Application
This unit of competency describes the skills and knowledge required to conduct clinical assessments and deliver standard patient care in the pre-hospital/out-of-hospital environment.
This unit applies to pre-hospital/out-of-hospital health care workers. The worker provides advanced life support, prioritises clinical care, implements time-critical health care procedures and therapies, and monitors patients based on patient needs and in accordance with established clinical practice guidelines.
The skills in this unit must be applied in accordance with Commonwealth and State/Territory legislation, Australian/New Zealand Standards and industry codes of practice.
Elements and Performance Criteria
ELEMENT | PERFORMANCE CRITERIA |
Elements define the essential outcomes | Performance criteria describe the performance needed to demonstrate achievement of the element. |
1. Perform pre-hospital/out-of-hospital patient assessment | 1.1 Conduct pre-planning of assessment before arrival at scene based on information communicated in the request for service 1.2 Perform appropriate clinical surveys to collect and analyse assessment information at critical points in time 1.3 Use applied clinical knowledge to assess the mechanism of injury, pattern of injury and potential for injury to identify any non-obvious clinical signs during patient assessment 1.4 Use a critical questioning process to make links between patient’s illness or injury and information found at the scene 1.5 Base patient assessment on a demonstrable and clearly thought out series of problem solving steps or linkages |
2. Identify variations in physical health status | 2.1 Integrate principles of anatomy and pathophysiology with assessment data for specific conditions, disorders and injuries 2.2 Identify variations from normal homeostasis and body system functions using established clinical guidelines/protocols 2.3 Identify variations to cellular metabolism when assessing patient for poor states of perfusion 2.4 Analyse the need for and potential impact of treatments and pharmacological therapies on patient’s health status 2.5 Identify the effects on patient’s health status of pharmacological therapies based on pharmacology, pharmacokinetics and pharmacodynamics 2.6 Use diagnostic reasoning when determining the potential for injury or illness |
3. Plan pre-hospital/out-of-hospital patient care | 3.1 Identify main patient complaints as a basis for prioritised treatment and care based on assessed patient needs and overall assessment of the scene 3.2 Analyse clinical and situational data gathered to plan treatment 3.3 Establish patient management plan based on primary and secondary survey, known patient history, assessment of the scene and factors related to distance from hospital or medical care 3.4 Evaluate the injury and potential for deterioration and develop contingency plans based on mechanisms of injury 3.5 Systematically evaluate and interpret patient assessment information to make judgements regarding patient care requirements 3.6 Ensure judgement, which forms the basis on which treatment is planned, can be reasonably justified in terms of the information available at the time 3.7 Differentiate between patients who require rapid stabilisation and transport because of trauma or illness, and those who require further on-the-scene assessment and management 3.8 Determine time-critical issues given resource considerations |
4. Implement pre-hospital/out-of-hospital patient care procedures | 4.1 Implement all care and treatment procedures to the level of own expertise and within established clinical guidelines and protocols 4.2 Commence pharmacological therapies as patient’s presenting condition determines, with reference to established clinical guidelines and protocols and pharmacological requirements 4.3 Recognise the need for assistance where the situation or patient’s condition requires treatment that is outside the practice guidelines and seek help immediately |
5. Monitor and evaluate pre-hospital/out-of-hospital patient care | 5.1 Monitor all aspects of patient’s condition at appropriate intervals to establish trends 5.2 Assess potential effects on patient’s condition of procedures implemented 5.3 Monitor pharmacological therapy, noting effectiveness of treatment regime and amend according to patient’s condition 5.4 Recognise changes in patient’s condition and adapt management according to the scope or authority to practice of the attending officer 5.5 Evaluate patient care interventions used against pre-hospital/out-of-hospital best practice for clinical care |
6. Hand over patient requiring pre-hospital/out-of-hospital patient care to receiving facility | 6.1 Document relevant patient details according to local standard operation procedures 6.2 Maintain patient confidentiality at all times 6.3 Ensure documentation for handover procedures conveys all necessary information 6.4 Maintain patient care until responsibility for patient care is taken over by staff of the receiving agency 6.5 Convey information appropriately to those individuals involved in ongoing patient care to facilitate understanding and optimise continuing patient care |
