(Test Bank) Paramedic Care: Principles & Practice, Vols. 1

Bledsoe,Porter,Cherry, 5

Nursing

Test Bank

5th Edition

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Test Bank for Paramedic Care: Principles & Practice, Vols. 1, The downloadable file consists of 491 pages, and the total size of the file is 6.78 MB. Purchase now only for highly discounted price.

Author(s): Bledsoe, Porter, Cherry

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©201 7 Pearson Education , Inc. Paramedic Care: Principles & Practice, Volume 1, 5th Ed. 1 Detailed Lesson Plan Chapter 1 Introduction to Paramedicine 130 Minutes Chapter 1 objectives can be found on text p. 1. These objectives, which form the basis of each chapter, were developed from the National Education Standards and the accompanying Paramedic Instructional Guidelines . Minutes Content Outline Master Teaching Notes 5 I. Case Study Teaching Tips Have a student read the scenario. Tell students that the case will be reviewed after the lecture . 90 II. Introduction A. Understand what the job of p aramedic in the twenty -first century involves 1. Member of allied health profession s (ancillary health care professions, apart from physicians and nurses ) 2. Highly regarded by society 3. Significant advances in EMS system over the past 30 years 4. Not long ago, the a mbulance was simply a vehicle that provided rapid , horizontal transport to the hospital . 5. Today the modern ambulance is equipped with the latest in equipment and technology and is truly a mobile emergency room on wheels . 6. Twenty -first century paramedic is a highly trained health care professional who provides comprehensive, compassionate, efficient prehospital emergency care B. Description of the Profession 1. Paramedic is highest level of prehospital care and leader of prehospital care team 2. Four nationally recogni zed levels of EMS providers in the United States: a. Emergency Medical Responder (EMR) b. Emergency Medical Technician (EMT) c. Advanced Emergency Medical Technician (AEMT) d. Paramedic Teaching Tips Before starting the Introduction, ask students to list on the board what roles paramedic s serve and how they help the public . Discussion Topics List the four levels of EMS, what each level can do, and the skills each level is not permitted to perform. MASTER TEACHING NOTES  Teaching Tips  Discussion Topics  Class Activities ©201 7 Pearson Education , Inc. Paramedic Care: Principles & Practice, Volume 1, 5th Ed. 2 Chapter 1 objectives can be found on text p. 1. These objectives, which form the basis of each chapter, were developed from the National Education Standards and the accompanying Paramedic Instructional Guidelines . Minutes Content Outline Master Teaching Notes C. The Modern Paramedic 1. Roles and responsibilities of paramedic are diverse and encom pass disciplines of health care, public health , and public safety 2. Illness and injury prevention are just as important as acute health care and public safety 3. Totality of roles and responsibilities of paramedic practice known as paramedicine 4. Primary tasks of paramedic include a. Providing emergency medical care in an out -of-hospital setting b. Using advanced training and equipment to extend the care of emergency physician to patient in the field c. Making accurate independent judgments in a timely manner (This is esse ntial, as it can mean the difference between life and death for the patient .) 5. In order to function as a paramedic , you must: a. Fulfill prescribed requirements of appropriate licensing or credentialing body b. Be licensed, registered, or otherwise credentialed b y appropriate agency in area of employment c. Function only under the direction of the EMS system’s medical director 1) Medical director must be appropriately licensed or credentialed . 2) Medical director must approve paramedic before allowing practice of advanced prehospital care . 6. Emerging roles and responsibilities include public education, health promotion , participation in injury and illness prevention programs 7. As a paramedic, you must: a. Recognize that you are an essential component in the continuum of care . b. Serve as a link between various health resources in the community . c. Understand that you may be a gatekeeper to the health care system as health care costs increase . Class Activities Ask students to list all the illness and injury prevention programs they can think of. Discuss with them the ways they can participate in these programs as paramedics. Examples include but are not limited to: - DARE - Safety Town - Bike Rodeos - Blood Pressure Screenings - MADD - Mock Auto Accidents at Schools - First Aid/CPR - Babysitting Courses - No Texting and Driving ©201 7 Pearson Education , Inc. Paramedic Care: Principles & Practice, Volume 1, 5th Ed. 3 Chapter 1 objectives can be found on text p. 1. These objectives, which form the basis of each chapter, were developed from the National Education Standards and the accompanying Paramedic Instructional Guidelines . Minutes Content Outline Master Teaching Notes 1) For example, you ensure that your patient gets to an appropriate health care facility in a timel y manner, even though it may not be a hospital ED . d. Strive toward maintaining high -quality health care at a reasonable cost . e. Always be an advocate for your patient and ensure that the patient receive s the best possible care , without regard to patient’s abil ity to pay or insurance status . f. Continue to fill the well-defined and traditional role of 911 response . g. Take on additional responsibilities . 1) Mobile integrated health care/community paramedicine is community -based health care focused on appropriate use of e mergency care resources 2) Become a facilitator of access to care, individual treatment provider h. Be responsible and accountable to the system medical director, their agency, the public, and your peers . i. Always act in the best interest of the patient. D. Paramedic Characteristics 1. As a paramedic, you may work for a fire department, private ambulance service, third city service, hospital, police department, or other operation . 2. You must : a. Be flexible to meet the demands of the ever -changing emergency scene . b. Be a confid ent leader . c. Have excellent judgment . d. Be able to prioritize decisions to act quickly and in the best interest of the patient . e. Be able to develop rapport with a wide variety of patients and communicate with members of diverse cultural and age groups . f. Functio n independently at an optimum level in a nonstructured, constantly changing environment . Class Activities Have students give examples of situations in which they had to be flexible in their job . Class Activities Have students list skills they learned as ©201 7 Pearson Education , Inc. Paramedic Care: Principles & Practice, Volume 1, 5th Ed. 4 Chapter 1 objectives can be found on text p. 1. These objectives, which form the basis of each chapter, were developed from the National Education Standards and the accompanying Paramedic Instructional Guidelines . Minutes Content Outline Master Teaching Notes E. The Paramedic: A True Health Professional 1. Emergency medical services now recognized as an important part of health care system 2. Paramedics are highly respected members of health care team . 3. Paramedics m ust always strive to earn acceptance as a professional . 4. Completion of initial paramedic course is start of professional education 5. Participation in continuing education programs and routine peer - evaluation is essential in yo ur career. 6. Standards for paramedics raised with the 2009 publication of National Emergency Medical Services Education Standards: Paramedic Instructional Guidelines a. Guidelines have taken paramedic education to a higher level b. Based on a national EMS practice analysis completed by the National Registry of EMTs in 2004 c. Anatomy and physiology course now a prerequisite to paramedic course d. Curriculum provides for improved understanding of pathophysiology of various illnesses and injury processes paramedics encount er e. Material in 2009 DOT EMS Instructional Guidelines is the foundation for this textbook 7. Strong practice now based on research a. Must be active in design, development, evaluation, and publication of research b. In the past, paramedicine was based on anecdotal d ata and tradition. c. In the last 20 years, application of scientific methods introduced into paramedic care after it was found that there was little to no scientific data to support many prehospital practices d. As a result of research, many traditional EMS tre atments have been abandoned or refined. 