hospital book - palm beach state college
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Palm Beach State College – Paramedic Program Hospital Book
Table of Contents
CODE OF CONDUCT OFFENSE – REFERRAL FORM ...................................................................... 2
DOCUMENTATION OF COMMENDATION ...................................................................................... 3
STUDENT CLINICAL PROCEDURES ............................................................................................ 4
PARAMEDIC STUDENT FIRST SEMESTER SKILLS: ....................................................................... 5
CLINICAL INFORMATION ........................................................................................................... 6
BOOK ATTESTATION PAGE ....................................................................................................... 7
CLINICAL SIGN IN SHEET .......................................................................................................... 8
DRUG CARDS .......................................................................................................................... 9
MANDATORY DRUGS ............................................................... ERROR! BOOKMARK NOT DEFINED.
CLINICAL GOALS BY SEMESTER ..............................................................................................11
REQUIRED SKILLS / CLINICALS - 2ND SEMESTER ........................................................................12
REQUIRED SKILLS / CLINICALS - GRADUATION .........................................................................13
PARAMEDIC REQUIRED CLINICAL GOALS .................................................................................14
PARAMEDIC CLINICAL GOALS CHECKLIST ................................................................................15
CLINICAL EVALUATION – PROGRESS REPORT ..........................................................................16
CLINICAL EVALUATION - COVER FOR LONG FORM ....................................................................17
CLINICAL EVALUATION - LONG FORM ......................................................................................18
SIGNIFICANT EXPOSURE OR INJURY IN A CLINICAL/LAB SETTING: .............................................21
DECLINATION OF POST-EXPOSURE EVALUATION .....................................................................22
PHYSICIAN NOTIFICATION OF SIGNIFICANT EXPOSURE ..............................................................23
EMERGENCY NEEDLESTICK INFORMATION ................................................................................24
RECOMMENDED CLEANING AND DISPOSAL OF CONTAMINATED CLOTHING ................................25
PATIENT CARE REPORT ..........................................................................................................26
PAYROLL REPORT – CLINICAL .................................................................................................29
Paramedic Student Improvement Plan ..............................................................................30
PROGRESS REPORT - CLINICAL EVALUATION ..................... ERROR! BOOKMARK NOT DEFINED.
Palm Beach Community College .......................................................................................31
PARAMEDIC STUDENT IMPROVEMENT PLAN GUIDELINES ..........................................................31
Palm Beach State College – Paramedic Program 1 Hospital Book
PALM BEACH STATE COLLEGE
EMS Academy - Paramedic Program
Typhon – Non-Compliance □ EMS 2664 – CLINICAL 1
□ EMS 2665 – CLINICAL 2
□ EMS 2658 – CLINICAL 3
□ EMS 2659 – Internship
Class Shift: ______ Clinical Shift: ______
Date of Non-compliance: Clinical instructor: Student Name (Print): I am aware that skills tracking and documentation are integral components of my paramedic training and is used for recording and verification of skills observed and performed while at clinicals. Entries must be made within 72 hours of occurrence. Non-compliance will affect the Documentation section of my Clinical long-form evaluation and may result in receiving an Unsatisfactory grade for that given semester.
Entries not made within 72 hours
Narrative deficiency Student Acknowledgement (signature):
Palm Beach State College – Paramedic Program 2 Hospital Book
PALM BEACH STATE COLLEGE
Paramedic Program - Clinicals CODE OF CONDUCT OFFENSE – REFERRAL FORM
Please refer to PBSC Health Sciences/EMS Disciplinary Procedures for a complete listing of offenses
Date: Instructor: Student Print Name: Class Shift Signature:
Group 1 Offense** Inappropriate language
Dress Code Violation
Failure to follow chain of command
Failure to act in a professional manner
Absence Non-Notification
Arrive late without notification
Smoke or chew tobacco at hospital or fire rescue setting
Conduct inconsistent to good order and discipline
Other:
Group 2 Offense**
Commit academic dishonesty.
“Any student who knowingly helps or is present when another student violates academic behavior standards is also in violation.”
Behave with intent to detract from the education of another student.
Leave assigned area (hospital or fire rescue setting) without notifying instructor.
Perform duties outside the scope of practice.
Perform as a firefighter while participating in a paramedic student capacity.
Respond to a fire/rescue call while in a PBSC lecture/lab/hospital setting.
Examine a patient without an instructor or preceptor present.
Not properly maintaining BSI and/ or properly utilizing PPE.
Show disrespect or be abusive to any instructor, hospital or fire rescue personnel.
