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Clinical Orientation Guidelines

EMT-Basic students are required to complete certain field and clinical rotations and turn in paperwork on these rotations and experiences which is signed by preceptors (persons certified or licensed as RN, MD,DO,PA,RT, EMT-B, EMT-I, or EMT-P who supervise the student during the patient contact). These experiences must be documented appropriately to successfully complete the EMT-Basic course through PERCOM, and all students are responsible for reviewing and complying with all clinical rules and regulations as specified in this document and in the Clinical and Field Rotation Manual that is a part of this document.
First, read the Rules and Regulations specified in the first section of the Clinical Manual. It has specific guidelines that you MUST follow including referring to the guidelines from the Infectious Disease Manual, which you were provided in your Student Enrollment Packet. Students are expected to review all of these guidelines and follow them during rotations. These rules and regulations are designed to protect you and to protect the future of PERCOM students and their ability to continue to be accepted as active participants at designated field and clinical sites.
Students are expected to behave in a professional manner any time that they are representing PERCOM, including in the rotation environment. Students should be aware that physical appearance plays a huge role in being accepted as a professional. Be sure to arrive for all rotations at least 15 minutes prior to your scheduled shift, in full uniform (including student nametag), clean and pressed, wearing a watch and bearing your own stethoscope. Plan to wear your uniform to ALL sites, even if you might have to change into scrubs at the request of the staff. If this occurs, remember that the scrubs are the property of the facility and are not to be removed from the facility, as this is theft and is grounds for dismissal from the program.
Also bring with you a good attitude and demeanor. You are expected to function as part of the EMS crew or clinical crew for the day, so you should actively look for ways to help your preceptors with daily responsibilities such as washing the unit, checking out the truck, stocking, changing beds and stretchers, etc. These activities not only acclimate you to various portions of the job that don’t necessarily have to
do with direct patient care, but they help you establish rapport with your preceptors so they are more willing to allow you to perform skills and assessments on their patients throughout the shift. You are also under the direct supervision of EMS or clinical staff during your rotation and must only do what they allow you to do and nothing more. Students are also barred from performing any skill for which a PERCOM designated instructor has not checked them off. Students are NOT allowed to be in the clinical environments until they have completed their EXIT SESSION
Bring all paperwork with you that you will need to complete and have signed by your preceptor. Ensure that the preceptor signs all appropriate places on your paperwork and completes and signs a Daily Clinical Evaluation form to evaluate your performance.
Whatever you do, do NOT remain a wallflower. Experiences will not usually find you; YOU must find them. When you arrive at your rotation site, introduce yourself to the shift leader, chief, or charge nurse. Tell that person that you are an EMT-Basic student from PERCOM EMS Academy and are scheduled to rotate with their department. Ask them who will be your preceptor. Be sure to introduce yourself to the preceptor and tell him or her that you are looking for every opportunity to help assess patients, take vital signs, and participate in every learning experience available.
If you are rotating in obstetrics, let the nurse know that you must observe a vaginal delivery so that you may be more prepared to deliver a baby in the field if the need arises and ask her to assist you in gaining access to the delivery room. (Male students typically will have a slightly more difficult time in this area of the hospital gaining experiences and must usually make a large effort to assist the mothers in labor, gain report with the patient and her family, and assist the nurse as much as possible to be able to gain access to a delivery suite.)
These clinical and field rotations will be what YOU make of them; you should strive to be personable and motivated, so that you can gain as much experience as possible during your limited time in these sites.
REQUIRED ROTATIONS
Review the Chart below which delineates what rotations will be required for you to complete this course. If you have questions, please e-mail them to the clinical Liaison. These rotations and experiences are mandatory for course completion and some students may have to attend more rotations than others before gaining the minimum patient contacts and experiences.
You should arrive for your rotation at least 15 minutes early. Take the clinical documentation paperwork with you, complete it prior to leaving the site, and have the preceptor complete and sign all appropriate places:
Instructions for Completing
Clinical Paperwork
On our website you should have downloaded PERCOM/TEEX Clinical Daily Form and the PERCOM/TEEX PCR. The Clinical daily form should be filled out for every shift (EMS and Hospital).