8. Essential aspect of the health profession is acceptance and adherence to professional ethics and etiquette a. Ethics are standards of right and honorable behavior; often EMTs that they have not used since class. If time permi ts, pull that equipment out and have a few students attempt to use it only by memory. Teaching Tip s Touch on research just briefly , since this will be discussed in later chapters. Focus on the changes research initiated, such as CPR and compressions first , O2 for chest pain/MI patients with low PSO 2 saturations, rapid transport , decreased scene time for stroke victims and trauma victims, etc . Class Activities Have one student change into a dirty shirt (an old shirt that you provide with spilled coffee on it, ink stains, etc .) and perform a patient assessment. Have another student perform an assessment using a poor attitude and no listening skills. Discuss with students their initial impressions. When discussing public expectations, use the scenario of cal ling a plumber to your house to fix your pipes, then finding out that he doesn’t know what he is doing. Have students give examples of how they can review their performance. Take students through a mock run review using an imaginary call that you make up . ©201 7 Pearson Education , Inc. Paramedic Care: Principles & Practice, Volume 1, 5th Ed. 5 Chapter 1 objectives can be found on text p. 1. These objectives, which form the basis of each chapter, were developed from the National Education Standards and the accompanying Paramedic Instructional Guidelines . Minutes Content Outline Master Teaching Notes arise in relationships with patients and the publ ic b. Etiquette refers to good manners; often related to behavior between health professionals 9. Public expectations a. Public must feel confident and know that their interests are always placed above personal, corporate, or financial interests b. Emergency patient i s always the primary concern F. Legal Considerations: Which Hat Are You Wearing ? 1. As a modern paramedic, you must wear several hats as a result of overlapping of duties. a. Cross trained as a fire fighter and police officer b. May participate in rescue operations, d irecting traffic, and other tasks on the emergency scene 2. Cross training can cause a certain degree of confusion and conflict. a. Police officer/paramedic and HIPAA considerations b. Remember that, as a paramedic, you must put care of the patient above other task s. 3. Laws regarding responsibilities of cross -trained individuals vary from state to state. Teaching Tip s Stress to students that , even if they are cross trained, they will be providing only one service at a time. 15 III. Expanded Scope of Practice A. Critical Care Transport 1. Critical care transport vehicles used to move critically ill patient s between facilities 2. Specialized ground ambulances, fixed -wing aircraft, and helicopters B. Helicopter air Ambulance (HAA) 1. Helicopters part of EMS system for more than 30 years 2. Most programs staff helicopter with two medical crew members and often include par amedics 3. Skills of flight paramedic very similar to those of critical care paramedic but include additional education in flight physiology, aircraft operations, flight safety, and similar areas C. Tactical EMS 1. Designed to enhance safety of special operations p ersonnel and the Teaching Tips If possible, have a paramedic who is trained in extended scope of practice speak to students briefly about their positions . ©201 7 Pearson Education , Inc. Paramedic Care: Principles & Practice, Volume 1, 5th Ed. 6 Chapter 1 objectives can be found on text p. 1. These objectives, which form the basis of each chapter, were developed from the National Education Standards and the accompanying Paramedic Instructional Guidelines . Minutes Content Outline Master Teaching Notes public 2. Role of tactical paramedic is to provide life -saving care, sometimes in dangerous environments, until patient can be safely evacuated to general EMS system D. Mobile Integrated Health Care 1. Several EMS systems have designated specialize d crews to periodically assess and monitor high -risk patients in their community. E. Industrial Medicine 1. Paramedics as principal health care provider on oil rigs, movie sets, and similar industrial operations 2. Specially trained for industry in question 3. Increas ed employee safety and decreased time lost from work F. Sports Medicine 1. Paramedics trained to deal with injuries specific to sport in question G. Corrections Medicine 1. Paramedics as emergency and medical care providers in jails and prisons 2. Responsible for medical emergencies, initial intake assessment, and overseeing medical needs of prison population H. Hospital Emergency Departments 1. Hospitals faced with a nursing shortage; paramedics founds to be suitable providers for emergency departments and minor care centers 2. Roles vary significantly from state to state, on the basis of local laws . ©201 7 Pearson Education , Inc. Paramedic Care: Principles & Practice, Volume 1, 5th Ed. 7 Chapter 1 objectives can be found on text p. 1. These objectives, which form the basis of each chapter, were developed from the National Education Standards and the accompanying Paramedic Instructional Guidelines . Minutes Content Outline Master Teaching Notes 5 IV. Summary A. EMS is now recognized