation must take place in the next month.

All clinical rotations must be authorized by the Clinical Coordinator. Students shall not schedule clinical rotations directly with hospital or ambulance services without prior authorization from the Clinical Coordinator. Any student found attending clinicals not authorized by the Clinical Coordinator shall be ask to leave the clinical site, and that student's grade shall be decreased by one letter grade. Further, any time or skills completed during the unauthorized clinical shall not be accepted toward completion of the hours or skills requirement for the paramedic program. Upon a second occurrence, the student shall be withdrawn from the clinical class for that semester.

GRADING POLICY

Grades for the clinical classes shall be based on the students demonstration of professionalism. As such, the student is expected to attend all scheduled clinicals, dress appropriately, and maintain a professional attitude while attending clinicals.

1. Students shall be graded according to attendance of clinical rotations under the following policy:

• Student shall lose a letter grade for every two (2) excused absences. Upon the 7th absence the student shall be withdrawn from the clinical class for that semester.

• Students who fail to attend a clinical rotation without notifying the clinical site and the Clinical Coordinator shall have the absence recorded as a NO SHOW. A NO SHOW will shall cause the students overall grade to be decreased by one letter grade. A second occurrence shall result in the student being withdrawn from the class.

2. Students shall be graded according the following policy under professionalism:

• Students who are requested to leave a clinical site due to inappropriate dress, poor attitude, or for attending an unauthorized clinical rotation, or for other cause shall be assessed one letter grade after investigation of the incident by the Clinical Coordinator shows the complaint to be valid. A second occurrence shall result in the student being withdrawn from the class.

Students must complete the required number of clinicals each semester in order to receive a passing grade for that semester. The only exception to this policy shall be when the student has been prevented from completing the required clinicals as the result of extended illness. In such cases the student will be allowed to complete clinical rotations in the next semester, and will receive an incomplete for that semester. All such cases shall require a physicians statement indicating the nature of the illness involved.

In order to show that the student has completed the required clinical rotations, the student must keep a Clinical Notebook. The Clinical Notebook shall consist of Skills Sign-Off Sheets and Clinical Hours Sign-Off Sheets issued by the Missouri Bureau of Emergency Medical Services. This notebook must be carried by the student while at a clinical site. Upon completion of a required skill or completion of clinical hours, the student must have a clinical preceptor "sign-off" the skill performed or the hours completed. Upon completion of the course, the Clinical Notebook will be reviewed by the Bureau of Emergency Medical Services to insure completeness and will be kept on file by the paramedic program. Only BOUND Clinical Notebooks shall be accepted by the paramedic program for review and course completion. Remember that all skills that are "signed-off" in the Clinical Notebook must be skills that were performed while either at a hospital or emergency service clinical site. Skills performed in the classroom will not be accepted unless otherwise authorized by the Program Coordinator or Clinical Coordinator and has the approval of the Bureau of Emergency Medical Services.

Authorized Clinical Schedules

The Authorized Clinical Schedule is a reporting form that must be completed by the student each week. The form is designed to provide the student with a record of all the authorized clinical rotations that the student is scheduled to attend during any given week. The form also allows the Clinical Coordinator the ability to track individual students each month as they progress through the clinical process. Finally, the form serves as "backup" documentation as to the number of clinical hours that the student has completed, and allows for the recreation of the HOURS portion of the Clinical Notebook if necessary.

To complete the Authorized Clinical Schedule the student should first schedule all of the clinical rotations that he or she wishes to attend for a given month. Then, the student shall receive a weekly Authorized Clinical Schedule indicating the clinical site, and expected date of attendance, and expected time the clinical rotation will begin and end on the form. The form will also include a section for a preceptor’s signature.

During the scheduled week, the student will need to have the Authorized Clinical Schedule "signed-off" by the various clinical preceptors to verify attendance. Finally, the student is required to submit the completed form to the Clinical Coordinator by the end of the week. The form is then kept on file for verification of the signatures in the Clinical Notebook, and to record clinical attendance. Remember, this form is required by the paramedic program, and failure to submit it as required will result in the student being dropped from the clinical class.

Hepatitis B is a viral infection caused by the hepatitis B virus (HBV); the mortality rate for HBV infection is 1-2%. Transmission occurs by percutaneous or mucosal exposure to infected blood or body fluids. It is advisable that anyone who is at risk to exposure these material be vaccinated against Hepatitis B. Most persons who develop Hepatitis B recover completely, but approximately 5-10% become chronic carriers of the virus. Some carriers may develop chronic active hepatitis and cirrhosis.

While Hepatitis B vaccination is recommended for most health care providers, it should be stated that those individuals who:

• Are Hypersensitive to yeast or any other component of the vaccine,
• Are pregnant, planning to become pregnant, or nursing,
• Have an active infection, or are immunosuppressed,
• Are receiving steroids,
• Suffer from asthma

should refrain from taking the vaccination.

Possible adverse reactions to the vaccination include, but are not limited to:

• Local reactions at the injection site, erythema, swelling.
• Fever, headache, dizziness, rash, joint aching
• Possibility exist for more serious side effects with extensive use.

Conclusion

The purpose of the clinical classes are to provide the student with the opportunity to develop the practical skills learned in the classroom setting as well as to develop the students' ability to communicate with patients, family members and other medical personnel. To develop these skills it is vital that the student attend each of the clinical rotations that are scheduled. Further, it is the purpose of the clinical classes to instill an attitude of professionalism in the student.

Also, please remember that the various hospitals and ambulance services wish to provide you with the best possible clinical experience. These organizations have chosen to donate their time, skills and staff members in order to enrich the clinical experience of each student.

It is the hope of the EMT-Paramedic program that your clinical experience will be an enjoyable as well as educational one.

Copyright © 1999 Arthur M. Brady, Jr.