Paramedic Care Principles Practice, V1, 5e Bledsoe SM Completed with Answers

Paramedic Care Principles Practice, V1, 5e Bledsoe SM Completed with Answers Paramedic CarePrinciples Practice, V1, 5e Bledsoe SM©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 1, 5th Ed. 1 Detailed Lesson Plan Chapter 1 Introduction to Paramedicine 130 Minutes Chapter 1 objectives can be found on text p. 1. These objectives, which form the basis of each chapter, were developed from the National Education Standards and the accompanying Paramedic Instructional Guidelines. Minutes Content Outline Master Teaching Notes 5 I. Case Study Teaching Tips Have a student read the scenario. Tell students that the case will be reviewed after the lecture. 90 II. Introduction A. Understand what the job of paramedic in the twenty-first century involves 1. Member of allied health professions (ancillary health care professions, apart from physicians and nurses) 2. Highly regarded by society 3. Significant advances in EMS system over the past 30 years 4. Not long ago, the ambulance was simply a vehicle that provided rapid, horizontal transport to the hospital. 5. Today the modern ambulance is equipped with the latest in equipment and technology and is truly a mobile emergency room on wheels. 6. Twenty-first century paramedic is a highly trained health care professional who provides comprehensive, compassionate, efficient prehospital emergency care B. Description of the Profession 1. Paramedic is highest level of prehospital care and leader of prehospital care team 2. Four nationally recognized levels of EMS providers in the United States: a. Emergency Medical Responder (EMR) b. Emergency Medical Technician (EMT) c. Advanced Emergency Medical Technician (AEMT) d. Paramedic Teaching Tips Before starting the Introduction, ask students to list on the board what roles paramedics serve and how they help the public. Discussion Topics List the four levels of EMS, what each level can do, and the skills each level is not permitted to perform. MASTER TEACHING NOTES  Teaching Tips  Discussion Topics  Class Activities©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 1, 5th Ed. 2 Chapter 1 objectives can be found on text p. 1. These objectives, which form the basis of each chapter, were developed from the National Education Standards and the accompanying Paramedic Instructional Guidelines. Minutes Content Outline Master Teaching Notes C. The Modern Paramedic 1. Roles and responsibilities of paramedic are diverse and encompass disciplines of health care, public health, and public safety 2. Illness and injury prevention are just as important as acute health care and public safety 3. Totality of roles and responsibilities of paramedic practice known as paramedicine 4. Primary tasks of paramedic include a. Providing emergency medical care in an out-of-hospital setting b. Using advanced training and equipment to extend the care of emergency physician to patient in the field c. Making accurate independent judgments in a timely manner (This is essential, as it can mean the difference between life and death for the patient.) 5. In order to function as a paramedic, you must: a. Fulfill prescribed requirements of appropriate licensing or credentialing body b. Be licensed, registered, or otherwise credentialed by appropriate agency in area of employment c. Function only under the direction of the EMS system’s medical director 1) Medical director must be appropriately licensed or credentialed. 2) Medical director must approve paramedic before allowing practice of advanced prehospital care. 6. Emerging roles and responsibilities include public education, health promotion, participation in injury and illness prevention programs 7. As a paramedic, you must: a. Recognize that you are an essential component in the continuum of care. b. Serve as a link between various health resources in the community. c. Understand that you may be a gatekeeper to the health care system as health care costs increase. Class Activities Ask students to list all the illness and injury prevention programs they can think of. Discuss with them the ways they can participate in these programs as paramedics. Examples include but are not limited to: - DARE - Safety Town - Bike Rodeos - Blood Pressure Screenings - MADD - Mock Auto Accidents at Schools - First Aid/CPR - Babysitting Courses - No Texting and Driving©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 1, 5th Ed. 3 Chapter 1 objectives can be found on text p. 1. These objectives, which form the basis of each chapter, were developed from the National Education Standards and the accompanying Paramedic Instructional Guidelines. Minutes Content Outline Master Teaching Notes 1) For example, you ensure that your patient gets to an appropriate health care facility in a timely manner, even though it may not be a hospital ED. d. Strive toward maintaining high-quality health care at a reasonable cost. e. Always be an advocate for your patient and ensure that the patient receives the best possible care, without regard to patient’s ability to pay or insurance status. f. Continue to fill the well-defined and traditional role of 911 response. g. Take on additional responsibilities. 1) Mobile integrated health care/community paramedicine is community-based health care focused on appropriate use of emergency care resources 2) Become a facilitator of access to care, individual treatment provider h. Be responsible and accountable to the system medical director, their agency, the public, and your peers. i. Always act in the best interest of the patient. D. Paramedic Characteristics 1. As a paramedic, you may work for a fire department, private ambulance service, third city service, hospital, police department, or other operation. 2. You must: a. Be flexible to meet the demands of the ever-changing emergency scene. b. Be a confident leader. c. Have excellent judgment. d. Be able to prioritize decisions to act quickly and in the best interest of the patient. e. Be able to develop rapport with a wide variety of patients and communicate with members of diverse cultural and age groups. f. Function independently at an optimum level in a nonstructured, constantly changing environment. Class Activities Have students give examples of situations in which they had to be flexible in their job. Class Activities Have students list skills they learned as©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 1, 5th Ed. 4 Chapter 1 objectives can be found on text p. 1. These objectives, which form the basis of each chapter, were developed from the National Education Standards and the accompanying Paramedic Instructional Guidelines. Minutes Content Outline Master Teaching Notes E. The Paramedic: A True Health Professional 1. Emergency medical services now recognized as an important part of health care system 2. Paramedics are highly respected members of health care team. 3. Paramedics must always strive to earn acceptance as a professional. 4. Completion of initial paramedic course is start of professional education 5. Participation in continuing education programs and routine peerevaluation is essential in your career. 6. Standards for paramedics raised with the 2009 publication of National Emergency Medical Services Education Standards: Paramedic Instructional Guidelines a. Guidelines have taken paramedic education to a higher level b. Based on a national EMS practice analysis completed by the National Registry of EMTs in 2004 c. Anatomy and physiology course now a prerequisite to paramedic course d. Curriculum provides for improved understanding of pathophysiology of various illnesses and injury processes paramedics encounter e. Material in 2009 DOT EMS Instructional Guidelines is the foundation for this textbook 7. Strong practice now based on research a. Must be active in design, development, evaluation, and publication of research b. In the past, paramedicine was based on anecdotal data and tradition. c. In the last 20 years, application of scientific methods introduced into paramedic care after it was found that there was little to no scientific data to support many prehospital practices d. As a result of research, many traditional EMS treatments have been abandoned or refined. 