Use a cellular telephone without the consent on an instructor.
Other:
Group 3 Offense** Immediate phone call to Clinical Coordinator required
Possess or be under the influence of controlled substance or alcohol
Perform skills on which s/he has not yet been signed-off in lab
Failure to comply with HIPAA
Conduct perceived to be sexual harassment
Conduct which threatens the health or safety of others
Other:
Palm Beach State College – Paramedic Program 3 Hospital Book
PALM BEACH STATE COLLEGE
Paramedic Program
DOCUMENTATION OF COMMENDATION Date: Instructor: Student Print Name: Signature: Student went “Above & Beyond” (Check all applicable):
Professionalism EMS Knowledge
Participation Creativity
Leadership Initiative
Teamwork Other (Describe):
COMMENTS:
Palm Beach State College – Paramedic Program 4 Hospital Book
PALM BEACH STATE COLLEGE
Paramedic Program
STUDENT CLINICAL PROCEDURES
Student Clinical Books will have individual tabs with the following categories: PCR’s, Evaluations, Medical Director, Pedi Partners, Healey, Medics, etc.
The Student Clinical Book and the Student Lab Skills Book will be taken to all clinical rotations, and be available during all classroom sessions as well.
While at Fire Rescue, one PCR will be written for every patient encounter. Not just transports.
During hospital rotations a minimum of four (4) full assessments along with four (4) full PCR reports shall be written each day.
Hand written drug cards will be turned in to Hospital instructor for approval by the end of EMS 2664. Instructor will match these to the drug card check sheet.
Skills and assessments performed at Healey, Dr. Scheppke, Medics, BVM, and Pedi Partners, etc. will be entered into Typhon
A total of 15 Team Leads must be accomplished during EMS 2659 regardless of the number of Team Leads the student had prior to this course.
Be mindful of the clinical “Do’s and Don’ts.”
Palm Beach State College – Paramedic Program 5 Hospital Book
PARAMEDIC STUDENT FIRST SEMESTER SKILLS:
All EMT-B Skills
IV Set Up and Insertion
Ventilation of Unintubated Patients
Encoding
Medication Administration, IV, IM, SQ, PO
Endotracheal Intubation
Student must demonstrate the ability to serve as the Team Leader in a variety of
prehospital emergency situations. The student should serve as the Team Leader for at
least 35 prehospital emergency responses.
PARAMEDIC STUDENT SECOND SEMESTER SKILLS:
ACLS, PHTLS
Comprehensive Assessments on all patient types including: OB, Trauma, Psychiatric,
Cardiac, Geriatric, etc.
Formulate and Implement Treatment Plans on Chest Pain, Dyspnea, Syncope,
Abdominal, and Altered Mental Status Patients.
Student must demonstrate the ability to serve as the Team Leader in a variety of
prehospital emergency situations. The student should serve as the Team Leader for at
least 35 prehospital emergency responses.
PARAMEDIC STUDENT THIRD SEMESTER SKILLS:
● Student must demonstrate the ability to serve as the Team Leader in a variety of
prehospital emergency situations. The student should serve as the Team Leader for at
least 35 prehospital emergency responses.
PALS
Palm Beach State College – Paramedic Program 6 Hospital Book
CLINICAL INFORMATION Q: What is Scope of Practice?
A: Defined parameters of various duties or services that may be provided by an individual with
specific credentials. Whether regulated by rule, statute, or court decision, it represents the limits
of the services an individual may legally perform.
Q: What is The Paramedic Students Scope of Practice?
A: Only the Skill Sheets you have signed off on in class
Q: What is Medical Direction?
A: Medical policies, procedures, and practices that are available to providers either on-line or
off-line.
Q: What is a Medical Director?
A: The physician who is legally responsible for all of the clinical and patient-care aspects of an
EMS system.
Q: Can the Medical Director Be Sued because of a paramedic’s mistake in the field?
A: Yes
Q: What is Negligence?
A: Deviation from accepted standards of care recognized by the law for the protection of others
against the unreasonable risk of harm
Q: What is Standard of care?
A: The degree of care, skill, and judgment that would be expected under like or similar
circumstances by a similarly trained Paramedic in the same State. Any deviation from this
standard might open you to allegations of negligence and liability for any resulting damages.
Q: What should I do if a doctor or nurse tells me to do something I haven’t learned yet?
A: Nicely let them know that the task isn’t in your scope of practice and thank them for trying to
give you the opportunity to try and learn.
Q: What should I do if I’m not sure if the task is in my scope of practice?
A: Go ask your clinical instructor and if they are unavailable do not perform the task.
