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TRANSCRIPT
Good Medical Practice
Working in Emergency
Medical Systems
Providing pre-hospital
Emergency Medical Care
Using pre-hospital
equipment
Supporting rescue and extrication
Supporting safe patient
transfer
Supporting emergency
preparedness and response
Sub-specialty Training in
Pre-hospital Emergency Medicine
Intercollegiate Board for Training in Pre-hospital Emergency Medicine
Curriculum and Assessment System
Produced by the Intercollegiate Board for Training in Pre-hospital Emergency Medicine (IBTPHEM).
Intercollegiate Board for Training in Pre-hospital Emergency MedicineFaculty of Pre-hospital CareThe Royal College of Surgeons of EdinburghNicolson StreetEdinburghEH8 9DWUnited Kingdom
© 2012,2014 and 2015 IBTPHEM
All rights reserved. No part of this publication may be produced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of the Intercollegiate Board for Training in Pre-hospital Emergency Medicine.
While every effort has been made to ensure the accuracy of the information contained in this publication, no guarantee can be given that all error and omissions have been excluded. No responsibility for loss occasioned to any person acting or refraining from action as a result of the material in this publication can be accepted by the Intercollegiate Board for Training in Pre-hospital Emergency Medicine or the contributors.
Photographs provided courtesy of the Emergency Medical Charity, Magpas.
Please refer to the IBTPHEM’s website at www.ibtphem.org.uk for any updates to this publication.
Printed by PMT Digital Print Ltd
FOREWARD
FOREWORD TO SECOND EDITION
At the turn of the current century, we were both struck by the contrast between our training as Emergency Physicians and that as Immediate Care doctors. Despite the fact that we had been fortunate enough to be able to gain experience in established pre-hospital services, we worried about the absence of a formally structured and recognised training programme. We argued passionately that patients with pre-hospital critical care needs had a right to access the same standards of care and professional medical expertise (and regulation) in the pre-hospital phase as they did in the hospital phase. In a spirited attempt to provoke debate about this area of specialist medical practice, we challenged the status quo and highlighted the plight of the critically injured:
“There is currently no system, training stream or workforce in place across the UK to ensure that the needs of
these patients are met in a consistent or organised manner.” 1
We wanted everyone involved in emergency care to rise to our challenge.
They did. Our arguments did not fall on deaf ears. In fact, they were not solely our arguments and they were not new: many colleagues from different specialties and disciplines shared these views and we are grateful to them for both channelling and tempering our enthusiasm. We are particularly grateful to The Royal College of Surgeons of Edinburgh’s Faculty of Pre-hospital Care for challenging us, in return, to lead the sub-specialty development programme, forge consensus on a curriculum framework and persuade governments and regulators to support the sub-specialty.
This second edition of the Guide to Sub-specialty Training represents the completion of the Faculty’s sub-specialty development programme and the maturation of Pre-hospital Emergency Medicine as a properly regulated specialist clinical endeavour. There are training programmes emerging all over the UK and new-generation trainees can benefit from a much more structured and organised training experience. It remains for us to thank the many individuals who have selflessly, usually voluntarily and without payment, worked long hours to ensure the success of the sub-specialty. They know who they are. One name deserves special mention and, in recognition of his wisdom, council and unwavering support, this second edition of the Guide and Curriculum is dedicated to Professor Sir Keith Porter.
Dr John BlackChairman, Intercollegiate Board for Training in Pre-hospital Emergency Medicine
Dr Roderick MackenzieSub-specialty Development Lead, Faculty of Pre-hospital Care, Royal College of Surgeons of Edinburgh
1 Mackenzie R, Bevan D. For debate: a license to practice pre-hospital and retrieval medicine. Emergency Medicine Journal 20015;22:286-29.
FOREWORD
FOREWORD TO FIRST EDITION
Pre-hospital Emergency Medicine involves providing immediate medical care in what is often a resource limited and physically challenging setting. Add to this the combination of time pressure, a medical emergency and an unfamiliar multi-disciplinary team and one wonders why any healthcare professional would seek to immerse themselves in this area of clinical practice. Yet over many years, a surprising number of doctors have, largely on a voluntary and altruistic basis, chosen to do so. Many of them regard the opportunity to support their local ambulance services and provide medical care in some of the most dangerous, distressing and challenging circumstances as both a privilege and, perhaps more importantly, a truly professional endeavour. In their desire to improve the quality and safety of their care, they have pioneered programmes of education and training, developed highly sophisticated operational services and championed the creation of postgraduate diplomas and professional bodies. Their drive and spirit is encapsulated in the introduction to the Pre-hospital Trauma Life Support Course:
“Our patients did not choose us. We chose them. We could have chosen another profession, but we did not. We have accepted responsibility for patient care in some of the worst situations: when we are tired or cold; when it is rainy and dark; when we cannot predict what conditions we will encounter. We must either embrace this responsibility or surrender it. We must give to our patients the very best care that we can - not while we are daydreaming, not with unchecked equipment, not
with incomplete supplies and not with yesterday’s knowledge”1
In 1994, one of those doctors, now a Professor of Emergency Medicine, challenged our thinking in this area of clinical practice. He wrote: “It needs to progress from a group of enthusiasts of varying qualifications and standards to a fully fledged specialty.” 2 It has perhaps taken longer than anticipated but we are pleased to report that the fully fledged specialty (or sub-specialty) has now arrived. What we hope will follow is a new generation of doctors who will benefit from even better access to structured and organised training and a career framework for clinical practice. In turn, our patients will continue to be assured of the highest possible standards of care.
We thank all of those who have contributed to this achievement and dedicate this first edition of the Guide and Curriculum to Professor Myles Gibson, who laid the foundations of Pre-hospital Emergency Medicine as a medical sub-specialty through the creation of the Faculty of Pre-hospital Care.
Professor Sir Keith PorterChairman, Faculty of Pre-hospital Care, Royal College of Surgeons of Edinburgh and Intercollegiate Board for Training in Pre-hospital Emergency Medicine
Dr Roderick MackenzieSub-specialty Development Lead, Faculty of Pre-hospital Care, Royal College of Surgeons of Edinburgh
1 Pre-hospital Trauma Life Support Committee of the National Association of Emergency Medical Technicians in co-operation with the Committee on Trauma of the American College of Surgeons. PHTLS: Pre-hospital Trauma Life Support (Seventh Edition). Mosby JEMS Elsevier, St Louis, 2011.2 Cooke MW. Immediate care: specialty or pastime? Injury. 1994;25:347-8.
CONTRIBUTORS
CONTRIBUTORS TO SECOND EDITIONAlmost all of those involved in the development of the first edition of the Guide and Curriculum have been involved to some extent in the review of the curriculum and development of the second edition. The review has been conducted by the Intercollegiate Board for Training in Pre-hospital Emergency Medicine (IBTPHEM) and co-ordinated by:
Dr Phil Hyde, Chair, Curriculum Committee, IBTPHEMDr Juergen Klein, Co-chair, Assessment Committee, IBTPHEMDr Simon Lewis, Chair, Training Committee, IBTPHEMDr Roderick Mackenzie, Co-chair, Assessment Committee, IBTPHEM and Convener, Pre-hospital Examinations, Royal College of Surgeons of Edinburgh
The review team have received additional support from:
Wg Cdr Chris Adcock, Consultant in Acute MedicineCara Featherstone, Psychometrician, Royal College of Surgeons of EdinburghDavid Greening, Training Manager, College of Emergency MedicineSusan Grant, Examinations Manager, Royal College of Surgeons of EdinburghAssiah Mahmood, Trauma Network Manager, East of England Trauma NetworkDr Robert Major, Consultant in Emergency MedicineRia Matthews, Administrator, IBTPHEMLindsay Millar, Administrator, Faculty of Pre-hospital Care, Claudia Moran, Training Manager, Royal College of AnaesthetistsJames Taylor, Programme Manager, PHEM Development Project, IBTPHEM The training programme directors from the first five Pre-hospital Emergency Medicine training programmes have also provided invaluable feedback.
Dr Ian Bowler, Wales DeaneryDr Dave Bramley, Northern DeaneryDr Nick Crombie, West Midlands DeaneryDr Anil Hormis, Yorkshire and Humber DeaneryDr Caroline Leech, West Midlands DeaneryDr Simon Lewis, East of England DeaneryDr Matt Thomas, Severn Deanery
CONTRIBUTORS
CONTRIBUTORS TO FIRST EDITIONThis guide was developed by the former Curriculum, Training and Assessment Sub-committee of the Intercollegiate Board for Training in Pre-hospital Emergency Medicine and represents a distillation of the work of a great many people over several years (including the members of the former Faculty of Pre-hospital Care Curriculum Advisory Group).
The members of the Curriculum, Training and Assessment Sub-committee were:
Dr John Black, Consultant in Emergency Medicine, Oxford Radcliffe Hospitals NHS Trust and Medical Director, South Central Ambulance Service NHS TrustDr Mark Bloch, Consultant in Anaesthesia, Aberdeen Royal Infirmary and BASICS ScotlandDr Richard Browne, Speciality Registrar in Emergency Medicine, Birmingham Children’s Hospital NHS Foundation Trust and Kids Intensive Care and Decision Support (KIDS) ServiceMr Dan Cody, Critical Care Paramedic, East of England Ambulance Service NHS Trust and Magpas HelimedixDr Mike Dronfield, Associate Postgraduate Dean, East of England Multi-professional DeaneryDr Richard Fairhurst, Chairman Training and Standards Board, Faculty of Pre-hospital CareDr Mark Folman, General Practitioner, Newark-on-Trent and East Midlands Immediate Care Scheme (EMICS)Dr Stephen Hearns, Consultant in Emergency Medicine, Royal Alexandra Hospital and Emergency Medical Retrieval Service (EMRS)Lt Col Jeremy Henning, Consultant in Intensive Care Medicine, South Tees Hospitals NHS Foundation Trust and Great North Air Ambulance Service (GNAAS)Flt Lt Oliver Hawksley, Specialty Registrar in Emergency Medicine, Royal Air ForceDr Phil Hyde, Consultant in Paediatric Intensive Care Medicine, University Hospital Southampton NHS Foundation Trust and BASICS HampshireFlt Lt Robert James, Specialty Registrar in Emergency Medicine, Royal Air ForceDr Juergen Klein (Assessment blueprint lead), Consultant in Anaesthesia and Intensive Care Medicine, Derby Hospitals NHS Foundation Trust and Magpas HelimedixDr Simon Lewis (Training programme lead), Consultant in Emergency Medicine, Cambridge University Hospitals NHS Foundation Trust and Magpas HelimedixDr Roderick Mackenzie (Chairman), Consultant in Emergency Medicine, Cambridge University Hospitals NHS Foundation Trust and Magpas HelimedixSqn Ldr Adam Manson, General Practitioner, Royal Air ForceDr Malcolm Russell, General Practitioner, Hereford and Mercia Accident Rescue Service (MARS)Mr Simon Standen, Critical Care Paramedic, East of England Ambulance Service NHS Trust and Magpas HelimedixDr Anne Weaver, Consultant in Emergency Medicine, Barts and The London NHS Trust and Helicopter Emergency Medical Service (HEMS)Wg Cdr Curtis Whittle, Consultant in Anaesthesia and Intensive Care Medicine, North Bristol NHS Trust and Great Western Air Ambulance
The participants in the Faculty of Pre-hospital Care Training Fellowship programme provided invaluable feedback regarding the structure and supervision of sub-specialty training:
Sqn Ldr Chris Adcock, Specialty Registrar in Acute Medicine, West Midlands DeaneryDr Nora Brennan, Speciality Registrar in Emergency Medicine, London DeaneryDr Anne Booth, Speciality Registrar in Anaesthesia and Intensive Care Medicine, London DeanerySqn Ldr Fiona Bowles, Specialty Registrar in Emergency Medicine, Wessex DeaneryDr Fran Corcoran, Specialty Registrar in Emergency Medicine, East of England Multi-Professional DeaneryDr Tristan Dyer, Consultant in Emergency Medicine, East Midlands Healthcare Workforce DeaneryDr James French, Consultant in Emergency Medicine, East Midlands Healthcare Workforce DeaneryDr Chrissie Hymers, Specialty Registrar in Emergency Medicine, London DeaneryLt Col Simon Le Clerc, Consultant in Emergency Medicine, Northern DeaneryDr Rob Major, Consultant in Emergency Medicine, East of England Multi-Professional DeaneryDr Alistair Steel, Consultant in Anaesthesia and Intensive Care Medicine, East of England Multi-Professional DeaneryDr Alison Tompkins, Specialty Registrar in Emergency Medicine, East of England Multi-Professional Deanery
The work of the sub-committee was supported by:
Marlies Kunnen, Administrator, Intercollegiate Board for Training in Pre-hospital Emergency MedicineAssiah Mahmood, Clinical Governance Manager, Magpas HelimedixLindsay Millar, Administrator, Faculty of Pre-hospital Care, Royal College of Surgeons of Edinburgh
Sub-specialty Training in Pre-hospital Emergency Medicine
Curriculum and Assessment System
Second Edition
Approved by the General Medical Council
23 September 2014
Intercollegiate Board for Training in Pre-hospital Emergency Medicine
Faculty of Pre-hospital CareThe Royal College of Surgeons of Edinburgh
Nicolson StreetEdinburghEH8 9DW
United Kingdom
www.ibtphem.org.uk
CONTENTS
CONTENTS
Part One - A guide for trainees, trainers, local education providers, employers and deaneries
1. Introduction to Pre-hospital Emergency Medicine................................................................ 3
1.1 Introduction ........................................................................................................................................................5 1.2 The Intercollegiate Board for Training in Pre-hospital Emergency Medicine .....................................................5 1.3 What is Pre-hospital Emergency Medicine? .......................................................................................................6 1.4 What is the role of a specialist in Pre-hospital Emergency Medicine? ...............................................................9 1.5 Expansion of Pre-hospital Emergency Medicine sub-specialist practice ..........................................................11
2. The Pre-hospital Emergency Medicine Curriculum .............................................................13
2.1 Purpose of curriculum ......................................................................................................................................15 2.2 Curriculum development ..................................................................................................................................15 2.3 Curriculum content...........................................................................................................................................15 2.4 Learning methods .............................................................................................................................................19 2.5 Implementation and management of curriculum ............................................................................................20
3. Training in Pre-hospital Emergency Medicine ......................................................................21
3.1 Training overview .............................................................................................................................................23 3.2 Structure of training ........................................................................................................................................23 3.3 Phases of training .............................................................................................................................................25 3.4 Management of training ...................................................................................................................................27 3.5 Entry to training ...............................................................................................................................................27 3.6 Progression through training ............................................................................................................................29 3.7 Duration of training ..........................................................................................................................................30 3.8 Less than full time training (LTFT) .....................................................................................................................30 3.9 Completion of training .....................................................................................................................................30 3.10 Research .........................................................................................................................................................30
4. The assessment framework for Pre-hospital Emergency Medicine ......................................31
4.1 Introduction to assessment ..............................................................................................................................33 4.2 Assessment framework ....................................................................................................................................33 4.3 Formative assessments ....................................................................................................................................34 4.4 Summative assessments ...................................................................................................................................35 4.5 Assessment blueprint .......................................................................................................................................37 4.6 Assessment tools ..............................................................................................................................................38 4.7 Use of assessment tools ...................................................................................................................................40 4.8 Decisions on progress .......................................................................................................................................46 4.9 Trainees in difficulty .........................................................................................................................................46 4.10 Complaints and appeals .................................................................................................................................46
5. Guidance for trainers, local education providers, employers and Deaneries ........................49
5.1 Introduction ......................................................................................................................................................51 5.2 Trainers .............................................................................................................................................................51 5.3 Local Education Providers .................................................................................................................................53 5.4 Employers .........................................................................................................................................................56 5.5 Deaneries .........................................................................................................................................................56
Part Two - Curriculum Framework and Assessment Blueprint for Pre-hospital Emergency Medicine .......... 59
3SECTION 1 - INTRODUCTION TO PRE-HOSPITAL EMERGENCY MEDICINE
SECTION 1. INTRODUCTION TO PRE-HOSPITAL EMERGENCY MEDICINE
5SECTION 1 - INTRODUCTION TO PRE-HOSPITAL EMERGENCY MEDICINE
1.1 INTRODUCTION1.1.1 This document describes the curriculum, training and assessment processes for Pre-hospital Emergency Medicine (PHEM) sub-specialty training. It reflects the General Medical Council (GMC) standards and the UK wide regulations for specialty training (the Gold Guide).1,2 Where there are differences between the four UK national agencies, the parts of the Gold Guide applicable to these agencies should be regarded as the definitive guidance.