8. Essential aspect of the health profession is acceptance and adherence to professional ethics and etiquette a. Ethics are standards of right and honorable behavior; often EMTs that they have not used since class. If time permits, pull that equipment out and have a few students attempt to use it only by memory. Teaching Tips Touch on research just briefly, since this will be discussed in later chapters. Focus on the changes research initiated, such as CPR and compressions first, O2 for chest pain/MI patients with low PSO2 saturations, rapid transport, decreased scene time for stroke victims and trauma victims, etc. Class Activities Have one student change into a dirty shirt (an old shirt that you provide with spilled coffee on it, ink stains, etc.) and perform a patient assessment. Have another student perform an assessment using a poor attitude and no listening skills. Discuss with students their initial impressions. When discussing public expectations, use the scenario of calling a plumber to your house to fix your pipes, then finding out that he doesn’t know what he is doing. Have students give examples of how they can review their performance. Take students through a mock run review using an imaginary call that you make up.©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 1, 5th Ed. 5 Chapter 1 objectives can be found on text p. 1. These objectives, which form the basis of each chapter, were developed from the National Education Standards and the accompanying Paramedic Instructional Guidelines. Minutes Content Outline Master Teaching Notes arise in relationships with patients and the public b. Etiquette refers to good manners; often related to behavior between health professionals 9. Public expectations a. Public must feel confident and know that their interests are always placed above personal, corporate, or financial interests b. Emergency patient is always the primary concern F. Legal Considerations: Which Hat Are You Wearing? 1. As a modern paramedic, you must wear several hats as a result of overlapping of duties. a. Cross trained as a fire fighter and police officer b. May participate in rescue operations, directing traffic, and other tasks on the emergency scene 2. Cross training can cause a certain degree of confusion and conflict. a. Police officer/paramedic and HIPAA considerations b. Remember that, as a paramedic, you must put care of the patient above other tasks. 3. Laws regarding responsibilities of cross-trained individuals vary from state to state. Teaching Tips Stress to students that, even if they are cross trained, they will be providing only one service at a time. 15 III. Expanded Scope of Practice A. Critical Care Transport 1. Critical care transport vehicles used to move critically ill patients between facilities 2. Specialized ground ambulances, fixed-wing aircraft, and helicopters B. Helicopter air Ambulance (HAA) 1. Helicopters part of EMS system for more than 30 years 2. Most programs staff helicopter with two medical crew members and often include paramedics 3. Skills of flight paramedic very similar to those of critical care paramedic but include additional education in flight physiology, aircraft operations, flight safety, and similar areas C. Tactical EMS 1. Designed to enhance safety of special operations personnel and the Teaching Tips If possible, have a paramedic who is trained in extended scope of practice speak to students briefly about their positions.©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 1, 5th Ed. 6 Chapter 1 objectives can be found on text p. 1. These objectives, which form the basis of each chapter, were developed from the National Education Standards and the accompanying Paramedic Instructional Guidelines. Minutes Content Outline Master Teaching Notes public 2. Role of tactical paramedic is to provide life-saving care, sometimes in dangerous environments, until patient can be safely evacuated to general EMS system D. Mobile Integrated Health Care 1. Several EMS systems have designated specialized crews to periodically assess and monitor high-risk patients in their community. E. Industrial Medicine 1. Paramedics as principal health care provider on oil rigs, movie sets, and similar industrial operations 2. Specially trained for industry in question 3. Increased employee safety and decreased time lost from work F. Sports Medicine 1. Paramedics trained to deal with injuries specific to sport in question G. Corrections Medicine 1. Paramedics as emergency and medical care providers in jails and prisons 2. Responsible for medical emergencies, initial intake assessment, and overseeing medical needs of prison population H. Hospital Emergency Departments 1. Hospitals faced with a nursing shortage; paramedics founds to be suitable providers for emergency departments and minor care centers 2. Roles vary significantly from state to state, on the basis of local laws.©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 1, 5th Ed. 7 Chapter 1 objectives can be found on text p. 1. These objectives, which form the basis of each chapter, were developed from the National Education Standards and the accompanying Paramedic Instructional Guidelines. Minutes Content Outline Master Teaching Notes 5 IV. Summary A. EMS is now recognized as a staple in the health care system. B. Paramedics have been identified as underutilized medical experts and are being offered opportunities that were unheard of a few years ago. C. As the scope of practice for paramedicine expands, so will the demand for skilled practitioners. D. The paramedic of the twenty-first century can have a more significant impact on health care than ever before. E. The paramedic is often the first person of the health care system with whom the patient interacts; the results of those actions can affect the patient’s opinion of the health care system in general. F. EMS is a profession in which you can make a difference on every call and interaction with a patient. G. Few professions carry such awesome responsibility. 5 V. Case Study 5 VI. You Make the Call Class Activities Read and discuss the You Make the Call scenario, and answer the critical thinking questions as a group. 5 VI. Review Questions Class Activities Pass out the review questions before the lesson starts. Have students answer them. Go over the questions again after the lecture to assess students’ understanding of the information.©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 1, 5th Ed. 1 Detailed Lesson Plan Chapter 2 EMS Systems 90 Minutes Chapter 2 objectives can be found on text pp. 12–13. These objectives, which form the basis of each chapter, were developed from the National Education Standards and the accompanying Paramedic Instructional Guidelines. Minutes Content Outline Master Teaching Notes 5 I. Case Study Teaching Tips Have a student read the scenario. Tell students that the case will be reviewed after the lecture. 10 II. Introduction A. EMS is a comprehensive network involving personnel, equipment, and resources established to deliver aid and emergency medical care to the community. 