A1 Principles Of Care

Question 1

1. First do no harm “primum non nocere”

Answer 1

• in all circumstance assess the risk vs benefits of any treatment or procedure

Question 2

2. Accountability and responsibility

Answer 2

Each paramedic’s professional and legal responsibilities are underpinned by:

• NSWA Core values
• Compliance with clinical protocols, pharmacology, skills and procedures
• Compliance with Standard Operating Procedures (SOPs), Clinical Safety Alerts (CSAs), Clinical Safety Notices (CSN), and Clinical Safety Information (CSIs)

Paramedics must treat within their scope of practice

Question 3

3. Teamwork and decision making

Answer 3

• Paramedics must perform multiple simultaneous activities whilst working collaboratively and individually to minimise “on scene” time.
• Paramedics will maintain effective working relationships with other paramedics, health and emergency service workers and members of the public

Question 4

4. Communication

Answer 4

• Early activation of additional resources is essential.
• Effective communication between paramedics is essential. This can be between paramedics on the same vehicle to multidisciplinary teams. Make sure requests or commands are understood and acted upon.
• Communication channels with the control centre must be kept open and free for timely, specific information.
• Clear, confident verbal and nonverbal communication is central to a patient’s perception of professional care.
• Psychosocial needs are important considerations when communicating with patients, family or carers about:
  
  • the provisional/differential diagnosis
  • the need for interventions and referral decisions
  • being able to obtain consent
  • being kept informed of progress, the patients’ response to treatment, and likely outcome

Question 5

5. Treatment and Referral Decisions

Answer 5

It is the responsibility of the paramedics to:

• Perform a comprehensive patient assessment (A2) including:
  
  • Primary survey whilst adopting a “treat as you go” approach to life threatening conditions
  • Thorough secondary survey
• Explain the patients condition to them and determine/implement the appropriate treatment and referral decisions (A10)
• Manage the patient as required through the application of protocols, pharmacology and skills
• Discuss the appropriate referral option (including timeframe and expected outcome) with the patient and the reasons for the referral decision made
• Include the patient (where possible) in making treatment and referral decisions
• If in doubt about the diagnosis and the specific treatment required, give basic supportive measures and minimise time on scene

Question 6

6. Transportation decisions - for patients transported via ambulance

Answer 6

• Time on scene must be kept to a minimum with treatment provided en-route
• If the arrival time of clinical back up exceeds the load and transport time to hospital, consideration should be given to a “load and go” approach
• Regularly repeat and document ABCD physical examinations and physiological observations in order to identify trends in clinical deterioration, response to therapy or the development of new problems

Question 7

7. Alternate referral decisions

Answer 7

• When patients are not transported by ambulance paramedics must:
  
  • Provide patient with information on how to manage their condition, what to do if their condition does not improve including when to see their GP
  • Confirm the patient is able to mobilise and alternative transport is available to enable patient access alternative care facilities

Question 8

8. Clinical handover

Answer 8

• It is the responsibility of paramedics to ensure they provide and receive a comprehensive clinical handover using the mnemonic IMIST-AMBO whenever patient care responsibility changes from one clinician to another and to ensure they understand all care requirements for the patient

Question 9

9. Documentation

Answer 9

• Documentation is important, particularly when paramedics recommend alternative treatment and referral options. A clinical record is required for patient contact.
• Documentation must:
  
  • be accurate and as factual as possible, distinguishing between what was stated and observed and provide a clear, concise, complete account of the event
  • Be completed at the time of, or as close as practicable to, the event
  • Include all treatment/interventions provided, including patient observations prior to and post treatment and recording of ECGs.
  • Record the assessment of competence and capacity, completion and findings of Mental Health Assessments (if applicable) including use of section 20 of the Mental Health Act 2007 and mechanical restraint device on the clinical record
  • Record the paramedics recommendations and reasons, including a summary of any communication made between paramedics and patients and/or family members
  • Paramedics must provide a copy of the clinical record to the patient/appropriate person in cases where the patient is not transported