1.1.2 PHEM was approved by the GMC as a medical sub-specialty of the existing specialties of Emergency Medicine and Anaesthetics on 20 July 2011 and of the existing specialties of Acute Internal Medicine and Intensive Care Medicine on 1 October 2013. The processes described in this document apply to PHEM training programmes and trainees entering PHEM sub-specialty training from 1 August 2014.
1.1.3 The PHEM sub-specialty approval process involved a wide range of services, providers and professional bodies. This document represents consensus from NHS, independent sector, defence medical services and third sector pre-hospital education and provider organisations across the UK and condenses many years of educational and operational experience. It reflects the real world challenges of training doctors to deliver high quality and safe emergency medicine in the hazardous, environmentally challenging and safety critical pre-hospital environment. It has evolved from the following documents, all of which are available from the Intercollegiate Board for Training in Pre-hospital Emergency Medicine:
• Pre-hospital and Retrieval Medicine: A new medical sub-specialty (16 June 2008).• Application for approval in principle for the introduction of the new sub-specialty of Pre-hospital
Emergency Medicine: GMC Step 1 Application (18 October 2010).• Application for approval of the curriculum and assessment system for Pre-hospital Emergency
Medicine: GMC Step 2 Application (4 January 2011).• Sub-specialty Training in Pre-hospital Emergency Medicine: Supplementary guidance following
consultation (7 February 2011).• Sub-specialty Training in Pre-hospital Emergency Medicine. A guide for trainees, trainers, local
education providers, employers and deaneries (20 February 2012).• Sub-specialty Training in Pre-hospital Emergency Medicine. Curriculum Framework and Assessment
Blueprint. (20 February 2012).
1.2 THE INTERCOLLEGIATE BOARD FOR TRAINING IN PRE-HOSPITAL EMERGENCY MEDICINE
1.2.1 PHEM training is supervised by the Intercollegiate Board for Training in Pre-hospital Emergency Medicine (IBTPHEM) on behalf of:
• The Royal College of Surgeons of Edinburgh (Faculty of Pre-Hospital Care)• The Royal College of Anaesthetists• The College of Emergency Medicine• The Faculty of Intensive Care Medicine• The Joint Royal Colleges of Physicians Training Board
1.2.2 The IBTPHEM is responsible for determining the duration, content and assessment of training and, in collaboration with the GMC, the postgraduate training bodies and the Colleges and Faculties, managing the quality of training. This document reflects the current recommendations of the IBTPHEM and is intended to assist trainees, trainers, local education providers, employers, Colleges, Faculties and Deaneries in managing sub-specialty training.
1 A Reference Guide for Postgraduate Specialty Training in the UK – the ‘Gold Guide’ 2010. 2 Standards for curricula and assessment systems. General Medical Council, 2010.
6SECTION 1 - INTRODUCTION TO PRE-HOSPITAL EMERGENCY MEDICINE
1.2.3 The IBTPHEM website (www.ibtphem.org.uk) provides access to the terms of reference of the IBTPHEM and its committees together with useful additional information for trainees, trainers and the public. The most up-to-date versions of the curriculum and assessment system, the associated workplace based assessments and a range of template documents are also available on the website.
1.2.4 The IBTPHEM encourage feedback regarding this guide, the associated curriculum framework and any aspect of PHEM sub-specialty training.
1.3 WHAT IS PRE-HOSPITAL EMERGENCY MEDICINE?1.3.1 The term ‘pre-hospital care’ covers a wide range of medical conditions, medical interventions, clinical providers and physical locations. Medical conditions range from minor illness and injury to life threatening emergencies. Pre-hospital interventions therefore also range from simple first aid to advanced emergency care and pre-hospital emergency anaesthesia. Care providers may be lay first responders, ambulance professionals, nurses or physicians of varying backgrounds.
1.3.2 All of this activity can take place in urban, rural or remote settings and is generally mixed with wider out- of-hospital and unscheduled care. The complexity of unscheduled and urgent care provision is illustrated in figure 1.1. 3 Another useful way to conceptualise this breadth of clinical providers is to use the levels of practice described in the Skills for Health Career Framework for Health (figure 1.2). 4 The Career Framework describes the level of autonomy, responsibility and clinical decision making expected of a healthcare professional operating at a particular level.
1.3.3 Sub-specialist PHEM practice relates to the Emergency Response, Primary Scene Transfer and Secondary Emergency Transfer functions highlighted in figure 1.1 at the level of the Consultant (level 8) practitioner illustrated in figure 1.2. PHEM relates to that area of medical care required for seriously ill or injured patients before they reach hospital (on-scene) or during emergency transfer to or between hospitals (in-transit). It represents a unique area of medical practice which requires the focused application of a defined range of knowledge and skills to a level not normally available outside hospital.
1.3.4 There is a long established tradition of provision of voluntary and charitable emergency pre-hospital care by physicians in the UK. Building on the success of these individuals and services, the aspiration of the IBTPHEM is that each NHS Ambulance Service should have consistent immediate access to deployable sub-specialist PHEM services 24 hours a day. Other key drivers for the development of PHEM as a medical sub-specialty are:
(a) to meet existing demand for on-scene and in-transit medical support (sometimes referred to as pre-hospital ‘enhanced care’),5,6
(b) to improve the quality and standards of pre-hospital critical care,7
(c) to improve equity of access to on-scene and in-transit medical support, 8
(d) to improve governance of pre-hospital care and inter-hospital transfer services, 9
(e) to support the Care Quality Commission essential standards for quality and safety in pre-hospital care, 10
3 Direction of Travel for Urgent Care: a discussion document. Department of Health, October 20064 See http://www.skillsforhealth.org.uk/workforce-transformation/customised-career-frameworks-services/5 A license to practice pre-hospital and retrieval medicine. Emerg Med J 2005;22:286-293.6 NHS Clinical Advisory Groups Report. Regional Networks for Major Trauma. 2010. 7 Views regarding the provision of prehospital critical care in the UK. Emerg Med J 2009;26:365-370.8 Availability and utilisation of physician-based pre-hospital critical care support to the NHS ambulance service in England, Wales and Northern Ireland.
Emerg Med J 2012;29:177-181.9 Clinical governance in pre-hospital care. J R Soc Med, 2001;94(Suppl 39):38–42.10 Care Quality Commission. Essential standards for quality and safety. March 2010.
7SECTION 1 - INTRODUCTION TO PRE-HOSPITAL EMERGENCY MEDICINE
11 Competence in prehospital care: evolving concepts Emerg. Med. J. 2005;22;516-51912 Department of Health. NHS Emergency Planning Guidance: Planning for the development and deployment of Medical Emergency Response Incident Teams
in the provision of advanced medical care at the scene of an incident. 2009.13 As defined within the Medical Leadership Competency Framework available at www.institute.nhs.uk
(f) to improve professional training and development of pre-hospital personnel, 11
(g) to provide a robust medical incident response (MERIT) 12 capability and,
(h) to provide medical leadership for pre-hospital care services and providers. 13
8SECTION 1 - INTRODUCTION TO PRE-HOSPITAL EMERGENCY MEDICINE
Figure 1.1. Conceptual model of effective urgent care. Adapted from: Direction of Travel for Urgent Care: a discussion document. Department of Health, October 2006.
More senior level (e.g. clinical director)
Consultant practitioner level
Advanced practitioner level
Senior / Specialist practitioner level
Registered practitioner level
Associate / Assistant practitioner level
Senior healthcare assistant / Technician level
Support worker level
Initial entry level
Figure 1.2. Skills for Health Career Framework
9SECTION 1 - INTRODUCTION TO PRE-HOSPITAL EMERGENCY MEDICINE
1.3.5 The IBTPHEM estimates that ten full-time equivalent (FTE) sub-specialist consultants would be required per region to achieve the aspirations of the sub-specialty. However, many regions encompass large populations and/or geographical areas and distinct PHEM services may be justified in several parts of the UK (perhaps more closely aligned to Major Trauma Centre outreach and retrieval services or Air Ambulance Services than to regional NHS Ambulance Services). Workforce estimates are therefore based on 200 to 250 FTE consultants in PHEM across the UK. Given that all will have at least a 50% commitment to their base specialty, this FTE would relate to a head count of 600 to 750 sub-specialty trained doctors nationally.
1.3.6 The development of this cadre of sub-specialty trained doctors should not be regarded as diminishing or de-emphasising the importance of individuals (including non-specialist medical practitioners and allied health professionals such as paramedics and nurses) continuing to provide clinical service at different levels of the Skills For Health framework. Instead, the sub-specialty is a mechanism by which this area of medical activity can be aligned with other areas of specialist medical practice and existing practitioners can be better supported. The IBTPHEM also believes that, by addressing the key drivers in paragraph 1.3.4, the sub-specialty will result in strong medical leadership within all areas of pre-hospital clinical practice and help to substantially develop services and standards across all levels of pre-hospital care.
1.3.7 The NHS Ambulance Services in the UK primarily deploy state registered paramedics. Specialist paramedics with a defined additional range of pre-hospital critical care knowledge and skills (often referred to as Critical Care Paramedics) have also been developed in many regions. 14 Multi- professional teams already work in many areas of specialist clinical and critical care and the combination of doctors and paramedics working closely together in pre-hospital care has been associated with effective operational services and good outcomes. The strengthening of education and training for doctors will support the further development of specialist paramedic practitioners and enhance the delivery of PHEM by doctor-paramedic teams.
1.4 WHAT IS THE ROLE OF A SPECIALIST IN PRE-HOSPITAL EMERGENCY MEDICINE?
1.4.1 PHEM encompasses the underpinning knowledge, technical skills and non-technical (behavioural) skills required to provide safe pre-hospital critical care and safe transfer.
1.4.2 ‘Pre-hospital’ refers to all environments outside an emergency department resuscitation room or a place specifically designed for resuscitation and/or critical care in a healthcare setting. It usually relates to an incident scene but it includes the ambulance environment or a remote medical facility. Implicit in this term is the universal need, for this specific group of patients, for transfer to hospital. Although a component of urgent and unscheduled care (figure 1.1), PHEM practice relates to a level of illness or injury that is usually not amenable to management in the community setting and is focused on critical care in the out-of-hospital environment.
1.4.3 ‘Critical care’ refers to the provision of organ and/or system support in the management of severely ill or injured patients. It is a clinical process rather than a physical place and it requires the application of significant underpinning knowledge and technical skills to a level that is not ordinarily available outside hospital. Hospital based critical care is typically divided into three levels: Level three (intensive care areas providing multiple organ and system support), level two (high dependency medical or surgical care areas providing single organ or system support) and level one (acute care areas such as coronary care and medical admission units). In the context of PHEM, all three levels of critical care may be required depending on the needs of the patient. In practical terms, the critical care interventions undertaken outside hospital more closely resemble those provided by hospital emergency departments, intensive care outreach services and inter-hospital transport teams.
14 www.collegeofparamedics.co.uk
10SECTION 1 - INTRODUCTION TO PRE-HOSPITAL EMERGENCY MEDICINE
1.4.4 ‘Transfer’ refers to the process of transporting a patient whilst maintaining in-transit clinical care. A distinction between retrieval and transport (or transfer) is sometimes made on the basis of the location of the patient (e.g. scene or hospital) and the composition or origins of the retrieval or transfer team. Successful pre-hospital emergency medical services in Europe, Australasia and North America have recognised that many of the competences required to primarily transport critically ill or injured patients from the incident scene to hospital are the same as those required for secondary intra-hospital or inter-hospital transport. In this guide, and the associated PHEM curriculum, the term ‘transfer’ means the process of physically transporting a patient whilst maintaining in-transit clinical care.
1.4.5 The IBTPHEM has consulted a wide range of individuals and organisations regarding the scope of practice of sub-specialist practitioners. Consensus has been reached: The sub-specialist in PHEM must be capable of providing at-scene and in-transit clinical care to a level commensurate with independent consultant practice at level 8 on the Skills for Health framework. To achieve this, they must have fulfilled the requirements for specialist registration (i.e. Certificate of Completion of Training or Certificate of Eligibility for Specialist Registration, CESR) in a relevant acute specialty (in the first instance, and for the purposes of this guide, Emergency Medicine, Anaesthetics, Acute Internal Medicine or Intensive Care Medicine) and have developed and demonstrated additional competence across the spectrum of activities that constitute the clinical practice of PHEM. These additional competences are described in detail in section 2. They include:
(a) Good Medical Practice(b) Working in emergency medical systems(c) Providing pre-hospital emergency medical care(d) Using pre-hospital equipment(e) Supporting rescue and extrication(f) Supporting safe patient transfer(g) Supporting emergency preparedness and response(h) Operational practice(i) Team Resource Management(j) Clinical Governance
1.4.6 A sub-specialist in PHEM, as defined above, should be capable of fulfilling a number of career or employment roles which include, for illustrative purposes, provision of on-scene, in-transit and/or on-line (telephone or radio) medical care in support of PHEM service providers such as:
(a) NHS Acute Hospitals (particularly regional specialist hospitals with an outreach and transfer capability);
(b) NHS Ambulance Trusts (e.g. as part of regional Medical Emergency Response Incident Teams (MERIT) or their equivalent);
(c) The Defence Medical Services;(d) Non-NHS independent sector organisations such as immediate care schemes, air ambulance
charities, event medicine providers and commercial ambulance and retrieval services.
1.4.7 The PHEM sub-specialist practitioner role is uniquely challenging. The tempo of decision making, the hazards faced at incident scenes, the relatively unsupported and isolated working conditions, the environmental challenges, the resource limitations and the case mix all make this a very different activity compared to in-hospital practice. The remainder of this guide describes the training structure, curriculum framework and assessment system to ensure that that individuals undertaking this role are properly equipped to face the challenges.
11SECTION 1 - INTRODUCTION TO PRE-HOSPITAL EMERGENCY MEDICINE
15 The College of Emergency Medicine. Curriculum and Assessment Systems for Core Specialty Training ACCS CT1-3 and Higher Specialty Training ST4-6 Training Programmes. June 2010 (revised 30 May 2012)
16. The Royal College of Anaesthetists. Curriculum for a CCT in Anaesthetics, Edition 2, Version 1.5, August 2010.17. Joint Royal Colleges of Physicians Training Board. Specialty Training Curriculum for Acute Internal Medicine, August 2009 (Amended August 2012).18. The Faculty of Intensive Care Medicine. Curriculum for a CCT in Intensive Care Medicine, Edition 3, August 2011.