1. Out-of-hospital components a. Members of community trained in first aid and CPR b. Communications system c. EMS providers, including paramedics d. Fire/rescue and hazardous materials services e. Law enforcement officers f. Public utilities, such as power and gas companies g. Resource centers, such as regional poison control centers 2. In-hospital components a. Emergency nurses b. Advanced practice providers c. Emergency physicians and specialty physicians d. Ancillary services (e.g., radiology and respiratory therapy) e. Specialty physicians (e.g., trauma surgeons and cardiologists) f. Social workers g. Mental health providers h. Rehabilitation services Teaching Tips Discuss with students the different out-ofhospital and in-hospital components. Class Activities Assign members of the class a particular role as an out-of-hospital and in-hospital component. Give students a scenario, and have them stand in a line as their part in the EMS call arrives. Once you have gone through the call, repeat with removal of one or two student roles, which allows students to visualize where the care is jeopardized when there is a break in the EMS and hospital components. MASTER TEACHING NOTES  Teaching Tips  Discussion Topics  Class Activities  Points to Emphasize  Knowledge Application©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 1, 5th Ed. 2 Chapter 2 objectives can be found on text pp. 12–13. These objectives, which form the basis of each chapter, were developed from the National Education Standards and the accompanying Paramedic Instructional Guidelines. Minutes Content Outline Master Teaching Notes B. Weakness in any one component will diminish the overall quality of patient care. 1. Usually, the first EMS provider to respond to the scene of an emergency is a police officer, firefighter, lifeguard, teacher, or other community member who has received basic medical training in an approved Emergency Medical Responder program. 2. Some areas of the country use a tiered response, sending multiple levels of emergency care and personnel to the same incident. 3. Once emergency care has been initiated, EMS providers quickly decide on the medical facility to transport the patient to. 4. Patient is assigned a priority of care upon arriving at medical facility 20 III. History of EMS A. Early Development 1. EMS developed from traditional and scientific beliefs of multiple cultures. 2. Most significant advances in EMS occurred during past 50 years 3. Ancient Times a. Evidence that emergency medicine has a very long history. b. Scribes in Mesopotamia (approximately 4,000–5,000 years ago) inscribed clay tablets with some of the earliest medical records. c. 1862: Egyptologist Edwin Smith purchased papyrus scroll dating back to 1500 B.C.E.; contained 48 medical case histories with data arranged in head-to-toe order of severity d. King Hammurabi of Babylon commissioned a large painting of 282 case laws known today as the “Code of Hammurabi.” 1) One section of code devoted to regulation of medical fees and penalties e. Around 900 C.E., Anglo Saxons used a hammock suspended across a horse-drawn wagon for transport. f. By 1100, Normans devised a litter carried between two horses to transport patients. g. First recorded use of ambulance in the Siege of Malaga in 1487 4. The Napoleonic Wars Teaching Tips Explore the history of EMS with students, expanding on the role the military has played, as well as the most recent developments with curriculum changes. Discussion Topics Discuss with students why EMS struggles with funding at the city and state level and through insurance and changes that have occurred in the standard of care for the paramedic. Class Activities Create a timeline of dates and important events in EMS history. Have students match them. (You may want to do this ahead of time. It works well if cards are laminated, which allows taping to the board.)©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 1, 5th Ed. 3 Chapter 2 objectives can be found on text pp. 12–13. These objectives, which form the basis of each chapter, were developed from the National Education Standards and the accompanying Paramedic Instructional Guidelines. Minutes Content Outline Master Teaching Notes a. Ambulances often used to evacuate the wounded in wars between Napoleon’s French Empire and other European countries 5. The United States in the Nineteenth Century a. Development of ambulances in U.S. occurred in first part of nineteenth century b. Civil War surgeon Jonathan Letterman c. Clara Barton – concept of ambulance volante d. First civilian ambulance established in 1860 (before the Civil War) in Cincinnati, Ohio, by Commercial Hospital e. Bellevue Hospital began to operate an ambulance service in 1869. f. Michael Reese Hospital began to operate a motorized ambulance in 1899. B. The Twentieth Century 1. From World War I to World War II a. High mortality rate associated with evacuation time of 18 hours b. System of transportation to increasing echelons was created c. Physician interns on ambulances d. 1926: Phoenix Fire Department “inhalator” service e. 1928: First bona fide rescue squad, the Roanoke Life Saving Crew, started f. 1929: Period of the Great Depression; few changes in civilian ambulance services 2. Effects of World War II a. Demands of war caused many hospital-based ambulance services to shut down b. Many city governments turned ambulance services over to local police and fire departments. c. No requirements for minimal training or care d. Ambulance work often seen as a punishment 3. Post–World War II a. End of war brought prosperity to U.S. b. Several medical advances occurred simultaneously. 4. The 1950s a. Use of helicopters in Korean War and Vietnam War©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 1, 5th Ed. 4 Chapter 2 objectives can be found on text pp. 12–13. These objectives, which form the basis of each chapter, were developed from the National Education Standards and the accompanying Paramedic Instructional Guidelines. Minutes Content Outline Master Teaching Notes b. 1956: Peter Safar and James Elam pioneered use of mouth-tomouth resuscitation c. 1959: First portable defibrillator used at Johns Hopkins Hospital 5. The 1960s a. 1966: Publication of Accidental Death and Disability: The Neglected Disease of Modern Society (National Academy of Sciences, National Research Council) 1) “White Paper” spelled out deficiencies in prehospital emergency care 2) Suggested guidelines for development of EMS systems, training of prehospital emergency medical providers, and upgrading ambulances and their equipment 3) Identified numerous problems b. Civilian EMS, as we know it today, evolved significantly in 1960s c. 1966: Highway Safety Act promulgated initial EMS guidelines for the U.S. 6. The 1970s a. 1970: National Registry of Emergency Medical Technicians established b. 1973: Congress passed Emergency Medical Services Systems Act 7. The 1980s a. Passage of the Consolidated Omnibus Budget Reconciliation Act (COBRA) essentially wiped out funding for EMS b. 1988: Statewide EMS Technical Assessment Program established by NHTSA 1) Regulation and policy 2) Resources management 3) Human resources and training 4) Transportation 5) Facilities 6) Communications 7) Trauma systems 8) Public information and education 9) Medical direction©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 1, 5th Ed. 5 Chapter 2 objectives can be found on text pp. 12–13. These objectives, which form the basis of each chapter, were developed from the National Education Standards and the accompanying Paramedic Instructional Guidelines. Minutes Content Outline Master Teaching Notes 10) Evaluation c. Helicopter air ambulances 8. The 1990s a. 1990: Trauma Care Systems and Development Act passed by Congress b. 1993: Emergency Medical Services for Children, published by the Institute of Medicine c. 1995: Significant variability in trauma system care across U.S. d. Ontario Prehospital Advanced Life Support (OPALS) study 9. EMS Agenda for the Future a. In 1966, National Highway Traffic Safety Administration (NHTSA) published EMS Agenda for the Future; proposed 14 core EMS attributes 1) Integration of health services 2) EMS research 3) Legislation and regulation 4) System finance 5) Human resources 6) Medical direction 7) Education systems 8) Public education 9) Prevention 10) Public access 11) Communication systems 12) Clinical care 13) Information systems 14) Evaluation C. The Twenty-First Century 1. Department of Homeland Security established 2. National Incident Management System (NIMS) 3. Less than ideal emergency response in 2005: Hurricane Katrina and Hurricane Rita a. Additional changes made to improve Federal Emergency Management Agency (FEMA) following these disasters©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 1, 5th Ed. 6 Chapter 2 objectives can be found on text pp. 12–13. These objectives, which form the basis of each chapter, were developed from the National Education Standards and the accompanying Paramedic Instructional Guidelines. Minutes Content Outline Master Teaching Notes 4. 