RIVERSIDE COMMUNITY COLLEGE



Riverside Community College

Emergency Medical Services Program

Liaison Guide

Table of Contents

Philosophy and Purposes Page 3

Overview Page 4

Student Scores and Measurement Page 5 Blue

Learning Concepts- Performance Appraisals Page 6

Learning Environment Page 7

Preceptor Requirements Page 10

Training Institution Requirements Page 10 Salmon

Training Institution Flow Chart (contacts) Page 10

Field Liaisons Page 11 --- Green

Field Participation Requirements (Time requirements) Page 12

Dress Code and Professional Behavior Page 13

Punctuality and Preparedness Page 13

Schedule Changes Page 13

Injury / Medical Liability Page 14

Fire Suppression Page 14 Yellow

Field Meetings Page 15

National Registry Page 15

Area Orientation Checklist Page 16

EMT-P Scope of Practice Page 17

Field Externship Performance Objectives Page 20

Grading Criteria Page 22 Documentation Page 22

Criteria for Evaluating Student Performance Page 23

Daily Performance Record Page 24 Salmon

Major Evaluation form Page 25

Tracking Forms Page 26

Individual Performance Comments Information Page 27

Individual Performance Comments form Page 28

Field Liaison Evaluation Page 29 Green

Field Care Audits Information Page 30

Field Care Audit Example Page 31

Field Care Audit Form Page 33

Student Field Notebooks Page 35 Yellow

Course Completion Information Page 36

Statement of Completion Page 37 --- Salmon

Daily Performance Record (White sheets)

Major Evaluation Form (White sheets)

Rating Criteria Forms (White sheets)

Individualized Education Plan (IEP) (White sheet)

Professional Behavior Evaluation (White sheets)

Riverside Community College

Liaison Program

Philosophy and Purposes

Institution

The EMS faculty concurs with the Riverside Community College philosophy and purposes as expressed in the statements regarding its mission, business, vision, and values. Riverside Community College is a vital, affordable, personalized public institution of higher education, which provides quality teaching and accessibility to a diverse student population. The college offers a comprehensive and flexible curriculum together with programs and services to meet diverse and evolving student needs. Excellence in teaching is provided by a faculty that communicates knowledge in a creative, stimulating, and challenging manner and encourages students to think critically and analytically, applying learned principles, concepts, and skills.

Riverside Community College faculty and staff believe master planning to meet

Immediate and projected needs of students and the community are essential to a viable educational program that enhances the quality of life. This process will move the college toward achievement of the vision, to be the leader among community colleges, highly regarded for commitment to students, widely respected for excellence in teaching, and openly responsive to the communities served. Partnerships with other educational institutions, business, industry, and community groups are established and evolving to meet the dynamic educational needs of Riverside Community College District constituents. Student centeredness, teaching excellence, an environment conducive to learning, and tradition, as values of the institution, form the foundation upon which Riverside Community College is built and grows. These values guide individual and collective actions of its faculty and staff.

Overview

The prospective paramedic will arrive with two critical elements. Their initial didactic training is provided to them as the basic foundation for their career as a paramedic. Their initial clinical preparation has brought their basic foundation together with a somewhat controlled treatment environment, in order to develop their basic patient interaction, thought processes, and psychomotor abilities. The current phase that they are embarking on, and that you are such an integral part of, is their Field Externship. It will be your responsibility to evaluate, critique, and positively influence the new Paramedic. You will be their guide to a strong and effective foundation development for a productive and meaningful career in the treatment of the sick and injured.

This manual is provided to you, as the Paramedic Preceptor, to assist you not only in the technicalities of the Emergency Medical Services program, but to guide you and the new Paramedic through a standard and consistent Field Externship program phase. However, it should be noted that one of the major factors (and all too often overlooked) in the development of the new paramedic is the environment that you and your employer provide on a daily basis. You must remember that the culture in which you surround the student with on a daily basis will directly affect not only their development as Paramedics, but their overall development as professional EMS providers as well. It is incumbent upon you as a Preceptor to continually evaluate the social surroundings that you are training the student in and that you are committed to providing a professional and ethically superior environment for the students learning. Only then will this manual provide you and the student the best direction and consistency necessary to begin the student on a sound educational and practical foundation.

You must also take note that each student must be treated as an individual, without specific regard to his or her ethnicity, socioeconomic background, gender, disabilities, age, sexual preferences, religious beliefs, political views, or cultural background. You have the ability to maintain a professional and academic environment by keeping your competencies to the most efficient and learned levels, and your individual standards, content, and methods should not differ between preceptors. You must make every effort to garner an atmosphere of mutual respect with your students, eliminating any harassment, exploitation or discriminatory treatment of students, peers, and patients.

Student Scores and Measurement

How the Student is measured:

The student is measured against the standard, which is an entry-level competent paramedic.

The definition of a competent entry-level paramedic is an individual that can operate safely within the standard of care. The definition of the standard of care is the degree of care, skill, and judgment that would be expected under like of similar circumstances by a similarly trained, reasonable paramedic in the same community.

