Application
This unit of competency describes the skills and knowledge required to deliver advanced clinical pre-hospital/out-of-hospital patient care at a specialised level by assessing the needs of a patient, planning and administering intensive clinical care, and monitoring the state of the patient.
This unit applies to pre-hospital/out-of-hospital health care workers. Workers follow established clinical guidelines and protocols and work independently, applying specialised knowledge of pathophysiology and pharmacology to perform intensive clinical care.
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. Assess need for specialised intervention | 1.1 Assess patient on the basis of a high level of clinical knowledge and a high level of contemporary clinical evidence based practice 1.2 Confirm that assessment of the need for specialised intervention is based on a demonstrable and clearly thought out series of problem-solving steps or linkages 1.3 Analyse and explain the patient assessment process when subject to clinical audit |
2. Analyse information from clinical assessment to make a judgement about specialised pre-hospital/out-of-hospital patient care | 2.1 Use systematic evaluation of patient assessment to interpret and make judgements regarding specialised patient care requirements 2.2 Confirm judgement is in line with high level contemporary evidence based practice and organisation clinical practice guidelines/protocols 2.3 Justify that the judgement, which forms the basis on which specialised treatment is planned, is reasonable in terms of the information available at the time |
3. Plan specialised pre-hospital/out-of-hospital patient care | 3.1 Establish priorities of care, based on assessment of the total scene and drawing on specialised knowledge and experience 3.2 Recognise and interpret mechanisms of injury and potential for patient deterioration in conjunction with factors inherent in patient’s condition, environment and potential impact of procedures or movement 3.3 Develop contingency plans, based on mechanisms of injury and potential for patient deterioration 3.4 Establish patient management plan, based on analysis of the scene and the patient and drawing on high level clinical knowledge 3.5 Determine patient’s potential or actual time criticality versus transport criticality |
4. Implement procedures for specialised pre-hospital/out-of-hospital patient care | 4.1 Commence all patient care procedures and pharmacological therapies as patient’s presenting condition determines, with reference to local clinical and legislative guidelines and pharmacological requirements 4.2 Confirm all actions are in accordance with established clinical guidelines and protocols. 4.3 Consult and collaborate with designated medical authorities as required |
5. Monitor specialised pre-hospital/out-of-hospital patient care and modify as required | 5.1 Monitor all aspects of patient’s condition including vital signs at appropriate intervals to establish trends in terms of specialised procedures, interventions or knowledge 5.2 Assess potential effects of procedures implemented on patient’s condition 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 Recognise the need for assistance and seek help immediately where the situation or patient’s condition requires treatment outside the scope or authority to practice of the attending officer 5.6 Maintain and/or modify treatment, according to patient need as determined by the re-assessment process |
6. Hand over patient requiring specialised care | 6.1 Document relevant patient details according to organisation clinical practice guidelines/protocols 6.2 Maintain patient confidentiality at all times 6.3 Ensure documentation for handover procedures conveys all necessary information 6.4 Convey information appropriately to those individuals involved in ongoing patient care to facilitate understanding and optimise continuing patient care 6.5 Maintain patient care until responsibility for patient care is taken over by staff of the receiving agency |
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 at least 80 hours under clinical supervision in the workplace
• delivered intensive clinical care in the workplace to 1 person to detect and correct any immediate life threatening conditions including:
- demonstrating the capacity to take into account subtle factors affecting the patient’s condition, from a broad range of areas
- making sound judgements on provision of patient care based on pathophysiology and pharmacology knowledge
- applying advanced skills to provide appropriate care for complex clinical conditions
- applying the clinical problem-solving process as it applies to specialised patient care
• performed each of the following 5 intensive clinical care interventions in the workplace or in a simulated environment, which are procedures approved for specialised patient care based upon organisation policies and procedures and in accordance with established clinical guidelines/protocols:
 applied leads, recorded and interpreted an electrocardiograph (ECG) to analyse cardiac dysrhythmia performed an endotracheal intubation for airway management
 performed intravenous (IV) cannulation to provide intravenous fluid therapy
 performed intraosseous (IO) needle insertion to provide a non-collapsible entry point into the systemic venous system for fluid therapy
 performed decompression of a tension pneumothorax with a needle
 performed defibrillation for a cardiac condition
• administered pharmacological therapy in the workplace to 1 patient 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:
• specialised patient care in the field of pre-hospital/out-of-hospital care – detailed knowledge to enable accurate judgement and service delivery
• the structure and function of major organs (detailed and appropriate to this level) including a detailed understanding of heart structure and function (including electrophysiology, dysrhythmias)
• cell transport systems
• pharmacological processes and actions, indications and contraindications (appropriate to this level)
• cellular respiration (glycolysis, Krebs’s Cycle, electron transport chain) and ATP production
• how to recognise the signs and symptoms of a broad range of clinical conditions and the (provisional) diagnosis of same
• advanced comprehension of trauma issues
• medical emergencies (advanced understanding including diving, altitude, temperature, overdose and poisoning, crush injuries and obstetrics)
• effects of intrinsic factors (such as age, health) and extrinsic factors (such as environment, medications) on patient condition and treatment
• human maintenance systems (including immunity and haemostasis)
• specialised patient care procedures and equipment used according to established clinical guidelines and protocols including IV and IO interventions used for fluid, blood and medication therapy
• patient social and emotional wellbeing related to trauma
• receiving facility requirements or how to access these requirements
• function of documentation being provided
• national and State/Territory legal and ethical requirements and 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 legislation 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.
Assessment Conditions
Skills must have been demonstrated in the workplace or in a simulated environment as specified in the performance evidence.
The requirement in the performance evidence to perform 5 intensive clinical care interventions in the workplace 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 and obstetric manikins suitable for simulation of clinical skills
 defibrillator
 12 lead ECG leads and recording device
 vital signs monitoring equipment
 sample medications used in emergency treatment
 oxygen resuscitation system with oxygen cylinder and oximeter and selection of oxygen masks with tubing
 simulation model suitable for simulation insertion of an oropharyngeal airway
 IV cannulation equipment and IV fluid therapy equipment
 IO needle insertion equipment
• modelling of industry operating conditions, including contingencies should be included in simulations and scenarios that reflect pre-hospital/out-of-hospital clinical care work.
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. |