as a staple in the health care system . B. Paramedics have been identified as underutilized medical experts and are being offered opportunities that were unheard of a few years ago . C. As the scope of practice for paramedicine expands , so will the demand for skilled p ractit ioners. D. The paramedic of the twenty -first century can have a more significant impact on health care than ever before. E. The paramedic is o ften the first person of the health care system with whom the patient interacts ; the results of those actions can affect the patient’s opinion of the health care system in general. F. EMS is a profession in which you can make a difference on every call and interaction with a patient . G. Few professions carry such awesome responsibility. 5 V. Case Study 5 VI. You Make the Call Clas s Activities Read and discuss the You Make the Call scenario, and answer the critical thinking questions as a group. 5 VI. Review Questions Class Activities Pass out the review questions before the lesson starts. Have students answer them. Go over the questi ons again after the lecture to assess students’ understanding of the information. ©201 7 Pearson Education , Inc. Paramedic Care: Principles & Practice, Volume 1, 5th Ed. 1 Detailed Lesson Plan Chapter 2 EMS Systems 90 Minutes Chapter 2 objectives can be found on text pp. 12 –13. These objectives, which form the basis of each chapter, were developed from the National Education Standards and the accompanying Paramedic Instr uctional Guidelines . Minutes Content Outline Master Teaching Notes 5 I. Case Study Teaching Tips Have a student read the scenario. Tell students that the case will be reviewed after the lecture . 10 II. Introduction A. EMS is a comprehensive network involving personnel, equipment, and resources established to deliver aid and emergency medical care to the community. 1. Out-of-hospital component s a. Members of community trained in first aid and CPR b. Communications system c. EMS providers, including paramedics d. Fire/rescue a nd hazardous materials services e. Law enforcement officers f. Public utilities, such as power and gas companies g. Resource centers, such as regional poison control centers 2. In-hospital component s a. Emergency nurses b. Advanced practice providers c. Emergency physicians an d specialty physicians d. Ancillary services ( e.g., radiology and respiratory therapy) e. Specialty physicians (e.g., trauma surgeons and cardiologists) f. Social workers g. Mental health providers h. Rehabilitation services Teaching Tips Discuss with students the different out -of- hospital and in -hospital components. Class Activities Assign members of the class a particular role as an out -of-hospital and in -hospital component. Give students a scenario , and have them stand in a line as their part in the EMS call arrives. Once you have gone through the call, repeat with removal of one or two student roles, which allows students to visualize where the care is jeopardized when there is a break in the EMS and hospital components. MASTER TEACHING NOTES  Teaching Tips  Discussion Topics  Class Activities  Points to Emphasize  Knowledge Application ©201 7 Pearson Education , Inc. Paramedic Care: Principles & Practice, Volume 1, 5th Ed. 2 Chapter 2 objectives can be found on text pp. 12 –13. These objectives, which form the basis of each chapter, were developed from the National Education Standards and the accompanying Paramedic Instr uctional Guidelines . Minutes Content Outline Master Teaching Notes B. Weakness in any one component will diminish th e overall quality of patient care. 1. Usually, the first EMS provider to respond to the scene of an emergency is a police officer, firefighter, lifeguard, teacher, or other community member who has received basic medical training in an approved Emergency Medi cal Responder program . 2. Some areas of the country use a tiered response, sending multiple levels of emergency care and personnel to the same incident. 3. Once emergency care has been initiated, EMS providers quickly decide on the medical facility to transport the patient to. 4. Patient is assigned a priority of care upon arriving at medical facility 20 III. History of EMS A. Early Development 1. EMS developed from traditional and scientific beliefs of multiple cultures . 2. Most significant advances in EMS occurred during past 50 years 3. Ancient Times a. Evidence that emergency medicine has a very long history . b. Scribes in Mesopotamia (approximately 4,000 –5,000 years ago) inscribed clay tablets with some of the earliest medical records . c. 1862: Egyptologist Edwin Smith purchased papyru s scroll dating back to 1500 B.C.E.; contained 48 medical case histories with data arranged in head -to-toe order of severity d. King Hammurabi of Babylon commissioned a large painting of 282 case laws known today as the “Code of Hammurabi .” 