The student is NOT measured against another student, provider, liaison or the preceptor. They are not measured by how well they are doing for a certain time in the field, or by whether the preceptor likes the student or not. The student is not measured against past experiences by the preceptor when he or she was a student.

The student is measured by cognitive, psychomotor and affective skills.

The standard does not change through the clinical/ field experience.

The standard is not subjective but it is objective.

Performance Appraisals- “If you can’t measure it—you can’t manage it”

So often we look at ourselves and ask, “Where are we and where are we going?” A common but accurate response suggests in general terms that we must not and cannot remain constant in a changing environment. As a paramedic preceptor you have answered this question already, now it is your opportunity to help the paramedic student answer this question.

Performance is and will be vital. Liaisons will be responsible for how paramedic students perform. One suggestion to this task is a structured, reliable, valid performance appraisal system as well as feedback to the paramedic student as to his/her position in relation to his/her goals.

Much of the responsibility or the process falls on the shoulders of the preceptor, and the success of the process becomes dependent on two key factors: the preceptor’s commitment to the philosophy of performance appraisals and the preceptor’s understanding of the process as well as recognition of its complexity. If commitment and understanding are present, only then can a program lead to performance improvement, increased motivation, enhanced personal development, and greater job satisfaction.

Preceptors must adopt a leadership style to define good performance, recognize it, and reward it. Only positive consequences encourage good future performance. Leadership can be a process of different styles for individuals at different time frames during the development process. Four (4) different leadership styles are:

1. Directing

2. Coaching

3. Supporting

4. Delegating

Establishing a Positive Learning Environment:

It is important to establish and maintain a positive learning environment. This can be accomplished in several ways.

Instruct in the positive. We know from experience this allows students to learn and respond to directions more quickly and easily. Tell the student what you want them to do, not what you do not want them to do. This will be difficult in the beginning and will take practice. The results will be amazing. Positive instructions are nurturing, negative instructions are controlling.

Counsel in the positive. In discussions with the student tell them:

• What went well

• What needs work or revision

• Specifically, how to fix the skill or behavior

• When the skill or behavior will be practiced and when it will be evaluated again

• Be the advocate for your student

• Be the intermediary between your student and other practitioners

• Praise in public

• Critique in private

• Maintain confidentiality for all students

Keep it simple:

• What is the problem?

• Why is it a problem?

• What needs to be done to fix the problem?

• When will the evaluation take place? (Time frame)

Make sure that communication between the preceptor and the student has taken place by having the student explain what was just said by the preceptor.

Keep in mind your behaviors have a significant impact of the behavior and attitude of the student. For example, your silence and distance are perceived by the student as an indication they have done something wrong. Always be honest with the student. If you are upset with them and need time to reflect, tell them. If you are angry about something else and need time to reflect, tell them that.

The Adult Learner:

A. Characteristics

1. Self directed

2. Usually demanding of knowledge

3. Career and goal oriented

4. Has competing demands on time from family, employment, and outside stresses

B. Positive Attributes of Adult Learners

1. Desire to learn

2. Desire to succeed

C. Difficulties with Adult Learners

1. May feel older and wiser than the preceptor

2. May have a know-it-all attitude

3. Less interested in direct input

4. May know more than the preceptor didactically

5. The preceptor may feel guilty failing a person with a family who has tried hard to succeed.

Qualities of a Good Learner / Preceptor:

A. Acceptance of

1. Self

2. Students

3. Patients

B. Congruence

1. Believability

2. You do what you say

C. Empathy

1. Looking at something from the student point of view

2. Looking at something from the patient point of view

3. Does not mean you have to accept it

4. Does mean you must affirm it

D. Genuine

1. No games

2. Honest and sincere

3. Trust and truth is the heart of learning

E. Do Not Micro Manage Them

1. They have to be responsible

a. Help plan their learning

b. Monitor their progress

c. Assess their learning

F. Choreography Learning

1. Timing is everything

2. Task delegation

3. Student maturity

G. Goal and Objectives

1. Goals

a. Long range

b. May include time in externship or through being a paramedic

2. Objectives

a. Short range plan to reach a goal

3. Intuition is a great guiding light but must have documentation

H. Define Relationship With the Student

1. Not the preceptor’s best friend

a. Not good to be too friendly at first because it may be difficult to be critical and objective later

b. May confuse the student

2. Not the preceptor’s worst enemy

a. Very important the student believes you

b. No tricks

1. Switching medications

2. Telling people not to help the student.

Liaison Requirements – Based on Title 22 and RCC Requirements

1. California licensed EMT-P or RN

2. Local accreditation as an EMT-P (only if a paramedic)

3. Have 2 years field experience in pre-hospital care as an ALS provider, within the last 5 years. If an RN, need to have minimum 2 years hospital experience in the Emergency Department or Intensive Care Unit.

