HomeMy WebLinkAboutpolicy-skills-competency-2000-9-27-18-finalAdministration: Quality Improvement 9/27/18
POLICY AND SKILLS COMPETENCY REQUIREMENTS (# 2000)
POLICY AND SKILLS COMPETENCY REQUIREMENTS (# 2000)
Authority: California Health and Safety Code, Division 2.5, 1797.214; California Code of
Regulations, Title 22, Chapter 4, Sections 100145, 100166, 100168, 100172 and 100173.
As part of the Alameda County Quality Improvement Program, ALS Service Providers are
responsible for assessing the current knowledge of their Paramedics in local policies and
procedures and for assessing their Paramedics’ skills competency.
1. STANDARDS FOR INDEPENDENT PARAMEDIC PRACTICE
1.1 Classifications
Classification Description
Entry Level
Paramedic
An Accredited Paramedic who has successfully:
Completed the accreditation guidelines and field evaluation (Sections 2 and 3)
BUT HAS NOT
completed the requirements for Advanced Level Paramedic (Section 4)
Advanced
Level
Paramedic
An Accredited Paramedic who has successfully:
Completed the accreditation guidelines and field evaluation (Sections 2 and 3)
Completed the requirements for Advanced Level Paramedic (Section 4)
Table 1
1.2 Principles for Independent Practice
1.2.1 Entry Level Paramedics may only work with Advanced Level Paramedics
(except for special circumstances at the discretion of the EMS Agency
Medical Director)
2. PARAMEDIC ACCREDITATION
2.1 Paramedic Accreditation Guidelines
2.1.1 Maintenance of continuous certification in the following “core-courses”:
Advanced Cardiac Life Support (ACLS) that is equivalent to AHA provider
level or Emergency Cardiac Care (ECC)
International Trauma Life Support (ITLS) or Prehospital Trauma Life
Support (PHTLS), Assessment and Treatment of Trauma (ATT)
Pediatric Advanced Life Support (PALS) that is equivalent to AHA provider
level, Pediatric Education for Prehospital Personnel (PEPP) or Emergency
Pediatric Care (EPC)
(Any courses on-line or otherwise, without a hands-on demonstration of skills competency
in front of a trainer certified by an approved CE provider are not considered equivalent to
these courses).
2.1.2 Educational Requirements
Current certification in core courses (see 2.1.1)
Completion of Alameda County EMS Orientation
Completion of a local optional scope skills lab provided by the provider
agency
Completion of 12-lead EKG course in accordance with 12-LEAD ECG
PROGRAM policy
Completion of waveform capnography training
Administration: Quality Improvement 9/27/18
POLICY AND SKILLS COMPETENCY REQUIREMENTS (# 2000)
POLICY AND SKILLS COMPETENCY REQUIREMENTS (# 2000)
2.1.3 Completion of an Entry Level Field Evaluation (see Section 3)
2.1.4 Completion of a Paramedic Accreditation Application and Fee
2.1.5 After completing Entry Level Paramedic guidelines in Sections 2 and 3,
to reach Advanced Level Paramedic status, a Paramedic must complete
the criteria set forth in Sections 4
2.1.6 A Paramedic whose accreditation has been withdrawn for more than one
year shall be required to re-apply for initial accreditation.