2010: EMS began to fill nontraditional roles through community paramedicine and mobile integrated health care programs. 5. EMS at the Crossroads a. Current delivery system suffers in a number of key areas: 1) Insufficient coordination 2) Coordination of transport within regions is limited. 3) Disparities in response time 4) Uncertain quality of care 5) Lack of readiness for disasters 6) Divided professional identity 7) Limited evidence base 6. National Report Card on the State of Emergency Medicine a. The National Report Care on the State of Emergency Medicine: Evaluating the Environment of Emergency Care Systems State by State (2006) 1) Pointed out significant problems in all aspects of emergency care 2) Primarily addressed problems in hospital departments but also EMS issues 3) Overall, report detailed that emergency services in U.S. are so overstressed that quality of care has been compromised 4) Each state given a letter grade that reflected the reported standard of emergency care in that state 7. Helicopter Air Ambulance Recommended Improvements a. 2001: Federal reimbursement for medical helicopters improved b. 2008: Record number of helicopter air ambulance crashes c. 2009: National Transportation Safety Board (NTSB) held hearings and later recommended sweeping changes for industry©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 1, 5th Ed. 7 Chapter 2 objectives can be found on text pp. 12–13. These objectives, which form the basis of each chapter, were developed from the National Education Standards and the accompanying Paramedic Instructional Guidelines. Minutes Content Outline Master Teaching Notes 35 IV. Today’s EMS Systems A. Various service types of EMS: 1. Fire-based 2. Third service 3. Private (profit or nonprofit) 4. Hospital-based 5. Volunteer 6. Hybrid A. Chain of Survival 1. Emergency health care may begin long before an emergency occurs. a. Preventive health care measures b. EMS personnel may periodically visit high-risk and homebound citizens and assess their health status and needs. 2. Chain of survival – consists of the five most important factors affecting survival of a cardiac arrest patient a. Immediate recognition and activation of EMS b. Early CPR c. Rapid defibrillation d. Effective advanced life support e. Integrated post–cardiac arrest care Teaching Tips Review all of the components with the student. Most information should be familiar. V. Essential Components for Continuum of Care A. Health Care System Integration 1. EMS recognized as major component of modern health care system 2. Renewed emphasis on roles and responsibilities of EMS system in all types of cardiac emergencies 3. PSAPS are primary interface between EMS and communities it serves 4. Role of EMS extremely important in identification of acute coronary syndrome and ST-segment elevation myocardial infarction (STEMI)©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 1, 5th Ed. 8 Chapter 2 objectives can be found on text pp. 12–13. These objectives, which form the basis of each chapter, were developed from the National Education Standards and the accompanying Paramedic Instructional Guidelines. Minutes Content Outline Master Teaching Notes 5. EMS stepping up and assuming important role as initial component and gatekeeper of modern health care system B. Levels of Licensure/Certification 1. Emergency Medical Responder (EMR) 2. Emergency Medical Technician (EMT) 3. Advanced EMT (AEMT) 4. Paramedic C. Quality of Education 1. National EMS Core Content, published by NHTSA in 2005 a. Defined body of knowledge, skills, and abilities desired in EMS personnel 2. The National EMS Scope of Practice, published in 2005 a. Consensus document; supported a system of EMS personnel licensure that was common in other allied health professions b. Serves as a guide for states and territories in developing their scope of practice legislation, rules, and regulations D. Oversight by Local- and State-Level Agencies 1. Oversight agency responsible for managing local system’s resources, developing operational protocols, and establishing standards and guidelines 2. Agency designates who may function within the system and develops policies consistent with existing state requirements 3. Creates quality assurance or quality improvement program E. Medical Oversight 1. Medical director – a physician who is legally responsible for all clinical and patient-care aspects of the system 2. Roles of medical director a. Educate and train personnel b. Participate in personnel and equipment selection c. Develop clinical protocols in cooperation with expert EMS personnel Points to Emphasize Focus on medical direction and off-line, online, prospective, and retrospective. Explain to students what to do if they have a physician arrive on their scene. Discuss with students the importance of safety. Have them list examples of unsafe practices in EMS and how those practices©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 1, 5th Ed. 9 Chapter 2 objectives can be found on text pp. 12–13. These objectives, which form the basis of each chapter, were developed from the National Education Standards and the accompanying Paramedic Instructional Guidelines. Minutes Content Outline Master Teaching Notes d. Participate in quality improvement and problem resolution e. Provide direct input into patient care f. Interface between EMS system and other health care agencies g. Advocate within the medical community h. Serve as the “medical conscience” of the EMS system, including advocating for high-quality patient care 3. On-Line Medical Direction a. Occurs when a qualified physician gives direct orders to a prehospital care provider by either radio or telephone b. Medical direction may be delegated to a mobile intensive care nurse (MICN), advanced practice practitioner, or paramedic. c. Offers several benefits to the patient 1) Gives EMS provider direct and immediate access to medical consultation for specific patient care 2) Allows for transmission of essential data 3) Recordings can be used for peer review d. When a nonaffiliated physician or intervener physician is on scene and on-line medical direction may not exist, the paramedic should relinquish responsibility to the physician. 4. Off-Line Medical Oversight a. Refers to medical policies, procedures, and practices that a system medical director has established in advance of a call b. Includes prospective medical oversight and retrospective medical oversight c. Clinical protocols – policies and procedures of all medical components of an EMS system; the responsibility of the medical director d. Protocols designed around the four “Ts” of emergency care 1) Triage 2) Treatment can be improved. Class Activities If not already done, take students through a mock peer review, first using a positive approach, then a negative approach. Discuss with students how a negative approach affects the review.