4. Recommended by the employing agency and approved by the college.

5. Be under the supervision of the Clinical Coordinator.

6. Not currently under investigation for clinical or patient care issues in the last 24 months.

7. Must verify completion of an approved Liaison workshop or a Liaison update workshop within the previous two years.

Training Institution Requirements

Training program shall enter into a written agreement with any agency involved in student training. In addition, the following stipulations apply:

1. No more than 1 student assigned at the same time on a unit.

2. The student must never be used as a paid substitute for paid personnel or required team member.

Training Institution Flow Chart

Medical Clinical Program

Director Coordinator Director

EMT/Paramedic Coordinator

Field Liaison

Preceptor

Student

Riverside Community College Emergency Contact System- (909) 571-6100 ext. 4601

First point of contact should be the Clinical Coordinator then the Program Director.

Field Liaison – TBD

Clinical Coordinator - Yvonne Nugent - Office (951) 571-6100 ext. 4621, (pgr) 344-6413

Paramedic Coordinator- Phil Rawlings - Office (951) 571-6100 ext. 4607, (cell) 906-2225

EMT Coordinator- Randy Nugent –Office (951)571-6100 ext. 4615, (cell) 232-8177

Program Director- Dr. Chris Nollette-Office number (951) 571-6100 ext. 4609, (cell) 242-4910

Clinical Liaisons

Each hospital will be assigned a clinical liaison. You are responsible to meet with the charge nurse and/or the student’s assigned nurse at the respective facilities. Every time you are on the schedule and visit the respective facilities, a weekly or daily report needs to be generated depending on the number of shifts you do. These reports are to summarize any issues the facilities or students are having either positive or negative and thus provide feedback to the clinical coordinator/college for review. It also provides a mean’s for keeping track of hour’s worked.

The facilities have been assured that liaison’s will be on the premises and available for consultation if needed. The facilities will be provided a schedule as well so they know who to contact if there is a problem.

The liaisons will also be provided a clinical schedule for paramedic students as well as EMT students. You will be expected to check in and monitor the EMT’s as well (with the exception of the noc shift of course).

Attire

Liaisons will be expected to purchase and wear an EMS program designated lab coat. These will be ordered through Ms. Kellie Wells.

Field Liaisons

Each student is assigned a Field Liaison. Once you have been assigned your student or student’s, YOU must contact them and identify yourself etc. within 48 hours and document you have done so via e-mail to the Clinical Coordinator (emrgnsi@). This method will hopefully alleviate miscommunication issues.

The liaison will meet with the student a minimum of 3 times during their field externship as outlined below:

4 hours ride along time must be done within the first 120 hours of your student(s) externship.

4 more hours ride along time must be done by the student(s) 360 hours of field externship.

4 hours of phone communication with the student throughout the student(s) externship are required as well.

*This can also include communication with the student’s preceptor, college faculty etc.*

It is imperative that these student(s) and preceptor’s feel they have support from the college you will be their contact if they have any questions or issues that you need to resolve. You will also be the pre-hospital provider’s first point of contact regarding your student(s). If you are not able to make contact or have any issues that arise, please contact the Clinical Coordinator or Program Director.

Field Liaisons Sheets

These sheets are to be filled out by the Field Liaison on each of their visits with the student and the preceptor. Please make sure you have these sheets in case the student doesn’t.

It is the responsibility of the liaison to fill these out and give them to the student to place in their field notebook. They should be placed in the notebook with the concurrent major evaluation. These forms are to be signed by the liaison, the student, and the preceptor.

**A total of 12 hours field liaison time will be paid per student providing all the above requirements are met per student. If any of the above requirements are not met, then per the college, you will not be paid.

*** At the Clinical Coordinator’s discretion, extra hours may be approved. This is on

A case by case basis***

*****Please remember that good, clear, concise documentation is imperative. *****

Attire

Field Liaison’s will be expected to purchase an EMS program designated black polo shirt. If you do both the “clinical and field liaison”, you will still be expected to purchase both items.

** It’s imperative that when you are riding out with your student, all agencies are able to identify you as being with and representing Riverside Community College/EMS Program regardless of your “title” elsewhere.

Field Participation Requirements

Time Requirements

Students are required to complete a minimum of 540-600 hours and must complete a minimum of 40 ALS contacts. If a student must complete more than 540-600 hours in order to complete 40 ALS contacts due to a lack of ALS responses, it will not affect his or her grade. If they must be extended due to a lack of performance, that extension will be evaluated and considered in their overall performance grade. The decision must be made in a timely fashion, as it will directly impact both the student and their externship organization. It should not be a surprise to the student that they are lacking in their performance and might be extended. This decision must be a coordinated decision, as determined collectively by the preceptor, the Field Liaison, Clinical Coordinator, and Paramedic Coordinator. Documentation is IMPERATIVE.