* Always exercise the degree of care, skill, and judgment expected under the circumstances by a similarly trained,
good paramedic in the same State.
Palm Beach State College – Paramedic Program 7 Hospital Book
Paramedic Clinical BOOK ATTESTATION PAGE
CLASS SHIFT: ____________
I hereby attest that the reports and documentation contained
within this Student Clinical Book for:
Are complete, accurate, have been reviewed by the student and
myself, verified with our signatures, and reflect the student’s
TYPHON entries.
Hospital Instructor Printed Name:
_______________________________________________
Hospital Instructor Signature:
_______________________________________________
Date of Submission:
_______________________________________________
□ EMS 2664 – CLINICAL 1 □ EMS 2658 – CLINICAL 3
□ EMS 2665 – CLINICAL 2 □ EMS 2659 – Internship
Palm Beach State College – Paramedic Program 8 Hospital Book
HOSPITAL INSTRUCTOR
FIRE RESCUE INSTRUCTOR INSTRUCTOR PHONE # ________________________________
PALM BEACH STATE COLLEGE PARAMEDIC STUDENT
CLINICAL SIGN IN SHEET STUDENT: Fill out this sheet every time you attend a clinical function. Fill out the dates you are absent.
Keep this sheet in your Clinical Book.
Student Name Date Time
In Time Out
Site Instructor Printed Name Instructor Signature
Palm Beach State College – Paramedic Program 9 Hospital Book
DRUG CARDS
Class
Generic Name
Brand Name
Indication(s)
Contraindication(s)
Precautions
Side Effects
Adult Dosage
Adult Route
Pediatric Dosage
Pediatric Route
Palm Beach State College – Paramedic Program 10 Hospital Book
MANDATORY DRUGS
1. These are mandatory for student drug cards. Instructors may also add additional drugs as they see fit.
2. All drug cards are to be hand written and turned into the Clinical Lead Instructor by the end of EMS 2664.
3. The Clinical Lead Instructor will check each box once they see and approve each drug card.
1) Adenocard 2) Albuterol 3) Amiodarone 4) Aspirin5) Atropine 6) Calcium Chloride7) Cimetidine 8) Dextrose 50%9) Diazepam10) Diltiazem 11) Diphenhydramine12) Dopamine13) Epinephrine 1:1,00014) Epinephrine 1:10,00015) Etomidate16) Furosemide17) Glucagon18) Hydroxocobalamin19) Ipratropium Bromide20) Labetalol21) Lidocaine22) Magnesium Sulfate 23) Methylprednisone 24) Morphine 25) Naloxone
26) Nitroglycerine27) Norepinephrine 28) Oxygen 29) Procainamide 30) Sodium Bicarbonate 31) Succinylcholine 32) Thiamine 33) Vasopressin 34) Vecuronium
Student Printed Name: _____________________________________ Student Signature: _________________________________________ Clinical Instructor Signature: _________________________________ Date Completed: ___________________________________________
Palm Beach State College – Paramedic Program 12 Hospital Book
PALM BEACH STATE COLLEGE
Paramedic Program
DATE: August 2011
PATH:
REQUIRED SKILLS / CLINICALS - 2ND
SEMESTER
Evidence of progression of clinical skills is required for success in the paramedic program.
In order to receive a Satisfactory grade in EMS2665 Paramedic Clinical II, the student must have
the following minimum skills accurately reflected in Typhon:
Skill Minimum # LIVE Skills Required
Med Administration 10
ET Intubation 2
IV Success 15
Bag-Valve-Mask 4
Team Lead 10
The numbers utilized for this benchmark will be the accumulation of Typhon numbers from
EMS2664 and EMS2665, Paramedic Clinicals I & II.
Regardless of any other evaluations in clinicals, the student will not be allowed to progress to
EMS2658 Paramedic Clinical III without the accomplishment of the above live skills.
These minimum goals are not meant as your target goals; they are at the lowest end of the
acceptable spectrum. We recommend that the students get as much possible experience while in
the program to be best prepared to enter their chosen field of EMS.
Palm Beach State College – Paramedic Program 13 Hospital Book
PALM BEACH STATE COLLEGE
Paramedic Program
DATE: August 2011
PATH:
REQUIRED SKILLS / CLINICALS - GRADUATION
Evidence of progression of clinical skills is required for success in the paramedic program.