1.5 EXPANSION OF PRE-HOSPITAL EMERGENCY MEDICINE SUB-SPECIALIST PRACTICE
1.5.1 PHEM is currently a sub-specialty of Emergency Medicine, Anaesthetics, Acute Internal Medicine and Intensive Care Medicine. The curriculum framework and assessment system have therefore been designed to complement and enhance core specialty training in these specialties. This guide should therefore be considered in the context of the current approved curricula and training management infrastructure for these specialties.15-18
1.5.2 To reflect the broad nature of pre-hospital emergency medical practice, the IBTPHEM continues to aim to expand the range of specialties for which PHEM sub-specialty training can be accessed. At the present time, prototype training fellowships are being developed for paediatrics and some relevant surgical specialties. There are currently no fixed timescales for further expansion of specialties with access to subspecialty PHEM training. The IBTPHEM website should be consulted for further updates.
1.5.3 A parallel process is underway with respect to individuals within the CCT specialty of General Practice (GP). The existing regulatory framework and the potential changes in GP training make this a complex process. GP’s in training should contact the Curriculum Committee or access the IBTPHEM website to obtain further information.
1.6 RECOGNITION OF PRE-HOSPITAL EMERGENCY MEDICINE SUB-SPECIALIST PRACTICE
1.6.1 Medical Practitioners are currently only eligible for PHEM to be added to their entry on the Specialist Register if (a) they hold a CCT or CESR in one of the four approved core specialties and (b) they have completed a prospectively GMC-approved PHEM training programme. Such programmes commenced in August 2012 but will have limited capacity for some years.
1.6.2 Although the GMC will not accept historical training experience from within the UK, it will allow CCT or CESR holders (or applicants) who trained in PHEM overseas to apply for their PHEM training to be recognised as equivalent for the purposes of UK PHEM sub-specialty recognition. The GMC should be contacted directly regarding the process for such applications.
1.6.3 There is also currently no mechanism for doctors who hold GP registration to have a sub-specialty added to their entry on the Register.
1.6.4 In recognition of the existing historical expertise in PHEM practice across the UK and the regulatory barriers to broader access to PHEM sub-specialist registration, the Faculty of Pre-hospital Care of the Royal College of Surgeons of Edinburgh, in collaboration with the IBTPHEM, has developed a process by which experienced PHEM practitioners who are on the Specialist Register or GP Register, may apply for recognition of their PHEM experience and Faculty Accreditation as a Consultant (Level 8) Practitioner in PHEM.
12SECTION 1 - INTRODUCTION TO PRE-HOSPITAL EMERGENCY MEDICINE
1.6.5 Detailed regulations pertaining to Faculty Accreditation and the application process are available from the Faculty of Pre-hospital Care. In summary the process involves two steps:
(a) Step 1 is successful completion of the Fellowship in Immediate Medical Care (FIMC) of the Royal College of Surgeons of Edinburgh. In recognition of the fact that the FIMC by examination will not be available for access by non-trainees until July 2015, a Step 1 (FIMC) exemption process has been developed specifically for those individuals who are applying for Faculty Accreditation. The Step 1 exemption process will only be available for Faculty Accreditation applications received between 1 August 2015 to 31 July 2017. The criteria for Step 1 exemption closely reflects the historical and current entry and success criteria for the FIMC by examination.
(b) Step 2 is submission and satisfactory assessment of a portfolio of clinical and operational experience that demonstrates their knowledge, skills and experience and reflects (a) the content of the GMC approved PHEM Curriculum and (b) the domains of the Skills for Health descriptors for the Level 8 (Consultant) practitioner. The process for review of the portfolio closely reflects the GMC CESR process.
1.6.6 Successful applicants are entitled to describe themselves as a Faculty Accredited Consultant (Level 8) Practitioner in Pre-hospital Emergency Medicine (PHEM). They will receive a certificate of Faculty Accreditation jointly endorsed by the Faculty of Pre-hospital Care and the IBTPHEM. This certificate will be valid for five years and renewal will require evidence similar to that required for the purposes of GMC revalidation.
1.6.7 The Faculty and IBTPHEM are in discussion with the GMC regarding whether successful Faculty Accreditation can be accepted by the GMC as evidence of eligibility for PHEM sub-specialty recognition. The Faculty should be contacted for any updates related to this process.
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SECTION 2. THE PRE-HOSPITAL EMERGENCY MEDICINE CURRICULUM
15SECTION 2. THE PRE-HOSPITAL EMERGENCY MEDICINE CURRICULUM
2.1 PURPOSE OF CURRICULUM2.1.1 The curriculum defines the objectives, content, outcomes and process of training and the competences needed in order to be recommended for a certificate of completion of PHEM sub-specialty training.
2.1.2 As a sub-specialty of Emergency Medicine, Anaesthetics, Intensive Care Medicine and Acute Internal Medicine, the PHEM curriculum has been closely mapped to the current curricula for these core specialties. This ensures that it is complementary and covers the additional discrete areas of underpinning knowledge and technical skill required of the PHEM specialist.
2.1.3 The trainee in PHEM will enter sub-specialty training with a relatively high level of medical expertise in one of the four core specialties (see section 3) but with potentially little or no experience of how to apply that expertise in the pre-hospital environment. The curriculum aims to balance the knowledge and skills of the in-hospital emergency physician, anaesthetist, intensivist or acute physician with the needs of the critically ill patient in the pre-hospital environment.
2.2 CURRICULUM DEVELOPMENT2.2.1 The curriculum was developed over a considerable time period using consensus development processes with trainees, other healthcare professionals and PHEM practitioners. The development process is described in detail on the IBTPHEM website. The derived curriculum relates to what should be expected of a newly ‘qualified’ consultant in PHEM across the four nations of the UK.
2.2.2 The Curriculum framework is illustrated schematically in figure 2.1. It comprises six sub-specialty specific and four cross-cutting themes. ‘Themes’ are over-arching areas of PHEM professional practice. The framework diagram illustrates the central importance of Good Medical Practice and the relationship between the cross-cutting generic themes of Operational Practice, Team Resource Management and Clinical Governance to the six specialty specific themes. The diagram also emphasises the inter-relationship of all themes – none stands alone.
2.3 CURRICULUM CONTENT2.3.1 Within each theme are a number of discrete work roles or activities which are referred to as ‘units’. Each unit contains grouped or related ‘elements’ of under-pinning knowledge, technical skill and behavioural attribute or non-technical skill – otherwise referred to as ‘competences’. These elements are described in detail within the full version of the Curriculum Framework and Assessment Blueprint for Pre-hospital Emergency Medicine (the Curriculum). The ten themes and their composite units are described below.
2.3.2 Cross-cutting theme - Good Medical Practice (GMP)
Good Medical Practice (GMP) is the term given to the core ethical guidance provided to doctors by the GMC. Other healthcare professional regulators such as the Nursing and Midwifery Council and the Health and Care Professions Council provide similar guidance. GMP sets out the principles and values on which good practice is founded; these principles together describe medical professionalism in action.19 The principles within the four GMP domains are listed below and provided in further detail within the curriculum. In all themes within the Curriculum Framework, relevant GMP domains are assigned to every element. This assignment ensures that the assessment tools used for any particular element incorporates the relevant aspect of GMP.
19 General Medical Council, 2013
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Domain 1. Knowledge, skills and performance1.1 Develop and maintain your professional performance1.2 Apply knowledge and experience to practice1.3 Record your work clearly, accurately and legibly
Domain 2. Safety and Quality2.1 Contribute to and comply with systems to protect patients2.2 Respond to risks to safety2.3 Protect patients and colleagues from any risk posed by your health
Domain 3. Communication, partnership and team work3.1 Communicate effectively3.2 Work collaboratively with colleagues to maintain or improve patient care3.3 Teaching, training, supporting and assessing3.4 Continuity and coordination of care3.5 Establish and maintain partnerships with patients
Domain 4. Maintaining trust4.1 Show respect for patients4.2 Treat Patients and colleagues fairly and without discrimination4.3 Act with honesty and integrity
Good Medical Practice
Working in Emergency
Medical Systems
Providing pre-hospital
Emergency Medical Care
Using pre-hospital
equipment
Supporting rescue and extrication
Supporting safe patient
transfer
Supporting emergency
preparedness and response
Figure 2.1. Schematic representation of the PHEM Curriculum Framework.
2.3.3 Cross-cutting theme A. Operational Practice
Maintaining safe and effective operational practice is a generic or cross-cutting theme of professional practice within PHEM. This theme concerns the knowledge, skills and non-technical skills required to maintain safe and effective operational practice within a pre-hospital emergency medicine service provider. The units within this theme are:
A.1 Apply the curriculum framework to local operationsA.2 Respond to incidents by roadA.3 Respond to incidents by airA.4 Utilise telecommunications and voice procedureA.5 Apply principles of dynamic risk assessment at incident scenesA.6 Provide scene managementA.7 Maintain recordsA.8 Apply infection prevention and control principles and proceduresA.9 Apply moving and handling principles and proceduresA.10 Apply principles of Equality and Diversity
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2.3.4 Cross-cutting theme B. Team Resource Management
Contributing to effective Team Resource Management is a generic or cross-cutting area of professional practice within PHEM. This theme concerns the knowledge, skills and non-technical skills required to work as part of a multi-disciplinary team in the high hazard, resource limited, environmentally challenging and time pressured pre-hospital environment The units within this theme are:
B.1 Understand human factors and their role in patient and team safety B.2 Maintain situational awarenessB.3 Understand and apply principles of decision makingB.4 Communicate effectivelyB.5 Employ effective team workingB.6 Demonstrate leadership and followershipB.7 Manage stress and fatigueB.8 Understand and apply principles of error investigation and management
2.3.5 Cross-cutting theme C. Clinical Governance
Application of clinical governance principles and techniques is a generic or cross-cutting area of professional practice within PHEM. This theme concerns the knowledge, skills and non-technical skills required to ensure that clinical governance principles and mechanisms are applied to clinical practice. The units within this theme are:
C.1 Understand and apply principles of clinical governance as applied to pre-hospital practice C.2 Manage and support continuous professional developmentC.3 Utilise clinical evidence to support clinical practiceC.4 Utilise and prepare documents that guide practiceC.5 Support and apply clinical auditC.6 Understand and apply organisational risk management processesC.7 Support training and developmentC.8 Understand and apply quality management processes
2.3.6 Specialty theme 1. Working in emergency medical systems
Specialist practitioners in PHEM operate within wider Emergency Medical Services (EMS) Systems. These systems have a number of inter-dependent components. Having an understanding of these components, the way in which they interact and the wider regulatory framework surrounding them is essential to effective professional medical practice in this field. The units within this theme are:
1.1 Understand Emergency Medical Services (EMS) Systems models and components1.2 Understand pre-hospital operational environments1.3 Understand the training and regulation of pre-hospital healthcare personnel1.4 Understand the process of ambulance emergency call handling, prioritisation, dispatch
categorisation and resource management1.5 Understand the role of pre-hospital emergency medical services within EMS1.6 Understand the law relevant to Pre-hospital Emergency Medicine practice1.7 Work effectively with emergency services 1.8 Work effectively with acute hospital services1.9 Provide EMS clinical advice, support and co-ordination 1.10 Understand the pre-hospital and acute sector management structures within the wider
healthcare system
18
2.3.7 Specialty theme 2. Providing Pre-hospital Emergency Medical Care
Sub-specialist training in PHEM currently commences after completion of ST4 in Emergency Medicine, Anaesthetics, Intensive Care Medicine or Acute Internal Medicine (see section 3). Trainees therefore have experience of emergency clinical care in the hospital environment. The established principles and techniques used in those settings often need to be modified for effective pre-hospital emergency use. In addition, the provision of emergency medical care in a relatively unsupported environment requires a greater in-depth knowledge of resuscitation in all age groups. The units within this theme reinforce resuscitation concepts learned during higher specialist training and relate them to the pre-hospital operational environment. The units within this theme are:
2.1 Assess patients in the pre-hospital phase 2.2 Provide immediate pre-hospital clinical care 2.3 Provide cardiopulmonary resuscitation in the pre-hospital environment 2.4 Manage acute medical emergencies in the pre-hospital environment 2.5 Manage injury in the pre-hospital environment 2.6 Provide analgesia, procedural sedation and anaesthesia in the pre-hospital environment 2.7 Manage obstetric emergencies in the pre-hospital environment 2.8 Manage the newborn in the pre-hospital environment 2.9 Manage injured or ill children in the pre-hospital environment 2.10 Manage the bariatric patient in the pre-hospital environment 2.11 Manage elderly patients in the pre-hospital environment 2.12 Manage acute behavioural disturbance in the pre-hospital environment 2.13 Provide end-of-life care and immediate management of bereavement
2.3.8 Specialty theme 3. Using Pre-hospital Equipment
Pre-hospital and in-transit emergency care requires use of a wide range of medicines, devices and portable equipment. Practitioners must be competent in both the application and operation of specific equipment items and the principles underlying their function and design. The units within this theme are:
3.1 Apply equipment governance principles and practice3.2 Understand and use personal protective equipment3.3 Operate all types of commonly used pre-hospital emergency medical device3.4 Operate common non-medical pre-hospital equipment3.5 Manage and administer medicines
2.3.9 Specialty theme 4. Supporting Rescue and Extrication
Pre-hospital emergency medical services are frequently targeted at patients who, because of physical entrapment, physical geography or functional geographic constraints, cannot just be taken to the nearest appropriate hospital. This competence theme focuses on the underpinning knowledge, technical skills and non-technical skills required to manage a trapped patient and effectively interact with professional rescue service personnel at common pre-hospital rescue situations. The units within this theme are:
4.1 Work within the rescue environment4.2 Understand entrapment4.3 Support extrication4.4 Clinically manage the trapped patient
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19
2.3.10 Specialty theme 5. Supporting Safe Patient Transfer
This theme covers the competences required to make destination hospital triage decisions, select the most appropriate transport platform, provide safe, effective and focused in-transit critical care and ensure that the patients’ condition and immediate needs are communicated to receiving hospital clinical staff. As with other competence themes, many of the elements are common across all clinical services. The constituent units within this theme are:
5.1 Understand the concepts underpinning transfer medicine5.2 Understand the applied physiology of patient transfer5.3 Co-ordinate and plan patient transfer5.4 Prepare patients for transport5.5 Utilise a range of patient transport modalities 5.6 Clinically manage patients during transport
2.3.11 Specialty theme 6. Supporting Emergency Preparadness and Response
This theme encompasses the competences required to ensure that practitioners are appropriately prepared and equipped for larger scale emergency incidents in terms of their understanding of emergency planning and the principles of major incident management. The units within this theme are:
6.1 Understand principles of emergency preparedness, response and recovery 6.2 Respond to emergencies at operational (bronze) level 6.3 Respond to emergencies at tactical (silver) level 6.4 Manage chemical, biological and radiological (CBR) emergencies6.5 Understand the psychosocial and mental health aspects of multiple casualty incidents
2.3.12 The full curriculum framework, detailing the elements of underpinning knowledge, technical skill and non-technical skill is provided in Part 2 of this document.