Evidence of Performance
The candidate must show evidence of the ability to complete tasks outlined in elements and performance criteria of this unit, manage tasks and manage contingencies in the context of the job role. There must be evidence that the candidate has:
• performed the activities outlined in the performance criteria of this unit during a period of at least 160 hours under clinical supervision in the workplace
• performed a clinical assessment and implemented standard care in a pre-hospital/out-of-hospital context on 5 different patients for an illness or trauma impacting health status including:
- performing primary survey
- performing secondary survey – systematic head to toe physical body examination including vital signs and level of consciousness
- considering psychosocial, developmental and cultural considerations
- considering mechanism of injury, pattern of injury and potential for injury
- planning and implementing standard clinical care based on assessment and time-criticality
- monitoring patient and implementing health care procedures and/or therapies
- safely delivering patient to receiving facility or service
• implemented the following standard clinical care interventions under a variety of conditions and circumstances within the established clinical guidelines and protocols:
- providing airway management for a patient
- attaching leads, recording and interpreting an electrocardiograph (ECG) to analyse cardiac dysrhythmia
- performing manual direct current counter shock on an adult simulation manikin according to established clinical guidelines and protocols
- administering and responding to the effects of pharmacological therapy to treat and manage patient’s illness or condition
• performed advanced life support on an adult, child and infant simulation manikin according to established clinical guidelines and protocols.
Evidence of Knowledge
The candidate must be able to demonstrate essential knowledge required to effectively complete tasks outlined in elements and performance criteria of this unit, manage tasks and manage contingencies in the context of the work role. This includes knowledge of:
• assessment and interpretation of vital signs
• advanced life support and advanced resuscitation, including procedures and equipment used as specified within established clinical guidelines and protocols
• critical thinking and diagnostic reasoning techniques and processes:
- process of critical questioning including purposeful, informed questioning in the clinical setting to make sense of the information presented at the scene of injury or illness
- process of diagnostic reasoning in the clinical setting, which requires careful identification of key problems, issues and the risks involved in responding to patient needs
- potential impacts of a range of factors in relation to identified body systems and their components
o internal (such as physical, mental, emotional factors)
o external (for example, in relation to specific patient assessment procedures)
- concept of rapid stabilisation and transport including:
o golden hour
o chain of survival
o time critical
o priority status
o transport consideration – for example, ground or aeromedical
• causes and effects of trauma including:
- kinematics of trauma
- blunt, penetrating, falls, blasts and motor vehicle accidents
- crush injuries and compartment syndrome
- physical laws of energy exchange (Newton’s laws of motion)
- cavitation
- impact and clinical consideration for trauma to pregnant person
• common environmental emergencies
• how to accurately obtain and document patient medical history including, pre-existing conditions, allergies, social and emotional wellbeing and current medication or treatment plans to provide to receiving health facility workers
• national and State/Territory legal and ethical considerations for emergency health care workers relevant to pre-hospital/out-of-hospital care, and how these are applied in organisations including:
- children in the workplace
- continuing professional education
- discrimination
- duty of care
- human rights
- informed consent
- mandatory reporting
- practice standards
- practitioner/client boundaries
- privacy, confidentiality and disclosure
- specific Commonwealth and State/Territory legislation or regulation for health care workers including covering, for example:
o children and young people
o anti-discrimination
o disability
o health, drugs and poisons
o mental health
o health records and information privacy
o industrial relations
- National Safety and Quality Health Service (NSQHS) Standards
- work role boundaries – responsibilities and limitations
- work health and safety
• organisation policies, procedures and established clinical guidelines and protocols for patient care and emergency equipment