**An IEP MUST be completed if there is ANY variation from the student’s initial schedule REGARDLESS of why they are extended. **

The student may be moved from one preceptor to another for a variety of reasons. This will not occur unless it is in the students’ best interest and it may result in an externship extension, with no specific bearing on the students overall grade. Once again, if the student is to be moved, it will be a coordinated decision by the preceptor, the Field Liaison, Clinical Coordinator, and the Paramedic Coordinator and of course, the student.

The first shift for each student WILL be a “zero shift” and will be an orientation to not only the general field paramedic requirements but also to the local agency operations and any requirements for third parties. This shift may be an observation shift for the new Paramedic, their first opportunity to ask the questions pertaining to their field orientation and their student role. This shift will be credited towards their total of shifts, and they will be evaluated on their active observation and limited participation in shift operations.

Dress Code And Professional Behavior

As the Paramedic student is direct reflection of RCC, it is imperative that the student maintain a clean and professional appearance at all times. Each student must arrive at their assigned station or workplace on time, appropriately attired, including a school uniform and approved nametag, and a generally professional appearance. They must be on time and have a spare uniform. Depending on circumstances, any student arriving late for their shift or without these items may be sent home and the Field Liaison and Clinical Coordinator are to be notified.

A portion of the student grade is based upon their professional appearance and behavior. It is important that the Liaison reflects and encourages this behavior and appearance throughout the student’s internship. Failure of the student to fulfill this requirement will count against his/her grade. Failure of the liaison to perform in a professional manner will jeopardize their continued participation in the externship program. Either of these situations must be addressed in a timely fashion by the appropriate supervisor with the use of written performance evaluation and improvement plans, outlining deficiencies and methods for immediate improvement. Please refer to the Student Clinical Manual for the Rules and regulations.

Punctuality, Preparedness, and Absences

Students are expected to be on time. Only an emergency is an acceptable excuse for being late. If a student is less than 15 minutes late on shift, they may be allowed to stay. If the student is more than 15 minutes late on shift, they will need to notify the Field Liaison and Clinical Coordinator. A second late of any kind will require the writing of an individualized education plan (IEP). A third late of any kind will result in dismissal from the program. Students are expected to show up for their assigned shifts. Only an excused emergency is acceptable for being absent. A second absence will require the writing of an IEP. A third absence will result in dismissal from the program. Please refer to the Student Clinical Manual for the Rules and regulations.

Schedule Changes

The overall externship program is to teach the Paramedic students’ how to conduct themselves in an appropriate manner for the profession. It is encouraged that they participate in their regular duty schedule as assigned, and there should be no deviation from that schedule. In the event that they must call in sick, every effort must be made to contact the Field Liaison and Clinical Coordinator, prior to the occurrence if possible. The preceptor should be notified as well, especially if the student must leave a shift early for some reason. Any portion of a shift not completed will not be counted toward the overall required hours, and depending on circumstances, may count against the professional behavior of the student. In addition to the Clinical Coordinator, the Preceptor must be notified of the absence by the Field Liaison (Not the student). Please refer to the Student Clinical Manual for the Rules and regulations.

Injury / Medical Liability

Any injury or medically related event is to be handled appropriately to the event. If the event requires immediate care or treatment, a physician should evaluate the student appropriately and care should be provided. In the event of a communicable disease exposure to the student, the Clinical Coordinator and Program Director must be notified immediately. This notification should take place prior to any care rendered, providing the event is non-life threatening or it is not time relevant. Failure to follow this guideline may make the student liable for any costs incurred. The Clinical Coordinator or Program Director will delegate the care of the student. Regardless of any care received, the student must see the school nurse within 24 hours of the injury or exposure. Refer to RCC student policy for further information. Please refer to the Student Clinical Manual for the Rules and regulations.

Fire Suppression

As the student is participating in the field internship as a medically oriented Paramedic student, there will be NO FIRE SUPRESSION OR FIRE GROUND ACTIVITIES allowed by the Paramedic student. ANY deviation from this policy will be grounds for expulsion from the program. In the event that the Preceptor must participate in fire ground activities as part of their normally assigned duties, the Paramedic student will stay well clear of any activity that may put them in jeopardy or danger, preferably in or near their assigned response unit. Please refer to the Student Clinical Manual for the Rules and regulations.

Field Meetings

Students are required to attend multiple field meetings that occur during the externship. They are to be excused from field to attend the meeting and will return to their shift directly after the meeting. Generally the meeting is scheduled from 9 a.m. to 12 p.m. The purpose of these meetings is to give the Clinical and Program Coordinator’s first hand knowledge of how the student is doing and to counsel the student and answer any questions. Paperwork is collected at these meetings. It is imperative for paperwork to be up to date and ready to be removed from the notebook.

It is the student’s responsibility to make sure the paperwork is correctly prepared. The preceptor must have their part of the paperwork completed (as well as the liaison if applicable).

All paperwork must be turned into Ms. Kellie Wells.

**********************************************************

National Registry

Students will complete the national registry test process during the field externship after they have completed a minimum of 540 hours. They are not scheduled on shift on the two days of testing.