1) One section of cod e devoted to regulation of medical fees and penalties e. Around 900 C.E., Anglo Saxons used a hammock suspended across a horse -drawn wagon for transport . f. By 1100, Normans devised a litter carried between two horses to transport patients . g. First recorded use of ambulance in the Siege of Malaga in 1487 4. The Napoleonic Wars Teaching Tip s Explore the history of EMS with students, expanding on the role the military has played, as well as the m ost recent developments with curriculum changes. Discussion Topics Discuss with students why EMS struggles with funding at the city and state level and through insurance and changes that have occurred in the standard of care for the paramedic. Class Acti vities Create a timeline of dates and important events in EMS history. Have students match them. ( You may want to do this ahead of time . It works well if cards are laminated, which allows taping to the board .) ©201 7 Pearson Education , Inc. Paramedic Care: Principles & Practice, Volume 1, 5th Ed. 3 Chapter 2 objectives can be found on text pp. 12 –13. These objectives, which form the basis of each chapter, were developed from the National Education Standards and the accompanying Paramedic Instr uctional Guidelines . Minutes Content Outline Master Teaching Notes a. Ambulances often used to evacuate the wounded in wars between Napoleon’s French Empire and other European countries 5. The United States in the Nineteenth Century a. Development of ambulances in U.S. occurred in first part of nineteenth century b. Civil War surgeon Jonathan Letterman c. Clara Barton – concept of ambulance volante d. First civilian ambulance established in 1860 (before the Civil War) in Cincinnati , Ohio , by Commercial Hospital e. Bellevue Hospital began to operate an ambulance service in 1869. f. Michael Reese Hospital began to operate a motorized ambulance in 1899. B. The Twentieth Century 1. From World War I to World War II a. High mortality rate associated with evacuation time of 18 hours b. System of transport ation to increasing echelons was created c. Physician interns on ambulances d. 1926: Phoenix Fire Department “inhalator” service e. 1928: First bona fide rescue squad, the Roanoke Life Saving Crew, started f. 1929: Period of the Great Depression; few changes in civili an ambulance services 2. Effects of World War II a. Demands of war caused many hospital -based ambulance services to shut down b. Many city governments turned ambulance services over to local police and fire departments. c. No requirements for minimal training or care d. Ambulance work often seen as a punishment 3. Post–World War II a. End of war brought prosperity to U.S. b. Several medical advances occurred simultaneously. 4. The 1950s a. Use of helicopters in Korean War and Vietnam War ©201 7 Pearson Education , Inc. Paramedic Care: Principles & Practice, Volume 1, 5th Ed. 4 Chapter 2 objectives can be found on text pp. 12 –13. These objectives, which form the basis of each chapter, were developed from the National Education Standards and the accompanying Paramedic Instr uctional Guidelines . Minutes Content Outline Master Teaching Notes b. 1956: Peter Safar and James Elam pioneered use of mouth -to- mouth resuscitation c. 1959: First portable defibrillator used at Johns Hopkins Hospital 5. The 1960s a. 1966: Publication of Accidental Death and Disability: The Neglected Disease of Modern Society (National Academy of Sciences, National Research Council ) 1) “White Paper” spelled out deficiencies in prehospital emergency care 2) Suggested guidelines for development of EMS systems, training of prehospital emergency medical providers, and upgrading ambulances and their equipment 3) Identified numerous problems b. Civilian EMS, as we know it today, evolved significantly in 1960s c. 1966: Highway Safety Act promulgated initial EMS guidelines for the U.S. 6. The 1970s a. 1970: National Registry of Emergency Medical Technicians established b. 1973: Congress passed Emergency Medical Services Systems Act 7. The 1980s a. Passage of the Consolidated Omnibus Budget Reconciliation Act (COBRA) essentially wiped out funding for EMS b. 1988: Statewide EMS Technical Assessment Program established by NHTSA 1) Regulation and policy 2) Resources management 3) Human resources and training 4) Transportation 5) Facilities 6) Communications 7) Trauma systems 8) Public information and education 9) Medical direction ©201 7 Pearson Education , Inc. Paramedic Care: Principles & Practice, Volume 1, 5th Ed. 5 Chapter 2 objectives can be found on text pp. 12 –13. These objectives, which form the basis of each chapter, were developed from the National Education Standards and the accompanying Paramedic Instr uctional Guidelines . Minutes Content Outline Master Teaching Notes 10) Evaluation c. Helicopter air ambulances 8. The 1990s a. 1990: Trauma Care Systems and Development Act passed by Congress b. 1993: Emergency Medical Services for Children , published by the Institute of Medicine c. 1995: Significant variability in trauma system care across U.S. d. Ontario Prehospital Advanced Life Support (OPALS) study 9. EMS Agenda for the Future a. In 1966, National Highway Traffic Safety Administration (NHTSA) published EMS Agenda for the Future ; proposed 14 core EMS attributes 1) Integration of health services 2) EMS research 3) Legislation and regulation 4) System finance 5) Human resources 6) Medical direction 7) Education systems 8) Public education 9) Prevention 10) Public access 11) Communication systems 12) Clinical care 13) Information systems 14) Evaluation C. The Twenty -First Century 1. Department of Homeland Security established 2. National Incident Management System (NIMS) 3. Less than ideal emergency respon se in 2005: Hurricane Katrina and Hurricane Rita a. Additional changes made to improve Federal Emergency Management Agency (FEMA) following these disasters ©201 7 Pearson Education , Inc. Paramedic Care: Principles & Practice, Volume 1, 5th Ed. 6 Chapter 2 objectives can be found on text pp. 12 –13. These objectives, which form the basis of each chapter, were developed from the National Education Standards and the accompanying Paramedic Instr uctional Guidelines . Minutes Content Outline Master Teaching Notes 4. 2010: EMS began to fill nontraditional roles through community paramedicine and mobile integrated healt h care programs . 5. EMS at the Crossroads a. Current delivery system suffers in a number of key areas: 1) Insufficient coordination 2) Coordination of transport within regions is limited. 3) Disparities in response time 4) Uncertain quality of care 5) Lack of readiness fo r disasters 6) Divided professional identity 7) Limited evidence base 6. National Report Card on the State of Emergency Medicine a. The National Report Care on the State of Emergency Medicine: Evaluating the Environment of Emergency Care Systems State by State (2006 ) 1) Pointed out significant problems in all aspects of emergency care 2) Primarily addressed problems in hospital departments but also EMS issues 3) Overall, report detailed that emergency services in U.S. are so overstressed that quality of care has been compr omised 4) Each state given a letter grade that reflected the reported standard of emergency care in that state 7. Helicopter Air Ambulance Recommended Improvements a. 2001: Federal reimbursement for medical helicopters improved b. 2008: Record number of helicopter ai r ambulance crashes c. 2009: National Transportation Safety Board (NTSB) held hearings and later recommended sweeping changes for industry ©201 7 Pearson Education , Inc. Paramedic Care: Principles & Practice, Volume 1, 5th Ed. 7 Chapter 2 objectives can be found on text pp. 12 –13. These objectives, which form the basis of each chapter, were developed from the National Education Standards and the accompanying Paramedic Instr uctional Guidelines . Minutes Content Outline Master Teaching Notes 35 IV. Today’s EMS Systems A. Various service types of EMS: 1. Fire-based 2. Third service 3. Private (profit or nonprofit) 4. Hospital -based 5. Volunteer 6. Hybrid A. Chain of Survival 1. Emergency health care may begin long before an emergency occurs . a. Preventive health care measures b. EMS personnel may periodically visit high -risk and homebound citizens and assess their health status and needs. 2. Chain of survival – consists of the five most important factors affecting survival of a cardiac arrest patient a. Immediate recognition and activa tion of EMS b. Early CPR c. Rapid defibrillation d. Effective advanced life support e. Integrated post –cardiac arrest care Teaching Tips Review all of the components with the student. Most information should be familiar . V. Essential Components for Continuum of Care A. Health Care System Integration 1. EMS recognized as major component of modern health care system 2. Renewed emphasis on roles and responsibilities of EMS system in all types of cardiac emergencies 3. PSAPS are primary interface between EMS and communities it serve s 4. Role of EMS extremely important in identification of acute coronary syndrome and ST -segment elevation myocardial infarction (STEMI)