You should fill out all the information at the top of the form. Be sure to get the preceptor you worked with to sign the form. The total patients contacted blank must match the information listed in the form. If you do not list the patient and the care given on the form you cannot claim it as a patient contact.
You should list the type of patient (adult, geri, pedi, ect) followed by illness/injury type (trauma, medical, respiratory, ect) followed by the skills/interventions you preformed on the patient. You can use the second sheet if need to add more patients. Remember if it is not on the chart, it did not happen.
Do not write in the area at the bottom of the page.
On the Evaluation form you should fill out the top only and sign at the bottom.
The Preceptor should fill out the remainder of the form and sign at the bottom.
You will not received clinical credit for any shift in which we do not receive back the Clinical Internship Documentation Form AND the Preceptor Evaluation Form.
The PCR should be filled out on EVERY Patient You Transport, during an EMS shift. They do not need to be filled out for Hospital shifts.
Inclusion of PHI (Protected Health Information) on the PCR is a violation of the HIPPA Policy that you have signed and is cause for dismissal from the Program!!!!! Please review what constitutes PHI before attending your first clinical rotation.
The PCR should be filled out fully. Incomplete PCR submissions will be disallowed and you will not receive credit for the contacts/skills preformed on the patient. If there is a blank that is not applicable to the call/patient with which you are dealing, it should be marked with an N/A.
If you check a box you should include information relating to the check mark on the form or in your narrative (preferably both).
Your Narrative should tell the story of all of the events of the call from dispatch to the transfer of patient care to a Medical Care Professional. This should be written as if you were the lead EMS caregiver for this patient and should include all pertinent information. Narratives should be written so that a jury member, notwithstanding medical terminology, would understand clearly everything that went on during this call. Narratives should be legible and the use of abbreviations should be curtailed.
Please use one of the standard charting formats for EMS Patient Care Reports. SOAP, CHART, Chronological, ect. You can find examples in your textbook. Incomplete PCR’s or unsubstantial or disorganized narratives may be cause for rejections of the PCR. PCRs that are rejected will not be counted towards contact/skills totals.
Clinical Documentation is a teaching/learning experience. Feedback will be given on your PCR documentation. For this reason Clinical paperwork must be submitted ASAP after completing the end of the shift. This allows for adequate review time and feedback. We recommend strongly to our students to fax the documentation from the clinical site at the end of the shift. Our toll free FAX number is 866-941-5105. Most facilities do not mind toll free outgoing faxes. Alternatively you may scan and email it to donroyder@percomonline.com .
All Clinical Documentation must be Faxed or emailed to us within 48 hours of the end of the Clinical shift. If documentation is not received within 48 hours, you will be considered a “NO SHOW” for the clinical shift and no credit will be given for the shift. You will also be subject to the disciplinary policy with regards to “NO SHOW” as stated in the student handbook.
Clinical and field rotations can be a fun and even exhilarating experience. Please try to relax and enjoy the opportunity to learn from these opportunities. We want you to learn everything possible during the short exposure you will have, so please seek out opportunities while at these hospital and field sites. If you have any problems, please contact your Clinical Liaison at (325)480-2617 or (979)595-8241. If it is an emergency situation, attempt to contact the Clinical Liaison immediately. If you cannot contact your Clinical Liaison regarding an EMERGENCY clinical situation, please contact Jane Dinsmore at (325)480-2617.
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PERCOM
Clinical/Internship Student Manual
EMT-Basic
CLINICAL/INTERNSHIP RULES:
ALL AMBULANCE RUNS, INCLUDING ROUTINE TRANSPORTS AND NO TRANSPORTS, MUST BE WRITTEN UP, JUST AS YOU WOULD IF YOU WERE ACTUALLY AN EMS EMPLOYEE.
Student shall not initiate or direct patient care. Student will perform only those specific tasks delegated by preceptors. Student will not perform any action that exceeds those permitted by the Clinical/Internship objectives.