2.4. LEARNING METHODS2.4.1 The curriculum framework tables presented in Part 2 define each element of knowledge, technical skill and non-technical skill and relate these to:
(a) The relevant GMP domain – to ensure that the assessment tools used for those particular groups of elements incorporate the relevant aspect of GMP
(b) The phase of training (see section 3)(c) Recommended assessment methods (see section 4)(d) Recommended learning methods
2.4.2 The recommended learning methods have been adapted from established learning methods within the specialties of Emergency Medicine, Anaesthetics, Intensive Care Medicine and Acute Internal Medicine. They are described in table 2.1. These were applied during prototype Faculty of Pre-hospital Care PHEM Training Fellowships. They were then further adapted according to the feedback provided by trainees, trainers and local education providers.20
2.4.3 Trainees in PHEM will be experienced adult learners with differing learning styles. The list of recommended learning methods should therefore be tailored to the individual. The list is not exhaustive but is to serve as a guide for trainers and trainees.
2.4.4 The IBTPHEM provides, through its Training Committee, training and guidance for trainers in relation to supporting these learning methods (see section 5).
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20 Sub-specialty Training in Pre-hospital Emergency Medicine. Supplementary guidance following consultation. 7 February 2011
20SECTION 2. THE PRE-HOSPITAL EMERGENCY MEDICINE CURRICULUM
Table 2.1. Recommended learning methods
2.5 IMPLEMENTATION AND MANAGEMENT OF CURRICULUM2.5.1 The curriculum and assessement system is managed by the IBTPHEM. Organisations with statutory responsibility for postgraduate training (e.g. Local Education and Training Boards in England, the NHS Education Scotland Deaneries, the Welsh Deanery and the Northern Ireland Medical and Dental Training Agency) who wish to implement the curriculum should consult the IBTPHEM to ensure that lessons identified from training programmes can be shared.
2.5.2 The IBTPHEM is responsible for curriculum review via its curriculum committee. The curriculum is formally reviewed on a two yearly cycle. The curriculum will indicate the date of formal review and document version.
2.5.3 As with all other specialties and sub-specialties, and in accordance with the GMC Quality Improvement Framework, the IBTPHEM are required to submit annual reports regarding the progress and effectiveness of sub-specialty training and seek approval for any change to the curriculum and assessment system from the GMC.
2.5.4 The IBTPHEM encourages all involved in implementing and using the curriculum to provide active feedback to inform the review process. It will aim to take into account new clinical and service developments, reports from sources such as trainees, educational supervisors, programme directors, deaneries, local education providers (LEPs), and patients.
Method Description
Directed Reading (DR) Reading recommended texts, journal articles and monographs (whether available online or offline)
Lectures and Tutorials (LT)Use of lectures, small group teaching and tutorials (including practical skills sessions) where the learning is moderated by the teacher
Deliberate Practice (DP) The repeated execution of a skill or task (without having to have a mentor present)
Simulation Learning (SL)
The simulation (at any level of fidelity and reality) of a situation in order to attain pre-determined learning objectives (e.g. simulated patients, simulated incident scenes, use of models, tabletop exercises)
Reflective Practice (RP) Reflection upon past events to critique performance and so guide further development
Role Modeling (RM)Role modeling is a process that allows trainees to learn new behaviours without the trial and error of doing things for themselves
Collaborative Learning (CL) Learning from peers through discussion of situations, cases or concepts
Experiential Learning (EL) Observation of or participation in events experienced by the learner
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SECTION 3. TRAINING IN PRE-HOSPITAL EMERGENCY MEDICINE
23SECTION 3. TRAINING IN PRE-HOSPITAL EMERGENCY MEDICINE
3.1 TRAINING OVERVIEW3.1.1 Sub-specialty training in PHEM takes place in the context of UK wide specialty training in Emergency Medicine, Anaesthetics, Intensive Care Medicine and Acute Internal Medicine. The relationship between LEPs, organisations with statutory responsibility for postgraduate training, the IBTPHEM and the core CCT specialties is illustrated in figure 3.1. 21 For ease of reference, organisations with statutory responsibility for postgraduate training throughout the UK, such as Local Education and Training Boards in England, the NHS Education Scotland Deaneries, the Welsh Deanery and the Northern Ireland Medical and Dental Training Agency, are all referred to in this guide as Deaneries.
Figure 3.1 Quality framework for PHEM training and relationships between LEPs, the IBTPHEM, the Colleges and Faculties, the Deaneries and the GMC.
3.1.2 It is recommended that trainees who might be interested in PHEM but who have had little previous exposure to the sub-specialty consult their nearest PHEM Training Programme Director for details of opportunities to observe PHEM services or otherwise gain some experience of the operational environment and clinical practice. Details of sub-specialty training programmes in PHEM can be obtained from the IBTPHEM (www.ibtphem.org.uk).
3.1.3 The PHEM trainee is required to undertake a minimum of 12 months whole time equivalent sub-specialist training in PHEM (in approved PHEM training posts) and successfully complete the required formative and summative assessments in order to be recommended for a certificate of completion of PHEM sub-specialty training.
3.1.4 Training in PHEM may be undertaken before or after completion of the core specialty CCT programme. For trainees who are pre-CCT, PHEM training is undertaken after the fourth year of specialty training (ST4). For post-CCT trainees, PHEM training may be undertaken at any stage.
3.2 STRUCTURE OF TRAINING3.2.1 For pre-CCT trainees, Deaneries and LEPs are able to design training programmes that integrate the recommended minimum 12 months whole time equivalent PHEM training into core specialty training. Although there are many possible ways of integrating PHEM sub-specialty training with core CCT training, the IBTPHEM recommend one of three options.
21 Quality framework for specialty including GP training. General Medical Council, April 2010
24
(a) a 24 month period of PHEM training blended with core CCT training (Scheme A) – figure 3.2(b) a 24 month period of alternating 6 month blocks of sub-specialty PHEM and core CCT training
(Scheme B) – figure 3.2(c) a 12 month period of PHEM training inserted into core CCT training (Scheme C) – figure 3.3
3.2.2 Scheme A comprises four six month posts which each provide a blended mixture of PHEM and core spe-cialty training that in total gives 12 months of PHEM training and 12 months of core specialty training over 24 months. This blending is achieved by proportionally splitting the PHEM and core CCT training in a way that is complimentary. Figure 3.2 illustrates the proportional split that has been found to be most successful. Experi-ence has also shown that two ‘paired’ trainees are required for LEPs to effectively deliver Scheme A. Trainees must commence scheme A with the majority of time allocated to PHEM training.
SECTION 3. TRAINING IN PRE-HOSPITAL EMERGENCY MEDICINE
12 months WTEover 24 months
Scheme A - Blending of 12 months PHEM training into extended core ST5/6
Scheme B - Alternating of 6 months PHEM training with core CCT training
Figure 3.2 Diagrammatic representation of Scheme A and B training programmes
3.2.3 Scheme B comprises alternating six month posts within PHEM and the core CCT specialty of the trainee. Scheme B may fit more conveniently with core CCT training placement rotations but the gap between phases 1 and 2 (see below) may potentially compromise PHEM training. Nonetheless, Scheme B illustrates another way of achieving 12 months whole time equivalent PHEM training.
3.2.4 Scheme C comprises two full-time six month posts undertaken outside of core specialty training. Scheme C is the preferred model for post-CCT trainees but is an intensive programme. Scheme C is illustrated in figure 3.3.
6 months 50% PHEM phase 1 post, 50% core CCT
6 months F/T PHEM phase 1 post
6 months 50% PHEM phase 1 post, 50% core CCT
6 months F/T Core CCT
6 months 50% PHEM phase 2 post, 50% core CCT
6 months F/T PHEM phase 2 post
6 months 50% PHEM phase 2 post, 50% core CCT
6 months F/T Core CCT
25SECTION 3. TRAINING IN PRE-HOSPITAL EMERGENCY MEDICINE
12 months WTEover 12 months
6 months F/T PHEM phase 1 post,
6 months F/T PHEM phase 2 post,
Scheme C - Addition of 12 months PHEM at ST5/6/7 or post core CCT
Figure 3.3 Diagrammatic representation of Scheme C training programme
3.2.5 All PHEM training programmes will take place after ST4 and should be expected to extend core specialty training by one year (figure 3.4). Experience gained through prototype Training Fellowships has suggested that a blended model of training delivery (Scheme A) is the preferred model for pre-CCT trainees with little or no previous PHEM experience as it allows more time for PHEM competences to develop and embed whilst retaining core specialty training experience. It also more closely reflects the future sub-specialist working pattern of a consultant in PHEM.
3.2.6 Those with a CCT in either Emergency Medicine, Anaesthetics, Acute Internal Medicine or Intensive Care Medicine who meet the person specification will be able to apply competitively for a training grade post in PHEM. Trainees on this pathway are likely to undertake 12 months full-time training (scheme C).
3.3 PHASES OF TRAINING3.3.1 All training programmes, regardless of which scheme is followed, will comprise three distinct phases of whole time equivalent (WTE) training:
(a) Phase 1(a) – Initial training (b) Phase 1(b) – Development training(c) Phase 2 – Consolidation training
26SECTION 3. TRAINING IN PRE-HOSPITAL EMERGENCY MEDICINE
Figure 3.4 Comparison of PHEM training schemes and their relationship to core CCT training pathways in (a) Emergency Medicine, (b) Anaesthetics, (c) Acute Internal Medicine and (d) Intensive Care Medicine.
PHEM sub-specialty training within Emergency Medicine and Acute Internal Medicine extends core specialty training by one year. Trainees should liaise with local core specialty and PHEM training programme directors
as it may be possible within Anaesthesia and Intensive Care Medicine to incorporate PHEM sub-specialty training within the core CCT programme envelope. All illustrated schemes relate to the ACCS route.
27SECTION 3. TRAINING IN PRE-HOSPITAL EMERGENCY MEDICINE
3.3.2 In a 12 month WTE programme, phase 1(a) would typically last 1 month, phase 1(b) would typically last 5 months and phase 2 would typically last 6 months. For those in a Scheme A training programme, the phases last slightly longer in proportion to the amount of PHEM being undertaken: for example, an 80% PHEM programme, phase 1(a) would typically last 4 to 6 weeks. Progression from one phase to the next relies upon successful assessment (see section 4).
3.3.3 Phase 1(a) involves dedicated training to allow the trainee to operate under supervision with a LEP in phase 1(b). Throughout phase 1(a), trainees will be taught the phase 1(a) clinical knowledge and skills (as defined in the Curriculum, receive an induction with the LEP and be taught the LEP specific knowledge and skills. Much of this training will be using patient simulators with an experienced faculty, and may be provided at a regional or supra-regional level. Section 4 describes the mandatory formative assessment at the end of phase 1(a) that allows progression to phase 1(b) of training.
3.3.4 Phase 1(b) involves directly supervised operational practice and demonstration of the phase 1(a) and 1(b) competences under close supervision. Trainees are expected to progressively become more autonomous in their practice during this phase, whilst retaining a high level of supervision. Section 4 describes the mandatory national summative assessment at the end of phase 1 that allows progression to phase 2 of training.
3.3.5 The trainee in phase 2 is expected to develop a greater depth of knowledge and improved clinical performance whilst retaining, at a more remote level, appropriate supervision. This phase may be undertaken with a different LEP to phase 1 to allow for exposure to a different case-mix or pre-hospital environment. Section 4 describes the mandatory summative assessment at the end of phase 2 that will provide information for the final Structured Training Report (STR), core CCT Annual Review of Competence Progression (ARCP) and recommendation via the IBTPHEM to the GMC regarding completion of sub-specialty training.
3.4 MANAGEMENT OF TRAINING3.4.1 The IBTPHEM is responsible for determining the duration, content and assessment of training in PHEM. Deaneries who provide PHEM training programmes must comply with the GMC generic standards for training and should fulfill the IBTPHEM requirements for LEPs in section 5.
3.4.2 Trainee and training programme management structures should reflect those in place for the parent CCT specialties. The Deanery must have a PHEM Regional Training Committee and a Training Programme Director who will be the trainee’s point of contact.
3.4.3 All elements of work in training posts must be supervised with the level of supervision varying depending on the experience of the trainee and the clinical exposure and case mix undertaken. A minimum of 20% direct supervision of trainees is expected throughout PHEM training. As training progresses the trainee should have the opportunity for increasing autonomy, consistent with safe and effective care for the patient.
3.4.4 Trainees will at all times have a named Educational Supervisor and Clinical Supervisor, responsible for overseeing their education. Depending on local arrangements these roles may be combined into a single role of Educational Supervisor. The responsibilities of supervisors are as defined by the GMC and are reproduced in section 5.
3.5 ENTRY TO TRAINING3.5.1 Recruitment to PHEM sub-specialty training will be managed nationally through a national recruitment scheme. The scheme recognises that not all regions will be able to deliver sub-specialty training and aims to:
(a) provide equity of access to approved training programmes (b) foster fair, criterion-referenced and competitive entry to programmes (c) support quality management of training programmes (d) guide workforce development and planning
28SECTION 3. TRAINING IN PRE-HOSPITAL EMERGENCY MEDICINE
3.5.2 The IBTPHEM has asked the Lead Deanery (Health Education East of England) to act as the co-ordinating body for national co-ordinated recruitment to PHEM sub-specialty training until such time as an independent specialty and sub-specialty National Recruitment Office is formed. The co-ordinating body will undertake all aspects of the recruitment process including advertising, application handling, assessment and matching of successful candidates to places.
3.5.3 The principle of national co-ordinated recruitment is that any PHEM service provider which meets, either alone or in partnership, the criteria and standards for LEPs, may become an LEP within a Deanery training programme. Any approved LEP can then offer training posts to the Deanery programme for inclusion in the national PHEM recruitment scheme. In the initial phases of sub-specialty development, LEPs may have national recruitment posts and locally organised recruitment posts within an approved programme. It is expected that all approved training posts will be accessed via the national recruitment scheme from August 2015.
3.5.4 National co-ordinated recruitment will be on an annual basis according to the timetable outlined in table 3.1. A detailed description of all declared national scheme posts within approved training programmes will be available to all applicants. Postgraduate Deans, Heads of Schools, and PHEM Training Programme Directors will be provided with copies of any adverts and post/programme descriptions so that all will be fully aware of the commencement of recruitment.
Table 3.1. Outline timetable for national recruitment process
3.5.5 Applications will be made online using software already widely used in postgraduate training and a standardised application form based upon the national specialty registrar template. Applicants will be asked to rank all training programmes and posts they are willing to be considered for in order of preference. It is possible that on completion of the recruitment process, a successful candidate’s preferences cannot be accommodated due to them already being filled by higher ranking candidates. Applicants should be aware that they will not be offered a programme they have not expressed a preference for in their original application.
3.5.6 Long-listing will be undertaken by the co-ordinating body and will be based on the person specification and confirmation of eligibility to commence sub-specialty training. The PHEM person specification available from the recruitment pages on the IBTPHEM website (www.ibtphem .org.uk) describes the detailed eligibility requirements. In summary:
(a) The earliest application for pre-CCT training is at ST3(b) The earliest commencement of PHEM sub-specialty training is at the end of ST4(c) Applicants must have been awarded core specialty NTN for an approved parent specialty(d) Applicants must have MCEM or primary FRCA or equivalent(e) Entry is conditional on successful ST4 ARCP
3.5.7 Short-listing, if required, will be undertaken using established processes and a short-listing panel which will include IBTPHEM and LEP representatives. All successfully shortlisted candidates will then be invited to a selection centre. The selection process will be confirmed in detail by the co-ordinating body but will typically be a total of thirty minutes between a number of stations (e.g. General interview station, Patient scenario station and Communication / team resource management station).
