HomeMy WebLinkAboutItem 8.3 DRFA Attach B
DOUGHERTY REGIONAL
FIRE AUTHORITY
ENGINE C'OMPANY
PARAMEDICS
Presented By, Engineer Jim Call
September' 1994,
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/EXHIBIT B '0 [:)(h'brr 1::-
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SECTION 1
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SECTION 2
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SECTION 3
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SECTION 4
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APPENDIX
· A.
· B.
· C.
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TABLE OF CONTENTS
INTRODUCTION
The Need for Engine Company Paramedics
OPERATIONS
Conditions for Approval
Medical Management and Responsibility
Replacement Policy
Initial Estimated Expenses
Continuing Estimated Expenses
TRAINING OPTIONS
CHP Academy
Chabotl Alameda County Fire Training Program
M.E.T.S. Program
San Ramon Regional Medical Center
CE RTI FICA TIONS/REQUI REMENTS
State Certi fication
State Recertification
County Accreditation
Continuing Education
Required Equipment
Paramedic Approved Skills
Application for Paramedic Course Approval
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SECTION 1
INTRODUCTION
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Throughout the
striving for ways of
new equipment to
programs.
As the population and technology of todays society increases, the
need for updated procedures such as hazardous materials training, disaster
preparedness, and emergency medical services also increases. The leaders
and employees of the fire service must continue to provide the public with
the highest level of service possible.
One particular area in need of constant upgrading is Emergency
Medical Services. Over seventy percent of Dougherty Regional Fire
Authority's responses are related to medical emergencies. Currently when
medical assistance is needed, a fire department vehicle staffed with
Emergency Medical Technicians responds as well as a privately owned,
contracted, Advance Life Support unit. The delay between the arrival of
the fire department and that of a paramedic ambulance is usually about
five to ten minutes. In some cases the ambulance may be delayed much
longer, due to depletion or responses in other parts of the county. The
time lost between the arrival of the fire department and that of the
ambulance IS valuable, and could mean the difference between life or
death.
The delay in patient care can be resolved by staffing DRFA engines
with one paramedic which will allow Advanced Life Support to begin
immediately. The engine company will continue its regular functions and
staffing with the exception of one firefighter being cross trained as a
paramedic. This staffing will assure the highest level of care In the
shortest amount of time.
The proposal of engine company paramedics is not a new concept.
Many cities have adopted this type of program and it has proven very
effective.
The following are but a few of the many benefits which by far
outweigh the program cost:
1. Faster delivery of Advanced Life Support.
2. Paramedics dedicated to DRFA fire districts.
3. Higher level of medical care for department specialty teams
i.e., Hazardous Materials Team, Heavy Rescue Team, etc.
Better disaster preparedness.
Better public relations/education.
Increased span of control at emergency scenes.
Provides Opportunities for future endeavors and financial gain.
history of the fire service departments have been
providing their communities with better service: from
increased public education and fire prevention
4.
5.
6.
7.
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1 SECTION 2
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_I OPERATIONS
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CONDlno~s OF APPROVAL
Prior to initiating an Engine Company Paramedic Program, Dougherty
Regional Fire Authority must be granted approval from both Alameda and
Contra Costa Counties. The following requirements must be met in order to
commence with a paramedic program:
A letter of intent to begin an Engine Company Paramedic
Program must be submitted to the County Emergency
Medical Services District as the initial step for consideration.
Engine company paramedic services must comply with all
related county protocols.
Engine company paramedics shall be staffed with one
certified/accredited paramedic, accompanied by two or more
certified Emergency Medical Technicians.
.
Engine company paramedic units shall be concurrently
dispatched with a paramedic ambulance staffed with two
certi fied paramedics.
Engine company paramedics shall not function as transport
units. Patient transportation shall be provided by an
Advanced Life Support Ambulance contracted by the
county.
Engine company paramedic units shall be equipped and
supplied according to county protocols (see Appendix A).
Engine company paramedic units shall not permanently
advertise that paramedic service is provided, unless
continuous 24-hour service is provided.
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.HEDICAL ,HANAGE.WE.VT .4,VD RESPO:VSiBiLiTiES
Initial responsibiiity for the patients medical management shall rest
with the paramedic of the first arriving unit. Patient care will be
transferred from the engine company paramedic to the transporting
paramedic unit after a patient report has been given. Engine company
paramedics will assist the transporting paramedics with medical care on
scene or while en.route to the hospital. Engine company paramedics are
authorized to perform all paramedic skills in accordance with protocols set
forth by County Emergency Medical Services (see Appendix B).
The following responsibilities also must be met by engine company
paramedics:
Both the engine company paramedic and the transporting
paramedic must initiate a patient care report for each patient
cOlltacl.
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Participation 10 the quality assurance program and incident
review process established by the county EMS is required.
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Engine company paramedics must comply with all treatment
protocols and procedures.
Participation with the county EMS District, base hospital and
the paramedic ambulance company is required.
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EQUIP.WENT REPLACEJIENT POLICY
Engine company
advanced life support
procedures. Options for
paramedic units are responsible
supplies according to their
restocking of supplies include:
for
own
restocking
policies
all
and
All controlled substances (narcotics) must be restocked
through an approved hospital emergency room, such as San
Ramon Regional or Valley Care Hospital.
Other supplies such as standard medications may be restocked
by the responding paramedic ambulance.
Extra supplies will be kept at Dougherty Fire stations in the
medical supply room.
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INITIAL ESTIMATED EXPENSES
Dougherty Regional Fire Authority currently owns a large amount of
required equipment. However, in order to begin
paramedic program approximately $12,000.00 of
and supplies are needed (see Appendix A). Some of
are as follows:
the engine company
additional equipment
the more costly items
.
EKG Monitor (cardiac monitoring/defibrillation)
EKG batteries
Battery charger
Cellular phone (base station
Intubation/advanced airway
Laryngoscope
Endotracheal tubes
hospital communications)
equipment
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CO,VT1.VU1NG ESTI:HA. TED EXPENSES
Continuing expenses will be minimal due to the ability to restock
from the contract ambulance or base hospital. The ambulance company or
hospital that restocks the engine will bill the patient for the equipment
use d.
Dougherty Regional Fire Authority will absorb the cost of various
first aid supplies.
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t SECTION 3
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I TRAINING OPTIONS
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OPTION #1
California Highway Patrol Paramedic Academy
Sacramento. CA
Length of class:
Class schedule:
prerequisites:
Cost:
Contact Person:
Notes:
Chabot College
Fremont, CA
Length of class:
Class Schedule:
Prereq u isi tes:
Cost:
Contact Person:
Notes:
One year to eighteen months
One week at school (08:00-17:00), two weeks
off, on site housing provided.
Anatomy and physiology
$ 900.00 per student
SGT. Fairbrother (916) 322-9717
Class limited to fifteen students, allied
agencies welcome.
OPTION #2
One year to fi fteen months
Firefighter schedule
Anatomy and physiology
$3,000.00 per student
Sheldon Gilbert, ALCO Fire (510) 670-5894
This is the program Alameda County Fire Dept.
has adopted. There is an "in house" preceptor
program being developed.
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M.E.T.S. Paramedic School
Lodi, CA
Length of class:
Class Schedule:
Prerequisites:
Cost:
Contact Person:
Notes:
OPTION #3
One year to eighteen months
Wed. and Fri. (0:900-19:00)
Pre-paramedic class
$ 750.00 for pre-paramedic class
$7,000.00 per student
Administration (209) 368-9690
Paramedic program used by Stockton Fire Dept.
OPTION #4
San Ramon Regional Medical Center
San Ramon, CA
Length of class:
Class Schedule:
Prerequisites:
Cost:
Contact Person:
Notes:
One year to eighteen months
Undetermined
Emergency Medical Technician
Unknown
Upper hospital management
This should only be considered as a possible
training option. As of this time, no specific details
have been discussed with the hospital management.
However, the hospital meets or exceeds all of the
county's required paramedic training standards
(see Appendix E).
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SECTION 4
CERTIFICATION
REQUIREMENTS
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Certi fication:
!:ill1:
Con tact:
Recerti fication:
Cost:
Contact:
5TA. TE CERT1F1CA TION
Certification of paramedics
California EMS Authority.
successful completion of:
is the responsibility of the
Initial certification reqUIres
I. State recognized/approved paramedic school
2. A minimum of 1,032 hours of instruction including:
320 hours of didactic/skills training
160 hours of clinical training
480 hours field internship
3. State written test
4. S tate ski 11 s test
$ 30.00 (written test)
$175.00 (certification fee)
California EMSA
Phone (916) 322-4336
STATE RECERTIFICATION
Recertification is also the responsibility of the
California EMS Authority. Recertification shall be
granted upon successful completion of:
1. State written test every four years
2. 48 hours of approved continuing education
every two years including:
· Category I Field Care Audit (l2hrs.)
· Category II Didactic (24 hrs)
$ 30.00 (written test)
$120.00 (recertification fee)
California EMSA
Phone (916) 322-4336
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COUNTY ACCREDITA T10N
Accredi tation:
After a candidate becomes certified as a paramedic with
the California EMS Authority, he/she must then apply for
accreditation in the county in which they wish to work.
Accreditation is the responsibility of the local county
EMS agency. Accreditation includes orientation to the
county EMS system, training in policies, procedures
and the use of additional skills or medications used by
the county (expanded scope of practice).
Initial Accreditation:
1.
2.
3.
Provide proof of valid California EMT -Paramedic
certi fication
Complete county orientation
Provide documentation of successful training in
the local expanded scope of practice
Provide proof of employment with approved
agency
Complete accreditation application
4.
5.
Cost:
$ 50.00
Contact:
ALCO EMS
Phone (510) 268-7355
Continuous Accreditation:
Once Issued, accreditation shall be continuous as long as
the following objectives are met:
1. Maintain paramedic certification in the state of
California
2. Provide documentation of training in any skill
added to the county's scope of practice
3. Complete the following courses within two years
of accreditation
a. Basic Trauma Life Support
b. Pediatric Advance Life Support
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CONTINUING EDUCA TION
All paramedics are required to complete 48 hours of continuing
education every two years. After submitting a continuing education
approval form to county EMS, the majority of continuing education can be
completed in house using the following methods:
Guest lecturers
Video tapes
Training drills
Audio tapes
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APPENDIX
A
REQUIRED
EQUIPMENT
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FIRST RESPONDER PARAMEDIC EQUIPMENT LIST
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Policy No.: 5503
Date: 04/30/88
FIRST RESPONDER EMT-P EQUIPMENT
OPERATIONS: First Responder
Item
Stretcher, scoop or back board
Airways: Oropharyngeal (sizes 0 thru 6)
41x4" sterile bandage compresses or equivalent
2" or 3" roller bandages
40" triangular bandages
lOx30" or larger universal dressings
1/2", 1", and 2" cloth adhesive tape
Tourniquets (for hemorrhage control)
Bandage shears
Vaseline gauze (3Ix8" or 10"x13")
Bite sticks, padded (commercial or homemade)
Tongue Blade
Blood pressure cuffs (portable):
Adult
Obese
Pediatric
Burn Sheets (sterile) - may be disposable
or linen (with date of sterilization indicated)
Cervical collars:
Stiff: Medium
Sma 11
Pediatri c
Cold packs
Emesis basins or emesis bags with containers
Irrigation equipment and supplies:
TUbing for irrigation
Saline, sterile: l,OOOcc
Water. sterile: 1.000cc
Obstetrical kit (sterile: prepackaged to
include minimum of 2 umbilical cord clamps.
scissors or scalpel. aspiring bulb syringe.
gloves, drapes, antiseptic solution)
Airways: Nasopharyngeal (soft rubber)
30 Fr.
32 Fr.
34 Fr.
Standard
Equipment
Reauirement
1
2 each
12
6
4
2
2 roll sea.