©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 1, 5th Ed. 10 Chapter 2 objectives can be found on text pp. 12–13. These objectives, which form the basis of each chapter, were developed from the National Education Standards and the accompanying Paramedic Instructional Guidelines. Minutes Content Outline Master Teaching Notes 3) Transport 4) Transfer F. Public Information and Education 1. EMS should have a plan to educate the public on recognizing an emergency, accessing the system, and initiating basic life support (CPR, bleeding control). 2. Teachable moment – an unplanned opportunity to present information when circumstances are such that a person is likely to understand and accept the information G. Effective Communications 1. Comprehensive, flexible communication plan includes: a. Citizen access b. Single control center c. Operational communications capabilities d. Medical communications capabilities e. Communications hardware f. Communications software 2. Emergency Medical Dispatcher a. Sends ambulances to the scene b. Makes sure system resources are in constant readiness to respond c. Must be medically and technically trained 3. Emergency Dispatch a. Nerve center of EMS system b. Means of assigning and directing appropriate medical care to patients c. Should be under full control of medical director and EMS agency d. Priority dispatching – EMDs are trained to medically interrogate a distressed caller, prioritize symptoms, select an appropriate response, and give life-saving prearrival Knowledge Application Assign students a 5-minute homework project that includes presenting a safety program to family/friends in an informal setting, and have the participants write an evaluation on how the information given will aid them in staying safe and healthy (e.g., texting and driving, use of seat belts, rugs in the kitchen) Discussion Topics Discuss different education programs paramedics might be called on to present. Discuss with students why they think it is important for the initial training program to©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 1, 5th Ed. 11 Chapter 2 objectives can be found on text pp. 12–13. These objectives, which form the basis of each chapter, were developed from the National Education Standards and the accompanying Paramedic Instructional Guidelines. Minutes Content Outline Master Teaching Notes instructions e. Effective system places first responding units on scene within minutes of onset of the emergency H. Initial and Continuing Education Programs 1. Initial education – original courses for prehospital providers a. Three specific learning domains: 1) Cognitive 2) Affective 3) Psychomotor b. Accreditation process: primary accrediting body is CAAHEP 2. Continuing education – programs that include refresher courses for recertification and periodic in-service training sessions b. Traditional lectures and prepackaged programs c. Web-based programs, podcasts, videos, and similar alternative delivery methods d. Continuing education is mandatory. I. Licensure, Certification, Registration, and Reciprocity 1. Licensure – a process of occupational regulation a. Governmental agency grants permission to engage in a certain trade or profession to an applicant who has attained the degree of competency required to ensure the public’s protection 2. Certification – process by which an agency or association grants recognition to an individual who has met its qualifications 3. Registration – accomplished by entering one’s name and essential information within a particular record 4. Reciprocity – the process by which an agency grants automatic certification or licensure to an individual who has comparable certification or licensure from another agency 5. National Registry of EMTs a. Nonprofit entity based in Columbus, OH follow a standard teaching curriculum. Discuss what could happen if there were no standard rules for education in EMS.©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 1, 5th Ed. 12 Chapter 2 objectives can be found on text pp. 12–13. These objectives, which form the basis of each chapter, were developed from the National Education Standards and the accompanying Paramedic Instructional Guidelines. Minutes Content Outline Master Teaching Notes b. Prepares and administers standardized tests for various EMS provider levels c. Establishes qualifications for registration and serves as a vehicle for establishing a national minimum standard of competency J. Staying Abreast 1. Professional Organizations a. National Association of Emergency Medical Technicians (NAEMT) b. National Association of Search and Rescue (NASAR) c. National Association of EMS Educators (NAEMSE) d. National Association of EMS Physicians (NAEMSP) e. International Flight Paramedics Association (IFPA) f. National EMS Management Association (NEMSMA) g. National Council of State EMS Training Coordinators (NCSETC) 2. Professional Journals and Magazines a. Academic Emergency Medicine b. American Journal of Emergency Medicine c. Annals of Emergency Medicine d. Emergency Medical Services e. Journal of Emergency Medical Services (JEMS) f. Journal of Pediatric Emergency Medicine g. Journal of Trauma: Injury, Infection and Critical Care h. Prehospital Emergency Medicine 3. The Internet a. Numerous websites designed for EMS providers b. Trade magazines and similar entities offer websites c. Numerous websites provide quality, accredited continuing education programs d. Didactic portion of initial EMS education also available on©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 1, 5th Ed. 13 Chapter 2 objectives can be found on text pp. 12–13. These objectives, which form the basis of each chapter, were developed from the National Education Standards and the accompanying Paramedic Instructional Guidelines. Minutes Content Outline Master Teaching Notes Internet e. International EMS discussions and networking K. Effective Patient Transportation 1. Air Transport a. Trauma care systems today use law enforcement, municipal, hospital-based, private, and military helicopter transport services to transfer patients. b. Fixed-wing aircraft used when patients must be transported long distances, usually more than 200 miles 2. Ambulance Standards a. All transport vehicles must be licensed and meet local and state EMS standards. b. Equipment lists should be consistent with statewide standards. c. “KKK-A-1822” Federal Specifications for Ambulances 1) Type I 2) Type II 3) Type III d. Only certified ambulances may display the registered “Star of Life” symbol as defined by NHTSA. e. Variety of specialized equipment may be on board ambulances f. Diesel ambulance g. “KKK-A-1822A” aimed at improving ambulance electrical systems to reduce overload. h. “KKK-A-1822E” provided guidelines to improve occupant protection in patient compartment. i. “KKK-A-1822F” primarily addressed electrical systems, signage, and safety. L. Appropriate Receiving Facilities 1. Hospitals organized into categories that identify readiness and©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 1, 5th Ed. 14 Chapter 2 objectives can be found on text pp. 12–13. These objectives, which form the basis of each chapter, were developed from the National Education Standards and the accompanying Paramedic Instructional Guidelines. Minutes Content Outline Master Teaching Notes capability of each hospital and its staff to receive and effectively treat patients 2. Categorization initially designed to identify trauma care capabilities for hospitals 3. Examples: burn, trauma, pediatric, psychiatric, perinatal, cardiac, etc. M. Mutual Aid and Mass-Casualty Preparation 1. Mutual aid agreements ensure that help is available when needed. 2. Cooperation must transcend geographical, political, and historical boundaries. 3. Disaster plans should be put in place by each EMS system. N. Quality Assurance and Improvement 1. Quality assurance program – designed primarily to maintain continuous monitoring and measurement of the clinical care delivered to patients 2. Continuous quality improvement (CQI) – ongoing effort to refine and improve the system to provide the highest level of service possible a. “Plan, do, check, act.” b. Rules of evidence 1) There must be a theoretical basis for the change. 