• pharmacology therapy and concepts underpinning pharmacology:
- pharmacological agents for the management of common disorders
- pharmacokinetics including routes of administration – enteral, parenteral, inhalation, topical
- preparation, properties, uses and actions of pharmacology
- pharmacology terminology
- absorption, distribution, metabolism and excretion of pharmacological products by the body
- pharmacodynamics- pharmacological interactions
- safe storage, handling and disposal of pharmacological products
- jurisdictional protocols and guidelines associated with administration, duration, magnitude and pharmacological response
• primary survey and secondary survey
• variations from normal functioning of body systems involving anatomy, physiology and pathophysiology, including:
- pathophysiology of integumentary system including:
o compromised integumentary system burns trauma or injury caused by the interaction of energy (thermal, chemical, electrical, or radiation)
o pathophysiology of burns injuries, local and systemic responses and burn shock
o classifications of burns injury and extent and severity of burns injury
- pathophysiology of musculo-skeletal injury including:
o soft tissue injury
o causes and types of fractures, dislocations, strains and sprains
- pathophysiology of the cardiovascular system including:
o cardiovascular insult
o how to interpret and analyse dysrhythmias and apply electric shock to obtain normal rhythm – for example asystole, ventricular fibrillations, ventricular tachycardia or heart block
o classifications and complications of shock including hypovolaemia, cardiogenic and distributive
- pathophysiology of the neurovascular system including:
o brain injury including – concussion, contusion, Diffuse Axonal Injury (DAI), haematomas
o traumatic brain injury including – primary and secondary injury, cerebral perfusion, raised intracranial pressure, herniation, cerebral agitation or irritation
o cerebral thrombosis, transient ischaemic attack (TIA), cerebral embolism and cerebral haemorrhage
o dementia
o seizures and febrile convulsions
o autonomic dysreflexia
- poisoning, envenomation or overdose emergencies including:
o neurotoxins, myotoxins, haemotoxins, illicit drugs
o chemical, biological and radiological
- pathophysiology of the respiratory system including:
o differences in paediatric and adult airways
o thoracic disorders or trauma
o respiratory disorders including asthma, acute respiratory distress syndrome, croup, epiglottis, pneumonia, emphysema, chronic obstructive airway disease
o gas laws and gas exchange (Boyle, Dalton, Charles, Henry)
o external and internal ventilation and respiration
o principles of lung volumes – minute volume and oxygenation
- pathophysiology of the digestive and endocrine system including:
o abdominal disorders including diabetes mellitus, thyroid and adrenal gland conditions
o nutritional disorders, appendicitis, gastroenteritis and hepatitis
o abdominal trauma including visceral, referred and somatic pain, gastro-intestinal bleeding
- processes of metabolism including:
o cellular respiration
o anaerobic and aerobic energy production
- pathophysiology of the urinary and reproductive system including:
o acute and chronic renal failure and obstetric and gynaecological disorders (for example, ectopic pregnancy, spontaneous abortion, vaginal haemorrhage, pelvic inflammatory disease, endometriosis)
o stages of labour – pre-delivery emergencies and post-delivery emergencies
o assessing neonate body temperature and Apgar scores
• situations where the patient requires treatment that is outside the scope or authority to practice of the attending worker.
Assessment Conditions
Skills and knowledge must be demonstrated in the workplace with the addition of simulations and scenarios where the full range of contexts and situations cannot be provided in the workplace or may occur only rarely.
The requirement in the performance evidence to implement standard clinical care interventions under a variety of conditions and circumstances within the established clinical guidelines and protocols, must have been demonstrated using simulation before being demonstrated in the workplace and with members of the public.
The following conditions must be met for this unit:
• use of suitable facilities, resources and equipment as per local governing body including:
- simulation adult, child, infant manikins suitable for simulation of clinical skills
- vital signs monitoring devices
- ECG recording device
- placebo samples of pharmacological preparations for use in simulation scenarios.
Assessors must satisfy the Standards for Registered Training Organisations (RTOs) 2015/AQTF mandatory competency requirements for assessors.
Foundation Skills
The Foundation Skills describe those required skills (language, literacy, numeracy and employment skills) that are essential to performance. |
Foundation skills essential to performance are explicit in the performance criteria of this unit of competency. |