2
1
4
2
2
2
1
1
2
2
2
2
2
2
1
2
2
1
2
1
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OPERATIONS: First Responder
Policy No.: 5503
Date: 04/30/88
FIRST RESPONDER EMT-P EQUIPMENT (continued)
Item
Standard
Equipment
Requirement
Oxygen equipment and supplies:
Nonrebreather masks for 02
administration (transparent)
Adult
Pediatric/Infant (simple)
Nasal cannula for 02 administration
02 tanks
Portable
3
2
4
Resuscitation equipment and supplies:
Face masks for resuscitation (clear)
Adult
Pediatri c
Pocket mask
2
2
1
Resuscitation bag-valve with 02 reservoir
Adult
Pediatric
Glucosepaste (30.8 gm 40~)
Sandbags, 10 lbs each (or equivalent)
Spineboards
Short with accessories/or short
with board extrication devise
2 tubes
4
Splints
With a soft or cushioned surface or
equivalent padded board, wrap ladder,
or cardboard splints
Arm 3x15"
Leg 3x36"
Splints, traction
Adult
Pediatric
Stethoscopes
4
4
1
1
2
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OPERATIONS: First Responder
Policy No.: 5503
Date: 04/30/88
FIRST RESPONDER EMT-P EQUIPMENT (continued)
Item
Pharyngeal tonsil tip (rigid) for suctioning
Suction apparatus (portable)
Suction catheters, No. 18
Suction catheters, Pedi
8 Fr
10 Fr
Standard
Equipment
Requirement
2
1
4
Trash bags
Paper (recommended)
Plastic
EMS Procedure Manual
Maps, entire county
Flashlight
Flairs
Fire Extinguisher
Triage Tags
3
2
1
1
1
6
1
20
ALS EQUIPMENT
Field radio unit (must be operational with
capability to transmit voice/telemetry over
telephone system, i.e., phone patch device)
Laryngoscope equipment:
Batteries (extra)
Blades (curved McIntosh)
Adult
No. 4
No. 3
Pediatric
No. 2
No. 1
Adult (Straight Miller)
No. 4
No. 3
Pediatric
No. 2
No. 1
Bulbs (extra)
Handle
set
1
1
1
1
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OPERATIONS: First Responder
Policy No.: 5503
Date: 04/30/88
FIRST RESPONDER EMT-P EQUIPMENT (continued)
Item
Standard
Equipment
Requirement
Magill Forceps:
Adult
Pediatric
Endotracheal tubes (uncuffed)
Size 3.0
Size 4.0
Size 5.0
1
1
1
Stylet
Pediatric
Adult
Endotracheal tubes cuffed w/adapter
Size 6.0
Size 6.5
Size 7.0
Size 7.5
Size 8.0
Esophageal Gastric Tube Airway (EGTA) with masks
Nasogastric tubes (Salem Sump)
Adult 16 Fr
Hand Held Nebulizer for Inhalation
Medical Trauma Box
1
2
2
2
2
2
1
1
Monitor/defibrillator equipment
Monitor/defibrillator must have strip
recorder and synchronized cardio-
version capabilities; must be portable
(must be operational)
Defibrillator
Batteries, extra (if applicable)
Defibrillating conductive gel or gel pads
1
set
1 tube/2
sets pads
Defibrillator paddle set
Adult
Pediatric
EKG electrodes
Electrode wire (spares) (complete sets)
1
1
9 electrodes
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OPERATIONS: First Responder
Policy No.: 5503
Date: 04/30/88
FIRST RESPONDER EMT-P EQUIPMENT (continued)
Item
Standard
Equipment
Requirement
Percutaneous Transtracheal Ventilation
(PTV) Kit
Pleural Decompression (PO) Kit
Shock trousers (three compartments with
velcro fasteners and "pop-off" valves)
Adult
Pediatric
Alcohol swabs
12 swabs
Blood specimen tubes (vacuum seal)
10 cc red top
7 cc purple top
7 cc green top
Armboards
Long
Short
Butterfly scalp vein needles
(continuous infusion sets)
No. 19
No. 21
No. 23
IV Catheters
No. 14
No. 16
No. 18
No. 20
No. 22
2
1
1
Tourniquet (1" wide)
Tubing
Blood administration sets
Standard with macrodrip
Standard with microdr;p
Lubricant, water soluble small
1
1
1
2
4
4
4
2
4
2
Extension tubes
4
2
4
4
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OPERATIONS: First Responder
Policy No.: 5503
Date: 04/30/88
FIRST RESPONDER EMT-P EQUIPMENT (continued)
Item
Standard
Equipment
Reauirement
Needles
18G:
20G:
22G:
25G:
111
111
1 11211
5/811
2
2
2
2
4
4
2
2
2
4
2
1
1 bottle
1 tube
Oral medication cups (plastic 30 cc graduated)
Paper cups
Syringes
1 cc TB with needle
3 cc with 22G - 1 1/211 needle
3 cc with 25G - 5/811 needle
10 cc without needle
30 cc without needle
50 cc with aspiration tip
Tincture of Benzoin
Betadine Ointment
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OPERATIONS: First Responder
Policy No.: 5503
Date: 04/30/88
FIRST RESPONDER EMT-P EQUIPMENT (continued)
Item
Standard
Equipment
Reauirement
DRUG AND SOLUTION INVENTORY
Alupent preload (0.3cc of 0.6t in 2.2cc NS)
Aminophylline (IV) ampule/500mg/20cc
Atropine sulfate lmg preload lmg/5cc
Benadryl preload 50mg/lcc
Bretylium Tosylate ambule 500mg/10cc
Calcium chloride preload 1 gm/10cc
Dextrose sot preload 25gm/SOcc
Dopamine Hydrochloride preload 400mg/5cc
Epinephrine 1:1.000 ampule lmg/lcc
Epinephrine 1:10.000 preload lmg/l0cc with
21G 1 1/2~ needles
Glucagon
Ipecac
Isuprel lmg/Scc preload
Lasix 40mg/4cc preload
Lidocaine 2t preload 10mg/lcc
Morphine sulfate preload 10mg/lcc
Narcan preload 2mg/2cc
Nitroglycerine tabs Gr. 1/150 (within
expiration date)
Saline. sterile (for injection
(lOcc/single-dose vials)
Sodium bicarbonate preload 44.6mEq or SOmEg/SOcc
Valium (injectable 10mg/2cc preload)
Solutions (in baqs)
DSW SOOcc
Ringer's Lactate (RL) 1.000cc
DSW 100cc
NQIE. :
1
1
2
2
3
1
2
2
2
4
1
bottle
2
2
2
2
6
bottle
1
3
2
2
4
1
Standard Eauioment Reauirement: This list of equipment will be the
minimum amount required to place a new unit into service. It will also be
the normal amount of equipment for operation.
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I eQUIPMENT PURCHASING LIST
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I DOUGHERTY REGIONAL FIRE AUTHORITY
EQUIPMENT PURCHASING LIST
ITEM QUANTITY PRICE
I LARYNGOSCOPE HANDEL 1 21.36
I BLADES [CURVED MciNTOSH] #1 1 29.68
#2 1 29.68
#3 1 29.68
I #4 1 29.68
BLADES [STRAIGHT]
I #1 1 29.68
#2 1 29.68
#3 1 29.68
I #4 1 29.68
REPLACEMENT BLUB 1 19.77 BX.
1 19.77 ex.
I MAGILL FORCEPS
PEDI. 1 6.42
I ADULT 1 6.42
ENDOTRACHEAL TUBES
UNCUFFED #2.5 10 19.50 ax.
I " " #3.0 10 19.50 BX.
" " #4.0 10 19.50 ax.
" " #5.0 10 19.50 ax.
I
CUFFED #6.0 10 19.50 ax.
#6.5 10 19.50 BX.
I #7.0 10 19.50 ex.
#7.5 10 19.50 ax.
I #8.0 10 19.50 ax.
STYL ET
ADULT 3 20.00
I PEDI 3 20.00
THORACENTESIS KIT 1 41.44
I CRICOTHVROMOTY KIT 1 25.84
OX ELECTRODES 2 ax 24.00
PEDI ELECTRODES 1 ax 24.00
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I EQUIPMENT LIST CONTINUIED
I ITEM QUANITY PRICE
JELCO LV. CATH
#14ga. 1 Bx 86.66
I #16ga. 1 Bx 86.66
#18ga. 1 Bx 86.66
I #20ga 1 Bx 86.66
INTEROSSEOUS CATH
#16ga. 1 Bx 68.38
I LV. TUBING
~Y"TYPE BLOOD 1 Ogtt. 1 Bx 279.79
STANDARD MINI DRIP 60gtt. 1 Bx 114.78
I EXTENTION TUBING 1 Bx 89.78
I. V. FLUID
I RINGERS 1000ee BAG 1 Bx 30.13
D5W 500ee BAG 1 Bx 51.46
SYRINGES
I 1 ee TB WITH NEEDLE 1 Bx 19.93
3ee 25G -5/8" NEEDLE 1 Bx 12.49
I 1 Oee WITH OUT NEEDLE 1 Bx 20.30
30ee WITH OUT NEEDLE 1 Bx 16.84
NEEDLES
I #18ga.-1 " 1 Bx 10.08
#20ga.-1 " 1 Bx 10.06
I #25ga- 1" 1 Bx 10.06
BLOOD SPECIMEN TUBES [RED TOPS] 1 Bx 18.85
I MEDICAL SUPPORT PACK 1 239.78
EKG MONITOR/DEFIBRILLATOR 1 8,945.00
I (ZOll PO-140m
BATTERY CHARGING SYSTEM 1 1400.00
(ZOll PD-4420)
I EXTRA BATTERY PAOf< 1 100.00
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APPENDIX
B
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APPROVED
.. SKILLS
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PARAMEDIC SCOPE OF PRACTICE
"Emergency Medical Technician-Paramedic" or "EMT-P" or "Paramedic" or "Mobile Intensive
Care Paramedic" means an individual:
1) who is educated and trained in all elements of prehospital advanced life support according
to standards described by Title 22 of the California Code of Regulations.
2) whose scope of practice to provide advanced life support is in accordance with standards
prescribed by Title 22 of California Administrative Code.
3) who has a valid state certificate and is accredited by the County EMS Medical Director.
100144. Scope of Practice of Emergency Medical
Technician-Paramedic (EMT-P).
(a) An EMT-P may perform any activity identified in the scope of practice of an EMT-I in
Chapter 2 of this Division, or any activity identified in the scope of practice of an
EMT-1I in Chapter 3 of this Division.
(b) An EMT-P student or a certified EMT-P, 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 nUfse, Of physician assistant, or while
at the scene of a medical emergency or during transport, or during interfacility transfer,
may perfofm the following procedures or administer the following 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.
(2) Perform synchronized cardioversion.
(3) Visualize the airway by use of the laryngoscope and remove foreign body( -ies)
with forceps.
(4) Perform pulmonary ventilation by use of the esophageal airway, and endotracheal
intubation. All EMT-Ps shall be trained and tested in adult oral endotracheal
intubation.
(5) Institute intravenous (IV) catheters, heparin locks, saline locks, needles, or other
cannulae (IV lines), in peripheral veins; and monitor and administer medications
through pre-existing vascular access.