Area Orientation Checklist

We have informed the paramedic student that he or she is a guest in your facility. As a guest their behavior should reflect the traits associated with this position. The following checklist is designed to help you orient the student to your agency’s policies.

Check each item when completed:

_____ Tour of station

_____ Introduction to personnel

_____ Who to contact if ill (Liaison. Liaison will contact the preceptor directly)

_____ Specific phone number needed

_____ Station duties

_____ Agency specific policies

_____ Equipment check and restock

_____ Primary base-hospital

_____ Other base-hospitals

_____ Other agencies where they may interface

_____ Documentation procedures

_____ Special communication problems

_____ Any necessary financial information

_____ Meal information

_____ Sleep information

EMT – P Scope of Practice

In order to establish the baseline for the required and allowed care to be rendered by the Paramedic student, both the student and the Preceptor must be familiar with the guidelines specified in Title 22 of the California Code of Regulations regarding the EMT-P’s Scope of practice.

100145. Scope of Practice for the Emergency Medical Technician - Paramedic

An EMT-P student…as part of an organized EMS system, while caring for patients in a hospital as part of his/her training or continuing education under the direct supervision of a physician, registered nurse, physician assistant or while at the scene of a medical emergency or during transport, or during interfacility transfer, may perform the following procedures and administer the listed medications when such are approved by the medical director of the local EMS agency and are included in the written policies and procedures of the local EMS agency.

1. Perform defibrillation/synchronized cardioversion

2. External cardiac pacing

3. Visualize the airway by use of the laryngoscope and remove foreign bodies) with forceps.

4. Use Blood Glucose measuring device

5. Perform pulmonary ventilation by use of lower airway multi-lumen adjuncts, the esophageal airway, and endotracheal intubation.

6. Institute intravenous (IV) catheters, heparin locks, saline locks, needles, or other cannulae (IV lines) in peripheral veins and monitor or administer medications through pre-existing vascular access

7. Administer intravenous solutions or isotonic balanced salt solutions.

8. Obtain venous blood sample

9. Perform Valsalva’s maneuver

10. Perform needle thoracostomy

11. Monitor thoracostomy tubes

12. Monitor and adjust IV solutions containing potassium equal to or less than 20 meq per liter

13. Perform needle cricothyroidotomy

14. Administer approved medication by the following routes: intravenous, intramuscular, subcutaneous, inhalation, transcutaneous, rectal, sublingual, endotracheal, oral, or topical.

15. Administer, using prepackaged products when available, the following medications:

a. 25% and 50% dextrose

b. Activated charcoal

c. Adenosine

d. Aerosolized or nebulized beta-2 specific bronchodilators

e. Aspirin

f. Atropine sulfate

g. Calcium chloride

h. Diazepam

i. Diphenhydramine hydrochloride

j. Dopamine hydrochloride

k. Epinephrine

l. Glucagon

m. Furosemide

n. Lidocaine hydrochloride

o. Morphine sulfate

p. Naloxone hydrochloride

q. Nitroglycerine preparations, except intravenous, unless permitted under Title 22, (c)(2)(A)

r. Sodium bicarbonate

s. Syrup of ipecac

t. Midazolam (Versed)

16. Perform or monitor other procedure(s) or administer any other medication(s) determined to be appropriate for EMT-P use in the professional judgment of the medical director of the local EMS agency, that have been approved by the Director of the EMS authority when the EMT-P has been trained and tested in those topics and skills as required to demonstrate competence in the additional practice(s).

17. Adult nasotracheal intubation

18. Percutaneous cricothyrotomy

19. Intraosseous infusion

20. Finger stick for blood glucose

21. Pulse oximetry

22. End tidal CO2 monitoring devices

23. Potassium

24. Decadron

25. Magnesium sulfate

26. Oxytocin

27. Phenylephrine

28. Procainamide

29. Verapamil

30. Heparin

31. Nasogastric tubes

In addition, these regulations stipulate, “students must perform all procedures under the direct supervision of the approved preceptor. The student is able to perform any skill or give any medication, within the scope of practice or expanded scope of practice, as long as the skill or medication was included in their training and the preceptor has been trained in the skill or medication administration.

Without direct supervision of the preceptor (direct defined as line-of-sight) the student must act as a BLS (EMT) provider and work within that scope of practice.

In addition to these regulations, it should be clearly understood that any student who falsifies documentation in any manner, or who performs outside the direct supervision of their preceptor for any reason will be immediately dropped from the program.

Students who display behavior that falls outside the guidelines of Board policy 6080 (“Standards of Student Conduct and Disciplinary Procedures”) may be dropped from the program without the ability to return. Copies of this policy may be found in the RCC library, the RCC student handbook, or the RCC website. rcc.edu.

Field Externship Performance Objectives

The field externship will offer the student the opportunity to perform many or all of the skills explored in the didactic and clinical portions of the program. The environment will change from the controlled to the uncontrolled and will afford the student the environment to “put it all together”.