In order to receive a satisfactory grade in EMS2659 Paramedic Internship, and therefore
graduate, the student must have met all of the required minimum clinical goals in each category:
Mandatory Skills
Assessments by Patient Age
Assessments and Plans
Assessments by Patient Type
The numbers utilized for this benchmark will be the accumulation of Typhon numbers from
EMS2664, EMS2665, EMS2658 (Paramedic Clinicals I, II, & III) and EMS2659 Paramedic
Internship.
Students MUST obtain, and accurately document, 15 Team Leads solely within EMS2659
Paramedic Field Internship, with a total of 35 to graduate.
These minimum goals are not meant as your target goals; they are at the lowest end of the
acceptable spectrum. We recommend that the students get as much possible experience while in
the program to be best prepared to enter their chosen field of EMS.
Students will utilize the current paramedic Required Clinical Goals (see policies).
Palm Beach State College – Paramedic Program 14 Hospital Book
PARAMEDIC REQUIRED CLINICAL GOALS
Palm Beach State College - Paramedic Required Clinical Goals
Mandatory LIVE Skills Assessments by Patient Age
Minimum Category Minimum Age15 *Med Administration 1 Newborn 0-1mo5 *ET 1 Infant 1m -1yr
25 *IV Success 3:1 Make-up Ratio (SimMan) 5 Toddler 1-3yr20 *Bag-Valve-Mask 5:1 Make-up Ratio (SimMan) 5 Pre School 4-5yr35 *Team Lead 1:1 Make-up Ratio 2 School Age 6-12yr
15 Live MUST be during EMS2659 2 Adolescent 13-17yr
35 Adult 18-65yr
35 Geriatric >65yr
Assessment and Plan Assessment by Patient Type
Minimum Encounter Minimum Encounter15 Cardiac 1 Obstetric
5 Respiratory 10 Trauma
5 Syncope 35 Medical
10 Abdominal 2 Psychiatric
5 AMS / Neuro
Palm Beach State College – Paramedic Program 15 Hospital Book
PARAMEDIC CLINICAL GOALS CHECKLIST
Required Current
Medication Administration 15
Live Intubations 5
Successful IV's 25
Ventillate a Patient Using BVM 20
Assessment ofNewborn (0-1mo) 1
Assessment ofInfant (1mo-1yr) 1
Assessment ofToddler (1-3yr) 5
Assessment ofPreschooler (4-5yr) 5
Assessment ofSchool Age (6-12yr) 2
Assessment ofAdolescents (13-17yr) 2
Assessment ofAdults (18-65yr) 35
Assessment ofGeriatrics (>65yr) 35
Assessment ofObstetric Patients 1
Assessment ofTrauma Patients 10
Assessment ofMedical Patients 35
Assessment ofPsychiatric Patients 2
Assessment and Plan of Cardiac Patients 15
Assessment and Plan of Respiratory Patients 5
Assessment and Plan of Syncope Patients 5
Assessment and Plan of Abdominal Patients 10
Assessment and Plan of AMS/Neuro Patients 5
Total Field Team Leads 35
Field Internship Team Leads in EMS 2659 15
Track Yourself!!
Palm Beach State College – Paramedic Program 16 Hospital Book
Palm Beach State College – Paramedic Program
CLINICAL EVALUATION – PROGRESS REPORT
□ EMS 2664 – CLINICAL 1 □ EMS 2658 – CLINICAL 3
□ EMS 2665 – CLINICAL 2 □ EMS 2659 – Internship
Class:
Date Student Name
Instructor Name Instructor Signature
Indicate how the student is progressing toward competency by rating the student on a scale of 1-5. A “1” or “2” rating indicates that immediate remedial work is indicated. A “5” indicates superior performance.
Cognitive Domain (Knowledge Base) 5 4 3 2* 1*
Psychomotor Domain (Clinical Proficiency) 5 4 3 2* 1*
Affective Domain (Behavioral Skills) 5 4 3 2* 1*
Documentation (FISDAP/Typhon) 5 4 3 2* 1*
Comments:
*Grades of 1 or 2 require comments, an Assistance Lab referral form, and Clinical Coordinator notification.
Student Signature:
Palm Beach State College – Paramedic Program 17 Hospital Book
Palm Beach State College – Paramedic Program
CLINICAL EVALUATION - COVER FOR LONG FORM
□ EMS 2664 – CLINICAL 1 □ EMS 2658 – CLINICAL 3
□ EMS 2665 – CLINICAL 2 □ EMS 2659 – Internship
CLASS: _______________
Date Student Name
Instructor Name Instructor Signature
Competent Not Competent
Cognitive Domain (Knowledge Base) Minimum Score: 24
Psychomotor Domain (Clinical Proficiency) Minimum Score: 16
Affective Domain (Behavioral Skills) Minimum Score: 36
Documentation (Typhon) Minimum Score: 12
Comments:
In any given semester, a Competent score is required in the Psychomotor domain in order to receive a course satisfactory grade (S). In EMS2664, EMS2665 and EMS2658, other than the above mentioned requirement, the student may receive only one Not Competent and still receive a course grade of satisfactory (S). In EMS2659, a Final Evaluation of Competent must be received in ALL categories to earn a satisfactory grade (S).