(6) Administer intravenous glucose solutions or isotonic balanced salt solutions,
including Ringer's lactate solution.
(7) Obtain venous blood samples.
(8) Use pneumatic antishock trousers.
(9) Perform Valsalva's maneuver.
(10) Perform needle thoracostomy.
(11) Perform nasogastric intubation and gastric suction.
(12) Monitor thoracostomy tubes and IV solutions containing potassium equal to or
less than 20 mEq/L.
Contra Costa County Prehospital Care Manual
Page 3
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(13) Administer, using prepackaged products when available, the following
medications:
(A) 25% and 50% dextrose;
(B) activated charcoal;
(C) aerosolized or nebulized beta-2 specific bronchodilators;
(D) atropine sulfate;
(E) bretylium tosylate;
(F) calcium chloride;
(G) diazepam;
(H) diphenhydramine hydrochloride;
(I) dopamine hydrochloride;
(1) epinephrine;
(K) furosemide;
(L) heparin (for use in heparin locks only) (not currently used in COlllra Costa County);
(M) isoproterenol (not ,'urrently used in Contra Costa County);
(N) lidocaine hydrochloride;
(0) morphine sulfate;
(P) naloxone hydrochloride;
(Q) nitroglycerin preparations, except intravenous, unless permitted under (b)(14)
of this Section;
(R) oxytocin (not currently used in Contra Costa County);
(S) sodium bicarbonate;
(T) syrup of ipecac (not c:urrently used in Contra Costa County); and
(U) terbutaline sulfate (not currently used in Contra Costa County).
(14) Perform or monitor other procedure(s) or administer any other medication(s)
determined to be appropriate for EMT-P use in the professional judgement of the
medical director of the local EMS agency, that have been approved by the
Director of the Emergency Medical Services 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).
,
State of California Paramedic Undefined Scope of Practice
The state EMS Regulations (Title 22) define the basic scope of practice which is authorized for
all paramedics certified in California. In addition, any local EMS Agency may apply to the State
EMSA for additions to the basic scope of practice. These items are considered to be a part of
each county's Paramedic Undefined Scope of Practice.
The following medications and procedures are approved for use in the Contra Costa County
Undefined Scope of Practice:
.I Pediatric Endotracheal Intubation
.I Needle Cricothyrotomy
.I Glucagon
.I High Dose Epinephrine
.I Adenosine
.I Pulse Oximetry
.I Rectal Valium
.I Intraosseous Infusion
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Contra Costa County Prehospital Care Manual
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ALS SKILLS ALLOWED PRIOR TO VOICE CONTACT
An EMT-P may initiate only the following forms of emergency treatment prior to attempting voice
contact with a physician or authorized registered nurse utilizing Contra Costa County Field Treatment
Guidelines:
1. Administer Ringer's Lactate in the adult patient, or intravenous or intraosseous Ringer's Lactate
in the pediatric patient, and obtain blood samples.
2. Perform pulmonary ventilation via endotracheal intubation in a full medical or traumatic
cardiopulmonary or respiratory arrest, or on a patient with a respiratory rate of 6 or less. See
ENDOTRACHEAL INTUBATION section for contraindications.
3. If endotracheal intubation is indicated and is not possible, perform pulmonary ventilation by use
of the EOA, except when an EOA is contraindicated.
4. Defibrillate a patient in ventricular fibrillation or pulseless ventricular tachycardia.
5. Visualize the airway by use of the laryngoscope and remove foreign bodies with Magill forceps
in complete airway obstruction.
6. The following drugs may be administered prior to base contact:
In a medical cardiac arrest:
Epinephrine I: 10,000
Atropine
Lidocaine
Narcan
- I mg - repeat every 3-5 minutes as necessary
- I mg - repeat every 3-5 minutes to max dose of 0.04 mg/kg
- 1.5 mg/kg
- 1.0-2.0 mg (may repeat once)
In an adult patient with symptomatic bradycardia:
Atropine
- 0.5 mg
In an adult patient with probable cardiac chest pain or pulmonary edema:
Nitroglycerin
- 0.4 mg (gr. 1/150) SL (one dose only)
In an adult patient in ventricular tachycardia with a pulse, or with significant PVC's:
Lidocaine
- 1 mg/kg
In an adult patient with an altered level of consciousness:
N arcan
Dextrose 50%
- 1.0-2.0 mg (may repeat once) if narcotic overdose suspected
- 25 gm if hypoglycemia suspected
In an adult or pediatric patient with respiratory distress and wheezes due to acute asthma or
bronchospasm:
Alupent 0.3 mg/2.5ml saline via nebulizer
IN EACIIINSTANCE WIIERE ALS SKILLS ARE PERfORMED PRIOR TO VOICE CONTACf, WITH TilE EXCEPTION
OF PROPHYLACTIC IVs IN STABLE PATIENTS TIIAT 00 NOT REOUlRE FURTIIER AU; INTERVENTIONS,
IMMEDIATELY UPON ABILITY TO MAKE VOICE CONTA(.'T, TilE PARAMEDIC SIIALL MAKE VOICE CONTACf
WITII TilE BASE 1I0SPITAL ON A TAPED LINE. A peR DOCUMENTING TilE ADVANCED LIFE SUPPORT SKILLS
PERfORMED, AND TilE TIME OF BASE CONTA(.'" MUST BE COMPLETED.
Contra Costa County Prehospital Care Manual
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DISRUPTED COMMUNICATIONS
When a paramedic at the scene of an emergency attempts direct voice contact with a base
hospital, but cannot establish or maintain that contact and reasonably determines that a delay in
treatment may jeopardize the patient, the paramedic is expected to transport the patient as soon
as possible. The paramedic may initiate necessary ALS procedures, specified in the Contra Costa
County field treatment guidelines, within the limitations of the disrupted communications policy,
until voice contact with a base hospital is established and maintained, or until the patient is
delivered to the closest appropriate receiving facility. The paramedic will be required to
demonstrate that the treatment delivered was appropriate. Whenever possible, treatment should
be delivered enroute.
Intraosseous infusion may be performed during disrupted communications only when the patient
is in cardiac arrest or profound shock. Rectal diazepam may be administered during disrupted
communications.
If the paramedic utilizes the disrupted communications policy and institutes ALS procedures, the
paramedic shall:
I) Immediately following delivery of the patient to the receiving hospital:
a. make voice contact with the base hospital on a taped line. Paramedics shall not respond
to further calls until this contact is made.
b. verbally notify the paramedic provider agency.
c. complete the PCR documenting the ALS skills performed, and the time of base hospital
con tact.
d. notify, or request that the agency dispatcher notify, Sheriffs Dispatch of the
communication problem, if the paramedic suspects that the problem was due to a
situation other than location.
,
2) Within 24 hours:
a. Send a copy of the completed PCR and a written report explaining the reason/s or
suspected reason/s for communication failure, and the rationale for initiating ALS
treatment, to the following agencies:
I. Base Coordinator at the assigned base hospital
2. Emergency Medical Services Agency
3. Paramedic provider agency
The base physician will evaluate the paramedic written report and forward an evaluation of the
report to the Emergency Medical Services Agency within five (5) working days.
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Contra Costa County Prehospital Care Manual
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ADV ANCED LIFE SUPPORT SKILLS LIST
The following skills may be performed by Contra Costa County paramedics following protocols
or base hospital orders:
1. Adult oral endotracheal intubation
2. Esophageal obturator airway
3. Removal of foreign body obstruction with magill forceps
4. Needle cricothyrotomy'"
5. Defibrillation
6. Cardioversion
7. Intravenous therapy
8. Drug therapy (see drug list)
9. Needle thoracostomy'"
10. Intraosseous infusion"''''
11. Rectal diazepam**
12. Pediatric oral endotracheal intubation'"
13. Use of pulse oximeter
"'Only paramedics who have completed the Contra Costa County advanced airway certification
requirements may perform these skills.
"''''Only paramedics who have completed the Contra Costa County pediatric skills training
requirements may perform these skills.
Contra Costa County Prehospital Care Manual
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ASSESSMENT A~L> PATIENT MANAGEMENT
Paramedics are dispatched on calls according to county dispatching policies. When paramedics
arrive at the scene, they should assess the environment, taking into account their own safety, as
well as that of the patient. They should evaluate the need and availability of on-scene assistance
as well as the ETA to the appropriate hospital.
The assessment of a patient includes the history and a physical examination. The history includes
the patient's stated chief complaint, evaluation of that complaint (may use the mnemonic
PASTMED for dyspnea, or PQRST for pain), the events immediately preceding the present
medical problem, or mechanism of injury in the case of trauma, the past medical history,
medications, and allergies. The physical should include an evaluation of the ABC's, skin signs,
level of consciousness, and vital signs, followed by a head-to-toe secondary survey. A paramedic
may choose to do the history first, followed by the physical, or may do them at the same time.
The two paramedics will work as a team with one doing the direct patient history and physical,
while the other obtains a history from firefighters, family, and by-standers.
Based on the data obtained from the history.and physical, the paramedics should make a general
assessment of the patient's problem. The assessment should include the systems involved that
will require treatment. If the data gathered from the history and physical lead to a more specific
field diagnosis, this may be included in the general assessment.
Based on the ETA to the appropriate hospital, the severity of the patient's condition, and the
general assessment, the paramedic should consider treatment options: I) no paramedic skills are
necessary, transport BLS; 2) ALS skills required, contact base to discuss data and assessment,
and initiate appropriate ALS protocols; 3) patient is critical and requires certain approved ALS
skills prior to contacting base hospital; 4) patient is critical and meets "load and go" criteria with
base and/or receiving hospital contact enroute; 5) patient refuses treatment or transport and signs
out AMA.
,
Regardless of which treatment option is chosen, a patient care report must be completed on each
patient including all the data collected, the general assessment, and treatment provided. The
appropriate copy should be left at the receiving hospital with the remaining copies, including
trauma triage forms, sent to the provider agency.
Monthly copies of forms for ALS calls, BLS calls, and dry runs are forwarded to the base
hospital. The EMS Agency and/or base hospital will periodically evaluate these forms to assure
that treatment was justified based on the assessment and data collected. Any patient care report
may be subject to quality assurance review to assess the appropriateness and adequacy of
advanced life support procedures initiated, and decisions regarding transport.