2) There must be ample scientific human research to support the idea. 3) It must be clinically important. 4) It must be practical, affordable, and teachable. 3. “Take-It-for-Granted” Quality a. Quality improvement through continuous evaluation 4. Service Quality and Customer Satisfaction a. Communication through body language and tone of voice b. Serve the patient by providing the highest-quality service©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 1, 5th Ed. 15 Chapter 2 objectives can be found on text pp. 12–13. These objectives, which form the basis of each chapter, were developed from the National Education Standards and the accompanying Paramedic Instructional Guidelines. Minutes Content Outline Master Teaching Notes and care available 5. Patient Safety a. Primary tenet of medicine: primum non nocere (first, do no harm) b. Causes for medical errors: 1) Skills-based failures 2) Rules-based failures 3) Knowledge-based failures c. High-risk areas of EMS: 1) Hand-off 2) Communications issues 3) Medication issues 4) Airway issues 5) Dropping patients 6) Ambulance crashes 7) Death pronouncements O. Research 1. Formal, ongoing research program is essential component for moral, educational, medical, financial, and practical reasons 2. Funding relies heavily on research. 3. Paramedics play a valuable role in data collection, evaluation, and interpretation of research. P. Evidence-Based Medicine (EBM) 1. The conscientious, explicit, and judicious use of the current best scientific evidence in making decisions about the care of individual patients 2. Requires combining clinical expertise with the best available clinical evidence from systematic research Q. System Financing 1. Most common source for funding is fee-for-service revenue, which may be generated from Medicare, Medicaid, private insurance companies, specialty service contracts, or private paying patients. Knowledge Application Assign students an assignment of finding two to four research articles from professional magazines, journals, Internet, etc. Have them write a few paragraphs on whether they agree or disagree with the information and why.©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 1, 5th Ed. 16 Chapter 2 objectives can be found on text pp. 12–13. These objectives, which form the basis of each chapter, were developed from the National Education Standards and the accompanying Paramedic Instructional Guidelines. Minutes Content Outline Master Teaching Notes 2. Third-party reimbursement rarely covers expenses of operating an EMS system. 5 VI. Summary A. Evolution of EMS has occurred over thousands of years. B. Comprehensive EMS system has many components. C. EMS systems designed with patient as highest priority D. Most EMS systems activated by way of a single, universal number (911) E. Mutual aid agreements ensure a continuum of care during multiplecasualty incidents. F. Continuous quality improvement programs document EMS system performance. 5 VI. Case Study 5 VII. You Make The Call Class Activities Read and discuss the You Make the Call scenario, and answer the critical thinking questions as a group. 5 VIII. Review Questions Class Activities Pass out review questions before the lesson starts. Have students answer them. Go over the questions again after the lecture to assess students’ understanding of the information.©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 1, 5th Ed. 1 Detailed Lesson Plan Chapter 3 Roles and Responsibilities of the Paramedic 90 Minutes Chapter 3 objectives can be found on text p. 42. These objectives, which form the basis of each chapter, were developed from the National Education Standards and the accompanying Paramedic Instructional Guidelines. Minutes Content Outline Master Teaching Notes 5 I. Case Study Class Activities Have a student read the case, and have another student document on the board the people involved EXCLUDING the paramedic crew. This will be reviewed after the lecture. 5 II. Introduction A. Paramedicine is an enormous responsibility that requires physical, mental, and emotional preparedness. B. Strong knowledge of pathophysiology and most up-to-date medical technology is required. 20 III. Primary Responsibilities A. Paramedic’s responsibilities are diverse. B. Include emergency medical care for the patient and a variety of other responsibilities that are attended to before, during, and after the call C. Preparation 1. The paramedic must be mentally, physically, and emotionally ready to meet the demands of the patient, the family, and other health care providers. 2. Ongoing training includes aerobics for cardiovascular fitness, exercises for muscle strength and endurance, stretching for increased flexibility, and understanding of biomechanics of lifting for prevention of lower-back injuries. 3. Ensure that inspection and routine maintenance have been completed on emergency vehicle. D. Response 1. Personal safety is the number-one priority, so care must be taken Teaching Tips Make sure students understand that their responsibilities do not include just patient care. Discussion Topics Have students list possible unsafe scenes and think of ways they could make them safe, including what resources they would use. Critical Thinking Questions What would happen to your patient if you were injured? How would the quality of patient care be affected? Should a paramedic be held accountable for purposely MASTER TEACHING NOTES  Teaching Tips  Discussion Topics  Critical Thinking Questions  Class Activities  Points to Emphasize©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 1, 5th Ed. 2 Chapter 3 objectives can be found on text p. 42. These objectives, which form the basis of each chapter, were developed from the National Education Standards and the accompanying Paramedic Instructional Guidelines. Minutes Content Outline Master Teaching Notes in operating the ambulance and beginning a proper scene size-up before arrival using dispatch information. E. Scene Size-Up 1. Primary concern during scene size-up is safety of your crew, patient, and bystanders 2. Never enter an unsafe scene until hazards have been dealt with. 3. Any scene has the potential to deteriorate. 4. Identify the mechanism of injury (MOI) or the nature of the illness (NOI). F. Patient Assessment 1. This is one of the most critical skills you will learn. 2. Basic components: primary assessment, patient history, secondary assessment, and ongoing assessment G. Recognition of Illness or Injury 1. This is the first aspect of patient prioritization. 2. Most commonly, patient priority is based on urgency for transport H. Patient Management 1. Always follow your system’s protocols. 2. Ensure use of proper equipment and availability of adequate personnel when moving patients from one location to another. I. Appropriate Disposition 1. Transportation a. Mode of transportation, via ground or air, is based on time and distance. b. Transport to the appropriate facility in a timely manner is critical for patient outcome. 2. Receiving Facilities a. Knowing the specialty of receiving hospitals allows the paramedic to make a sound decision for patient care. b. Level I, II, III, and IV trauma centers c. Burn, pediatric, psychiatric, perinatal, cardiac, spinal, and poison centers 3. Other Types of Disposition a. In some areas, paramedics provide primary care at the putting himself in harm’s way? Why or why not? Class Activities Put together a small jump kit with a laryngoscope, ET tube, airway equipment, etc. Take the batteries out of the laryngoscope, and have students respond to a mock scenario in the classroom with the patient needing intubation. Discuss with them the importance of checking their equipment. Give students a scenario and a blank run report. Have each of them document the call, then have a few students read them to a “pretend” receiving hospital (another student, instructor). Have a few students pretend to be paramedics, a patient, and a receiving hospital. Perform a patient transfer properly, then improperly, to identify the crucial components and dangers of an improper patient transfer.