CURRENT GRADE: Satisfactory Unsatisfactory*
*Requires immediate Clinical Coordinator notification
Student Signature:
Palm Beach State College – Paramedic Program 18 Hospital Book
Palm Beach State College – Paramedic Program
CLINICAL EVALUATION - LONG FORM CLASS: _____________ □ EMS 2664 – CLINICAL 1 □ EMS 2658 – CLINICAL 3 □ EMS 2665 – CLINICAL 2 □ EMS 2659 – Internship
Date Student Name
Instructor Name Instructor Signature
Indicate how the student is progressing toward competency by rating the student on a scale of 1-5. A “1” rating indicates that immediate remedial work is indicated. A “5” indicates superior performance.
Comments are required in all categories.
Cognitive Domain (Knowledge Base)
Has the EMS knowledge necessary to function in a healthcare setting.
5 4 3 2 1
Has the general medical knowledge necessary to function in his/her given semester.
5 4 3 2 1
Is able to collect data from charts and patients. 5 4 3 2 1
Is able to interpret patient data. 5 4 3 2 1
Is able to recommend appropriate diagnostic and therapeutic procedures.
5 4 3 2 1
Uses sound judgment while functioning in a healthcare setting.
5 4 3 2 1
Minimum 24 SCORE _____ / 30
Comments:
Psychomotor Domain (Clinical Proficiency)
Effectively performs clinical skills for given semester.
5 4 3 2 1
Possesses the skills to perform patient assessment.
5 4 3 2 1
Is able to perform approved therapeutic procedures and modalities.
5 4 3 2 1
Is able to perform and interpret diagnostic procedures.
5 4 3 2 1
Minimum 16 SCORE _____ / 20
Comments:
Palm Beach State College – Paramedic Program 19 Hospital Book
Affective Domain (Behavioral Skills) 1. INTEGRITY Examples of professional behavior include, but are not limited to: Consistent honesty; being able to be trusted with the property of others; can be trusted with confidential information; complete and accurate documentation of patient care and/or learning activities.
5 4 3 2 1
2. EMPATHY Examples of professional behavior include, but are not limited to: Showing compassion for others; demonstrating respect for others; being supportive and reassuring to others.
5 4 3 2 1
3. SELF – MOTIVATION Examples of professional behavior include, but are not limited to: Taking initiative to complete assignments; taking initiative to improve and/or correct behavior; taking on and following through on tasks without constant supervision; showing enthusiasm for learning and improvement; consistently striving for excellence; accepting constructive feedback in a positive manner; taking advantage of learning opportunities.
5 4 3 2 1
4. APPEARANCE AND PERSONAL HYGIENE Examples of professional behavior include, but are not limited to: Clothing and uniform is appropriate, neat, clean and well maintained; good personal hygiene and grooming.
5 4 3 2 1
5. SELF – CONFIDENCE Examples of professional behavior include, but are not limited to: Demonstrating the ability to trust personal judgment; demonstrating an awareness of strengths and limitations; exercises good personal judgment.
5 4 3 2 1
6. COMMUNICATIONS Examples of professional behavior include, but are not limited to: Speaking clearly; writing legibly; listening actively; adjusting communication strategies to various situations.
5 4 3 2 1
7. TIME MANAGEMENT Examples of professional behavior include, but are not limited to: Consistent punctuality; completing tasks and assignments on time.
5 4 3 2 1
8. TEAMWORK AND DIPLOMACY Examples of professional behavior include, but are not limited to: Placing the success of the team above self interest; not undermining the team; helping and supporting other team members; showing respect for all team members; remaining flexible and open to change; communicating with others to resolve problems.
5 4 3 2 1
9. RESPECT Examples of professional behavior include, but are not limited to: Being polite to others; not using derogatory or demeaning terms; behaving in a manner that brings credit to the profession.
5 4 3 2 1
Minimum 36 SCORE _____ / 45
Comments:
Palm Beach State College – Paramedic Program 20 Hospital Book
Documentation (Typhon Entries and Narratives)
Typhon reports match paper reports. 5 4 3 2 1
Typhon reports are entered within 72 hours of clinical.