Contra Costa County Prehospital Care Manual
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OPERATIONS: Patient Care Policies (ALS)
POlicy No.: 7100
Date: 07/01/91
EMT-P AUTHORIZED SKILLS/DRUGS
1. Alameda County Authorized Paramedic Skills
1.1 Antishock trousers
1.2 Cardioversion
1.3 Cricothyrotomy and transtracheal jet insufflation
1.4 Defibrillation
1.5 EKG monitoring and dysrhythmia recognition
1.6 Endotracheal intubation
1.7 Endotracheal medication administration
1.8 Injections (subcutaneous. intramuscular. sublingual)
1.9 Intravenous lines (peripheral. including external jugular)
1.10 Intravenous medication administration
1.11 Intraosseous Infusion
1.12 KCL infusions (monitoring)
1.13 Laryngoscope use
1.14 Magill forceps use
1.15 Oral medication administration
1.16 Percutaneous transtracheal ventilation (needle cricothyrotomy)
1.17 Pleural decompression (needle thoracostomy)
1.18 Preexisting vascular access devices (previously established)
1.19 Rectal Valium
1.20 Sublingual medication (tablet. injection)
1.21 Thorocostomy tubes (monitoring)
1.22 Valsalva maneuver
1.23 Venipuncture
2. Alameda County Authorized Paramedic Drugs
2.1 Alupent Neubulizer (metaproternol sulfate)
2.2 Activated charcoal
2.3 Adenosine - Trial study
2.4 Atropine sulfate
2.5 Benadryl (diphenhydramine)
2.6 Bretylium tosylate
2.7 Calcium Chloride
2.8 Charcoal
2.9 DSH (for drips only)
2.10 Dextrose 251
2.11 Dextrose 501
2.12 Dopamine hydorchloride
2.13 Epinephrine (1:1.000. 1:10.000)
2.14 Glucagon hydrochloride
2.15 Glucose paste
2.16 Isuprel (isoproterenol)
2.17 Lactated Ringers
2.18 Lasix (furosemide)
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OPERATIONS: Patient Care policies (ALS)
Policy No.: 7100
Date: 07/01/91
EMT-P AUTHORIZED SKILLS/DRUGS (continued)
2. Alameda County Authorized Paramedic Druas (continued)
2.19 Lidocaine hydorch1oride (Xy1ocaine)
2.20 Morphine sulfate
2.21 Narcan (naloxone)
2.22 Oxygen
2.23 Sodium bicarbonate
2.24 Nitroglycerine spray
2.25 Valium (diazepam)
3. No EMT-P will perform any skill which has not been authorized by the
Alameda County Health Officer.
4. EMT-Ps will not draw blood alcohols for legal purposes.
5. ALS mobile units are prohibited from carrying any medical equipment or
medication which has not been authorized for prehospita1 use by the
Alameda County Health Officer.
6. While on duty. no EMT-P will carryon his/her person any medical equipment
which has not been approved for use by the Alameda County Health Officer.
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APPENDIX
C
'COUR,SE
,
APPRO'VAL . '
. '
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CONTRA COSTA COUNTY
HEALTH SERVICES DEPARTMENT
EMERGENCY MEDICAL SERVICES
50 GLACIER DRIVE
MARTINEZ, CA 94553-4822
(510)646-4690
EMERGENCY ME_DICAL TECHNICIAN - PABA-MEDIC
TRAINING PROGRAM
APPLICATION FOR COURSE APPROVAL
1/92
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CONTRA COSTA COUNTY HEALTH SERVICES DEPARTMENT
EMERGENCY MEDICAL SERVICES
CHECK LIST: Emergency Medical Technician.Paramedic Training Program Approval
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PAGE # MA TERIALS TO BE SUBMITTED ENCLOSED TO FOLLOW EMS USE ONLY
Application Form
Program Medical Director Information Form
Program Course Director Information Form
Principal Instructor Form(s)
(one for each instructor)
Teaching Assistant Information Form(s)
(one for each assistant)
HospitallField Affiliation Forms
(include written agreements specifying roles
and responsibilities of training program,
hospital, and ambulance company. Also
include copies of evaluation forms and
evaluation criteria)
Class Site Location Fonn
Student Eligibility Criteria
Entrance Qualifying Exam and/or
Prerequisites
Statement of Course Objectives
Course Outline: must include topics identified
in US DOT curriculum
Lesson Plans and Objectives
Perfonnance Objectives for each Skill ..
Course Scbedule(include proposed dates)
Samples of Written and Skills Exams
Final Written Exam
Statement verifying usage of DOT EMT-P
Curriculum
"No more than six(6) students will be assigned to one(l) individual during the skills practice/laboratory.
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CONTRA COSTA COUNTY HEALTH SERVICES DEPARTMENT
EMERGENCY MEDICAL SERVICES
PARAMEDIC TRAINING PROGRAM
Name of Training Institution:
Street:
City:
County:
Phone: (
Zip:
)
State:
Course Title:
Program Director:
Program Medical Director:
Principal Instructor( s):
Basic Paramedic Course:
Total Hours:
Didactic/Skills Hours:
Clinical Hours:
Field Internship Hours:
(minimum 1032 hours)
(minimum 320 hours)
(minimum 160 hours)
(minimum 480 hours)
WEEKS
Semester:
Units of Credit:
Other(specify):
Quarter:
TEXT(S) TITLE
AUTHOR
COPYRIGHT DATE
REVISED EDmON
PERSON WHO PREPARED APPLICATION PACKAGE:
NAME:
TITLE:
TELEPHONE: (
DATE SUBMITIED:
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CONTRA COSTA COUNTY HEALTH SERVICES DEPARTMENT
EMERGENCY MEDICAL SERVICES
PARAMEDIC TRAINING PROGRAM
PROGRAM DIRECTOR INFORMATION FORM
Name:
Occupation:
(must be physician. RN. or paramedic)
Professional and/or Academic Degree{s) held: (must have baccalaureate degree)
Professional License Number(s):(if applicable)
What California Teaching Credential(s) do you now hold?
Type:
Type:
Expiration Date:
Expiration Date:
Administrative and/or Management Experience: (minimum 1 year)
Academic or Clinical Experience in ALS prehospital care:(minimum 3 years within the past 5 years)
Course content you will teach. by subject: (if applicable)
Signature of Program Director
Date
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CONTRA COSTA COUNTY HEALTH SERVICES DEPARTMENT
EMERGENCY MEDICAL SERVICES
PARAMEDIC TRAINING PROGRAM
PROGRAM MEDICAL DIRECTOR INFORMATION FORM
Name:
Occupation:
(must be physician)
Professional and/or Academic Degree(s) held:
Professional License Number(s):(if applicable)
What California Teaching Credential(s) do you now hold?
Type:
Type:
Expiration Date:
Expiration Date:
Administrative and/or Management Experience:
Academic or Clinical Experience in ALS prehospital care:(minimum 2 years within the past 5 years)
Course content you will teach, by subject: (if applicable)
Signature of Program Medical Director
Date
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CONTRA COSTA COUNTY HEALTH SERVICES DEPARTMENT
EMERGENCY MEDICAL SERVICES
PARAMEDIC TRAINING PROGRAM
PRINCIPAL INSTRUCTOR INFORMATION FORM
Name:
Occupation:
(must be physician. RN, or paramedic)
Professional and/or Academic Degree(s) held:
Professional License Number(s):(if applicable)
What California Teaching Credential(s) do you now hold?
Type:
Type:
Expiration Date:
Expiration Date:
Academic or Clinical Experience in ALS prehospital care:(minimum 2 years within the past 5 years)
Course content you will teach, by subject:(if applicable)
Principal Instructor Signature Date
is qualified to teach those sections of the course s/he is assigned.
Signature of Program Director
Date
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CONTRA COSTA COUNTY HEALTH SERVICES DEPARTMENT
EMERGENCY MEDICAL SERVICES
PARAMEDIC TRAINING PROGRAM
TEACHING ASSISTANT INFORMATION FORM
Name:
Occupation:
Professional and/or Academic Degree(s) held:
Professional License Number(s):(if applicable)
What California Teaching Credential(s) do you now hold?
Type:
Type:
Expiration Date:
Expiration Date:
Academic or Clinical Experience in ALS prehospital care:(minimum 2 years within the past 5 years)
Course content you will teach. by subject: (if applicable)
Teaching Assistant Signature Date
is qualified to teach those sectiODS of the course slbe is assigned.
Signature of Program Director
Date
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CONTRA COSTA COUNTY HEALTH SERVICES DEPARTMENT
EMERGENCY MEDICAL SERVICES
PARAMEDIC TRAINING PROGRAM
HOSPITAL AFFILIATION FORM
Name(s) of hospital(s) where student emergency department instruction is located:
NAME:
STREET:
CITY:
CONTACT PERSON:
ZIP:
NAME:
STREET:
CITY:
CONTACT PERSON:
ZIP:
NAME:
STREET:
CITY:
CONTACT PERSON:
ZIP:
NAME:
STREET:
CITY:
CONTACT PERSON:
ZIP:
NAME:
STREET:
CITY:
CONTACT PERSON:
ZIP:
NAME:
STREET:
CITY:
CONTACT PERSON:
ZIP:
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CONTRA COSTA COUNTY HEALTH SERVICES DEPARTMENT
EMERGENCY MEDICAL SERVICES
PARAMEDIC TRAINING PROGRAM
AMBULANCE AFFILIATION FORM
Name(s) of ambulance service(s) where student field internship is located:
NAME:
STREET:
CITY:
CONTACT PERSON:
ZIP:
NAME:
STREET:
CITY:
CONTACT PERSON:
ZIP:
NAME:
STREET:
CITY:
CONTACT PERSON:
ZIP:
NAME:
STREET:
CITY:
CONTACT PERSON:
ZIP:
NAME:
STREET:
CITY:
CONTACT PERSON:
ZIP:
NAME:
STREET:
CITY:
CONTACT PERSON:
ZIP:
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CONTRA COSTA COUNTY HEALTH SERVICES DEPARTMENT
EMERGENCY MEDICAL SERVICES
PARAMEDIC TRAINING PROGRAM
CLASS SITE LOCATION FORM
Please indicate below the address where each Paramedic Training Program will be offered, if the location is other than at the
address shown on the Application Form.
Primary Instructor:
Teaching Assistants:
Location:
Address:
City:
Zip:
Proposed Dates:
Primary Instructor:
Teaching Assistants:
Location:
Address:
City:
Zip:
Proposed Dates:
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CONTRA COSTA COUNTY HEALTH SERVICES DEPARTMENT
EMERGENCY MEDICAL SERVICES
PARAMEDIC TRAINING PROGRAM
STUDENT ELIGIBILITY FORM
To be eligible to enroll in the Paramedic Training Program, what requirements must be met:
Are there additional requirements that must be met for course completion:
YES
NO
If Yes, please describe:
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CONTRA COSTA COUNTY HEALTH SERVICES DEPARTMENT
EMERGENCY MEDICAL SERVICES
PARAMEDIC TRAINING PROGRAM
BASIC COURSE OUTLINE CHECKLIST
Please attach this form to your basic course outline
REQUIRED TOPICS
ROLES AND RESPONSIBILITIES
EMERGENCY MEDICAL SERVICES SYSTEMS:
Recognition and access
Initiation of the Emergency Medical Services Response
Management of the scene
- Medical control
- Scene control
- When to call for backup
Transportation of emergency personnel, equipment. and the patient
- CHP equipment mandate(requirements)
- Determination of destination
Overview of hospital categorization and designation
- Base hospital
- Critical care centers(trauma centers, pediatric centers, etc.)
- Emergency facility - comprehensive. basic, standby
- Receiving hospital
Communications overview
- Radio
- Telemetry
1 1
Indicate by page number where
included in course outline
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- Telephone
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Recordkeeping and evaluation, including data collection
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MuIticasuaIty incidents and disasters
Role and responsibility of the State and local EMS system management
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MEDICAL/LEGAL CONSIDERATIONS
Laws governing the EMT-P:
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Abandonment
Child abuse, elder abuse, and other laws that require reporting
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Consent - implied and informed
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Good Samaritan Laws
Legal detention(Welfare and Institutions Code, Section 5150 and 5170)
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Local policies and procedures, to include pronouncing/determining death
Medical control
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Medical practice acts affecting the EMT-P
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Negligence
Overview of EMT-I. EMT-II, and EMT-P in California
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Special procedures utilized for victims of suspected criminal acts, including
preservation of evidence.