Month Process
September PHEM Training Programme Directors and Deaneries declare the number of posts they have available for appointment in the next recruiting cycle.
October Standard adverts will be published on the NHS jobs and IBTPHEM websites. Deaneries may also advertise on their websites.
October/November Long-listing and Short-listing
November/December Selection and matching process
February/August Successful applicants commence training
29SECTION 3. TRAINING IN PRE-HOSPITAL EMERGENCY MEDICINE
3.5.8 The selection centre will operate in keeping with standard national recruitment processes. Candidates will be scored using a standard framework. Appointable candidates will be ranked in order of merit. Once the final ranking has been confirmed, co-ordinating body staff will complete the matching process using the candidate’s previously declared preferences. For all appointable candidates, offers will be based on firstly where the candidate is ranked and then the candidates preference (i.e. the top ranked individual is matched to their first choice programme, the second ranked candidate if possible will receive their first choice, unless it has already been filled and so on).
3.5.9 Once offers are accepted, details of applicants will be passed on to the respective Deanery who will take over all correspondence. The co-ordinating body will provide further detailed guidance regarding the recruitment scheme (available through the IBTPHEM website).
3.5.10 The advantages of a national recruitment scheme is that it will allow trainees who wish to train in PHEM to apply in open competition for the programmes available nationally. If successful through shortlisting and selection, candidates are then matched to the programmes offered within the sub-specialty, based on the maximum appointments to be made and the candidates’ programme preferences in rank order. The scheme will therefore enable the sub-specialty to ensure that the appropriate numbers of trainees are being trained.
3.6 PROGRESSION THROUGH TRAINING3.6.1 Progression through training is dependant upon successful completion of formative and summative assessments and evidence of satisfactory progression through the curriculum. On appointment to a training post in PHEM, all trainees are required to register with the IBTPHEM in order that training numbers and progression can be monitored. In the future, it is intended that following enrolment, trainees will be given access to an electronic Portfolio for PHEM. In the interim, trainees are encouraged to maintain records of all aspects of training – duty hours, clinical cases, assessment tools etc. These records will form an essential component of PHEM programme structured training reports (STRs).
3.6.2 The trainee is responsible for ensuring that the Portfolio is kept up to date, arranging assessments and ensuring they are recorded, preparing drafts of appraisal forms, maintaining a personal development plan, recording their reflections on learning and recording their progress through the curriculum.
3.6.3 Educational supervisors and trainees should work together to provide this evidence of progression at regular meetings. The Educational Supervisor, when meeting with the trainee, should discuss issues of clinical governance, risk management and any clinical incidents involving the trainee. The Educational Supervisor should be part of the PHEM clinical specialty team. Thus if the LEP clinical directorate/clinical director has any concerns about the performance of the trainee, or where there are issues of doctor or patient safety, these can be discussed directly with the Educational Supervisor.
3.6.4 Opportunities for feedback to trainees about their performance will arise through the use of the workplace based assessments, regular appraisal meetings with supervisors, other meetings and discussions with supervisors and colleagues, and feedback from STRs and the ARCP.
3.6.5 A formal process of appraisal assists with training and development, ensures adequate supervision during training, and provides feedback to trainees. All appraisals should be recorded in the PHEM Portfolio. The trainee and educational supervisor should have an appraisal meeting at the beginning of each post to review the trainee’s progress, agree learning objectives for the post ahead and identify the learning opportunities presented by the post using the curriculum framework. A mid-point review meeting should be conducted within each post to ensure trainees are progressing satisfactorily.
3.6.6 On completion of each placement, post or programme, trainees should review their progress with their Educational Supervisor using evidence from the PHEM Portfolio related to their phase of training. Specific concerns may be highlighted from this appraisal. It should also record the areas where further work is required to overcome any shortcomings. Further evidence of competence in certain areas may be needed, such as planned workplace based assessments, and this should be recorded. If there are significant concerns then the Training Programme Director should be informed.
30
3.7 DURATION OF TRAINING3.7.1 Trainees are expected to undertake a minimum of 12 months whole-time equivalent training in approved training posts. This may take place over a time period agreed with the Training Programme Director. Training time may have to be increased depending upon a trainee’s progress.
3.7.2 It is recognised that each training provider is likely to provide a slightly different clinical case mix or environment exposure. Services in large UK cities will, for example, offer different cases and challenges to services operating in a remote and rural area. For that reason, with the agreement of the Training Programme Directors and in the context of an approved programme, trainees may split their training between different LEPs.
3.8 LESS THAN FULL TIME TRAINING (LTFT)3.8.1 Trainees are entitled to opt for less than full time training programmes in PHEM. This training shall meet the same requirements as full-time training and the Deanery shall ensure that the competences achieved and the quality of part-time training are not less than those of full-time trainees. These posts are not supernumerary and may fit easily into existing training programmes running Scheme A. Deaneries will be able to give advice on this.
3.8.2 In order to comply with GMC guidance, retain competence and acquire new knowledge and skills, LTFT trainees would still normally be expected to work a minimum of 50% of full time.
3.8.3 LTFT trainees should assume that their clinical training will be of pro-rata duration compared with the full time indicated/recommended, but this should be reviewed during annual appraisal by their Training Programme Director, Specialty Training Committee and Deanery.
3.9 COMPLETION OF TRAINING3.9.1 Completion of training is achieved by successful completion of an approved training programme of appropriate duration combined with successful assessment as detailed in section 4 and the award of an IBTPHEM certificate of completion of sub-specialist training.
3.9.2 The IBTPHEM, via its National Training Review Panel, is responsible for making recommendations to the trainee’s core specialty ARCP panel regarding eligibility for inclusion of sub-specialty registration in PHEM on the specialist register.
3.9.3 Pre-CCT PHEM trainees will have recognition of PHEM sub-specialty training included in their core specialty CCT application. The GMC will initiate the process once the core specialty CCT training programme has been completed.
3.9.4 Post-CCT PHEM trainees will need to apply separately to the GMC for the addition of the PHEM sub-specialty to their existing entry on the specialist register. The process for making this application is available from www.gmc-uk.org.
3.10 RESEARCH3.10.1 There is currently no specific provision for academic training within the sub-specialty program. Where appropriate, Deaneries may integrate PHEM training with the academic training program. After completion of Academic Clinical Fellow and PhD posts an ‘academic’ PHEM trainee would extend the Academic Clinical Lecturer Post from 3 years to 4 years, integrating PHEM sub-specialty training in exactly the same pattern as the sub-specialty program integrates with ST4-6 for trainees who are not in an academic training program.
SECTION 3. TRAINING IN PRE-HOSPITAL EMERGENCY MEDICINE
31SECTION 4. THE ASSESSMENT FRAMEWORK FOR PRE-HOSPITAL EMERGENCY MEDICINE
SECTION 4. THE ASSESSMENT FRAMEWORK FOR
PRE-HOSPITAL EMERGENCY MEDICINE
33SECTION 4. THE ASSESSMENT FRAMEWORK FOR PRE-HOSPITAL EMERGENCY MEDICINE
4.1 INTRODUCTION TO ASSESSMENT4.1.1 The purpose of assessment is to:
• assist learning and development• evaluate progress and support transition through training• ensure achievement of necessary competence relevant to the work role• ensure trainees possess the essential underlying knowledge, technical skills and behaviours• assure the profession and public regarding the standards of performance• inform trainees’ Structured Training Reports (STRs) and Annual Review of Competence Progression
(ARCP), identifying any requirements for targeted or additional training where necessary and facilitating decisions regarding progression through the training programme
4.1.2 The integrated assessment system for PHEM mirrors, in many respects, the established assessment systems for the core CCT specialties. It measures progress of trainees against the curriculum for sub-specialist PHEM training and is composed of a mixture of workplace based assessments and summative assessments at the end of each phase.
4.1.3 The overall assessment system (figure 4.1) comprises:
(a) A defined number of educational and appraisal meetings.
(b) A target number of work-place based training and learning opportunities over the full twelve months WTE of subspecialty training.
(c) A locally managed structured formative assessment towards the end of the initial phase of training.
(d) A nationally co-ordinated and managed structured summative assessment towards the end of each of the developmental and consolidation phases of training.
(e) Structured training reports from Educational Supervisors.
(f) An overall review of training by the IBTPHEM National Training Review Panel.
4.2 ASSESSMENT FRAMEWORK4.2.1 The assessment framework utilises a combination of formative and summative assessment. Figure 4.1 illustrates the duration of each phase of PHEM training and the relationship between continuous workplace based assessments and end-of-phase summative assessments for both phase 1 and phase 2.
Figure 4.1. The 2 phases of sub-specialist training in PHEM with assessment types and timings.
Phase 2 Na!onal
Summa!ve Assessment
Phase 1 Na!onal
Summa!ve Assessment
Con!nuous Assessment within training programmes
Phase 1 Local Forma!ve Assessment
Phase 1 Educa!onal Review and STR
Phase 2 Educa!onal Review and STR
Ini!al Educa!onal Review
PHASE 1 (6 months WTE) PHASE 2 (6 months WTE)
34SECTION 4. THE ASSESSMENT FRAMEWORK FOR PRE-HOSPITAL EMERGENCY MEDICINE
4.2.2 Within PHEM sub-specialty training, the majority of assessment is formative and conducted within training programmes. There are however key stages in training where there is formal assessment of the knowledge, technical skills and non-technical skills assimilated at that point in training. Evidence of completion of formative and summative assessments is summarised in the trainee’s STR and will be required at ARCP. An overview of the formal assessment elements is provided in table 4.1.
Table 4.1. Overview of formal assessment elements of the assessment system.
4.3 FORMATIVE ASSESSMENTS 4.3.1 Formative assessments take place throughout PHEM training. Formative assessment is a supported, reflective process that aims to promote trainee learning and development. It is used to develop and support trainees as their understanding and experience increases. Trainers, peers, and other healthcare professionals can conduct formative assessments. They are, in a sense, a learning method and they relate closely to the Experiential Learning and Reflective Practice methods described in table 2.1.
Phase of Training Phase 1(a) - Initial Training Phase 1(b) – Developmental
Training Phase 2 – Consolidation Training
Duration 1 month WTE 5 months WTE 6 months WTE
Content of training
Phase1(a) clinical knowledge and skills.
LEP induction and teaching of LEP specific knowledge and
skills – with a specific focus on operational practice and patient
and team safety.
Development of phase 1(a) and 1(b) elements.
Trainees are expected to progressively become more
autonomous in their practice during this phase, whilst retaining a high level of
supervision.
Consolidation of phase 1 elements and development of
phase 2 elements.
The trainee in phase 2 is expected to develop a greater
depth of knowledge and improved clinical performance
whilst retaining, at a more remote level, supervision.
Supervision 100% direct supervision Minimum 20% direct supervision
Minimum 20% direct supervision
Purpose of assessment
Ensure safe practice and support progression to phase
1(b) of training.
Assure proficiency across all phase 1(a) and phase 1(b)
elements (performing at a level equivalent to medical practice
expected in later specialty training years (ST5/6))
Enable transition to phase 2 (with a different LEP) at a nationally recognised and
defined level of knowledge and skill.
Assures that all elements of the PHEM sub-specialty
curriculum framework have been assimilated and
demonstrated at the level of the newly qualified independent
consultant practitioner.
Formal Assessment
Phase 1(a) structured assessment (local formative
assessment)
Phase 1 structured assessment (NSA)
Multi-source Feedback
Educational review (appraisal) and STR
Phase 2 structured assessment (NSA)
Multi-source Feedback
Educational review (appraisal), STR and core specialty ARCP
35SECTION 4. THE ASSESSMENT FRAMEWORK FOR PRE-HOSPITAL EMERGENCY MEDICINE
4.3.2 The following assessment tools will be used throughout the entire PHEM training to support this process:• Mini-Clinical Evaluation Exercise (CEX) • Case-Based Discussions (CbD)• Direct Observation of Procedural Skills (DOPS)• Acute Care Assessment Tool (ACAT)• Audit Assessment (AA)• Teaching Observation (TO) • Multi-Source Feedback (MSF) • Full case Simulation (SIM)
4.3.3 Defining minimum numbers for formative assessments is challenging given that a number of tools can be used to assess the same elements and many elements can be assessed with one tool. The minimum number must also reflect the clinical exposure and number of duty periods working under direct supervision – some assessment tools are most effectively applied during, or soon after, provision of clinical care whilst others can be utilised at a later stage. Nonetheless, the IBTPHEM recognise the need to set a minimum number of assessments to guide trainees, trainers and Deaneries.
4.3.4 Table 4.2 shows the minimum recommended number of each assessment tool to be used over 12 monthWTE PHEM training period. The IBTPHEM believes that these minimum numbers of assessments are achievable,will adequately sample from the curriculum and will reflect the importance of direct consultant supervisionand training in this discipline:
Table 4.2 Count of formative assessments.
4.3.5 As shown in the Assessment Blueprint in Part 2, the bulk of formative assessment takes place in phase 1(b). This assessment burden is achievable because this is a phase of close supervision and the assessment tools can sample across many elements of the curriculum framework.4.3.6 In addition to workplace based formative assessments throughout training, trainees will undergo a locally organised structured formative assessment at the end of phase 1(a). This assessment, typically 4 to 6 weeks after commencing training, is analogous to the Anaesthetic Initial Assessment of Competence at 3 months. It is intended to support the trainee in progressing to phase 1(b) and satisfy the needs of the LEP in relation to evidence of assimilation of:
(a) phase 1(a) elements of the curriculum framework(b) LEP safety policies and procedures(c) LEP clinical policies and procedures
4.4. SUMMATIVE ASSESSMENTS4.4.1 Summative assessment refers to the assessment of learning at a particular time. It is used to assess progression through training, support transition through training phases and confirm achievement of competences. Summative assessments are made against clear descriptors and only conducted by formally trained assessors.
Minimum recommended number of assessment tools used over 12 month PHEM training
Assessment tools
CEX CbD SIM DOPS MSF ACAT TO
15 30 10 30 2 25 5
36SECTION 4. THE ASSESSMENT FRAMEWORK FOR PRE-HOSPITAL EMERGENCY MEDICINE
4.4.2 There are two components to summative assessment within the overall assessment system:• Two National Summative Assessments (NSA): the phase 1 NSA at the end of phase 1 and the phase 2
NSA at the end of phase 2 (1 month before the end of each phase at the earliest).• Two Structured Training Reports which draw on the results of both formative and summative
processes and are used to inform the ARCP process and determine progression through, or completion of, training.
4.4.3 The phase 1 and 2 NSAs are conducted on behalf of the IBTPHEM by the Royal College of Surgeons of Edinburgh (RCSEd). The pre-existing Diploma and Fellowship in Immediate Medical Care examinations have been re-designed to allow them to fulfil the function of the phase 1 and phase 2 NSA respectively. The NSAs are conducted twice a year in January and July. Detailed regulations and guidance pertaining to the NSA 1(the Diploma in Immediate Medical Care) and NSA 2 (the Fellowship in Immediate Medical Care), including the dates, application processes and fees are available on the Royal College of Surgeons of Edinburgh website (www.rcsed.ac.uk).