5 4 3 2 1
Typhon narratives completed and well written. 5 4 3 2 1
Minimum 12 SCORE _____ / 15
Comments:
Student Signature:
Palm Beach State College – Paramedic Program 21 Hospital Book
SIGNIFICANT EXPOSURE OR INJURY IN A CLINICAL/LAB SETTING:
An exposure can be defined as a percutaneous injury (e.g., needlestick or cut with a sharp object)
or contact of mucous membrane or nonintact skin (e.g., exposed skin that is chapped, abraded, or
with dermatitis) with blood, saliva, tissue, or other body fluids that are potentially infectious.
Exposure incidents might place health care personnel at risk for hepatitis B virus (HBV),
hepatitis C virus (HCV), or human immunodeficiency virus (HIV) infection, and therefore
should be evaluated immediately following treatment of the exposure site by a qualified health
care professional. (Centers for Disease Control and Prevention)
The following is a recommended approach for student reporting and instructor action should
a significant exposure or injury occur during a clinical /lab setting.
** Unless student has a major medical policy, this college policy only covers injuries and
exposure issues**
1. Student shall notify Clinical/Lab instructor.
2. Clinical instructor to notify Hospital Infection Control Nurse (exposures only)
3. Student proceeds to facility’s Emergency Department, signs in as a patient for
treatment. If off site, the student should go to nearest hospital emergency
department.
4. Clinical/Lab instructor to notify the Clinical Coordinator / Program Manager
via Voice Mail. 868-3418.
5. Clinical/Lab instructor to call Palm Beach State College Security for an
incident report to be completed. 561-868-3600, day or night.
6. Clinical Coordinator/Program Manager notifies Safety and Security 868-3487.
7. (Optional) Clinical instructor to call or page Dr. Landman for student
counseling and follow up care for exposures only. 561-969-7900, day or night.
8. Student shall send a detailed e-mail to Clinical Coordinator / Program Director
regarding incident specifics.
9. Clinical instructor to provide a copy of the insurance form to emergency
registration upon student registration, and file claim with insurance company.
Palm Beach State College – Paramedic Program 22 Hospital Book
PALM BEACH STATE COLLEGE
EMS PROGRAMS
DECLINATION OF POST-EXPOSURE EVALUATION
On___________________, I experienced an incident while participating in a Palm Beach State
College EMS Program, which may have caused my exposure to bloodborne pathogens. An
Accident-Incident Report was filed at that time.
I have been advised that I may be evaluated by a physician pursuant to this incident, which may
include serologic testing for HIV and HBV, and that there will be no cost to me for this
evaluation. However, I choose to decline having the evaluation performed, with the
understanding that I may have blood drawn at this time but not tested until a later time of my
choosing (up to 90 days following the date of the incident).
_________________________________________
Printed Name
_________________________________________
Signature
__________________________________________
Date
Palm Beach State College – Paramedic Program 23 Hospital Book
Palm Beach State College
PHYSICIAN NOTIFICATION OF SIGNIFICANT EXPOSURE
To: Emergency Room Physician
From: Dr. Ken Scheppke, MD
Subject: Significant Exposure to Bloodborne Pathogens
The student before you has sustained a significant exposure to a potentially infectious body fluid
during the course of medical treatment of ________________________________________
(patient name)
Per Florida State Statute 381.004(10), this medical personnel (student) has the right to know the
HIV status of this source patient. Florida law allows you to perform a HIV test on this patient
either with their consent or without their consent if blood specimens have been obtained for other
purposes.
In addition, it is not mandated by the state but if the source patient consents, we are also
requesting a Hepatitis B and C test be performed.
Please have your staff contact the hospitals Infection Control Coordinator and advise them of the
incident. They will forward the results to Palm Beach State College, 4200 Congress Avenue,
Risk Management Department, Lake Worth Florida, 33461. Thank you for your cooperation.
Ken Scheppke, MD
Medical Director
Palm Beach State College EMS Programs
Student Name _______________________________________________ Date ____________
Student Signature ___________________________________________________
Blood specimen obtained from source patient (check one) □Yes □No
Source patient HIV testing (per state statute 381.004)
□ With consent □ Without consent □ Refused
Palm Beach State College – Paramedic Program 24 Hospital Book
EMERGENCY NEEDLESTICK INFORMATION
Workers Please Note
If you experienced a needlestick or sharps injury or were exposed to the blood or other body fluid of a patient during the course of your work, immediately follow these steps:
Wash needlesticks and cuts with soap and water.