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The health professional at the scene
Written medical records
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Overview of issues concerning the health professional:
Death and dying
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Malpractice protection
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Medical ethics and patient confidentiality
Safeguards against communicable diseases
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EMERGENCY MEDICAL SERVICES COMMUNICATIONS
Emergency medical services communication system:
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Radio communication
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System components
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Telephone Communication
Communication regulations and procedures:
Communication policies and procedures
Radio troubleshooting
Radio use
Role of Federal Communications Commission(FCC)
Skills Protocols:
Radio mechanics(operational skill)
EXTRICATION AND RESCUE
Extrication and Rescue:
MAJOR INCIDENT RESPONSE
Multicasualty Disaster Management: (including Incident Command System)
Local policies and protocols
Medical management
Triage (including S.T.A.R.T.)
Hazardous Materials:
Principles of hazardous materials management, to include tear gas and radiation
exposure and precautions
STRESS MANAGEMENT
MED ICAL TERMINOLOGY ~li;11!1.'l;~:il~~1rl~jl~jl~~~:::!~1~1:::::::.:;I'!':1I:I~~:~:::':I.
Medical Terminology, including anatomical terms:
GENERAL PATIENT ASSESSMENT AND INlT1AL MANAGEMENT
:1..,.::i'~:il~il~~~::~1111'Jlt'~;r~::~:11:ii!iiil.l~:i~iii.i:.,::i~::I:I:I'I:'.l!'i:~
:::I:.:\\:.~!~!i~I~~~11ItI1~~11:;ll::::::ll:::in::i:~::::;,::::i::~::::'.:.:'::::::
. -. ...................
Human Systems:
Basics of anatomy and physiology. to include:
- Body cavities
- Cardiovascular (circulatory) system
. Digestive system
. Endocrine system
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- Genitourinary system
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- Homeostasis
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- Integumentary system
. Muscular system
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- Nervous system
- Respiratory system
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- Skeleton system
- The cell - basic structure and function
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. Tissues
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Patient assessment:
Pertinent patient history
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Physical examination
Prioritization of assessment and management
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Scene assessment
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Reporting format for presenting patient information:
Skills protocols:
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Diagnostic signs
Patient assessment
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Reporting patient information
AlRW A Y AND VENTILATION
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Airway Management: assessment and prehospital management of the patient i respiratory
distress, emphasizing techniques under Skills Protocols
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Skills Protocols:
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Basic airway adjuncts:
- Bag/valve systems
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- Demand valves
- Nasopharyngeal airways
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- Oropharyngeal airways
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- Oxygen administration devices
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- Suctioning and portable suction equipment
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Chest auscultation
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Direct laryngoscopy and use of Magill forceps for removal of foreign body
Endotracheal intubation(ET), to include drug administration and suctioning, and
intubation of the chronic stoma
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Esophageal aifWay, including esophageal gastric tube aifWay (EGT A)
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PATHOPHYSIOLOGY OF SHOCK
Fluids and Electrolytes:
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Acid-base balance
Blood and its composition
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Body fluids and distribution
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Electrolytes
Intravenous solutions
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Osmosis and diffusion
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Assessment and Management - Pathophysiology, specific patient assessment, associated
complications, and the prehospital management of shock to include:
Cardiogenic shock
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Distributive shock
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Hypovolemic shock
Obstructive shock
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Skills Protocols:
IV techniques
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- peripheral IV insertion, to include sterile techniques and preparation of equipment(IV
tubing, bottle, and bag)
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- withdrawal of blood samples by venipuncture
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Pneumatic antishock trousers, to include indications, contraindications, associated
complications, and application/deflation procedure
GENERAL PHARMACOLOGY
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Introduction to phannacology
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Classi fications
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Factors which affect action, onset of action and duration
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General drug actions
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Home medications
Routes of administration
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Terminology
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Computing dosages
Drug Dosages:
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Weights and measures, including review of the metric system
Autonomic Nerves:
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Parasympathetic
Sympathetic, to include alphalbeta
.\lj~~::~!~~:I.t~II~I~~~.~\..\I\\~\~:\:.::\\~::i\\:::.:~\\\\ii\:\.:\:::\\.m::
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Drug Preparation and Administration Skills:
Addition of drugs to IV bottle, bag or volutrol, and regulating rate of infusion
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Administration of drugs directly into a vein
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Administration of drugs through an endotracheal tube(as part of ET skill)
Inhalation
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Intramuscular injections
Oral
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Subcutaneous injections
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Sublingual (not for injection)
Sublingual injections
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Preexisting vascular access devices
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Anatomy and Physiology
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Soft-Tissue lnjuries - pathophysiology, specific patient assessment, mechanism of injury.
associated complications, and the prehospital management of soft tissue injuries to include:
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Head and neck injuries
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Wounds - open and closed
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Eye injuries
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Skills Protocols:
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Bandaging
Control of external hemorrhage
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Eye irrigation
Immobilizing impaled objects
Impaled objects including removal of impaled object in cheek
Pneumatic antishock trousers
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MUSCULOSKELETAL INJURIES
Anatomy and Physiology
Musculoskeletal Injuries: Pathophysiology, specific patient assessment, mechanism of injury,
associated complications, and the prehospital management of musculoskeletal injuries to
include:
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Fractures
Dislocations
Sprains and strains
Skills Protocols:
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Pneumatic antishock trousers
Rigid splint
Sling and swath
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Traction splint
CHEST TRAUMA
Hemothorax
Impaled objects
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Myocardial and great vessel trauma
Pneumothorax and tension pneumothorax
Rib fractures and flail chest
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Skills Protocols:
ABDOMINAL TRAUMA - to include pelvic and genitourinary trauma
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HEAD AND SPINAL CORD TRAUMA: pathophysiology, specific assessment, mechanism of
injury, associated complications
Skills Protocols:
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Cervical immobilization
Helmet removal
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Spinal immobilization
MUL nSYSTEM INJURIES
BURNS
Anatomy and Physiology
Assessment and Treatment
RESPIRATORY SYSTEM
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Anatomy and Physiology of the Respiratory System to include:
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Composition of gases in the environment
Exchange of gases in the lung
Regulation of respiration
Respiration patterns
Respiratory Distress:
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Asthma and chronic obstructive pulmonary disease
Cerebral and brain stem dysfunction
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Dysfunction of spinal cord, nerves or respiratory muscles
Hyperventilation syndrome
Pneumonia
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Pulmonary embolism
Spontaneous pneumothorax
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Upper airway obstruction
Acute Pulmonary Edema - cardiac and noncardiac
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Near drowning
Toxic Inhalations
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CARDIOVASCULAR SYSTEM
Anatomy and Physiology
Cardiac conduction system
Cardiac cycle
Cardiac output and blood pressure
Electromechanical system of the heart
Nervous control
Introduction of Electrocardiogram Interpretation
Components of the electrocardiogram record
Electrophysiology
Identifying normal sinus rhythm
Dysrhythmia recognition, to include prebospital management for:
Artifact
Artificial pacemaker rhythms
Atrial fibrillation
Atrial flutter
Cardiac standstill (asystole)
Electromechanical dissociation
First degree atrioventricular block
Idioventricular rhythm
Junctional rhythm
Premature junctional contractions
Premature ventricular contractions
Second degree atrioventricular block
Sinus arrhythmia
Sinus bradycardia (with hypotension)
Sinus tachycardia
Supraventricular tachycardia
Third degree atrioventricular block
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Ventricular fibrillation
Ventricular tachycardia
Cardiovascular Disorders:
aortic aneurysm
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Cardiogenic shock
Congestive heart failure
Coronary artery disease, angina, and acute myocardial infarction
Hypertensive emergencies
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Skills Protocols:
ACLS megacode modified for field situation
Basic cardiac life support (BCLS)
Cardiac monitoring
Defibrillation and synchronized cardioversion
Vagal maneuvers, specifically, val salva maneuvers
ENDOCRINE EMERGENCIES
Pathophysiology, specific patient assessment, associated complications, and the prebospital
management of emergencies, including diabetic ketoacidosis and hypoglycemic reactions
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NERVOUS SYSTEM
Anatomy and Physiology of the Nervous System to include:
Autonomic nerves
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Brain and spinal cord
Peripheral nerves
Nervous System Disorders, to include altered level of consciousness and other central nervous
system (CNS) disorders
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Coma
Seizures
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Stroke
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Syncope
Other causes
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ACUTE ABDOMEN. GENITOURINARY, REPRODUCTIVE SYSTEMS,
NONTRAUMA TIC ACUTE ABDOMEN
Gastrointestinal bleeding and emergencies of the genitourinary and reproductive
systems
AN APHYLAXISI ALLERGIC REACTIONS
TOXICOLOGY, ALCOHOLISM, AND DRUG ABUSE
Toxicology and Poisoning
Alcoholism and Drug Abuse
INFECTIOUS DISEASES
Communicable diseases - understanding of communicable diseases to include
transmission and special precautions
ENVIRONMENTAL INJURIES
Environmental Emergencies:
Atmospheric pressure related emergencies to include:
- compressed air diving injuries and illnesses
- mountain sickness and other high altitude syndromes
Lightning and other electrical injuries
Poisonous and nonpoisonous bites and stings
The atmospheric and thermal environment and the physiology of temperature
regulation
- cold exposure
- heat exposure
Thennal injuries and illnesses
Skills Protocols:
Application of constricting bands
Snake bite kit
PEDIATRIC
Special considerations in relationship to illness and injury to include:
Approach to parents
Approach to pediatric patients
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Growth and development
Pediatric Emergencies:
Cardiopulmonary arrest, to include ACLS protocols
Child abuse/neglect, including preservation of evidence
Medical emergencies to include:
- altered level of consciousness, including coma
- common communicable diseases(childhood illnesses)
- meningitis
- seizures
Near drowning
Poisoning
Respiratory distress
- allergic reactions/anaphylaxis
- asthma/bronchitis
- epiglottitis
- foreign body aspiration
- pneumonia
- tracheobronchitis( croup)
Sudden Infant Death Syndrome(SIDS)
Trauma, including shock
Skills Protocols:
Airway adjuncts utilized for neonates, infants, and children
Child resuscitation
Cooling measures
Infant resuscitation
Intravenous techniques utilized for neonates, infants. and children
,:;:\",:,-pij$1iriUq..\L;qYNEtiQt.ooiqAEi:NE.QNiTg:JttI~~!QJW~l!:!:i:::..,::i:::,:.j.:::,i:,::::j:j!::::;::!:,.!:
ANATOMY AND PHYSIOLOGY OF THE FEMALE REPRODUCTIVE SYSTEM
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NORMAL CHILDBIRTH - The states of labor and normal deliver. including assessment and
management
OBSTETRICAL EMERGENCIES
Abnormal fetal presentation
Abortion
Abruptio Placenta
Breech Birth
Failure to Progress
Multiple Birth
Placenta Previa
Post Partum Hemorrhage
Premature Birth
Prolapsed Cord
Ruptured Ectopic Pregnancy
Supine Hypotension Syndrome
Toxemia of Pregnancy
GYNECOLOGICAL EMERGENCIES
Pelvic Inflammatory Disease
Ruptured Ovarian Cyst
Vaginal Bleeding
THE NEONATE
APGAR scoring
Resuscitation
Temperature regulation
Skills Protocols:
Assisting with Breech delivery
Assisting with Normal deliveries, to include care of the newborn
Management of the prolapsed cord
Neonatal resuscitation
;;.'~II~~lj!illr~:~j::;':;~~~~~:;i"":::"I:::::.::":",:1
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. .
... ..... .............
.. . ... .
....~:p*~.PRdj~~<..
..... ..," ............. ,','....'.'................ ......,...........