2.1.7 Accredited Paramedics shall substantially comply with the requirements of
the applicable Federal, State, and County of Alameda laws, rules, and
regulations
2.2 Provider Agency Guidelines
2.2.1 The Provider Agency must retain the following records:
Verification of a current California State Paramedic License
Confirmation of continued employment with an approved Paramedic
Provider Agency
Verification of completion of an Entry Level accreditation field evaluation
(see section 2 and 3)
Verification of completion of Advanced Level Paramedic guidelines
(section 4)
Satisfactory performance in the professional development evaluation
(see section 5)
Current certification in the “core-courses”
Successful completion of any mandatory training/skills required by the
EMS Agency, including the annual updates
2.2.2 Each provider agency must submit to the EMS Agency their field evaluation
plan they intend to use for evaluation of accreditation candidates (see
section 3). The plan shall detail the agency’s requirements for selection
and monitoring of field training officers as well as the scoring and
remediation process for prospective accreditation candidates
2.2.3 Each provider agency is required to notify the EMS Agency Medical
Director of the results of the Entry Level accreditation field evaluation
(Section 3) for each accreditation candidate within 30 calendar days of
completion or failure. Supporting documentation is also required
2.2.4 The EMS Agency will conduct periodic audits to ensure compliance with
the above requirements
3. ENTRY LEVEL FIELD TRAINING AND EVALUATION
In order to become an accredited Entry Level Paramedic, it is necessary to complete a field
training evaluation to consist of no less than Five (5) and no more than Ten (10) ALS
contacts under the direct supervision of a field training officer or equivalent (designated by
the provider agency). The field training officer is ultimately responsible for the care
delivered at the scene by the candidate. The purpose of the field evaluation is to
determine if the Paramedic is able to function under local policies and procedures
(Title 22 Section 100166)
Administration: Quality Improvement 9/27/18
POLICY AND SKILLS COMPETENCY REQUIREMENTS (# 2000)
POLICY AND SKILLS COMPETENCY REQUIREMENTS (# 2000)
3.1 Policy And Skills Competency Components
The accreditation candidate will be required to show proficiency in the following
skills/procedures:
3.1.1 Acquiring a patient’s history and physical exam
3.1.2 Direction of overall scene care as prescribed by local policies and
procedures
3.1.3 Leadership
3.1.4 Completing the patient care reports as prescribed by policies and
procedures and demonstrate competency in documentation (Title 22
100148, Alameda County EMS Field Manual - ALS Responder)
3.1.5 Show sufficient knowledge of all parenteral and oral medications and
solutions included in the Alameda County scope including proficiency in
indications, contraindications, side effects, dosage and concentrations
3.1.6 All local optional scope procedures and infrequent skills
3.1.7 The field evaluation should be completed in no more than thirty (30)
calendar days from the date of the first evaluation shift
If at the end of thirty (30) days the accreditation candidate has not met
the above requirements, but has shown sufficient progress, the field
training officer may continue the evaluation for another thirty (30) days
upon approval of the EMS Agency’s Medical Director
If an accreditation candidate fails the field evaluation, the EMS Agency
Medical Director shall be immediately notified in writing. After an
evaluation by the EMS Agency Medical Director, recommendations for
further evaluation or training will be made.
3.1.8 No more than two (2) attempts to complete a field evaluation are allowed.
After the second failed attempt the candidate will have to wait 365 calendar
days from the last day of the field evaluation. A candidate who has failed
the accreditation evaluation is required to start the process over (section
2.2). A candidate who fails to meet the requirements of this policy is not
accredited and therefore not allowed to work as a Paramedic (basic scope
or local optional scope) in Alameda County’s EMS system
3.1.9 An accreditation candidate’s application will be reviewed and a decision on
accreditation status will be made within thirty (30) calendar days after the
EMS Agency receives the completed application
3.1.10 Documentation of the candidate’s field evaluation will also need to be
submitted with the application as well as any documentation of procedures
and skills demonstrated to a training officer that were not performed on an
actual emergency call (see 3.1.6 above)
3.1.11 Upon successful completion of a field evaluation, Paramedic Accreditation
shall be continuous for as long as state Paramedic licensure is maintained
and as long as the Paramedic meets county requirements for updates in
local policies, procedures, protocols and local optional scope of practice. It
