Week 1 Flashcards
Why did the Extended Care Paramedic role evolve?
– Health care demand is increasing including demand on
ambulance and EDs
– People living longer with comorbidities
– Ambulance requests have increased 4% annually
– Many requests are not emergencies
– EMS models at the time only had ED as a transport option
– Shortage of GPs, no cover at night in rural areas
– Elderly are more affected by transporting, for minor conditions
What does an ECP do?
– Address the health needs of the low acuity patient calling Triple 000
– Enhance clinical role of a group of paramedics
– Better meet the needs of our communities
– By providing safe & effective healthcare choices for non
acute conditions
– Reduce ED Presentations by Paramedics providing
treatment/discharge or referral for appropriately identified low acuity patients
– Identify sick ’ or high risk patients and ensure that these
patients are transported to the ED
What is community Paramedicine (CP)?
The term CP covers emerging models of care that are a
community focused extension of the traditional emergency response and transportation paramedic model that has
– Models of care are theoretically informed and evidence based
What is a General Care Paramedic (GCP)?
Is an advanced clinical practitioner in Paramedicine who
specialises in facilitating a comprehensive medical
history/assessment, initiation of relevant treatment and
appropriate referral for low and medium acuity patients in a variety of community and clinical settings with an emphasis on managing a patient in their own environment/context
What presentations do NOT need to go to ED?
Chronic pain issues that are NOT different to normal e.g. back pain, arthritis
Nose bleeds if NOT hypotensive and control is
achieved
Sprains / strains
Hypoglycaemia when recovered and person with them
Respiratory infections, colds, flu
Hypertension
Minor injuries
Skin complaints rashes, wounds
Ear, nose throat complaints
Infections UTI, cellulitis
What is the scope of practice for an ECP
- Detailed history taking including mental health, social and family aspects
- Physical examination of all body systems
- Advanced Psychosocial assessment
- Point of care testing devices and screening tools for
diagnosis and treatment evaluation - Medical and critical care skills
- Simple surgical procedures
- Expanded pharmacology for administration and management
- Palliative care and management
- Referrals
Whjat is included in the scope of ECP in regards to physical examination of body systems?
- General survey and vital signs
– Head, Eyes Ears, Nose and Throat (HEENT) examination with otoscope
– Cardiac and carotid sound examination
– Complete integumentary assessment
– Spirometry
– Advanced musculoskeletal assessment including joints such as the shoulder or temporomandibular joint
– Advanced neurological assessment including cranial nerve evaluation and reflexes” (CQU: 2017)
Whjat is included in the scope of ECP in regards to advanced psychosocial assessment?
– Fall risks
– Palliative care
– Dialysis follow up
– Dietary evaluation
– Age care assessments including test such as a MMSE
– Home medication review
– Diabetic follow up and other chronic medical
assessments/counselling ”
Whjat is included in the scope of ECP in regards to Point of care testing devices and screening tools for
diagnosis and treatment evaluation?
– Urinalysis
– Glucose and diabetic monitoring
– Blood tests such as CBCs, chemistries, INR or cardiac markers (such as troponin)
– Sonography (including FAST)
– Stool guaiac or faecal occult blood test
– Corneal abrasion evaluation using fluorescein staining (screening only)
– Other diagnostic tests to be obtained and sent for evaluation such as cultures
Whjat is included in the scope of ECP in regards to Medical and critical care skills?
– Fracture reduction and short term casting/ immobilization
– Joint relocation
– Intubation and RSI
– Cricothyrotomy
– Mechanical ventilator use
– Advanced cardiac dysrhythmia management with synchronised cardioversion and transcutaneous pacing
– Thoracostomy and chest tube maintenance
– Intraosseous access
– Central line maintenance and management
– Gastric tube placement, evaluation or maintenance
– Urinary catheter replacement or maintenance
– Acute and chronic wound evaluation, debridement, drain & other care
WHat needs tyo occur in regards to patient plans with ECP?
– Must have follow up (Accountability)
– Patients must know that if condition changes to call ambulance again
– Paramedics must write down instructions
AV information sheets tablets to supplement T&R CPGs, for example
– Encourage questions
– Ensure patients have understood the instructions
Capacity and competency needs to be determined by assessing the patients ability to understand, analyse and process information disclosed by the paramedic in order to make an informed decision
– Other Plans
Paediatric Palliative Care Plan, Adult Palliative Care Plan
Authorised Care Plans : administration of pre authorised medications
and procedures outside of Ambulance practice
Advanced Care Plans (Alfred Health Advanced care plan)
When should a patient NOT be left at home?
If unable to mobilise
If something is significantly different than normal
The patient has deteriorated since you last saw them
Any vitals that is not normal for the patient
If the patient looks sick
If they live on their own and are unable to care for
themselves
If you are unsure consult