PREHOSPITAL CARE OF PATIENTS EXPERIENCING BEHAVIORAL EMERGENCIES
Behavioral Respo0se8 to illness, injury. death, and dying by:
Bystanders
EMT-Ps
Family
Friends
Other responders
Patients
Bebavioral Emergencies:
.!~:;1.;!i::i!:i~ii~ii:!!ir~.!:~llt~I\~'~i!~II~lii~~:!I
Emotional crisis
Substance abuse
Victims of assault, to include sexual assault
Use of community resources
Skills Protocols:
Application of restraints
Management of difficult patient situations
ASSAULT VICTIMS
GERIATRIC PATIENTS
DISABLED PATIENTS
Actions, classification, indications, contraindications, dosages, how supplied, interactions, side
effects, complications, and preferred routes of administration of the following drugs:
li~I~.!~~i'I,:~!:::;i:.ii.II.I~1.1~:li~~[lrl~:::;i::::\.;:.~!iii:i!i;;;;:.:!;:;:::;
~.
25 % and 50 % Dextrose
Activated Charcoal
Aerosolized or Nebulized bet-2 specific Bronchodilators
Atropine Sulfate
Bretylium Tosylate
Calcium Chloride
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Diazepam
Diphenhydramine Hydrochloride
Dopamine Hydrochloride
Epinephrine
Furosemide
Heparin (for use in heparin locks only)
Isoproterenol
Lidocaine Hydrochloride
Morphine Sulfate
Naloxone Hydrochloride
Nitroglycerin preparations
Oxytocin
Sodium Bicarbonate
Syrup of Ipecac
Terbutaline Sulfate
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OAL Approved: November 1991
Effective: January 1, 1992
Article 3. Program Requirements for EMT-P Training programs
100147. Approved Training programs.
(a) The purpose of an EMT-P training program shall be to prepare
individuals to render prehospital advanced life support within an
organized EMS system.
(b) EMT-P training shall be offered only by approved training
programs. Eligibility for program approval shall be limited to
the following institutions:
(1) Accredited universities and colleges, including junior and
community colleges and private post-secondary schools.
(2) Medical training units of a branch of the Armed Forces or
Coast Guard of the United States.
(3) Licensed general acute care hospitals which meet the
following criteria:
(A) Hold a special permit to operate a basic or comprehensive
emergency medical service pursuant to the provisions of
Division 5;
(8) provide continuing education to other health care
professionals; and
(C) are accredited by the Joint Commission on the Accreditation
of Healthcare Organizations.
(4) Agencies of government.
NOTE: Authority cited: Sections 1797.107, 1797.172 and 1797.173,
Health and Safety Code. Reference: Sections 1797.172, 1797.173,
1797.208 and 1797.213, Health and Safety Code.
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OAL Approved: November 1991
Effective: January 1. 1992
100148. Teaching staff.
(a) Each program shall have an approved program medical director
who shall be a physician currently licensed in the State of
california, who has two (2) years experience in prehospital care
in the last five (5) years, and who is qualified by education or
experience in methods of instruction. Duties of the program
medical director shall include, but not be limited to:
(1) Approval of all course content.
(2) Approval of content of all written and skills examinations
administered by the training program, except the state skills
examination,
(3) Approval of provision far hospital clinical and field
internship experiences.
(4) Approval of principal instructor(s) qualifications,
(b) Each program shall have an approved course director who
shall be a physician Or registered nurse or EMT-P who has a
baccalaureate degree. These individuals shall be currently
licensed or certified in the State of California. Individuals
who hold a baccalaureate degree in a related health field or in
education may also be a COUrse director. The course director
shall have a minimum of one year experience in an administrative
or management level position and have a minimum of three (3)
years experience in prehospital care within the last five (5)
years. Duties of the cOUrse director shall include, but not be
limited to:
(1) Administration of the training program.
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OAL Approved: November 1991
Effective: January 1, 1992
(2) In coordination with the program medical director, approve
the principal instructor, teaching assistants, field and hospital
clinical preceptors, clinical and internship assignments, and
coordinate the development of curriculum.
(3) Ensure training program compliance with this Chapter and
other related laws.
(4) sign all course completion records.
(c) Each program shall have a principal instructor(s), who may
also be the program medical director or course director if the
qualifications in subsections (a) and (b) are met, who shall:
(1) Be a physician, registered nurse, physician assistant, or
EMT-P, currently licensed or certified in the State of
California.
(2) Have two (2) years experience in prehospital care within the
last five (5) years.
(3) Have six (6) years experience in an allied health field or
related technology and an associate degree or, two (2) years
experience in an allied health field or related technology and a
baccalaureate degree.
(4) Be responsible for areas inClUding, but not limited to,
curriculum development, course coordination, and instruction.
(d) Each training program may have a teaching assistant(s) who
shall be an individual(s) qualified by training and experience to
assist with teaching of the course. A teaChing assistant shall
be supervised by a principal instructor, the course director
and/or the program medical director.
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OAL Approved: November 1991
Effective: January 1, 1992
(e) Each program shall have a field preceptor(s) who shall:
(1) Be a physician, registered nurse, or physician assistant, or
EMT-P currently licensed or certified in the State of California;
and
(2) Have two (2) years field experience in prehospital care
within the last five (5) years.
(3) Be under the supervision of a principal instructor, the
course director and/or the program medical director.
(f) Each program shall have a hospital clinical preceptor(s) who
shall:
(1) Be a physician, registered nurse or physician assistant
currently licensed in the State of California.
(2) Have two (2) years experience in emergency care within the
last five (5) years.
(3) Be under the supervision of a principal instructor, the
course director, and/or the program medical director.
NOTE: Authority cited: sections 1797.107 and 1797.172, Health and
Safety Code. Reference: Sections 1797.172 and 1797.208, Health
and Safety Code.
100149. Didactic and Skills Laboratory.
An approved EMT-P training program shall assure that no more than
six (6) students are assigned to one (1) instructor/teaching
assistant during skills practice/laboratory.
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OAL Appro ved: No vember 1991
Effective: January 1, 1992
NOTE: Authority cited: 1797.107, 1797,172 and 1797.173 Health and
Safety Code. Reference: Sections 1797.172, 1797.173 and
1797.208, Health and Safety Code.
100150. Hospital Clinical Education and Training for EMT-P.
(a) An approved EMT-P training program shall provide for and
monitor a supervised clinical experience at a hospital(s) that is
licensed as a general acute care hospital and holds a permit to
operate a basic or comprehensive emergency medical service. The
clinical setting may be expanded to include areas commensurate
with the skills experience needed. Such settings may include
surgicenters, clinics, jails or any other areas deemed necessary
by the local EMS agency., The maximum number of hours in the
expanded clinical setting shall not exceed forty (40) hours of
the total clinical hours specified in section 100158(a) (2).
(b) Training programs in nonhospital institutions shall enter
into a written agreement(s) with a licensed general acute care
hospital(s) that holds a permit to operate a basic or
comprehensive emergency medical service for the purpose of
providing this supervised clinical experience.
(c) EMT-P clinical training hospital(s) shall provide clinical
experience, supervised by a clinical preceptor(s). The clinical
preceptor may assign the student to another health professional
for selected clinical experience. No more than two (2) students
shall be assigned to one (1) preceptor or health professional
during the supervised hospital clinical experience at anyone
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OAL Approved: November 1991
Effective: January 1, 1992
time. Clinical experience shall be monitored by the training
program staff and shall include direct patient care
responsibilities, which may include the administration of
additional medications that are designed to result in the
competencies specified in this Chapter. Clinical assignments
shall include, but are not limited to: emergency, cardiac,
surgical, obstetric, and pediatric patients.
NOTE: Authority cited: Sections 1797,107, 1797.172 and 1797.173,
Health and Safety Code. Reference: sections 1797.172, 1797.173
and 1797.208, Health and Safety Code.
100151. Field Internship.
(a) An approved EMT-P training program shall enter into a
written agreement with an EMT-P service provider(s) to provide
for field internship, as well as for a field preceptor(s) to
directly supervise, instruct, and evaluate the students. If the
EMT-P service provider is located outside the jurisdiction of the
EMT-P Approving Authority, then the EMT-P training program shall
notify the local EMS agency where the EMT-P service provider is
located.
(b) No more than one EMT-P student shall be assigned to a
response vehicle at anyone time during the field internship.
NOTE: Authority cited: Sections 1797.107, 1797.172 and 1797.173,
Health and Safety Code. Reference: Sections 1797.172, 1797.173
and 1797.208, Health and safety Code.
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OAL Approved: November 1991
Effective: January 1, 1992
100152. Procedure for Program Approval.
(a) Eligible training institutions shall submit a written
request for program approval to the EMT-P Approving Authority.
(b) The EMT-P Approving Authority shall receive and review the
following prior to program approval:
(1) A statement verifying that the course content is equivalent
to the U.S. Department of Transportation (DOT) Emergency Medical
Technician-Paramedic National Standard Curriculum HS 900 089,
(2) A course outline if different from the outline specified in
Section 100159 of this Chapter.
(3) Performance objectives for each skill.
(4) The name and qualifications of the training program course
director, program medical director, and principal instructors.
(5) provisions for supervised hospital clinical training
including student evaluation criteria and standardized forms for
evaluating EMT-P students; and monitoring of preceptors by the
training program.
(6) Provisions for supervised field internShip including student
evaluation criteria and standardized forms for evaluating EMT-P
students; and monitoring of preceptors by the training program.
(7) The location at which the courses are to be offered and
their proposed dates.
(c) The EMT-P Approving Authority shall review the following
prior to program approval:
(1) Samples of written and skills examinations administered by
the training program for periOdic testing.
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GAL Approved: November 1991
Effective: January 1, 1992
(2) A final written examination administered by the training
program.
(3) Evidence that the program provides adequate facilities,
equipment, examination security, and student record keeping.
(d) The EMT-P Approving Authority shall make available to the
state EMS Authority, upon request, any or all materials submitted
pursuant to this section by an approved EMT-P training program in
order to allow the state EMS Authority to make the determination
required by section 1797.173 of the Health and Safety Code.
NOTE: Authority cited: sections 1797.107 and 1797.172, Health and
Safety Code. Reference: Sections 1797.172, 1797.173 and
1797.208, Health and Safety Code.
100153. program Approval.
(a) Program approval or disapproval shall be made in writing by
the EMT-P Approving Authority to the requesting training program
after receipt of all required documentation. This time period
shall not exceed three (3) months.
(b) The EMT-P Approving Authority shall establish the effective
date of program approval in writing upon the satisfactory
documentation of compliance with all program requirements.
(e) Program approval shall be for two (2) years following the
effective date of approval and may be renewed every two (2) years
SUbject to the procedure for program approval specified in this
Chapter.
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OAL Approved: November 1991
Effective: January " 1992
NOTE: Authority cited: Sections 1797.107 and 1797.172, Health and
Safety Code, Reference: Sections 1797,172, 1797.173 and
1797.208, Health and Safety Code.
1001S~. Application of Requlations to Existing Training programs.
All EMT-P training programs in operation prior to the January 1,
1992 revisions to these regulations shall submit evidence of
compliance with this Chapter to the EMT-P Approving Authority for
the county in which they are located within six (6) months after
the effective date of the revised regulations.
NOTE: Authority cited: sections 1797.107 and 1797.172, Health and
Safety Code. Reference: Section 1797.172, Health and Safety
Code.
100155. program Review and Reporting.
(a) All program materials specified in this Chapter shall be
subject to periodic review by the EMT-P Approving Authority and
may also be reviewed by the EMS Authority.