Students will not attend any clinical or internship experience for which they are not signed up on the Clinical /Internship roster unless authorized by the Clinical Coordinator, instructor or the Course Coordinator.
Student shall study Clinical and ambulance objectives and become familiar with them. Student shall carry the Clinical Manual at all times during clinical and internship. Students who perform activities not authorized by the objectives for the experience involved do so without authority and beyond the scope and purpose of training and are solely and personally responsible for such acts. Students who violate state regulations may be dropped from the course without access to the Appeals Process. PERCOM and its instructors are not responsible for such acts.
Students must sign up for clinical and ambulance times through the Clinical Liaison or other designated route. Students shall arrive on time for all scheduled rotations and must notify the Clinical Coordinator personally or by paging his/her if there is a problem. A fine of $50.00 will be paid for each missed rotation. Refer to the “NO SHOW” Policy in your student handbook.
Students found sleeping during clinical rotations (except for in designated sleep hours during designated sleep periods) may be dismissed from the course. Breaks of not more than 10 minutes for each hour of clinical time may be taken. Students who are absent from the clinical area for longer periods of time may be disciplined or dismissed from the course.
Students must complete all clinical, internship, and skills requirements by the designated deadline for the course. Clinical and Internship documentation that is incomplete will not be counted toward the minimum required number of patient reports. Students with incomplete Clinical/ Internship records will receive a course grade of “F”. Applications for extension to the deadline will be made in writing to the course coordinator and will be evaluated on an individual basis. Extensions will ONLY be granted in cases of unusual or extenuating circumstances.
The decision is entirely up to the course coordinator and will not be automatically granted for any reason.
Students with” Incomplete” grades will not be certified to take the NREMT exam until the “Incomplete” grade is removed. Failure to do so within 30 days from the due date of Clinical/Internship records may result in the student receiving an "F" for the course. Such students may be required to retake the course, clinical practicum and/or internship in order to be certified to take the national examination.
Students must learn and follow all rules set forth by clinical and ambulance providers. Rules may vary concerning the number of students and level of students allowed on an ambulance or at a clinical site at any one time. Students must comply with rules that are announced by instructors and Clinical Coordinator. Students should report any incidents or difficulties with clinical or ambulance preceptors or otherwise immediately to the Clinical Liaison by paging him/her. A student who is barred from any Clinical /Internship site by the Clinical /Internship provider may be dropped from the course with an overall grade of F.
INFECTIOUS DISEASE CONTROL: Please refer to the MANUAL FOR INFECTION CONTROL AND EXPOSURE POLICY AND PROCEDURES.
ALCOHOL AND DRUG POLICY:
Consumption of alcohol and drugs is inconsistent with a good learning experience. Students who come to class after having ingested alcoholic beverages will be required to leave class, and an unexcused absence will be recorded. Students will not drink alcoholic beverages while performing clinical or internship experiences; nor within a period of 8 hours prior to such experiences; nor at any time or place when wearing the PERCOM EMS Academy uniform or nametag. Students shall not perform clinical or internship experiences while under the influence of any drug that impairs performance, whether such drug be prescription or over-the-counter. Students shall not be under the influence of any illegal drug. An instructor who has reason to believe that a student is under the influence of either alcohol or drugs during class or during clinical or internship experiences may require that the student submit to a blood or urine test at the student’s expense. Refusal to submit to a required alcohol or drug test will result in dismissal from the program with the grade of “F”. If it is determined that a student is under the influence of alcohol and/or drugs during class or a clinical or internship experience, the student may either be required to receive counseling or be dropped from the program as determined by the Course Coordinator. Violation of the drug and alcohol policy may result in dismissal from the program and an overall grade of "F" assigned to the course.
Clinical and Field Internship Objectives:
***Because of patient availability, it is possible that all objectives may not be
met and that all skills may not be performed. Nonetheless, as many skills as
possible should be observed and practiced by the student. Minimum patient contacts/skills must be achieved in order to graduate.