At the end of this course, the student will be able to:

1. Determine safety for self, team members, and patient and ensure an adequate work environment in a timely manner.

2. Use universal precautions, wear appropriate personal protective equipment specific for patient condition, clean and sanitize equipment in accordance with provider policy and procedures.

3. Initiate or delegate appropriate crowd control and deal effectively with family members and bystanders.

4. Recognize the need for and request additional assistance or equipment needed in a timely manner.

5. Perform an organized primary assessment and intervene appropriately in a timely manner.

6. Obtain a relevant and accurate patient history, chief complaint/problem, medications and allergies in a systematic and timely manner.

7. Perform a thorough exam with appropriate inquiry and inspection pertinent to the patient’s chief complaint with accurate findings.

8. Interpret and correlate assessment information correctly.

9. Identify breath sounds and have adequate knowledge of chest auscultation.

10. Identify cardiac rhythms in an accurate and timely manner.

11. Develop and implement an appropriate plan of action.

12. Assure the adequate delivery of oxygen to a patient, including the use of appropriate airway adjuncts and achieving or maintaining patency of the airway in a timely manner.

13. Correctly use advanced airways in a timely manner.

14. Use all equipment correctly.

15. Assess patient response to therapy and interventions.

16. Communicate all pertinent information to team members.

17. Utilize medical control appropriately, including organized and complete radio reports.

18. Complete patient care reports in an accurate, thorough and legible manner.

Field Externship Performance Objectives Continued…

19. Function as a member of the patient care team.

20. Assume a leadership role and direct members appropriately.

21. Exhibit a professional demeanor.

22. Build rapport with patient, family and bystanders, showing consideration and respect for others, and instilling confidence in the patient.

23. Participate in the evaluation of self; including accepting feedback and suggestions and taking necessary steps to correct performance.

24. Re-supply all inventory per provider policy.

25. Demonstrate respect for the dignity of each individual he or she is associated with in the practice of his or her professional duties.

26. Respond to the field-learning environment in such a manner to invite confidence of patients, supervisors, peers and other health care professionals.

Grading Criteria

In order to complete field successfully, the student must earn 80% of the total points available during their internship, and must earn a minimum of 80% in each of the categories of major evaluation points, field care audit points and professional behavior points.

Professional behaviors include the student’s responsibility for notification of the field coordinator and liaison, scheduling of meetings as outlined, appearance and attitudes while on shift, the maintenance and completeness of the field notebook, and the attendance at all field meetings.

The field externship is limited to 600 hours maximum and may only be repeated one time.

Documentation

The documentation completed by the preceptor is one of the most important tools the college has to guide students in helping them improve their performance and in creating a repeat student contract.

Documentation must be completed daily, during and at the end of each shift. It is not appropriate to leave evaluations not completed. Students need to be able to review in writing what was done well and what needed to improve on calls.

Documentation should include the what, when, how and why method, so students have a clear picture of the steps they need to take to correct any problem(s).

Verbal communication and written documentation should match. For example, a student should not hear the run went well and then see poor scores on the evaluation. If the student performs in a competent manner on a call, or on portions of a call, they should receive a competent score. This does not mean that on every call after that their performance will be the same.

Criteria For Evaluating Student Performance

When evaluating the student’s performance on the Daily Performance Record and on the Major Evaluation, the evaluation criteria sheet must be used as a guide. The guide is to be used by the student as they do self-evaluation and by the preceptor and liaison as they evaluate the student.

The criteria sheet was written as a guide for the major evaluation. However, by dropping the verb (frequently, inconsistently, consistently) in each category and considering the student’s behavior on each individual call the evaluation criteria should be used for the individual evaluation as well.

When the school evaluates the student’s progress, this is the criterion, which will be used.

The student is always measured against the standard. This criteria is the standard. A rating of 3 in a category means the student is performing at the level of a competent entry-level paramedic.

All students must be evaluated equally and against the set standard!

A sample of the Daily Performance Record and the evaluation criteria is included in the Tracking Forms Section.

Daily Performance Record

One (1) daily performance record is to be completed by the Preceptor for each shift. The top of the form must be filled out by the student and the bottom of the form must always be signed by the student and the preceptor. The liaison should sign or initial the bottom of the form when they have reviewed the paperwork. Failure to obtain the proper signatures will result in the loss of professional behavior points.

All calls, including AMA’s are to be listed on this form. Preceptors are only required to evaluate ALS calls and AMA calls, however they may evaluate BLS calls if they wish.

To qualify for an ALS call, an IV must be attempted and one other type of ALS care must be rendered. A simple IV start or cardiac monitoring does not constitute an ALS call, yet both together do constitute an ALS call. ALS transfers do not qualify unless there is ALS intervention during the transfer. An IV attempt should never be performed simply to add to the total number of ALS calls. ALS should only be performed if it is in the best interest of the patient.