(b) All programs shall be subject to periodic on-site evaluation
by the EMT-P Approving Authority and may also be evaluated by the
EMS Authority.
(c) Any person or agency conducting a training program shall
notify the EMT-P Approving Authority in writing, in advance when
possible, and in all cases within thirty (30) days of.any change
in course content, hours of instruction, course director, program
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medical director, principal instructor, provisions for hospital
clinical experience, or field internship,
NOTE: Authority cited: sections 1797,107 and 1797.172, Health and
Safety Code. Reference: Sections 1797,172 and 1797.208, Health
and Safety Code.
100156. withdrawal of Program Approval.
Noncompliance with any criterion required for program approval,
use of any unqualified teaching personnel, or noncompliance with
any other applicable provision of this Chapter may result in
suspension or revocation of program approval by the EMT-P
Approving Authority. An approved EMT-P training program shall
have no more than sixty (60) days from date of written notice to
comply with this Chapter.
NOTE: Authority cited: sections 1797.107 and 1797.172, Health and
Safety Code. Reference: Sections 1797.172, 1797.208 and
1798.202, Health and Safety Code.
100157. Student Eligibility.
(a) To be eligible to enter an EMT-P training program an
individual shall meet the following requirements:
(1) Possess a high school diploma or general education
equivalent; and
(2) possess a current basic cardiac life support card according
to the standards of the American Heart Association or American
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Red Cross or have possessed a valid card within the past twelve
(12) months; and
(3) possess a current EMT-I A certificate or have possessed a
valid EMT-I A certificate within the past twelve (12) months; or
(4) possess a current EMT-II certificate in the State of
California or have possessed a valid EMT-II certificate within
the past twelve (12) months.
(b) EMT-P training programs that include the twenty-four (24)
hour ambulance module and required testing as specified in
Chapter 2 of this Division, within their training program, may
allow an individual to enter their training program who:
(1) Possesses a current EMT-I NA certificate in the state of
California or has possessed a valid EMT-I NA certificate in the
State of California within the past twelve (12) months; and
(2) meets the requirements of subsections (a) (1) and (a)(2) of
this Section.
(c) EMT-P training programs that include the EMT-I A course
content as specified in Chapter 2 of this Division, within their
training program and required testing, may exempt applicants from
provision (a) (3) of this Section.
(d) EMT-P training programs that include a bas'ic cardiac life
support course according to the standards of the American Heart
Association or American Red Cross, within their program and
required testing, may exempt applicants from provision (a) (2) of
this Section.
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NOTE: Authority cited: Sections 1797.107 and 1797.172, Health and
Safety Code. Reference: sections 1797.172 and 1797.208, Health
and Safety Code.
100158. Required Course Hours.
(a) The total training program shall consist of not less than
1032 hours. These training hours shall be divided into:
(1) A minimum of 320 hours of didactic instruction and skills
laboratories;
(2) The hospital clinical training shall consist of no less than
160 hours and the field internship shall consist of no less than
480 hours.
(b) The student shall have a minimum of forty (40) ALS patient
contacts during the field internship. An ALS patient contact
shall be defined as the student performance of one or more ALS
skills, except cardiac monitoring and basic CPR, on a patient.
(c) The minimum hours shall not include the following:
(1) Course material designed to teach or test exclusively EMT-I
knowledge or skills including CPR.
(2) Examination for student eligibility.
(3) The teaChing of any material not prescribed in section
100159 of this Chapter.
(4) Examination for EMT-P certification.
(d) The required course hours may be reduced by the ~ocal EMS
agency upon the request of the training institution for
individuals who have submitted proof of previously completed
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hours of equivalent training and passed by preestablished
standards developed and/or approved by the EMT-P Certifying
Authority pursuant to Section 100146 of this Chapter, a written
and skills examination for the area in which the reduction in
training hours is requested.
NOTE: Authority cited: Sections 1797.107 and 1797.172, Health and
Safety Code. Reference: Section 1797.172, Health and Safety
Code.
100159. Required Course Content.
The content of an EMT-P course shall include adequate instruction
to result in the EMT-P student being competent in the following
topics and skills listed below:
(a) Division 1: Prehospital Environment.
(1) section 1: Roles and Responsibilities.
(2) Section 2: Emergency Medical services systems.
(A) Emergency medical services systems components.
1. Recognition and access.
2. Initiation of the emergency medical services response.
3. Management of the scene.
a. Medical control.
b. Scene control.
c. When to call for backup.
4. Transportation of emergency personnel, equipment, and the
patient.
a, California Highway Patrol equipment mandate (requirements).
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b. Determination of destination.
5. overview of hospital categorization and designation.
a. Base hospital.
b, critical care centers (e.g. Trauma Centers, Pediatric
Centers) .
c. Emergency facility -- comprehensive, basic, standby.
d. Receiving hospital.
6. Communications overview.
a. Radio.
b. Telemetry.
c. Telephone.
7. Recordkeeping and evaluation including data collection.
s, Multicasualty incidents and disasters.
9. Role and responsibility of the state and local EMS system
management.
(3) section 3: Medical/Legal Considerations.
(A) Laws governing the EMT-P.
1, Abandonment.
2. Child abuse, elder abuse, and other laws that require
reporting.
3. Consent -- implied and informed.
4. Good Samaritan Laws.
5. Legal detention (Welfare and Institutions Code, section 5150
and 5170).
6. Local policies and procedures, to include
pronouncing/determining death.
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7. Medical control.
8. Medical practice acts affecting the EMT-Ps.
9. Negligence.
10. Overview of EMT-I, EMT-II, and EMT-P in California.
11. Special procedures utilized for victims of suspected
criminal acts, including preservation of evidence.
12. The health professional at the scene.
13. Written medical records.
(B) Overview of issues concerning the health professional.
1. Death and dying.
2. Malpractice protection.
3. Medical ethics and patient confidentiality.
4. Safeguards against communicable diseases.
(4) Section 4: Emergency Medical Services Communications.
(A) Emergency medical services communication system.
1. Radio communication.
2. System components.
3. Telephone communication.
(B) Communication regulations and procedures.
1. Communication policies and procedures.
2. Radio troubleshooting.
3 . Radio use.
4. Role of Federal Communications commission (FCC).
(C) Skills Protocols.
1. Radio mechanics (operational skill).
(5) Section 5: Extrication and Rescue.
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(A) Extrication and rescue,
(6) section 6: Major Incident Response.
(A) Multicasualty disaster management, including Incident
Command System.
1. Local policies and protocols.
2, Medical management
3. Triage, including START.
(B) Hazardous materials. Principles of hazardous materials
management, to include tear gas and radiation exposure and
precautions.
(7) section 7: Stress Management.
(b) Division 2: Preparatory Knowledge and Skills.
(1) Section 1: Medical TerminOlogy.
Medical terminology, including anatomical terms.
(2) Section 2: General Patient Assessment and Initial
Management.
(A) Human systems.
Basics of anatomy and physiology to include:
1. Body cavities.
2. Cardiovascular (circulatory) system.
3. Digestive system.
4. Endocrine system.
5. Genitourinary system.
6. Homeostasis.
7. Integumentary system.
8. Muscular system.
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9. Nervous system.
10. Respiratory system.
11. Skeletal system.
12, Surface anatomy,
13. The cell -- basic structure and function.
14. Tissues.
(B) Patient assessment.
1. Pertinent patient history.
2. Physical examination.
3. Prioritization of assessment and management.
4. Scene assessment.
(C) Reporting format for presenting patient information.
(D) Skills Protocols.
1. Diagnostic signs.
2. Patient assessment.
3, Reporting patient information.
(3) Section 3: Airway and Ventilation.
(A) Airway management.
Assessment and prehospital management of the patient in
respiratory distress emphasizing techniques listed under Skills
Protocols.
(B) Skills Protocols.
1. Basic airway adjuncts.
a. Bag/valve systems.
b. Demand valves.
c. Nasopharyngeal airways.
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d. oropharyngeal airways.
e. oxygen administration devices,
f. suctioning and portable suction equipment.
2. Chest auscultation.
3. Direct laryngoscopy and use of Magill forceps for removal of
foreign body.
4. Endotracheal intubation (ET), to include drug administration
and suctioning, and intubation of the chronic stoma.
5. Esophageal airway, including esophageal gastric tube airway
(EGTA) .
(4) section 4: Pathophysiology of Shock.
(A) Fluids and electrolytes.
1, Acid-base balance.
2. Blood and its composition.
3, Body fluids and distribution.
4. Electrolytes.
5. Intravenous solutions.
6, osmosis and diffusion.
(B) Assessment and management.
Pathophysiology, specific patient assessment, associated
complications, and the prehospital management of shock to
include:
1. cardiogenic shock.
2. Distributive shock.
3. Hypovolemic shock.
4. Obstructive shock.
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(C) Skills Protocols.
1. IV techniques:
a. Peripheral IV insertion, to include sterile techniques and
preparation of equipment (IV tubing, bottle, and bag) .
b. Withdrawal of blood samples by venipuncture.
2. Pneumatic antishock trousers, to include indications,
contraindications, associated complications, and
application/deflation procedure.
(5) section 5: General Pharmacology.
(A) Introduction to pharmacology.
1. Classifications.
2. Factors which affect action, onset of action and duration.
3. General drug actions.
4. Home medications.
5. Routes of administration.
6. Terminology.
(B) Drug dosages.
1. Computing dosages.
2. Weights and measures, including review of the metric system.
(C) Autonomic nerves.
1. Parasympathetic.
2. Sympathetic, to include alpha/beta.
(D) Specific drugs.
Actions, classification, indications, contraindications, dosages,
how supplied, interactions, side effects, complications, and
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preferred routes of administration of the drugs specified in
section 100144(b) (12) and (b)(13).
(E) Drug preparation and administration skills,
1. Addition of drugs to IV bottle, bag or volutrol and
regulating rate of infusion.
2. Administration of drugs directly into a vein.
3. Administration of drugs through an endotracheal tube (as
part of ET skill).
4, Administration of drugs through an IV tubing medication
port.
5. Inhalation.
6. Intramuscular injections.
7 . oral.
8. Subcutaneous injections.
9. Sublingual (not for injection).
10. Sublingual injections.
11. Administration of drugs into pre-existing vascular access
devices.
(c) Division 3: Trauma.
(1) section 1: Soft Tissue Injuries.
(A) Anatomy and physiology.
(8) Soft-tissue injuries.
Pathophysiology, specific patient assessment, mechanism of
injury, associated complications, and the prehospital.management
of soft tissue injuries to include:
1. Eye injuries,
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2. Head and neck injuries.
3. Wounds -- open and closed,
(C) Skills Protocols.
1. Bandaging.
2. Control of external hemorrhage.
3. Eye irrigation.
4. Immobilizing and removal of impaled objects.
5. Pneumatic antishock trousers.
(2) Section 2: Musculoskeletal Injuries.
(A) Anatomy and physiology,
(B) Musculoskeletal injuries.
Pathophysiology, specific patient assessment, mechanism of
injury, associated complications, and the prehospital management
of musculoskeletal injuries to include:
1. Fractures.
2. Dislocations.
3, Sprains and strains.
(C) Skills Protocols.
1. Pneumatic antishock trousers.
2, Rigid splint.
3. Sling and swathe.
4. Traction splint.
(3) Section 3: Chest Trauma.
(A) Pathophysiology, specific patient assessment, mechanism of
injury, associated complications, and the prehospital management
of chest trauma to include:
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1. Hemothorax.