©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 1, 5th Ed. 3 Chapter 3 objectives can be found on text p. 42. These objectives, which form the basis of each chapter, were developed from the National Education Standards and the accompanying Paramedic Instructional Guidelines. Minutes Content Outline Master Teaching Notes scene and then transfer patients to facilities other than a hospital. b. “Treat and release” disposition – paramedics arrive on scene, assess patient, and provide emergency care; if no need for further medical attention, medical direction is contacted and orders not to transport are requested. J. Patient Transfer 1. First priority during patient transfer is the patient. 2. While en route, contact receiving facility and provide ETA and update on patient’s condition. 3. On arrival at destination, seek out contact person (usually a registered nurse or physician) and provide an updated patient report. K. Documentation 1. Patient care report is essential to flow of patient information, to research efforts, and to the quality improvement of EMS system a. Patient care report should be completed in its entirety as soon as emergency care has been completed. b. Record only your observations, not your opinion. c. Report should be complete, neat in appearance, and written legibly with no spelling errors. d. Report will be a reflection of emergency care provided if a lawsuit is filed in the future. L. Returning to Service 1. Clean and decontaminate the unit, properly discard disposable materials, restock supplies, and replace and stow away equipment. 2. Refuel the unit if necessary. 3. Review the call with crew members, including any problems that may have occurred. 4. Paramedic team leader should check crew members for signs of critical incident stress and assist anyone who needs help.©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 1, 5th Ed. 4 Chapter 3 objectives can be found on text p. 42. These objectives, which form the basis of each chapter, were developed from the National Education Standards and the accompanying Paramedic Instructional Guidelines. Minutes Content Outline Master Teaching Notes 15 IV. Additional Responsibilities A. Administration 1. Duties the paramedic performs to ensure efficient operation of the EMS system 2. Station duties, record keeping and reporting, special projects, and developing interagency relationships B. Community Involvement 1. Teaching basic first aid measures, how to properly access the EMS system, prevention projects 2. Benefits of community involvement a. Enhances visibility of EMS b. Promotes positive image c. Puts forth EMS personnel as positive role models d. Creates opportunities to improve integration of EMS with other health care and public safety agencies through cooperative programs C. Support for Primary Care 1. Development of prevention and wellness programs that decrease need for emergency services 2. Established protocols that specify mode of transportation for nonemergency patients 3. Transport of patients to freestanding outpatient centers or clinics as an alternative to the emergency department 4. Caution should be taken to ensure that the patient always receives the appropriate emergency care based on need, not cost. D. Citizen Involvement in EMS 1. Helps to give “insiders” an outside, objective view of quality improvement and problem resolution 2. Community members are “customers” and their needs are your priority. E. Personal and Professional Development 1. Continuing education and recertification ensures that high-quality patient care is being delivered consistently. 2. Goal is to review previously learned materials and to receive new Discussion Topics List ways in which the paramedic can stay current on education, both traditional and nontraditional. Critical Thinking Questions What guidelines should be in place before a service decides on transport of a patient versus denying transport? What could the legal ramifications be? Points to Emphasize At no point should a patient not be transported because of an inability to pay.©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 1, 5th Ed. 5 Chapter 3 objectives can be found on text p. 42. These objectives, which form the basis of each chapter, were developed from the National Education Standards and the accompanying Paramedic Instructional Guidelines. Minutes Content Outline Master Teaching Notes information. 3. New technology and data emerge rapidly. 4. Participate in activities designed to address work-related issues. 5. Alternative career paths may open as well. 20 V. Professionalism A. Professional Ethics 1. Ethics are the rules or standards that govern the conduct of members of a particular group or profession. 2. Ethics are not laws, but they are a standard for honorable behavior. B. Professional Attitudes 1. Health care professionals put their patients first and set high standards for themselves. 2. A professional paramedic is responsible for acting in a professional manner both on and off duty. C. Professional Attributes 1. Leadership a. Self-confidence b. Established credibility c. Inner strength d. Ability to remain in control e. Ability to communicate f. Willingness to make a decision g. Willingness to accept responsibility for the consequences of the team’s actions 2. Integrity a. Single most important behavior by which paramedic is judged is honesty. b. You must be trustworthy. c. Follow protocols and accurately document all patient care. 3. Empathy a. Be supportive and reassuring. b. Demonstrate an understanding of the patient’s feelings and the Teaching Tips Stress to students that they are not just “ambulance drivers.” Paramedicine is a true profession that requires them to act the part all of the time. Discussion Topics Have students list the traits they think make someone a professional. Go online and pull up some articles relating to EMT and paramedic thefts, poor judgment, etc. Discuss these as a group.©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 1, 5th Ed. 6 Chapter 3 objectives can be found on text p. 42. These objectives, which form the basis of each chapter, were developed from the National Education Standards and the accompanying Paramedic Instructional Guidelines. Minutes Content Outline Master Teaching Notes feelings of the family. c. Demonstrate respect for others. d. Have a calm, compassionate, and helpful demeanor. 4. Self-Motivation a. Complete assigned duties without being asked or told to do so. b. Complete all duties and assignments without the need for direct supervision. c. Correctly complete all paperwork in a timely manner. d. Demonstrate a commitment to continuous quality improvement. e. Accept constructive feedback in a positive manner. f. Take advantage of learning opportunities. 5. Appearance and Personal Hygiene a. Wear a clean, pressed uniform. b. Be well groomed. c. Hair should be kept off the collar. d. If facial hair is allowed, it should be kept neat and trimmed. e. A light-colored t-shirt may be worn under your uniform shirt, which should be buttoned up, with only the top collar button open. f. Jewelry – other than a wedding ring, a watch, or small plain earrings – is unprofessional. g. Long fingernails should be avoided. 