is also necessary for the Accredited Paramedic to meet the requirements of
the EMS Agency approved Quality Improvement Plan** adopted by the
agency with which the Paramedic is employed
3.1.12 An Entry Level Paramedic may upgrade to Advanced Level upon
successful completion of the requirements set forth in Sections 4 and 5
Administration: Quality Improvement 9/27/18
POLICY AND SKILLS COMPETENCY REQUIREMENTS (# 2000)
POLICY AND SKILLS COMPETENCY REQUIREMENTS (# 2000)
4. ADVANCED LEVEL PARAMEDIC
4.1 Guidelines For Advanced Level Paramedic
4.1.1 A minimum of 6 months experience as an accredited Entry Level
Paramedic
4.1.2 Completion of Benchmark Criteria in 4.3 Table 2
4.1.3 Has no clinical or operational issues, or corrective actions
4.1.4 Paramedics are allowed to reach Advanced Level earlier than six (6)
months and/or before benchmark criteria are met, on a case by case
basis, at the discretion of the EMS Agency Medical Director. The
following is necessary for advanced placement:
Documentation of considerable EMS experience
Completion of a Professional Development Evaluation (Section 5)
Documentation of the Paramedic’s ability to work independently as an
Advanced Level Paramedic by an FTO (or equivalent) AND the
provider’s Quality Coordinator/ Medical Director
Ongoing PCR audits by QI Coordinator or Provider Medical Director
Documentation of QI indicators (but not limited to):
Rate of Patient Transport/Refusal
% of 12 Leads/ASA received by ACS patients
% of ETCO2 monitoring received by indicated patients
% of CPSS/Blood Glucose Check received by CVA and ALOC
patients
EMSA Core Measures
Pain Management received by patients
Other useful process and outcome indicators designated by the
EMS Agency Medical Director
4.2 Timeframe For Completion
4.2.1 Benchmark criteria (see 4.3 Table 2) must be completed within a 365 day
period from accreditation as an Entry Level Paramedic
4.2.2 If an Entry Level Paramedic wishes to attain Advanced Level status after
the 365 day timeframe, s/he is required to undergo a professional
development evaluation (see section 5) with a satisfactory or better score.
The benchmark criteria then must be completed within 365 days from the
date of the professional development evaluation
4.2.3 Provider agencies will notify the EMS Agency when:
An Entry Level Paramedic attains or fails to attain Advanced Level Paramedic status
An Advanced Level Paramedic fails to maintain Advanced Level Paramedic status
Administration: Quality Improvement 9/27/18
POLICY AND SKILLS COMPETENCY REQUIREMENTS (# 2000)
POLICY AND SKILLS COMPETENCY REQUIREMENTS (# 2000)
4.3 Benchmark Criteria
In addition to completing the Benchmark Criteria, the Paramedic’s decision
making competency in administering specific treatments and skills under local
policies and procedures must be evaluated.
Acquisition of the patient's history, documentation
and direction of overall scene care. Use of
standard evaluation criteria
60
BLS Airway Management:
Patient Position, Suctioning **, BLS Airway
Adjuncts **, BVM **
Advanced Airway Management:
ETT **, Supraglottic **
BLS Management
4 each
ETT 4
Supraglottic 4
Defibrillator/Cardioversion discharge is counted as
one defibrillation/cardioversion 4
Successful placement in a peripheral or external
jugular location with success rates < 10% less
than overall field average
30
(10 if simulated)
By any route: intravenous, intraosseous,
subcutaneous, intranasal, aerosol, intramuscular 20
All of the following: intraosseous infusion, pleural
decompression, transcutaneous pacing 1 each
If not included above
2
**May be simulated Table 2
5. SKILLS COMPETENCY MAINTENANCE REQUIREMENTS
5.1 Professional Development Evaluation
5.1.1 Within every two year period, each Accredited Paramedic, as part of the
County’s CQI Program, shall undergo a professional development evaluation
by the provider agency
5.1.2 The Professional Development Evaluation should include the following:
A chart review of at least 5 randomly selected patient care reports
A Paramedic field training officer, a nurse, a physician or the provider’s QI
coordinator, at a minimum, may administer the components of the skills
evaluation listed below (a-h); however, all components must be overseen by
the provider's QI coordinator or physician liaison (Table 3)
A recommendation for future development/training. The recommendation
should include the evaluator's assessment of the Paramedic's capability/
potential for a future Paramedic "career ladder": training, teaching, research,
advancement to a field training officer or supervisor, or to an enhanced
scope of practice Paramedic level (e.g. - CCT-P)
Administration: Quality Improvement 9/27/18
POLICY AND SKILLS COMPETENCY REQUIREMENTS (# 2000)
POLICY AND SKILLS COMPETENCY REQUIREMENTS (# 2000)
Skills Competency Maintenance Evaluation
a) Basic Life Support (BLS) - management of emergency childbirth, spinal injury
assessment, spinal motion restriction (SMR), adult and pediatric CPR, and bleeding control
and shock management.