Clinical Objectives:
1. Tour and receive orientation to the assigned area.
2. Perform equipment/vehicle checks and any other preparatory tasks.
3. Utilize “Universal Precautions” of infection control.
4. Perform a patient assessment:
a) Primary survey
b) Secondary survey
c) Vital signs, including lung sounds
d) History
5. Assist and observe the triage of patients.
6. Perform airway management:
a) Manual techniques
b) Oropharyngeal airways
c) Nasopharyngeal airways
d) Oropharyngeal suctioning
7. Perform respiratory support:
a) Oxygen administration
b) Bag-valve mask ventilation
c) Demand valve resuscitators
8. Perform CPR:
a) Observe and assist in cardiac resuscitation
b) Observe and assist in trauma resuscitation
c) Observe and assist in the use of the Automatic External Defibrillator (AED)
9. Recognize and evaluate mechanisms of injury.
10. Assist in the treatment of trauma cases:
a) Perform bleeding control
b) Dress and bandage wounds
c) Perform musculoskeletal immobilization
d) Apply traction splint
e) Assist with spinal immobilization
f) Penetrating wounds of the chest and abdomen
g) Apply Pneumatic Anti-shock Garment
h) Other trauma cases as available
11. Assist in the treatment of medical cases
a) Chest pain
b) Assist in the administration of nitroglycerine
c) Congestive heart failure
d) Chronic obstructive pulmonary disease
e) Obstructed airway/Asthma attack
1. Assist in the administration of the metered dose inhaler
2. Assist in the administration of nebulizer treatment
f) Diabetic emergencies
1. Assist in the use of the glucometer
2. Assist in the administration of an instant glucose product
g) Seizures
h) Coma
i) Overdose (alcohol or drug abuse)
1. Assist in the administration of Activated Charcoal
j) Other medical cases as available
k) Anaphylactic Shock
1. Auto-injector
12. Assist or observe the care of behavioral emergencies:
a) Suicidal behavior
b) Hostile/violent behavior
c) Acute grief or depression
d) Paranoia
e) Hysterical conversion
f) Acute anxiety/agitation
g) Schizophrenia
h) Anger
i) Confusion
j) Fear
k) Hyperactivity
l) Alcohol and drug abuse
m) Other behavioral cases which are safely available
13. Assist in the care of geriatric patients:
a) Senility
b) Alzheimer’s disease
c) Osteoporosis
d) Rheumatoid arthritis
e) Immobility
f) Other geriatric cases as available
14. Assist in the care of pediatric patients:
a) Signs and symptoms of pediatric illness
b) Febrile seizures
c) Restraint procedures
d) Psychological states of age progression
e) Note vital sign differences
f) Parental care
g) Poisonings
h) Other pediatric cases as available
15. Assist or observe the care of obstetric patients:
a) Identify the three stages of labor
b) Cephalic delivery
c) Clamping and cutting of the umbilical cord
d) Complications of delivery
e) Observe a caesarian section
f) Note medications given to the mother
g) Inspect the delivered placenta and umbilical cord
h) Postpartum hemorrhage control
i) Newborn care
j) APGAR scoring
k) Premature infant care
l) Fetal monitoring
m) Other obstetric cases as available
16. Observe the management of cases with legal implications or which require evidence preservation:
a) Sexual assault/rape
b) Child/elderly abuse
c) Shootings/stabbing
d) Animal bites
e) Other cases as available
17. Observe sterile techniques and assist as directed.
18. Assist in lifting, moving and patient transfers.
19. Perform patient access, packaging and extrication.
20. Assist in any restocking, cleaning or other duties as assigned in the clinical/field facility.
21. Observe diagnostic procedures/tests and review lab results.
22. Review charts for clinical findings, diagnosis and treatment plans.
23. Monitor and record radio and oral communication of patient information.
24. Document, for student records, patient and/or incident information.
25. Assist or observe in any procedure authorized by the attending physician and/or preceptor that will increase the understanding of anatomy and physiology of illness or injury.
Field Internship Objectives
Performance of skills contained in the field internship objectives shall be based on
performance criteria established by standard medical practice unless otherwise
defined by the course coordinator. During the field internship, the student must
practice under direct supervision of a recognized preceptor and should
demonstrate proficiency for each of the following skills.
