PARA213 - Paramedic Theory and Practice: Medical 2

Year

Credit points

Campus offering

Prerequisites

PARA202 Paramedic Practice: Medical 1

Teaching organisation

Unit rationale, description and aim

In paramedicine it is a requirement that the paramedic is able to link theory with practice and perform clinical duties which are underpinned by a theoretical understanding. This unit provides opportunities for students to integrate theoretical and practical knowledge in lectures, practical laboritories, computer assisted learning, and clinical placement.

This unit will explore both the theoretical and practical aspects of pathophysiology and paramedic assessment and management of advanced medical presentations related to cardiovascular, neurology, endocrine and toxicology conditions and emergencies. The learning in this unit compliments paramedic practice knowledge and practice skills learnt in PARA201 Paramedic Theory: Medical 1 and PARA202 Paramedic Practice: Medical 1. Students will apply theory both in the laboratory environment and during clinical placement. This unit is required by students to assist them to develop knowledge and skills in paramedic practice which will guide their future performance as a health care professional.

The aim of this unit is to assist student to achieve knowledge of the principles of management for medical conditions and emergencies and of the application of appropriate management plans in the out-of-hospital setting.

Learning outcomes

To successfully complete this unit you will be able to demonstrate you have achieved the learning outcomes (LO) detailed in the below table.

Each outcome is informed by a number of graduate capabilities (GC) to ensure your work in this, and every unit, is part of a larger goal of graduating from ACU with the attributes of insight, empathy, imagination and impact.

Explore the graduate capabilities.

On successful completion of this unit, students should be able to:

LO1 - Describe the incidence, pathophysiology, implications, assessment and management of the advanced medical presentations of cardiovascular, neurology, endocrine and toxicology emergencies and apply appropriate paramedic interventions to patients presenting with the conditions considered; (GA5, GA8, GA9)

LO2 - Outline current best practice management of advanced medical presentations of cardiovascular, neurology, endocrine and toxicology emergencies explored in pre-, in- and post-hospital settings; (GA3, GA5)

LO3 - Relate the advanced medical presentations of cardiovascular, neurology, endocrine and toxicology emergenciesexplored to the concept of time criticality and apply the principle of time criticality to the management the advanced medical presentations considered; (GA5,GA8)

LO4 - Critically appraise management strategies currently used by paramedics to manage the medical conditions considered and think critically and reflectively to evaluate the effectiveness of various paramedic interventions applied to manage a particular presentation; (GA4, GA5, GA8, GA9)

LO5 - Differentiate between provisional diagnoses of a range of presentations on the basis of understandings of pathophysiology with reference to available clinical data; (GA4, GA5, GA6)

LO6 - Apply a paramedic clinical assessment framework to the patient presenting with a range of advanced medical presentations of cardiovascular, neurology, endocrine and toxicology emergencies within a team environment operating with the therapeutic objective; (GA5,GA6,GA9)

Graduate attributes

GA3 - apply ethical perspectives in informed decision making

GA4 - think critically and reflectively 

GA5 - demonstrate values, knowledge, skills and attitudes appropriate to the discipline and/or profession 

GA6 - solve problems in a variety of settings taking local and international perspectives into account

GA8 - locate, organise, analyse, synthesise and evaluate information 

GA9 - demonstrate effective communication in oral and written English language and visual media 

Paramedicine Board of Australia Professional Capabilities for Registered Paramedics

Website of capabilities: https://www.paramedicineboard.gov.au/Professional-standards/Professional-capabilities-for-registered-paramedics.aspx

Content

Topics will include:

Theory

Cardiac advanced

• Principles of permanent pacemakers and automatic implantable cardioversion devices
• Electrocardiograph rhythm interpretation
• 12 lead electrocardiograph
• Infarct pattern recognition
• Associated pharmacology 
• Coagulation modifying agents
• Thrombolytic agents
• Nitrates
• Analgesia
• Antiemetics
• Cardiovascular agents
• Reperfusion therapies and ongoing management

Neurological medical

Review of anatomy and physiology of the nervous system

• Pathophysiology of selected neurological conditions / emergencies
• Pre-Hospital assessment and management of selected neurological conditions / emergencies
• Altered Level of Consciousness 
• Stroke / Transient Ischaemic Attack
• Seizure disorders 
• Neurogenic shock
• Autonomic Dysreflexia 
• Headache/Migraine 
• Neuroleptic Malignant Syndrome
• Malignant Hyperthermia
• Dystonic reactions
• Cerebral neoplasms and abscesses
• Degenerative neurological disorders
• Myasthenia gravis, multiple sclerosis, Parkinson’s disease, motor neurone disease
• Other neurological/spinal conditions
• Behavioural disorders
• Psychiatric disorders
• Violent patient
• Deliberate self harm
• Glasgow Coma Scale 
• Principles underpinning Neurological Status Assessment
• Associated pharmacology 

Endocrine

• Diabetes Mellitus – Type I & Type II
• Hypoglycaemia
• Hyperglycaemia
• Diabetic ketoacidosis
• Hyperosmolar Hyperglycaemic State (HHS) 
• Alcoholic ketoacidosis

Toxicology (overdose)