2. Impaled objects.
3. Myocardial and great vessel trauma.
4. Pneumothorax and tension pneumothorax.
5. Rib fractures and flail chest.
(B) Skills Protocols.
(4) Section 4: Abdominal Trauma.
Pathophysiology, specific patient assessment, mechanism of
injury, associated complications, and the prehospital management
of abdominal trauma, to include pelvic and genitourinary trauma.
(5) Section 5: Head and Spinal Cord Trauma.
(A) Pathophysiology, specific patient assessment, mechanism of
injury, associated complications, and the prehospital management
of head and spinal cord trauma.
(B) Skills Protocols.
1. Cervical immobilization.
2. Helmet removal.
3. Spinal immobilization.
(6) Section 6: MUltisystem Injuries,
Pathophysiology, specific patient assessment, associated
complications, and the prehospital management of the multisystem
injured patient.
(7) section 7: Burns.
(A) Anatomy and physiology.
(B) Assessment and treatment.
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(d) Division 4: Medical Emergencies.
(1) Section 1: Respiratory system.
(A) Anatomy and physiology of the respiratory system to include:
1. composition of gases in the environment.
2. Exchange of gases in the lung.
3. Regulation of respiration.
4. Respiration patterns.
(B) Respiratory distress.
Pathophysiology, specific patient assessment, associated
complications, and the prehospital management of respiratory
distress, to include:
1. Asthma and chronic obstructive pulmonary disease.
2. Cerebral and brain stem dysfunction. '
3. Dysfunction of spinal cord, nerves or respiratory muscles.
4. Hyperventilation syndrome.
5. Pneumonia.
6. pulmonary embolism.
7. spontaneous pneumothorax.
8. Upper airway obstruction.
(C) Acute pulmonary edema.
Pathophysiology, specific patient assessment, associated
complications, and the prehospital management of acute pulmonary
edema -- cardiac and noncardiac.
(0) Near drowning.
pathophysiology, specific patient assessment, associated
complications, and the prehospital management of near drowning.
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(E) Toxic inhalations.
Pathophysiology, specific patient assessment, associated
complications, and the prehospital management of toxic
inhalations.
(2) section 2: cardiovascular System.
(A) Anatomy and physiology.
Anatomy and physiology of the cardiovascular system to include:
1. Cardiac conduction system.
2. Cardiac cycle.
3. Cardiac output and blood pressure.
4, Electromechanical system of the heart.
S, Nervous control,
(B) Introduction of electrocardiogram interpretation.
1. Components of the electrocardiogram record.
2. Electrophysiology.
3. Identifying normal sinus rhythm.
(C) Dysrhythmia recognition, to include prehospital management
for the following:
1. Artifact.
2, Artificial pacemaker rhythms.
3, Atrial fibrillation.
4. Atrial flutter.
5. Cardiac standstill (asystole).
6. Electromechanical dissociation.
7. First degree atrioventricular block.
s, Idioventricular rhythm.
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9. Junctional rhythm.
10. Premature atrial contractions.
11. Premature junctional contractions.
12. Premature ventricular contractions.
13. Second degree atrioventricular block.
14. Sinus arrhythmia.
15. Sinus bradycardia (with hypotension).
16. Sinus tachycardia.
17. supraventricular tachycardia.
18. Third degree atrioventricular block.
19. ventricular fibrillation.
20. ventricular tachycardia,
(D) Cardiovascular disorders.
Pathophysiology, specific patient assessment, associated
complications, and the prehospital management of cardiovascular
disorders to include:
1. Aortic aneurysm.
2. Cardiogenic shock.
3. Congestive heart failure.
4. coronary artery disease, angina, and acute myocardial
infarction.
5. Hypertensive emergencies.
(E) Skills Protocols.
1. Advanced cardiac life support (ACLS) meqacode mOQified for
field situation.
2. Basic cardiac life support (BCLS).
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3. Cardiac monitoring.
4, Defibrillation and synchronized cardioversion.
5. Dysrhythmia recognition of the rhythms listed in
subsection (2) (C) ,
6. Vagal maneuvers, specifically, valsalva maneuvers.
(3) Section 3: Endocrine Emergencies.
Pathophysiology, specific patient assessment, associated
complications, and the prehospital management of endocrine
emergencies not included in other sections to include diabetic
emergencies, including diabetic ketoacidosis and hypoglycemic
reactions.
(4) Section 4: Nervous System.
(A) Anatomy and physiology of the nervous system to include:
1. Autonomic nerves.
2. Brain and spinal cord.
3. Peripheral nerves.
(B) Nervous system disorders.
Pathophysiology, specific patient assessment, associated
complications, and the prehospital management of nontraumatic
altered level of consciousness and other central nervous system
(CNS) disorders to include:
1. Coma.
2. Seizures.
3. stroke.
4. syncope.
5. other causes.
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(5) section 5: Acute Abdomen, Genitourinary, and Reproductive
Systems, Nontraumatic acute abdomen.
Pathophysiology, specific patient assessment, associated
complications, and the prehospital management of the nontraurnatic
acute abdomen, to include gastrointestinal bleeding and
emergencies of the genitourinary and reproductive systems.
(6) Section 6: Anaphylaxis.
Pathophysiology, specific patient assessment, associated
complications, and the prehospital management of allergic
reactions to anaphylaxis.
(7) section 7: Toxicology, Alcoholism, and Drug Abuse.
(A) Toxicology, and poisoning.
(B) Alcoholism and drug abuse.
(8) Section 8: Infectious Diseases.
Communicable diseases. Understanding of communicable diseases to
include transmission and special precautions.
(9) section 9: Environmental Injuries.
(A) Environmental emergencies.
Pathophysiology, specific patient assessment, associated
complications, and the prehospital management of environmental
emergencies to include:
1. Atmospheric pressure related emergencies to include:
a. Compressed air diving injuries and illnesses.
b_ Mountain sickness and other high altitude syndromes.
2. Lightning and other electrical injuries.
3. Poisonous and nonpoisonous bites and stings.
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4. The atmospheric and thermal environment and the physiology
of temperature regulation.
a. Cold exposure.
b, Heat exposure.
5. Thermal injuries and illnesses.
(B) Skills Protocols.
1. Application of constricting bands.
2. Snake bite kit.
(10) Section 10: Pediatrics.
(A) Special considerations in relationship to illness and injury
to include:
1. Approach to parents.
2. Approach to pediatric patient.
3. Growth and development.
(B) Pediatric emergencies.
Specific patient assessment, and the prehospital management of
emergencies especially related to the pediatric age group to
include:
1. cardiopulmonary arrest, to include advanced cardiac life
support protocols.
2. Child abuse/neglect, including preservation of evidence.
3. Medical emergencies to include:
a. Altered level of consciousness, including coma.
b. Common communicable diseases (childhood illnesses).
c. Meningitis.
d. Seizures.
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4. Near drowning,
5. poisoning.
6. Respiratory distress.
a. Allergic reactions/anaphylaxis,
b. Asthma/bronchitis.
c. Epiglottitis.
d. Foreign body aspiration.
e. Pneumonia.
f. Tracheobronchitis (croup).
7. Sudden infant death syndrome as mandated by Chapter 1111,
statutes of 1989.
8. Trauma, including shock.
(C) Skills Protocols.
1, Airway adjuncts utilized for neonates, infants, and
children.
2. Child resuscitation.
3. cooling measures.
4, Infant resuscitation.
5. Intravenous techniques utilized for neonates, infants, and
children.
(e) Division 5: Obstetrical, Gynecological, Neonatal
Emergencies.
(1) Anatomy and physiology of the female reproductive system.
(2) Normal childbirth. The stages of labor and normal delivery,
including assessment and management.
(3) Obstetrical emergencies.
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Pathophysiology, specific patient assessment, associated
complications, and the prehospital management of obstetric
emergencies to include:
(A) Abnormal fetal presentation.
(B) Abortion.
(e) Abruptio placenta,
(D) Breech birth.
(E) Failure to progress,
(F) Multiple birth.
(G) Placenta previa.
(H) Post partum hemorrhage.
(I) Premature birth.
(3) Prolapsed cord.
(K) Ruptured ectopic pregnancy.
(L) Supine hypotension syndrome.
(M) Toxemia of pregnancy.
(4) Gynecological emergencies.
Pathophysiology, specific patient assessment, associated
complications, and the prehospital management of gynecologic
emergencies to include:
(A) Pelvic inflammatory disease.
(B) Ruptured ovarian cyst.
(e) Vaginal bleeding.
(5) The neonate.
Specific patient assessment, and the prehospital management of
the neonate to include:
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(A) APGAR scoring.
(B) Resuscitation.
(C) Temperature regulation.
(6) skills Protocols.
(A) Assisting with breech delivery.
(B) Assisting with normal deliveries, to include care of the
newborn.
(C) Management of the prolapsed cord.
(D) Neonatal resuscitation.
(f) Division 6: Special Patient Problems.
(1) section 1: prehospital Care of Patients Experiencing
Behavioral Emergencies.
(A) Behavioral responses. Behavioral responses to illness,
injury, death, and dying by:
l. Bystanders.
2. EMT-Ps,
3 . Family.
4. Friends.
5. Other responders.
6 . Patients.
( B) Behavioral emergencies.
Specific patient assessment, associated complications, and the
prehospital management of behavioral emergencies to include:
1. Emotional crisis.
2. Substance abuse.
3. Victims of assault, to include sexual assault.
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(C) Use of community resources,
(D) Skills Protocols.
1. Application of restraints.
2. Management of difficult patient situations.
(2) Section 2: Assault victims.
Special considerations for the victims of assault to include
sexual assault.
(3) Section 3: Geriatric Patients.
special considerations for the geriatric patient.
(4) Section 4: Disabled Patients.
Special considerations for the disabled patient.
NOTE: Authority cited: Sections 1797.107 and 1797.172, Health and
Safety Code. Reference: sections 1797.172, 1797.173, 1797.185
and 1797.213, Health and Safety Code.
100160. Required Testing.
(a) An approved EMT-P program shall include periodic
examinations and final comprehensive competency-based
examinations to test the knowledge and skills specified in this
Chapter.
(b) Successful passage of the state skills examination approved
by the EMS Authority shall be required prior to course completion
or certification.
(c) Successful performance in the clinical and field. setting
shall be required prior to course completion or certification.
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OAL Approved: November 1991
Effective: January 1, 1992
NOTE: Authority cited: sections 1797.107, 1797.172 and 1797,185,
Health and Safety Code. Reference: Sections 1797.172, 1797.185,
1797,208, 1797.210 and 1797.213, Health and Safety Code.
100161. Course Completion Record.
(a) An approved EMT-P training program shall issue a course
completion record to each person who has successfully completed
the EMT-P training program.
(b) The course completion record shall contain the following:
(1) The name of the individual.
(2) The date of completion.
(3) The following statement: "The individual named on this
record has successfully completed an approved EMT-P training
program."
(4) The name of the EMT-P Approving Authority.
(5) The signature of the course director.
(6) The name and location of the training program issuing the
record.
(7) The following statement in bold print: "This is not an
EMT-P certificate."
(8) A list of optional procedures approved pursuant to
subsection (b) (14) of Section 100144, included in the course.
(e) The name and address of each person receiving a course
completion record and the date on which the record was issued
shall be reported in writing to the EMT-P Certifying Authority
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GAL Approved: November 1991
Effective: January 1, 1992
for the county in which the training was given within thirty (JO)
days of course completion.
NOTE: Authority cited: sections 1797.107 and 1797.172, Health and
Safety code. Reference: section 1797,172, Health and Safety
Code.
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