All Levels
1. Complete an orientation of expected behavior before, during and after a response with ambulance crew.
2. Locate, inspect and prepare each piece of equipment for use on the ambulance.
3. Locate and operate radio equipment.
4. Practice loading and unloading the ambulance stretcher, with and without a load.
5. Locate and become familiar with emergency equipment such as flares and fire extinguishers.
6. Perform patient assessment including developing relevant medical history and conducting a physical examination. The assessments should include, at a minimum, assessments on medical patients, unconscious patients, trauma patients and pediatric patients.
7. Assist and review the treatment of trauma cases and medical emergencies.
8. Assist in triaging patients.
9. Assist in hemorrhage control and splinting.
10. Assist in cases of cardiac arrest, including the performance of CPR.
11. Assist in basic airway management.
12. Assist in the use of an Automatic External Defibrillator (AED).
EMT and above
13. Administration of Epinephrine for use in treatment of allergic reactions.
14. Assist in use of Bronchodilator.
15. Assist in the management of cardiac arrest through the use of an AED
16. Assist in the treatment of shock by applying the PASG
CLINICAL EXPERIENCE: 36 HOURS MINIMUM
Clinical experience will consist of 28 hours in the Emergency department. However, 8 hours of the total 28 MAY be completed at an approved clinic site. Students must complete a minimum of 9 CLINIC or EMERGENCY DEPARTMENT patient care documentations to pass the clinical practicum. Each patient contact MUST be thoroughly documented utilizing all information blanks on the Clinical form to count toward the minimum number of patient contacts for this environment.
Preceptors for clinical can include Paramedics, PAs, RNs, MDs or DOs. Only personnel at these levels of certification or licensure are authorized to precept the student experience or sign clinical paperwork.
AMBULANCE INTERNSHIP: 36 HOURS MINIMUM
Internship will be scheduled with approved EMS or Fire/EMS agencies. Students must complete a minimum of 4 AMBULANCE patient care documentations for emergency responses to pass ambulance internship. Student should write a documentation report on every patient transported or contacted. No Transports should also be thoroughly documented and MAY count toward the minimum number of required contacts IF a thorough patient assessment and some treatment was administered prior to no transport.
NO AMBULANCE INTERNSHIP PATIENT CONTACTS MAY BE DONE WHILE AT WORK UNLESS YOU ARE IN 3RD RIDER STATUS WITH A PRECEPTOR. ALL AMBULANCE INTERNSHIPS MUST BE DONE AS THIRD RIDER IN THE PATIENT COMPARTMENT. SKILLS OPPORTUNITIES ON DUTY MAY RECEIVE CREDIT WITH PRIOR APPROVAL. STUDENT IS PROHIBITED FROM DRIVING.
REMEMBER!!! You must have a total of 13 patient care documentations to pass!!!!
STUDENT EVALUATION OF PRECEPTOR/SITE
Please complete one of these forms for each of your clinical or internship sites. We would like to know when you have good experiences as well as bad ones. This will help guide us in making improvements to our preceptor training, site selection process, etc.
1. Name of Clinical or Internship Site:
_________________________________________________
2. Location within site (ED, OB Department, Station or Unit #, etc.):
_________________________________________________
3. Name and certification or licensure level of preceptor:
_________________________________________________
4. On a scale of 1 – 5 (with one being poor and 5 being the best), how would you rate your experiences and treatment at this site?
1=poor or not beneficial 2=slightly beneficial 3=good, beneficial
4=above average or very beneficial 5=excellent, extremely beneficial
5. Also using a scale of 1-5, please rate your designated preceptor for the shift.
1=not professional, not helpful, or did not seem comfortable with students
2=seemed professional but was not very helpful or was uncomfortable with students
3=seemed professional and facilitated skills opportunities during the rotation
4=very professional and worked closely with the student during the rotation to facilitate skills opportunities and provided guidance
5=extremely professional and helpful, guided and taught the student as well as provided skills opportunities
6. Do you have any suggestions or comments regarding this clinical or internship site, or specific comments regarding your preceptor
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