b) Paramedic Equipment Skills Assessment - this assessment includes the operation and
location of all ALS equipment. The Paramedic should be able to explain the operation of
each piece of equipment in the airway bag and drug box as well as suction apparatus and
the cardiac monitor. The operation of all of this equipment including needleless systems
and radio equipment should also be described and discussed. Replacement procedures
including supply, restock, broken equipment, and narcotic restock should also be described.
c) Alameda County Protocols - Paramedics should discuss and describe at least the
following ALCO protocols: Acute Stroke, Advanced Airway Management, Anaphylaxis,
Consent and Refusal Guidelines: (Refusal of Care/Refusal of Service), Assess and Refer,
Trauma Patient Care/Criteria, Psychiatric Evaluation, CPAP, 12-lead EKG, Sepsis, Spinal
Injury Assessment, Spinal Motion Restriction (SMR), Death in the Field, Grief Support,
Aircraft Transport, MCI, Pain Management, and Base Contact.
d) Dysrhythmias - Paramedics should demonstrate, using a rhythm generator, the typical
ACLS rhythms. These include sinus, atrial fibrillation, atrial flutter, SVT, junctional,
idioventricular, ventricular tachycardia, ventricular fibrillation, first degree block, second
degree block type one, second degree block-type two, and third degree block.
e) Procedures - Paramedics should demonstrate either in a clinical setting or a simulated one
the following procedures: adult intubation, EtCO2 Monitoring (waveform capnography for
both intubated and non-intubated patients), 12-lead EKG acquisition and interpretation,
needle finger stick glucose, needle thoracostomy, intraosseous infusion (adult and
pediatric), transcutaneous pacing, and IV starts.
f) Physical Assessment - Paramedics should demonstrate a thorough physical assessment
on at least one trauma and one medical patient, either clinical or simulated.
g) Medication Knowledge - Paramedics should demonstrate knowledge of medications,
including dosage, indications, contraindications, and side effects of the medications
approved for use in the Paramedic scope of practice
h) Scenario Testing - Paramedics should demonstrate competency in scenario-based testing
on the following commonly encountered Paramedic scenarios: 1) trauma, 2) cardiac arrest,
3) shortness of breath, 4) dysrhythmia recognition, 5) pediatrics. Providers may use EMS
Agency secure scenarios OR other pertinent scenarios (preferably real case). Other
scenarios may be added as needed (e.g. environmental, obstetrical, etc.).
Table 3
5.1.3 As part of a Provider Agency’s quality improvement program, needs-based
quality improvement skills/policy training and evaluation may be substituted
for items listed in Table 3 provided that:
There is evidence of competent quality patient care for those specific
substituted skills/policy maintenance items listed in Table 3
Provider Agencies evaluate the patient care impact of the needs-based
skills/policy training
5.1.4 The service provider must inform the EMS Agency immediately of any
Paramedic who fails to meet or maintain the standards set forth in this policy
Approved:
____________________________ _________________________________
Karl Sporer, Acting EMS Director Karl Sporer, MD, EMS Medical Director