Flush splashes to the nose, mouth, or skin with water.
Irrigate eyes with clean water, saline, or sterile irrigants.
Report the incident to your supervisor.
Immediately seek medical treatment.
Medical Providers Please Note
Recommendations for the management of occupational exposures to blood: MMWR Recommendations and Reports, Volume 54, Number RR-9, Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HIV and Recommendations for Postexposure Prophylaxis www.cdc.gov/mmwr/PDF/rr/rr5409.pdf MMWR Recommendations and Reports, Volume 50, Number RR-11, Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis
(PDF format, 329 KB) http://www.cdc.gov/mmwr/PDF/rr/rr5011.pdf If you have questions about appropriate medical treatment for occupational exposures, 24 hour assistance is available from the Clinicians' Post Exposure Prophylaxis Hotline (PEPline) at 1-888-448-4911. http://www.ucsf.edu/hivcntr
Palm Beach State College – Paramedic Program 25 Hospital Book
Palm Beach State College EMS Academy
RECOMMENDED CLEANING AND DISPOSAL OF CONTAMINATED CLOTHING
LAUNDRY:
The appropriate personal protective equipment should be utilized when handling possibly contaminated laundry. Students are encouraged to wash uniforms at the station in order to minimize the potential of spreading infection to their families. Use the following method if the uniform is contaminated with body fluids. While the washing machine is filling with hot water (120- 130 degrees) add 2 cup (4 oz) of color safe bleach and 1 cup of detergent. The washing machine should be set at its highest water level and after it is full add the garments to be washed. Run items through the rinse cycle twice. Dry items in the dryer on the highest heat setting, do not line dry.
CLEANING AND DISINFECTING AREAS:
Used equipment from an emergency incident should be bagged and transported to the designated cleaning area. Red bags designated for contaminated equipment are stored on all emergency medical response vehicles and may be identified by the biohazard symbol. When used, these biohazard bags must be disposed of in an approved biohazard container. Contaminated medical equipment should never be cleaned, disinfected, or stored in the stations living quarters or outside hospital biohazard cleaning room. MSDS sheets for each disinfectant will be posted at a prominent place in the designated cleaning area.
Palm Beach State College – Paramedic Program 26 Hospital Book
PALM BEACH STATE COLLEGE
EMT/Paramedic Program
PATIENT CARE REPORT
Student:
_________________________
EMT Paramedic Date:
____/____/_____
Time of Call: _______________ Hospital/Agency: ____________ Unit:
____________
□ I accompanied this patient to the hospital during transport.
Instructor/Preceptor Name:
______________________
Instructor/Preceptor Signature:
______________________
ETHNICITY M F
African American
American Indian
Asian
Caucasian
Hispanic
Other:
___________________
Chief MEDICAL COMPLAINT
Abdominal OD-Poison Cardiac Psychiatric
CVA Respirator
y Diabetic Seizure OB/GYN Sepsis
Other ___________________
Chief TRAUMA COMPLAINT
Abdome
n
Neck/Back
Chest Pelvic Extrem. Head/Face
Muscular Multi-
system
Other ___________________
MECHANISM OF INJURY None Driver MVA Passenger MVA Auto-Pedestrian
Motorcycle Fall/Jump
Airbag Seatbelt Entrapment Ejection
Rollover Blunt Penetrating Injury – Type: _____________________ Other: ______________________________________
ALLERGIES:
MEDICATIONS:
PAST MEDICAL HX:
Time BP Pulse Resp AVPU Pupils Lungs Drug/Tx Dose Route
Palm Beach State College – Paramedic Program 27 Hospital Book
Eyes Open→ Spontaneous 4 To Voice 3 To Pain 2 None 1 Glasgow Score =
_________ Verbal→ Orient 5 Confused 4 Inappropriate 3 Garbled 2
None 1
Motor→ Obey Com. 6 Pain/Local 5 Pain/Withdraw 4 Pain/Flexion 3 Pain/Ext 2
None 1
BLS AIRWAY NC NRB Nasal airway Oral airway
BVM @ ______L/Min
ALS AIRWAY Surgical Nasal ET Oral ET Attempts X: ____ Success Y N ET
size: ___
Pulse Ox on room air ________ % After O2 ________ % Glucometer __________
IV / IO Attempts X:
_____
Success: Y
N
Site: ________ Gauge: ______ Solution: ______
ELECTRICAL