Patient Information should include an age, sex and chief complaint. Treatment rendered should include all treatment given the patient. ALS Patient contacts should have a sequential number in the column, so a running account is kept of the number of ALS contacts.

The evaluation section is to be filled out by the intern first, as a self-evaluation and then by the preceptor. Note the general categories on this form and remember they include all of the individual categories listed on the major form under the same heading. In order to show improvement, the preceptor may use an increasing decimal number to indicate the improvement. All scores less than three (3) should be supported by comments.

Summary of Performance section should be completed at the end of each shift-period to serve as a guide for the student and the liaison. It should include areas where the student did well and those where the student needs to improve. Drill / Demonstrations completed by the student during this shift or assignments given for another shift should be listed as well.

Plan for improvement must include the specific things the student and / or preceptor will do to improve the student’s performance. This is an informal IEP and should be clear and concise in outlining what is to be done and when it will be evaluated again.

Major Evaluation Form

The preceptor must complete a minimum of four (4) major evaluations.

The major evaluations should be a summary of the proceeding 120 hours and must reflect the scores given on individual calls during that time. All scores of less than three (3) must be supported by comments.

The evaluations may be completed with or without the liaison present, depending on the preference of the preceptor and the schedule for the liaison visit. The completion of this evaluation should not be postponed while waiting for the liaison to come.

The evaluation on this form is more detailed than on the daily performance record. Each of the criteria is listed on the evaluation criteria sheet and is to be used as a guide for applying the score. However, scores should be easily traced and documented by reviewing the individual daily performance records.

The major evaluation form does not require self-evaluation by the student.

Any area where the student has not performed the skill in the last 120 hours should be marked N/A.

The comment section is particularly important as an indication of how the student’s behaviors or skills have changed since the last major evaluation. It allows the school and the liaison to have a good summary of the student’s progress.

The preceptor should complete the summary of performance and the plan for improvement. If the preceptor needs or wishes guidance on how to plan for improvement, this section could be completed when the liaison visits and could be guided by his or her input. The field coordinator and the program director are always available to preceptors or students for guidance in implementing a plan for improvement.

The student should complete the top of the form. The bottom of the form requires the signatures of both the student and the preceptor. The field liaison should initial or sign when they review the form. Failure to obtain the proper signatures will result in the loss of professional behavior points.

Tracking Forms

Each student will complete tracking forms.

The information is to be completed at the end of each call and the information will be reviewed at all meetings with the field coordinator. Failure to complete the forms correctly and completely will result in the loss of professional behavior points.

A sample of the following tracking forms is included:

• Daily Performance Record

• Major Evaluation

• Major Evaluation Rating Criteria

• Individual Performance Comments

Individual Performance Comments

These sheets were designed to give the preceptor more comment room on calls where they felt the daily sheet was not sufficient. This is not a requirement, but simply an extra tool for the preceptor’s convenience. Some preceptors have the student fill this sheet out on each call, and then use it as a discussion tool to better define the student’s areas of strengths and weaknesses. Signatures on these forms are not necessary.

Field Externship

Individual Performance Comments

Date: ______________ Shift: __________________ Call #: _______________

Scene Management:

Patient Assessment / Rx:

Communication:

Leadership:

Treatment Skills:

Other Comments:

Field Liaison Sheets

These sheets are to be filled out by the field liaison on each of their visits with the student and the preceptor. They should be placed in the notebook with the concurrent major evaluation. These forms are to be signed by the liaison, the student and the preceptor. It is the responsibility of the liaison to make sure the sheets are given to the student to place in the notebook.

Riverside Community College

Field Liaison Evaluation

Student: ____________________________________________

Liaison: ____________________________________________

Date: ______________ Hours completed ___ 135 ___ 270 ___ 405 ____ 540____675

Major Evaluation completed by Preceptor? Yes No

Daily Evaluations completed by student/preceptor? Yes No

Comments?

Assessment of Student’s Current Strengths:

Areas for Improvement:

Techniques/Plan for Improvement?

Absent/Tardy: _________ Total to date ___________

IEP Written: _____ Yes _____ No Extended: _____ Yes _____ No

Plan of Action:

Liaison Signature: Student Signature:

Preceptor Signature: _______________

Field Care Audits

The purpose of this exercise is to guide the student through the pathophysiology of a call and to help the student develop their critical thinking skills by documenting their thoughts about certain calls. Each student will complete ten (10) field care audits during his or her field externship. They are to be completed after ever 48 hours of field-time. The best-case scenario would be that the preceptor and the student complete the form while reviewing the call, however this is not mandatory. The student and the preceptor must sign every sheet. The forms must be legible.

A separate copy of the field run report form must be stapled to the field care audit.

These field care audits are graded and are a part of the student’s field grade. The field care audits are collected at the meetings with the field coordinator as outlined in the student’s manual.

Late forms will earn only ½ points. Failure to have the signatures and the copy of the run report form will cause the loss of professional behavior points.