4.4.4 The phase 1 NSA is a test of underpinning knowledge. It assures that sub-specialty trainees have assimilated (and can demonstrate) the relevant underpinning knowledge expected at that level of specialist training. For the phase 1 NSA, the candidate is expected to be able to apply the underpinning knowledge across all phase 1(a) and phase 1(b) elements in the Curriculum. This is equivalent to medical practice expected in later specialty training years (ST5/6). A person is eligible for the phase 1 NSA after completion of a minimum of 5 months WTE training in PHEM.
4.4.5 The phase 2 NSA assures that all elements of the PHEM sub-specialty curriculum framework have been assimilated and demonstrated at the level of the newly qualified independent (level 8) consultant practitioner. The candidate is therefore expected to perform to the standard expected of a newly qualified sub-specialist consultant (level 8) practitioner in PHEM. This is equivalent to independent clinical practice with high levels of underpinning knowledge, technical expertise and clinical experience across all elements of the Curriculum. A person is eligible for the phase 2 NSA after completion of a minimum of 11 months WTE training in PHEM and successful completion of the phase 1 NSA.
4.4.6 NSA 1 is blueprinted against the phase 1 elements of the Curriculum whereas NSA 2 is blueprinted against the whole curriculum (with an emphasis on phase 2 elements). The assessments have an identical format with two parts (A and B).
4.4.7 Part A comprises a written paper comprising:
(a) a multiple choice question paper (MCQ) of 150 minutes duration consisting of both Single Best Answer (SBA) questions and extended matching item (EMI) questions;
(b) a written paper of 30 minutes duration containing projected material and related multiple choice format questions.
4.4.8 Part B comprises an Objective Structured Practical Examination (OSPE). The OSPE will normally consist of 14 OSPE testing stations. Twelve of the OSPE stations will each be of 8 minutes duration and two will either be of 16 minutes duration for NSA 1 or 24 minutes duration for NSA 2. Each 24 minute OSPE will involve high-fidelity simulation of a pre-hospital clinical scenario. The OSPE is intended to cover the technical skills in the Curriculum pertinent to the NSA. Note that approximately 25% of the stations will relate to neonates, infants or children (three or four stations in each diet).
4.4.9 For Part A, candidate’s scores for the two papers are added together (giving equal weight to all questions across the two papers). Candidates pass or fail Part A as a whole based on how their total score compares to the combined pass mark for these two papers. The pass mark in each assessment is determined in advance following a standard-setting exercise conducted by the panel of examiners. Examiners are formally appointed and trained by the RCSEd according to defined criteria agreed with the IBTPHEM Assessment Committee. The panel utilise the Angoff method of standard setting.
37SECTION 4. THE ASSESSMENT FRAMEWORK FOR PRE-HOSPITAL EMERGENCY MEDICINE
4.4.10 For Part B, each station is marked using a predetermined item checklist reflecting the complexity and length of the station. The contribution to the pass mark from each station is determined using an appropriate Standard Setting method (Borderline regression or modified Angoff method based on the number of candidates in each diet). The contributions to the pass mark from each of the 14 stations are summed to obtain the pass mark for the whole assessment. Up to two additional stations may be included in an examination to test new questions. Neither the candidates nor the examiners will know which stations these are and the marks from these two stations will not contribute to the final result.
4.4.11 The two full immersion high fidelity human simulations in Part B of NSA 2 involve a critically injured or ill adult or child in a simulated pre-hospital setting. The clinical equipment available for these simulations will be identical to that used across the NSA OSPEs and will be standardised across examination diets and made available in advance. The expected clinical course will be determined prior to the assessment and be related to specified elements of the Curriculum. Each simulation will be marked independently by two assessors using a marking sheet with specific components for underpinning knowledge, technical skills and non-technical skills relevant to the simulation and the expected clinical course. The marking sheets will indicate whether the relevant elements were demonstrated in a manner which reflected pre-determined criteria for acceptable practice.
4.5 ASSESSMENT BLUEPRINT4.5.1 The Curriculum and Assessment Blueprint is detailed in Part 2. It is presented in the form of ten theme tables:
• Cross-cutting theme. Good medical practice• Theme 1. Working in Emergency Medical Systems• Theme 2. Providing pre-hospital emergency medical care• Theme 3. Using pre-hospital equipment• Theme 4. Supporting rescue and extrication• Theme 5. Supporting safe patient transfer• Theme 6. Supporting emergency preparadness and response• Cross-cutting theme A. Operational practice• Cross-cutting theme B. Team resource management• Cross-cutting theme C. Clinical governance
4.5.2 The first curriculum theme table relates to the central role of Good Medical Practice (GMP). In contrast to the other tables, no specific learning or assessment methods are listed. This is because GMP has been incorporated into, and directly mapped against, all aspects of the curriculum.
4.5.3 The subsequent curriculum theme tables describe the theme, unit and element type in terms of underpinning knowledge (UK), technical skill (TS) and non-technical skill (NTS). The A column indicates the earliest formal assessment in which an individual element can be assessed. Note that phase 1 is sub-divided into phase 1 (a) and phase 1 (b) to reflect the initial and developmental phases of training. The tables then provide recommended learning and assessment methods as defined in tables 2.1 and 4.4. The assessment methods with an asterisk in table 4.4 may be used for summative assessment. All may be used to inform the Structured Training Report (STR) and, in turn, the relevant ARCP. Only one method need be used for an individual element.
4.5.4 The final GMP column in the curriculum theme tables indicates the relationship between the individual elements and the GMP domains. The domain indicated is the dominant domain for that element.
38SECTION 4. THE ASSESSMENT FRAMEWORK FOR PRE-HOSPITAL EMERGENCY MEDICINE
4.5.5 Throughout the theme tables, consistent language has been used to ensure common understanding of each element of underpinning knowledge, technical skill or non-technical skill. The definition used for each descriptor is shown in table 4.3
Table 4.3 Curriculum element descriptors (from Concise Oxford English Dictionary)
4.6 ASSESSMENT TOOLS4.6.1 The Assessment Blueprint in Part 2 details the range of assessment tools recommended for each element within each theme. Appropriate assessment tools have been selected from the range already in use by the core CCT specialties (Table 4.3).
4.6.2 A Knowledge test (KT) is a summative written assessment of underpinning knowledge using a combination of extended matched and single best answer questions (EMQ and SBA). Knowledge tests combined with selected DOPS, simulation and case based discussion, are used to support transition between phases. They are only used for summative assessment.
4.6.3 The Mini-Clinical Evaluation Exercise (CEX) evaluates a clinical encounter with a patient to provide an indication of competence in skills essential for good clinical care such as history taking, examination and clinical reasoning. The trainee receives immediate feedback to aid learning. The CEX can be used at any time and in any setting when there is a trainee and patient interaction and an assessor is available. Trainees should aim to complete a minimum of 15 CEXs during their training.
4.6.4 The Case-Based Discussion (CbD) assesses the performance of a trainee in their management of a patient or situation to provide an indication of competence in areas such as clinical reasoning, decision-making and application of knowledge in relation to patient care. It also serves as a method to document conversations about, and presentations of, cases by trainees. The CbD should focus on a written record such as written case notes. CbD is also used for assessing the more generic, and less clinical, knowledge and skills needed for effective practice. e.g. evidence based practice, maintaining safety, teamwork, clinical research methodologies etc. Trainees should aim to complete a minimum of 30 formative CbDs during their training.
Element descriptor Definition
Describe Give a detailed account of (someone or something) in words
List Make a list of
Explain Make something clear by providing more detail
Define State or describe exactly the nature, or meaning of
Demonstrate Give a practical exhibition and explanation of
Critique Evaluate in a detailed and analytical way
Contrast Compare so as to emphasize differences
Select Carefully choose as being the best or most suitable
Categorise Place in a particular category; classify
Differentiate Recognize or identify as different; distinguish
Display Give a clear demonstration of (a quality, emotion, or a skill)
Analyse Examine methodically and in detail for the purposes of explanation or interpretation
Table 4.4 Recommended assessment methods
4.6.5 A Direct Observation of Procedural Skills (DOPS) is an assessment tool designed to evaluate the performance of a trainee in undertaking a practical procedure, against a structured checklist. The trainee receives immediate feedback to identify strengths and areas for development. DOPS may be used for formative assessments and is used for the phase 1 workplace based summative assessments. Trainees are required to complete 10 summative DOPS in phase 1 and should aim to complete a minimum of 30 formative DOPs during their training.
4.6.6 The PHEM curriculum requires that trainees develop skills and behaviours that allow them to manage rare and critically important events. Simulated situations allow trainees skills to be tested before practicing in live situations and also for trainees to be exposed to a range of situations that would not be met in one year of training. They can be repeated as guided by the learner’s needs and performance.
4.6.7 As well as technical skills, full case simulation (SIM) is appropriate for assessment of non-technical skills such as task management, team working, situational awareness and decision-making. Simulation does not require complex technology; high fidelity situations can be achieved with low or intermediate fidelity technology. Models or manikins can be used for invasive procedures; actors can be used to assess communication and teamwork in simulated situations. PHEM simulations should be carefully structured with key learning points derived from audit and review of real life cases (‘lessons identified’). PHEM simulations should be delivered, wherever possible, within appropriate contexts, e.g. in an ambulance, in a car wreck or in the ‘hostile’ conditions frequently encountered in pre-hospital work. By using simulators for formative assessments regularly during PHEM training, trainees will become familiar with the modality and allow its successful use in summative assessments. Trainees should aim to complete 10 formative simulation assessments during their training.
4.6.8 The Acute Care Assessment Tool (ACAT) is designed to assess and facilitate feedback on a doctor’s performance across a number of domains. The ACAT is designed for use during their practice on a pre-hospital emergency medicine duty period. Any doctor who has been responsible for the supervision of the duty period
39SECTION 4. THE ASSESSMENT FRAMEWORK FOR PRE-HOSPITAL EMERGENCY MEDICINE
Assessment method Role
Knowledge Test (KT)* Summative assessment of underpinning knowledge using multiple choice type questions.
Mini-Clinical Evaluation Exercise (CEX)* Evaluates a clinical encounter. May be used for formative and summative assessments
Case based discussion (CbD) Assesses performance in clinical reasoning, decision-making and application of knowledge.
Simulation (SIM)* Assessment of technical skills and non-technical skills such as task management, team working, situational awareness and decision-making.
Direct Observation of Procedural Skills (DOPS)*
Evaluates performance in undertaking a practical procedure. May be used for formative and summative assessments.
Multisource feedback (MSF) Assesses generic skills such as communication, leadership, team working, reliability etc.
Acute care assessment tool (ACAT) Facilitates feedback on performance across a number of domains during a pre-hospital emergency medicine duty period.
Logbook (LOG) Supports the STR/ARCP in relation to clinical case mix, operational experience and achievement of competences.
Patient Survey (PS) Assesses performance in areas such as interpersonal and communication skills by concentrating on performance during patient consultations.
Teaching observation (TO) A form of formative assessment for complex knowledge and skills given the need for the teacher to demonstrate competence (and often mastery).
40SECTION 4. THE ASSESSMENT FRAMEWORK FOR PRE-HOSPITAL EMERGENCY MEDICINE
can be the assessor for an ACAT. This tool should only be used formatively. It should cover as many domains as possible. For each case, the case notes and management plan should be reviewed by the clinical supervisor/assessor before it is signed off on the ACAT form. If the assessor raises concern about the performance of a particular case, this case should be further assessed using a CEX or CbD. ACAT may only be used as a means of formative assessment. Trainees should aim to complete 25 ACAT formative assessments during their training.
4.6.9 The Teaching Observation (TO) tool is designed to provide structured, formative feedback to trainees on their competence at teaching. The Teaching Observation can be based on any instance of formalised teaching by the trainee, which has been observed by the assessor. The process should be trainee-led (identifying appropriate teaching sessions and assessors). Teaching Observation is an acceptable form of formative assessment for complex knowledge and skills given the need for the teacher to demonstrate competence (and often mastery). Trainees should aim to complete 5 formative teaching observations during their training.
4.6.10 The Multi-Source Feedback (MSF) is a method of assessing generic skills such as communication, leadership, team working, reliability etc, across the domains of Good Medical Practice. This provides objective systematic collection and feedback of performance data on a trainee, derived from a number of colleagues. ‘Raters’ are individuals with whom the trainee works, and includes doctors, administration staff, and other allied professionals. The trainee will not see the individual responses by raters and formative feedback is given to the trainee by the Educational Supervisor. A MSF is required in each phase of PHEM training. Trainees should aim for a minimum of 10 respondents for each MSF.
4.6.11 The Portfolio or Logbook (LOG) provides information to support the ARCP in relation to clinical case mix, operational experience and achievement of competences across the spectrum of the curriculum framework. The logbook informs the STR process and should record all educational activity, including formative and summative assessments.
4.6.12 The Patient survey (PS) addresses issues, including behaviour of the doctor and effectiveness of the consultation, which are important to patients. It is intended to assess the trainee’s performance in areas such as interpersonal skills, communication skills and professionalism by concentrating solely on their performance during one consultation. Patient surveys may be conducted by LEPs and used to inform the STR and ARCP process.
4.6.13 The Audit Assessment (AA) Tool is designed to assess a trainee’s competence in completing an audit. The Audit Assessment can be based on review of audit documentation or on a presentation of the audit at a meeting. If possible the trainee should be assessed on the same audit by more than one assessor. Audit assessments are used to inform the STR and ARCP process.
4.7 USE OF ASSESSMENT TOOLS4.7.1 The assessment tools mirror those in place for core CCT specialties. Templates for each tool are available on the IBTPHEM website (www.ibtphem.org.uk) along with guidance notes for rating satisfactory or unsatisfactory performance.
4.7.2 The following examples illustrate how assessment tools for a CEX and a DOPS can be used across several elements of the curriculum.
Case Scenario
Guy, a year 5 emergency medicine trainee, is spending a year in pre-hospital emergency medicine sub-specialty training. He has successfully completed his phase 1 training and summative assessment and is now managing patients with supervision during his phase 2 training.
It is 21:00 on a wet winter’s night and the pre-hospital team are tasked to a road traffic incident involving a car that has driven head on into a tree at 60 mph. Guy, his supervising consultant and their paramedic colleague attend the scene, treat the patient and transfer the patient to hospital.
On arriving back from the incident, Guy and his supervising consultant take the opportunity to discuss the incident and their management, and complete a CEX and a DOPS form.
41SECTION 4. THE ASSESSMENT FRAMEWORK FOR PRE-HOSPITAL EMERGENCY MEDICINE
INTER-COLLEGIATE BOARD FOR TRAINING IN PRE-HOSPITAL EMERGENCY MEDICINEMINI-CLINICAL EVALUATION EXERCISE (CEX)
Trainee name: Guy Secratan Training Phase: 2
Assessor name: Alan Stathan Registration no: 123456
Grade of assessor: Consultant Date 12 / 01 / 2012
Clinical scenario observed Curriculum elements covered
24 year old male, unrestrained driver of car, high speed head on collision with tree. Police, fire and ambulance services on scene. Massive deformation to vehicle, patient physically trapped due to dashboard intrusion. Severe head and facial injuries with airway compromise, shocked due to blood loss from scalp and bilateral femoral fractures. Reduced conscious level, became combatative.