6. Self-Confidence a. Have confidence in yourself and your abilities. b. Accurately assess your strengths and limitations, then seek opportunities to improve any weaknesses. c. Ask for assistance when you need it. 7. Communication a. Constant communication is required with the patient, family, bystanders, and other EMS providers and rescuers from other agencies. b. Gather all patient information in a clear, concise format. c. Speak clearly, listen actively, and write legibly. Class Activities Have a student dress in old, dirty clothes and perform a patient assessment. Have another student perform an assessment with a disinterested attitude and another with a lack of confidence. Discuss with the class how these examples of a lack of professionalism can hinder patient care.©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 1, 5th Ed. 7 Chapter 3 objectives can be found on text p. 42. These objectives, which form the basis of each chapter, were developed from the National Education Standards and the accompanying Paramedic Instructional Guidelines. Minutes Content Outline Master Teaching Notes d. Speak in a way that is appropriate to your audience. 8. Time Management a. Be punctual for shifts and meetings. b. Complete tasks on or ahead of schedule. c. Tips include making lists, prioritizing tasks, arriving at meetings or appointments early, and keeping a personal calendar. 9. Teamwork and Diplomacy a. Place the success of the team ahead of personal self-interests. b. Never undermine the role or opinion of another team member. c. Provide support for members of the team, both on and off duty. d. Remain open to suggestions from team members, and be willing to change for the benefit of the patient. e. Communicate openly with everyone. f. Above all, respect the patient, other care providers, and the community. 10. Respect a. Show and feel deferential regard, consideration, and appreciation for others. b. Show that you care for the patient and family members. c. Be polite. d. Avoid the use of demeaning or derogatory language toward even the most difficult patients. 11. Patient Advocacy a. Defend, protect, and act in the best interests of your patient. 12. Careful Delivery of Service a. Master and refresh skills. b. Perform complete equipment checks. c. Perform careful and safe ambulance operations. d. Follow policies, procedures, and protocols. D. Continuing Education 1. Maintaining certification is the responsibility of the paramedic. 2. Paramedics cannot work without satisfying continuing education requirements. 3. Continuing education programs provide the opportunity to review©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 1, 5th Ed. 8 Chapter 3 objectives can be found on text p. 42. These objectives, which form the basis of each chapter, were developed from the National Education Standards and the accompanying Paramedic Instructional Guidelines. Minutes Content Outline Master Teaching Notes material and address weak points inpatient care. 5 VI. Summary A. As a paramedic, you must be willing to accept the responsibility of being a leader in the prehospital phase of emergency medical care. B. Responsibilities of the paramedic include on-call emergency duties and offduty preparation. C. The best paramedics are those who make a commitment to excellence. 5 VII. Case Study 10 VIII.You Make the Call Class Activities Referring to the list that was created during the Case Study, change an attitude of one of the care providers anywhere during the call, except for the paramedics. Have students discuss what the patient’s attitude may be toward health care workers, even though the prehospital care was appropriate. This scenario can be changed multiple times. 5 IX. Review Questions Class Activities Pass out review questions before the lesson starts. Have students answer them. Go over the questions again after the lecture to assess students’ understanding of the information.©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 1, 5th Ed. 1 Detailed Lesson Plan Chapter 4 Workforce Safety and Wellness 100–110 Minutes Chapter 4 objectives can be found on text p. 58. These objectives, which form the basis of each chapter, were developed from the National Education Standards and the accompanying Paramedic Instructional Guidelines. Minutes Content Outline Master Teaching Notes 5 I. Case Study Class Activities Have a student read the scenario. Tell students that the case will be reviewed after the lecture. 5 II. Introduction A. Ensuring the safety and well-being of the workforce is a fundamental aspect of top-notch performance as a paramedic B. Death, dying, stress, injury, infection, and fear all threaten wellness. C. Most paramedic injuries are caused by lifting and being in or around motor vehicles. 1. Those who train to be physically prepared for their jobs as paramedics stand a better chance of avoiding early forced retirement due to an injured back or knees. 2. Those who train themselves to be mentally alert stand a better chance of staying alive and uninjured. Teaching Tips Stress to students that safety issues are the most important component of the prehospital professional. 10 III. Prevention of Work-Related Injuries A. Ambulance collisions, lifting of patients, and long shifts all contribute to injuries and illness among EMS personnel. B. Because of a renewed interest in EMS provider safety and injury prevention, strategies are in place to prevent injuries and illness. C. Sleep, nutrition, and physical fitness play roles in long-term survival in EMS. Discussion Topics Have students give you different scenarios that can cause injuries or illnesses at work and how they can prevent these. Discuss with students the different pieces of equipment that have made the workplace safer (needleless IVs, sharps containers, etc.). MASTER TEACHING NOTES  Teaching Tips  Discussion Topics  Critical Thinking Questions  Class Activities  Points to Emphasize  Knowledge Application©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 1, 5th Ed. 2 Chapter 4 objectives can be found on text p. 58. These objectives, which form the basis of each chapter, were developed from the National Education Standards and the accompanying Paramedic Instructional Guidelines. Minutes Content Outline Master Teaching Notes 20 IV. Basic Physical Fitness A. Unfortunately, physical fitness has not been a major emphasis in EMS. B. Benefits of achieving physical fitness: 1. Decreasing resting heart rate and blood pressure 2. Increased oxygen-carrying capacity 3. Increased muscle mass and metabolism 4. Increased resilience to illness and injury 5. Slows progression of osteoporosis 6. Positive self-image 7. Improved mental outlook 8. Reduced anxiety levels C. Core Elements 1. Muscular strength, cardiovascular endurance, and flexibility 2. Isometric exercise – active exercise performed against stable resistance, in which muscles are exercised in a motionless manner 3. Isotonic exercise – active exercise during which muscles are worked through their range of motion 4. Weight-lifting helps to achieve muscular strength and is excellent all-around training for the body. 5. Cardiovascular endurance results from exercising at least three days a week vigorously enough to raise your pulse to its target heart rate. 6. Even modest exercise programs will improve cardiovascular endurance and muscle strength. 7. Stretching every day improves flexibility. D. Nutrition 1. Good nutrition is fundamental to your well-being. 2. ChooseMyPlate chart (U.S. Department of Agriculture) a. Balance calories. b. Enjoy your food but eat less. c. Eat certain foods more often. d. Make half your plate fruits and vegetables. e. Switch to fat-free or low-fat (1%) milk. f. Make half your grains whole grains. Teaching Tips Make sure students understand the mechanisms of lifting. Class Activities Using a dummy, have students practice different lifts, using correct body mechanics. Have students find their target heart rate. Knowledge Application For homework, have students journal everything they eat and drink for a week.©2017 Pearson Education, In