Riverside Community College

Field Externship

Field Care Audit

(Example)

Preceptor signature _____________________________________

Intern signature _________________________________________

1. What is the patient’s chief complaint? What pathophysiology is involved?

This patient had chest pain radiating to the neck and jaw with SOB, diaphoresis and nausea. The patient was probably having an MI, which means there is decreased oxygen being delivered to the myocardial muscle due to a blockage in the coronary vessels. The decrease in oxygen to the tissues has continued long enough to have caused muscle tissue death.

2. What were the main concerns for patient care and how were those concerns managed?

The main concerns on this patient were increase of oxygen delivery, control of pain, anticoagulation and treatment for dysrhythmias. The concerns were managed by high flow O2 via non-rebreather mask, and the administration of ASA, NTG and MS and also a lidocaine bolus and drip.

The patient was monitored carefully and changes to status post treatment were documented.

3. List the patient’s home medications and give their primary indication. What history did they give you about the patient? What concerns were raised about the care of the patient?

Lanoxin: given to control the heart rate and strengthen myocardial contractility

Lasix: diuretic

Capoten: given for HTN

This patient has a cardiac history, probably has had an MI with resultant CHF and has a history of HTN. The meds did not raise a concern with the care of the patient at this time. The patient appeared well hydrated and was not hypotensive. If there had been a need for fluid challenge, fluid overload would have been a concern.

4. Which protocol(s) was used to treat the patient?

The adult chest pain protocol was used to treat this patient.

5. Was more than one protocol applicable to this patient? If so, name them. Describe your understanding of the protocol you chose.

No

6. Did the ED agree with your therapy? If not, why not?

Yes

7. In retrospect, would you change patient management? If yes, how?

I did not give the patient adequate O2 initially and I had to be reminded to treat the ventricular ectopy.

8. Name 1 new thing you learned on this call.

Field takes the ability to think, talk and act all at the same time. This is a skill that comes with diligence and practice.

Riverside Community College

Field Externship

Field Care Audit

Preceptor signature _____________________________________

Intern signature _________________________________________

1. What is the patient’s chief complaint? What pathophysiology is involved?

2. What were the main concerns for patient care and how were those concerns managed?

3. List the patient’s home medications and give their primary indication. What history did they give you about the patient? What concerns were raised about the care of the patient?

Field Care Audit continued…

Preceptor signature _____________________________________

Intern signature ________________________________________

4. Which protocol(s) was used to treat the patient?

5. Was more than one protocol applicable to this patient? If so, name them. Describe your understanding of the protocol you chose.

6. Did the ED agree with your therapy? If not, why not?

7. In retrospect, would you change patient management? If yes, how?

8. Name 1 new thing you learned on this call.

Student Field Notebooks

Each student assembles a notebook during his or her externship. They have detailed information on how the notebook is to be assembled. The preceptor’s only responsibility for the notebook is the timely completion and signatures on necessary paperwork. The student loses professional behavior points if their notebook is not in order and complete when they meet with the field coordinator.

Sections to include the following information:

• Student information (name, address, student id. #, etc.)

• Preceptor information (name, Provider, station location, etc.)

• Liaison information (name, phone numbers, etc.)

• Field Coordinator (name, phone numbers, etc.)

• Program Director (name, phone numbers, etc.)

• Medical Director (name, Hospitals associated with, etc.)

• General information (Field meetings, National Registry test dates, etc.)

• Area Orientation Checklist and information

• Daily Performance Records (1 for each shift)

• Copies of PCR’s (Blank-out Patient information)

• Major Evaluations

• Individual Performance Comments

• Field Liaison Evaluations

• Field Care Audits

• IEP

Course Completion

At the end of the field externship a preceptor must sign the course-completion form. The preceptor’s signature indicates the student meets the entry-level competencies listed on the form. The form must be hand carried by the preceptor to the field coordinator or must come with the student in a sealed and signed envelope. It will not be accepted any other way. It is imperative that all the information on the form be completed.

Riverside Community College

Paramedic Field Internship

Statement of Completion

To the Medical Director of the Paramedic Program:

I have been the preceptor for ________________________________________ during his or her field internship. The student has demonstrated the following entry-level paramedic competencies:

1. Respects the dignity of each individual with whom he or she is associated in the practice of their professional duties.

2. Responds to the field-learning environment in such a manner to invite confidence of patients, supervisors, peers and other health care professionals.

3. Analyzes subjective and objective information to formulate a plan of action and correctly implements the plan.

4. Assures and procures scene safety.

5. Assesses and treats patients as they present during the field internship, according to standard protocols.

6. Communicates effectively verbally and in writing.

7. Displays leadership abilities.

8. Maintain equipment.

I recommend successful completion of their field internship from Riverside Community College Paramedic Program.

Preceptor Signature: _______________________________ Date: ________________

Agency: _______________________________________________________________

State License No.: _____________________ County Accreditation No. _____________

This Document Is To Be Sealed And Forwarded To The Clinical Coordinator

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