1.3.5 Demonstrate respect for individuals within the multi-professional workforce
1.4.3 Formulate response decisions on the basis of ambulance service emergency call information
2.1.9 Demonstrate ability to perform an organised, structured, relevant and focused assessment across the range of pre-hospital situations in infants, children and adults
2.1.10 Demonstrate ability to accurately interpret clinical history and physical signs in the pre-hospital environment in infants, children and adults
2.1.11 Demonstrate appropriate use and interpretation of pre-hospital monitoring in infants, children and adults
2.1.13 Demonstrate ability to balance risk and benefits of actions prior to full patient assessment
2.1.16 Demonstrates effective communication with patients and their family during clinical assessment
2.2.7 Demonstrate the immediate clinical interventions for managing and supporting:
2.2.9 Demonstrate ability to provide safe and effective immediate clinical care in the pre-hospital environment
2.2.10 Display a calm and methodical approach to providing immediate clinical care
The patient required basic airway manoeuvres, oxygen and in line manual immobilisation of C-spine whilst in the vehicle. He is fully monitored and, to enable extrication, he receives procedural sedation and analgesia intravenously. Once extricated has a pre-hospital emergency anaesthetic, intubation and continuation of anaesthetic. His limbs are splinted. He is transferred directly to a specialist neurosurgical centre by the team, who provide neuro-protection en route
2.5.8 Describe the immediate pre-hospital management of the following: (a) Injuries to the head, (b) Injuries to the face, (c) Injuries to the neck, (h) Injuries to the limbs
2.6.13 Demonstrate appropriate risk/benefit analysis for pre-hospital: (a) Analgesia, (c) procedural sedation, (d) emergency anaesthesia,
2.6.14 Demonstrate safe pre-hospital: (a) Analgesia, (c) procedural sedation, (d) emergency anaesthesia
3.1.4 Apply equipment governance procedures (b) during deployment and clinical care, (c) on completion of deployment
3.2.5 Demonstrate the correct use of PPE
3.2.6 Demonstrate the ability to operate whilst using PPE
3.2.7 Demonstrate a professional approach to use of PPE
3.3.3 Demonstrate confident and technically correct operation of: (a) Airway management devices, (b) Ventilatory support devices, (d) Devices for accessing the circulation, (f) Devices for administering medicine and blood products, (h) Devices for immobilizing joints, limbs and patients, (i) Devices for near patient testing, (j) Devices for temperature management, (k) Devices for non-invasive patient monitoring, (n) Devices for moving and handling patients
3.5.10 Demonstrate preparation of medicines for parenteral use
3.5.11 Demonstrate safe and effective administration of medicines by all routes
42SECTION 4. THE ASSESSMENT FRAMEWORK FOR PRE-HOSPITAL EMERGENCY MEDICINE
Clinical scenario observed Curriculum elements covered
See above
3.5.12 Demonstrate compliance with legislation related to Controlled Drugs
3.5.16 Demonstrate a professional approach to management and administration of medicines
4.1.10 Demonstrate a dynamic risk assessment in practice at a rescue operation
4.3.6 Demonstrate ability to make a rapid assessment of the extrication needs of a trapped patient
4.3.7 Demonstrate ability to manage clinical equipment during the extrication process
4.3.8 Demonstrate ability to facilitate extrication through medical intervention
4.3.11 Display medical leadership in co-ordinating medical and rescue interventions
4.4.10 Demonstrate ability to make a rapid assessment of the clinical needs of a trapped patient
4.4.11 Demonstrate effective management of the trapped patient
4.4.13 Display leadership in co-ordinating multi-professional medical care of trapped patients
4.4.14 Demonstrate a compassionate patient-focussed approach throughout rescue and extrication
5.4.4 Demonstrate correct preparation of patients for safe pre-hospital transfer
5.6.5 Determine appropriate choices of sedation, muscle relaxation and analgesia to maintain the patient’s clinical status during transfer
5.6.6 Demonstrate the safe pre-hospital transfer of ventilated patients
5.6.9 Demonstrate the ability to maintain monitoring of vital signs throughout transfer
B 1.6 Demonstrate a professional attitude to patient safety
B 2.4 Demonstrate, in the context of PHEM practice, the ability to: (a) gather information, (b) interpret information, (c) anticipate likely events
B 4.5 Demonstrate the ability to communicate in an accurate, brief and clear manner
B 4.8 Demonstrate the ability to communicate effectively with different groups encountered in the pre-hospital environment
B 4.9 Recognises the importance of effective communication to safe and efficient delivery of patient care in the pre-hospital environment
B 5.5 Demonstrate the ability to work in multi-disciplinary and unfamiliar teams
Formative? – Yes Summative? – No
Please TICK to indicate the standard of the trainee’s
performance in each area Not observed
Unsatisfactory for current level of
training
Satisfactory for current level of
training
Achievement above current level of
trainingMust
address
Should address
Initial operational approach 3
Initial clinical approach 3
History and information gathering
3
Examination 3
Clinical decision making and judgment
3
43SECTION 4. THE ASSESSMENT FRAMEWORK FOR PRE-HOSPITAL EMERGENCY MEDICINE
Please TICK to indicate the standard of the trainee’s
performance in each area
Not observed
Unsatisfactory for current level of
training
Satisfactory for current level of
training
Achievement above current level of
trainingMust
address
Should address
Communication with patient, relatives, staff
3
Overall plan 3
Adherence to Good Medical Practice
3
Areas of strength
Initial clinical approach - Obtained information from the pre-hospital personnel already on scene and utilised their skills to continue care.
History and information gathering - Performed an organised, structured, relevant and focused assessment of a trapped adult patient in cold, dark and wet conditions.
Examination - Demonstrated accurate interpretation of clinical history and physical signs in cold, wet and dark condition in a trapped critically injured adult patient.
Communication with patient, relatives, staff - Utilised the multi-disciplinary team well and allowed appropriate involvement of all members.
Adherence to Good Medical Practice - Demonstrated work with an unfamiliar team
Areas for improvement
Initial operational approach - A slower walk into the scene, obtaining an overview of the scene risks and current scene activity would benefit your ability to maintain situational awareness.
Clinical decision making and judgment - Risk to the patient from their injuries and situation have to be balanced against risks of medical interventions. Chaotic situations with unstable patients require imposed control in order to ensure safety of patient and the team. Control of the patient’s agitation could have been gained more quickly.
Overall plan - Incidents are dynamic environments and require decisions to be revised in the face of new information. The tempo of patient management should be consistent with the severity of injury. The flow of the extrication was affected by the patients change in agitation level.
Action plan
1. Concentrate on obtaining a scene overview before involving yourself in patient detail
2. Compare the various methods of achieving sedation to allow extrication in a head injured patient
If summative: Fail N/A Pass N/A Good pass N/A
Assessor Signature:
Alan Statham
Trainee Signature:
Guy Secretan
44SECTION 4. THE ASSESSMENT FRAMEWORK FOR PRE-HOSPITAL EMERGENCY MEDICINE
INTER-COLLEGIATE BOARD FOR TRAINING IN PRE-HOSPITAL EMERGENCY MEDICINE DIRECT OBSERVATION OF PROCEDURAL SKILLS (DOPS)
Trainee name: Guy Secratan Training Phase: 2
Assessor name: Alan Stathan Registration no: 123456
Grade of assessor: Consultant Date 12 / 01 / 2012
Procedure assessed Curriculum elements covered
Pre-hospital emergency anaesthesia
2.6.13 Demonstrate appropriate risk/benefit analysis for pre-hospital: (a) Analgesia, (c) procedural sedation, (d) emergency anaesthesia,
2.6.14 Demonstrate safe pre-hospital: (a) Analgesia, (c) procedural sedation, (d) emergency anaesthesia
3.3.3 Demonstrate confident and technically correct operation of: (a) Airway management devices, (b) Ventilatory support devices, (d) Devices for accessing the circulation, (f) Devices for administering medicine and blood products, (k) Devices for non-invasive patient monitoring,
3.5.10 Demonstrate preparation of medicines for parenteral use
3.5.11 Demonstrate safe and effective administration of medicines by all routes
3.5.12 Demonstrate compliance with legislation related to Controlled Drugs
3.5.16 Demonstrate a professional approach to management and administration of medicines
B 1.6 Demonstrate a professional attitude to patient safety
Formative? – Yes Summative? – No
Please TICK to indicate the standard of the trainee’s
performance in each area Not observed
Unsatisfactory for current level of
trainingSatisfactory for current level of
training
Achievement above current level of
trainingMust
address
Should address
Clinical indication 3
Appropriately deals with issues related to consent
3 3
Appropriate preparation 3
Technical skills 3
Situational awareness and clinical judgement
3
45SECTION 4. THE ASSESSMENT FRAMEWORK FOR PRE-HOSPITAL EMERGENCY MEDICINE
Please TICK to indicate the standard of the trainee’s
performance in each area
Not observed
Unsatisfactory for current level of
training Satisfactory for current level of
training
Achievement above current level of
trainingMust
address
Should address
Safety, including prevention and management of complications
3
Post procedure management 3
Professionalism, communication and consideration for patient, relatives and colleagues
3
Documentation 3
Adherence to Good Medical Practice
3
Areas of strength
Clinical reasoning for appropriateness of intervention.
Preparation of personnel, equipment and patient for procedure.
Clear communication with multi-disciplinary team
Areas for improvement
Intubation technique should use a lifting action, not a rotatory action. Sliding down the tongue prevents the blade entering the oesophagus.
Delivery of the long acting muscle relaxant required prompting.
Action plan
1. Concentrate on obtaining a scene overview before involving yourself in patient detail
2. Compare the various methods of achieving sedation to allow extrication in a head injured patient
If summative: Fail N/A Pass N/A Good pass N/A
Assessor Signature:Alan Statham
Trainee Signature:Guy Secretan
46SECTION 4. THE ASSESSMENT FRAMEWORK FOR PRE-HOSPITAL EMERGENCY MEDICINE
4.8 DECISIONS ON PROGRESS (ARCP)4.8.1 Educational Supervisors and Training Programme Directors will determine progression through phases of training according to the assessment framework described in the Guide and Curriculum. Trainees are responsible for collating evidence of progression in their Portfolio or logbook.
4.8.2 Parent specialty Annual Review of Competence Progression (ARCP) panels may continue to monitor the progress of trainees within their specialty but should be informed by PHEM Structured Training Reports (STRs) for each phase of training - it is not necessary for Deaneries and Schools to conduct separate PHEM ARCP panels. The ARCP panel will also need to take into account the trainee’s phase of PHEM training and the type of PHEM training scheme when making any judgments related to progression within the parent CCT specialty. ARCP panels are encouraged to liaise closely with TPDs and Educational Supervisors during PHEM sub-specialty training to ensure that a trainee is not being subjected to unfair assessment of core specialty progress.
4.8.3 All PHEM trainees will be invited to a National Training Review Panel towards the end of phase 2. The panel will review all PHEM training evidence and will be responsible for providing trainees with an outcome certificate on behalf of the IBTPHEM. This outcome certificate will then be presented by trainees at their next appropriate parent specialty ARCP and will enable the ARCP panel to make a recommendation for sub-specialty registration.
4.9 TRAINEES IN DIFFICULTY4.9.1 When a trainee’s performance gives cause for concern, more assessments will be needed. It is the responsibility of the trainee to provide at their Educational Review meetings what they consider to be evidence of satisfactory performance and satisfactory progress. They will need evidence of performance in each unit of training or section of the curriculum they have undertaken. This may increase the number of assessments they need. It is the educational supervisor’s responsibility to help the trainee to understand what that evidence will be appropriate in their specific circumstances. The educational supervisor will then write a summary of the learner’s performance for the STR. The Trainee will work with their educational supervisor to develop evidence of satisfactory progression through their agreed learning. The educational supervisor will then present a summary of this evidence to the ARCP via the STR.
4.9.2 It is recognised that trainees learn at different paces, and will improve as they progress through the training programme. The formative assessments may be undertaken many times and are expected to improve whilst the summative phase assessments give trainees the opportunity to demonstrate their learning at that point in time. Where either progression or summative assessment falls below the expected standard, the trainee and supervisors must rapidly evaluate and form plans for future learning supported by the educational team.
4.9.3 Persistent failure to progress indicates a trainee in difficulty and this should be managed through local Deanery systems to support the trainee. The Training Programme Director should be involved at the earliest opportunity.
4.9.4 Where the trainee is unsuccessful in a summative assessment, discussions with the Training Programme Director, Educational Supervisor and LEP will need to take place to identify the trainee’s learning needs. This may require examining possible opportunities for the extension of PHEM training or abandonment of PHEM training to focus on core specialty training.
4.10 COMPLAINTS AND APPEALS4.10.1 All workplace based assessment methods incorporate direct feedback from the assessor to the trainee and the opportunity to discuss the outcome. If a trainee has a complaint about the outcome from a specific assessment this is their first opportunity to raise it. Further disagreement should follow local grievance procedures.
47SECTION 4. THE ASSESSMENT FRAMEWORK FOR PRE-HOSPITAL EMERGENCY MEDICINE
4.10.2 Appeals concerning any aspect of PHEM sub-specialty training should follow Deanery and Training Programme procedures. Training Programme Directors must maintain an overview of any complaints or appeals within their programme.
4.10.3 Appeals related to the National Summative Assessments should, in the first instance, follow the relevant examination regulations of the Royal College of Surgeons of Edinburgh.
4.10.4 Unresolved disputes regarding summative phase assessments will be handled at IBTPHEM level and the IBTPHEM is responsible for setting up and reviewing suitable processes.
49SECTION 5. GUIDANCE FOR TRAINERS, EDUCATION PROVIDERS AND EMPLOYERS
SECTION 5. GUIDANCE FOR TRAINERS, EDUCATION PROVIDERS AND
EMPLOYERS
51SECTION 5. GUIDANCE FOR TRAINERS, EDUCATION PROVIDERS AND EMPLOYERS
5.1 INTRODUCTION5.1.1 This section of the guide provides guidance for trainers, education providers and employers in their role in managing and delivering sub-specialty PHEM training.
5.2 TRAINERS5.2.1 In the context of PHEM sub-specialty training, the IBTPHEM differentiate between Local Trainers (LTs) and Medical Trainers (Clinical Supervisors and Educational Supervisors).
5.2.2 Local Trainers (LT), a term introduced by the IBTPHEM, are experienced members of the pre-hospital team who provide training and educational support for trainees on a day-to-day basis. LTs are allocated by Local Education Providers (LEPs) and may undertake a wide range of planned and ad-hoc educational activities to support trainees. They do not however have a formal supervisory role for named trainees and cannot fulfil the mandatory elements of direct supervision. Provided that they have undertaken the appropriate training however, they may conduct formative assessments and deliver educational material. They do not need to be medically qualified and are not required to meet the GMC or Deanery eligibility requirements for a Medical Trainer.
5.2.3 The regulatory environment for Medical Trainers is changing.22 A Medical Trainer is an appropriately trained and experienced doctor who is responsible for the education and training of PHEM trainees. The roles undertaken by Medical Trainers are Clinical Supervisor (CS) and Educational Supervisor (ES). New arrangements for the recognition of Medical Trainers, including the requirement for Deanery registration and GMC approval, are currently being implemented. All Medical Trainers must be registered and approved by 31 July 2016.