THERAPY ENERGY
LEVELS
OBS. PERF. EKG INTERPRETATION OBS PERF
MANUAL DEFIBRILLATION Rhythm 1:
SYNCHRONIZED
CARDIOVERSION
Rhythm 2:
TRANSCUTANEOUS
PACING
Rhythm 3:
PHTLS CARE BLS CARE
OBS PERF
OBS PERF
PATIENT INTERVIEW WITNESSED ARREST
VITAL SIGNS SUCTION
02 ADMINISTRATION CHEST COMPRESSIONS
BANDAGING VENTILATIONS
TRACTION SPLINT BLS airway adjunct
C-SPINE
IMMOBILIZATION
AIRWAY ADJUNCT TYPE:
LONG BACKBOARD ALS CARE – OTHER LONG BONE
IMOBILIZATION DESCRIBE # PERFORMED Obs Per
STUDENT PHYSICALLY
INVOLVED IN LIFTING
PATIENT
YES NO CHEST DECOMPRESSION
CRICOTHYROIDOTOMY
12 LEAD ECG
PULSE OXIMETRY
BLOOD GLUCOSE
Field Diagnosis:
CHIEF COMPLAINT:
HISTORY OF PRESENT ILLNESS / INJURY: (include pertinent negatives / positives as
indicated)
ONSET (i.e. slow, sudden, etc.):
PROVOCATION:
QUALITY:
RADIATION:
SEVERITY:
Palm Beach State College – Paramedic Program 28 Hospital Book
TIME:
LAST ORAL INTAKE:
ASSESSMENT: (include pertinent negatives / positives for each area if indicated)
SKIN COLOR / CONDITION:
CAP REFILL:
HEAD:
EYES:
EARS:
NOSE:
MOUTH:
NECK:
CHEST:
LUNGS SOUNDS:
ABDOMEN:
PELVIS:
GENITALIA:
EXTREMITIES:
BACK:
IMPRESSIONS (rule out):
RX: TREATMENT, RESPONSE AND REASSESSMENT:
TRANSPORT / TRANSFER: Verbal and written report given to: Time of transfer:
E: EXCEPTIONS:
Palm Beach State College – Paramedic Program 29 Hospital Book
PAYROLL REPORT – CLINICAL
NAME:
DEPARTMENT: Paramedic
PAYROLL PERIOD: Start Date: End Date:
DATE
Course ID: (2664, 2665,
2658, 2659)
Ref#
Shift
A B C
Location Hosp, FR,
Other
Start-End Time
DAILY
TOTALS
TOTAL
HOURS
_____
Timesheets are to be submitted to the Clinical Coordinator by noon of due date. If your time sheet is not submitted
on time, the Clinical coordinators signature is required; your hours will not be paid until the following pay date.
Name of Hospital must be stated, not just hosp.
I certify that the information I have recorded above is accurate.
Signature/Date
Approved
Palm Beach State College – Paramedic Program 30 Hospital Book
PALM BEACH STATE COLLEGE
Paramedic Program
PARAMEDIC STUDENT IMPROVEMENT PLAN
DIDACTIC CLINICAL (Please fax to Clinical Coordinator @ 868.3419 and keep original)
LAB Name of Student: ___________________________________ Date ________________ Initiated by: _________________________ Lead Instructor: ________________________
Problem Identified:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Test Scores ________ Attendance / Tardy Policies
Suggested Remediation Plan:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
I have participated in the development of my remediation plan and agree to the plan as stated. I understand I now have the responsibility to see this plan thru with the assistance of the Occupational Skills Evaluators and my Instructors.
Student’s Signature Date
Instructor’s Signature Date
Palm Beach State College – Paramedic Program 31 Hospital Book
PALM BEACH STATE COLLEGE PALM BEACH COMMUNITY COLLEGE
Paramedic Program
PARAMEDIC STUDENT IMPROVEMENT PLAN GUIDELINES
Once the plan is filled out, it should be placed in the top, middle slot of the mail boxes in the office. Clinical Instructors will fax.
Any time a student is seen in an Assistance Lab and identifies themselves as a remediation student, the form is used as reference for the problem identified.
When a student participates in the remediation process, the Progress Report should be filled out as completely as practical and identified as meeting the expectations for remediation or additional remediation is recommended, by checking one of the associated boxes.
Paperwork should be returned to the slot to be picked up by either the class Lead, OSE or Clinical coordinator.
Leads, OSE’s and the Clinical Coordinator originating the paperwork should routinely check the box to follow up on their students’ progress throughout the plan.
When a student has successfully completed any remediation plan as suggested by our program, the completed paperwork should be placed in their appropriate student file folder.
Any questions an Instructor may have on any student can be referred to the Lead responsible for that student.