• Poisons 
• Overdose
• Alcohol
• Polypharmacy
• Tricyclic antidepressants
• Benzodiazepines
• Narcotic 
• Paracetamol
• Acetyl salicylate
• Illicit drugs
• Other prescription and / or over-the-counter medications

Practical

Cardiac advanced

• Perfusion Status Assessment
• Electrocardiogram
• 12 Lead 
• Monitoring lead placement
• Infarct pattern identification
• Fluid therapy
• Drug dose calculation and administration
• Coagulation modifying agents
• Nitrates
• Analgesia
• Antiemetics
• Reperfusion therapies 

Neurological medical

• Glasgow Coma Scale
• Neurological Status Assessment
• Glucometry
• Stroke assessment
• Seizure management
• Thermoregulation techniques
• Drug dose calculation and administration
• Anticonvulsant agents
• Antiemetic agents
• Dextrose
• Glucagon 
• Glucose paste / gel oral
• Naloxone
• Benztropine
• Other relevant pharmacological agents

Endocrine

• Diabetes Mellitus – Type I & Type II
• Hypoglycaemia
• Hyperglycaemia
• Diabetic ketoacidosis
• Hyperosmolar Hyperglycaemic State (HHS) 
• Alcoholic ketoacidosis

Toxicology (overdose)

• Poisons 
• Overdose
• Alcohol
• Polypharmacy
• Tricyclic antidepressants
• Benzodiazepines
• Narcotic 
• Paracetamol
• Acetyl salicylate
• Illicit drugs
• Other prescription and / or over-the-counter medications
• Bites and stings (marine / land)

Learning and teaching strategy and rationale

Modes of delivery in this unit include lectures, laboratories, simulations, online activities and self-directed study. Consistent with adult learning principles, the teaching and learning strategies used within these modes of delivery will provide students with foundational knowledge and skills relevant to professional paramedic practice. These strategies will also support students in meeting the aim, learning outcomes and graduate attributes of the unit and the broader course learning outcomes. Learning and teaching strategies will reflect respect for the individual as an independent learner. Students will be expected to take responsibility for their learning and to participate actively with peers. 

To guide students in their learning feedback is required to identify what is being done well, what requires additional work and to identify progress toward required learning outcomes. Practicum assists students to link theory with its application. Located in the second/third year of the programme, this theory/practice  unit includes significant face-to-face teaching hours, during which case scenarios are used to assist students in linking theory with practice. Lectures are utilised to convey content and its central principles while laboratories and simulations deliver interactive learning sessions which assist students in applying the theory to clinical practice while also providing an opportunity to consolidate clinical skills. Students will be presented with a selection of case scenarios during in-class activites that will guide the learning of the unit. 

Students will undertake a clinical placement of 80 hours within an emergency, emergency, simulated emergency or other appropriate environment The supervised clinical placement provides a safe environment where students can provide assisted person-centred care essential for successful graduate practice. 

Assessment strategy and rationale

A range of assessment procedures consistent with University assessment requirements will be used to meet the unit learning outcomes and develop graduate attributes. 

The assessments will provide an opportunity for students to demonstrate skills and knowledge required to care for those with medical conditions and emergencies. The development of a professional portfolio will allow students to showcase their learning experiences in a professional manner ensuring that documentation meets the professional legal requirements for practice. The written examination evaluates students’ understanding of pathophysiology and paramedic assessment and management of advanced medical presentations of cardiovascular, neurology, endocrine and toxicology emergencies. There are two hurdles in this unit; the hurdles assess knowledge that is so essential to the unit that the student  cannot progress in the course if a pass is not achieved for each hurdle.  In real world practice it is a requirement that the paramedic student demonstrates professional competence on clinical placement. Achieving pass as a standard for the Objective Structured Clinical Examination (OSCE) is  mandatory.

Overview of assessments

Representative texts and references

Ambulance Victoria (2016). Ambulance Victoria clinical practice guidelines for ambulance and MICA paramedics. Doncaster: Ambulance Victoria.

Ambulance Victoria (2015). Clinical work instructions. Doncaster, Victoria: Ambulance Victoria.

Bryant, B., & Knights, K. (2015). Pharmacology for health professionals (4th  ed). Chatswood, N.S.W.: Elsevier Australia.

Copstead, L., & Banasik, J. (Eds). (2013). Pathophysiology (5th ed.). Philadelphia, PA: Saunders.

Marieb, E.N., & Hoehn, K. (2016). Human anatomy and physiology (10th Global ed.). Harlow: Pearson Education Limited. 

Martini, F., Nath, J. & Bartholomew, E. (2015). Fundamentals of anatomy & physiology ( 10th Global ed.), Boston: Pearson. 

McCance, K., & Huether. S, (2014). Pathophysiology: The biologic basis for disease in adults and children (7th  ed.). St Louis: Mosby.

Queensland Ambulance Service (2017). Clinical practice guidelines (CPG) and clinical practice procedures (CPP). Brisbane: Queensland Ambulance Service.

Queensland Ambulance Service (2017). Drug therapy protocols (DTP). Brisbane: Queensland Ambulance Service.

Sanders, M. J. (2012). Mosby’s paramedic textbook (4th ed.). St Louis, MO.: Mosby.