5.2.4 Specific criteria for recognition as an ES or CS will be developed by Deaneries in partnership with LEPs. In addition to existing standards for postgraduate training and the GMC’s professional guidance for doctors (trainers must be positive role models demonstrating good medical practice), the criteria for recognition will be mapped to evidence related to seven areas originally set out by the Academy of Medical Educators.23 It is the responsibility of LEPs and Deaneries to ensure that PHEM trainers are compliant with these requirements.
5.2.5 A PHEM Clinical Supervisor (CS) is a Medical Trainer who is responsible for overseeing a specified trainee’s clinical work throughout a PHEM placement in a clinical environment. The CS will provide constructive feedback during that placement and will lead on providing a review of the PHEM trainee’s clinical practice throughout the placement to inform the Educational Supervisor’s structured training report on whether the trainee should progress to the next stage of PHEM training.
5.2.6 Clinical supervisors will be expected to undertake direct clinical supervision of their allocated trainees while they undertake operational duties. While no specific number of clinical shifts is specified, trainees will be expected to have work place based assessments from clinical supervisors.
5.2.7 An Educational Supervisor (ES) is a Medical Trainer who is responsible for the overall supervision and management of a PHEM trainee’s trajectory of learning and educational progress throughout their PHEM training programme. Every trainee must have a named Educational Supervisor. The ES helps the trainee to plan their training and achieve agreed learning outcomes. The ES is responsible for the educational agreement and for bringing together all relevant evidence to form a summative judgement at the end of PHEM sub-specialty training.
5.2.8 The ES would ordinarily remain a trainee’s ES throughout their programme. This may involve the ES supervising a trainee across multiple organisations within the programme. Educational supervisors should be identified and allocated to trainees as they start their PHEM training programmes. The responsibility for ensuring trainees have the required educational supervision lies with the Training Programme Director (TPD). The allocation of educational supervisors should be made in consultation between employers, PHEM TPD’s and LEPs.
22 General Medical Council. Recognising and approving trainers: the implementation plan August 2012. 23 www.medicaleducators.org
52SECTION 5. GUIDANCE FOR TRAINERS, EDUCATION PROVIDERS AND EMPLOYERS
5.2.9 The roles of Clinical and Educational Supervisor may be merged for some placements or programmes. It is expected that organisations hosting PHEM trainees will have individuals able to undertake both Clinical and Educational Supervisor roles working within them to support training.
5.2.10 Within Local Education Providers (LEPs), all Medical Trainers must:
(a) have a detailed understanding of the PHEM curriculum and assessment blueprint;(b) understand and demonstrate ability in the use of the recommended PHEM assessment tools and
be clear as to what is deemed acceptable progress;(c) ensure that all involved in training and assessment of their designated trainee understand the
requirements of the programme;(d) regularly review trainee progress and understand the process for dealing with a trainee whose
progress gives cause for concern;(e) liaise as necessary with other trainers and the TPD to ensure a consistent approach to education
and training and the sharing of good practice across specialties and professions;(f) have adequate time for training identified in their job plans;(g) have knowledge of, and comply with, the GMC’s regulatory framework for medical training.
5.2.11 In addition to compliance with generic GMC and Deanery requirements regarding training, the IBTPHEM requires Medical Trainers in PHEM to:
(a) be clinically active in PHEM at the level of consultant practice, ideally with Faculty Accreditation of Sub-specialist PHEM practice and/or PHEM sub-specialty registration; (b) have at least five years clinical and operational experience in PHEM;(c) be employed as a consultant, by either substantive or honorary contract, to an NHS employing institution (NHS Trust or Ambulance Service Trust);(d) satisfactorily complete a IBTPHEM Trainer Workshop (and undertake refreshers as stipulated by the IBTPHEM). Details of workshops are available from the IBTPHEM.(e) be able to demonstrate generic competencies and specific skills for simulation-based training (described by the Association for Simulated Practice in Healthcare [previously the National Association of Medical Simulators).24
5.2.12 While PHEM trainees are on operational/clinical duties, especially at the beginning of their training, they will require close direct clinical supervision. The requirement is for 100% direct supervision for phase 1(a) of PHEM training and a minimum of 20% direct supervision throughout the remainder of their PHEM training programme. Direct supervision must be carried out by consultants recognised and approved as Medical Trainers. Direct supervision is distinct from indirect or remote supervision. For direct supervision, the trainer must be physically present.
24 www.namsonline.com
53SECTION 5. GUIDANCE FOR TRAINERS, EDUCATION PROVIDERS AND EMPLOYERS
5.3 LOCAL EDUCATION PROVIDERS5.3.1 Local Education Providers (LEPs) are approved by a Deanery to support and provide sub-specialty training in PHEM following assessment that they meet the standards for LEPs and are able to maintain the provision of high quality training in PHEM.
5.3.2 Due to the nature of the current pre-hospital medical service provision, the LEP may be an NHS Trust (Acute or Ambulance), an independent healthcare provider, the Defence Medical Services or a third sector (charitable) organisation operating in partnership with the NHS.
5.3.3 Organisations seeking to become LEPs within a Deanery PHEM sub-specialty training programme must:
(a) either have a Learning Development Agreement (or equivalent) with the relevant Deanery or with the organisation that holds that agreement
(b) be compliant with the Care Quality Commission essential standards for quality and safety 25
(c) be compliant with the GMC standards for training 26
(d) have PHEM training locations approved by the GMC for core specialty training (GMC Form B)
5.3.4 The LEP is subject to inspection, both initially and subsequently, within the local Deanery Quality Management framework. Results of inspections will be reported to regional and national bodies as per GMC guidelines.
5.3.5 Sufficient practical experience must be available within the clinical services and LEPs associated with a Deanery programme to support acquisition of the knowledge and skills set out in the Curriculum. The Deanery programme, and associated LEPs (either individually or in collaboration) must therefore:
(a) have an adequate case volume. It seems reasonable to suggest that the pre-hospital emergency anaesthetic rate is a useful surrogate marker of overall exposure. A programme should therefore demonstrate that it could achieve at least 8 pre-hospital emergency anaesthetics per trainee per 6 months.
(b) offer exposure to the full range of undifferentiated adult and paediatric PHEM case presentations as described in the Curriculum.
(c) include exposure to both primary and secondary transfer cases.
5.3.6 Compliance with 5.3.3 and 5.3.5 above will be a significant challenge for many current PHEM services. It is likely that regionalised services, perhaps mirroring the regionalisation of trauma care and development of trauma networks, will be required to support sub-specialty training.
5.3.7 A key challenge for LEPs relates to the essential role of simulation. Simulation is used widely throughout postgraduate medical training for both learning and assessment. Within existing core specialty curricula, it is recognised that some skills may only be acquired by simulation and simulator based training courses are strongly recommended. Effective use of simulation will support:
• Acquisition and application of knowledge.• Training and ingraining new skills: learning routines and steps that together comprise a complex
skill.• Reinforcement of drills: teaching and testing learners responses to specific critical incidents• Developing professional behaviour and the set of non-technical skills which support delivery of
expert anaesthetic practice, especially in the context of working within multi-professional teams and a variety of clinical environments.
5.3.8 - Within the PHEM curriculum, ‘Simulation Learning’ is a specified learning method. It is defined as the simulation (at any level of fidelity and reality) of a situation in order to attain predetermined learning objectives and it includes simulated patients, simulated incident scenes, use of models and tabletop exercises. Simulation is also recommended as an assessment tool for both formative and summative assessment.
25 www.cqc.org.uk26 Generic standards for specialty including GP training. General Medical Council, April 2010.
54SECTION 5. GUIDANCE FOR TRAINERS, EDUCATION PROVIDERS AND EMPLOYERS
5.3.9 Simulation is an essential and central part of training and assessment in PHEM clinical practice. There has historically been debate regarding high vs. medium vs. low fidelity simulators and the merits of each. There is a tendency to feel it necessary to use the highest fidelity simulators available with these often being extremely expensive to purchase. Experience of simulation in PHEM so far has demonstrated that the overall fidelity of the scenario is more important than the fidelity of the simulator mannequin itself. Many PHEM simulations can be effectively achieved with low to medium fidelity human simulators and the correct environmental set.
5.3.10 The general principles of simulation teaching and training can be summarised using the Best Evidence Medical Education (BEME) guidelines (table 5.1).27 The IBTPHEM will produce further detailed guidance on the use of simulation for formative and summative assessment.
Table 5.1 Attributes of simulation that lead to effective learning
27 BEME Guide no 4: Features and uses of high-fidelity medical simulations that lead to effective learning. 2004, Dundee, UK: Association for Medical Education in Europe
Attribute Rationale
Provide feedback during the learning experience with the simulator
Slows decay in skills over time; Formative feedback and self-assessment allows individual to monitor progress; Feedback can be “built-in” to simulator training session or provided by trainer immediately or later via video debriefing
Learners engage in repetitive practice (and deliberate practice)
Found to be a primary factor in studies showing skills transferring to real patients; Shortens learning curves and leads to faster automaticity; simulator must be made available to achieve this – convenient location, accommodates learner schedule
Simulation is integrated intooverall curriculum
Simulation fully integrated into overall curriculum – e.g. resuscitation, team resource management, use of equipment, patient transfer etc.
Learners practice with increasing levels of difficulty
Increasing the degree of difficulty increases mastery of the situation and technical skills
Adapt the simulator to complement multiple learning strategies
Large and small group tutorial settings; independent small-group and individual trainee practice settings
Ensure the simulator providesfor clinical variation
Increases the number and variety of patients a learner encounters; Provides equity to smaller training programs; Provides exposure to rare encounters
Learning on the simulator should occur in a controlled environment
Learners make and detect mistakes without consequences; Instructors can focus on learners through “teachable moments”; Reflects educational “culture” focused on ethical training
Provide individualized (in addition to team) learning on the simulator
Provides reproducible, standardised experience for all learners; Learner is active participant, responsible for his/her own learning
Clearly define outcomes and benchmarks for the learners to achieve using the simulator
Learners more likely to master situation and skill if outcomes are clearly defined andappropriate for learner level of training
Ensure the simulator is a valid learning tool
Face validity – realism provides context for understanding complex principles/tasks, increases visio-spatial perceptual skills, learners prefer realism; Concurrent validity – ability on simulator transfers to real patient
55SECTION 5. GUIDANCE FOR TRAINERS, EDUCATION PROVIDERS AND EMPLOYERS
5.3.11 Additional support for learning and training is being developed by the IBTPHEM in the form of a virtual learning environment (VLE), access to a portfolio and access to resources for training the trainers.
5.3.12 The VLE is intended to be a web accessible collection of tools to support self-directed learning, physical learning (face to face teaching) and curriculum management. The VLE will provide, through a single, consistent, and intuitive interface, all the components required for a course of education or training such as:
• The syllabus and curriculum – a road map for education and training• Administrative information such as the location of teaching sessions• An e-notice board for up-to-date information• Participant tracking facilities• Basic teaching materials (which may include the content of courses and e-learning resources)• Self-assessment quizzes and formal assessment procedures• A mechanism for remote support with electronic communication including e-mail and threaded
discussions• Differential access rights for trainers, trainees and other participants• Production of documentation and statistics in the format required for administration and quality
control• A digital library / repository for additional resources, including reading materials, and links to other
resources• A mechanism for remote assessment• A mechanism for sustaining Continuous Professional Development and stimulating self-learning
5.3.13 The PHEM Portfolio has been developed to support the PHEM training programme. This portfolio is currently paper based but it is likely these resources will transfer to an e-portfolio and logbook in the future.
5.3.14 The Portfolio is intended to provide trainees, trainers and LEPs with an easy to use, accessible and effective tool to record work-place based assessments, clinical activity and educational experiences against the Curriculum.
56SECTION 5. GUIDANCE FOR TRAINERS, EDUCATION PROVIDERS AND EMPLOYERS
5.4 EMPLOYERS5.4.1 All PHEM sub-specialty trainees, regardless of their LEP or funding arrangements, should normally be employed by a UK NHS body that holds a Deanery Learning and Development Agreement that defines the duties and responsibilities of employers and trainees. If the employer is not the LEP, the employers must also have clear and binding agreements with the LEP. Employers must also ensure compliance with employment and occupational health requirements.
5.4.2 All employers of trainees and trainers must ensure that their third party liability, indemnity and personal injury insurance arrangements specifically include clinical practise outside of a hospital setting, the full range of pre-hospital operational environments and the use of helicopters as transport platforms.
5.4.3 Employers must inform trainees and trainers of the value of insurance arrangements so that they can make personal informed decisions regarding whether to obtain additional personal injury insurance.
5.4.4 Employers must inform trainees and trainers of any limitations in third party liability, indemnity or personal injury insurance arrangements that may restrict their pre-hospital emergency medicine practise.
5.4.5 Regardless of the employer, the NHS Employment Check Standards 28 should be applied to all trainees and trainers. These cover all the pre-employment checks required by law, those that are mandated by the UK Departments of Health, and those that are required for access to NHS records. LEPs who are also employers will be required to show evidence of their compliance with these standards.
5.4.6 PHEM practice involves working in a range of environments which are physically challenging and demanding and may place the trainee and trainer at some risk. Whilst there are no standards for physical fitness and functional capability required to undertake core CCT specialty duties within hospital, NHS Ambulance Services undertake an assessment of functional capability and physical fitness as part of the selection process for pre-hospital work. The IBTPHEM recommend that the standard applied to Ambulance service recruitment is applied to PHEM trainee selection. The nationally co-ordinated recruitment process requires applicants to have passed the physical assessments used for recruitment to the paramedic higher education institutions.
5.5 DEANERIES5.5.1 Deaneries who seek to provide PHEM training programmes should discuss their proposals with the IBTPHEM. The role of the IBTPHEM is to assist the Deanery in developing a robust training programme.
5.5.2 In addition to compliance with the GMC standards for Deaneries,29 a regional PHEM training committee should be formed which may operate under the auspices of an appropriate Deanery school. The training committee will appoint a training programme director of suitable qualifications to oversee the training programme. It is suggested that the committee takes its membership from:
• PHEM Consultants• Emergency Medicine Consultants• Anaesthetic Consultants• Acute Medicine Consultants• Adult or Paediatric Intensive Care Consultants• Ambulance Service personnel• Local Education Providers• PHEM Trainees• Lay persons• Deanery management personnel
28 www.nhsemployers.org29 Standards for Deaneries. General Medical Council, April 2010
57SECTION 5. GUIDANCE FOR TRAINERS, EDUCATION PROVIDERS AND EMPLOYERS
5.5.3 Given the number of trainees in PHEM, and the requirements for LEPs, Deaneries may decide to create arrangements for supra-regional management of training programmes. Any such arrangements must be made with full support of the participating Deaneries and LEPs.
5.5.4 The IBTPHEM has a role in supporting GMC review processes and quality managing training (see figure 3.1). In order for the IBTPHEM to assist the Deanery in setting up a programme that fulfils the requirements for training in PHEM as defined by the Board, Deaneries are asked to consult with the IBTPHEM and provide:
• A detailed description of the infrastructure underpinning and supporting the training programme.• A detailed description of how the curriculum will be delivered within the programme (including
details of the anticipated trainee case volume and exposure).
A template statement of training programme assurance and compliance to assist this process is available from the IBTPHEM.
5.5.5 PHEM Training Programme Directors are supported by a number of Educational Supervisors. Educational Supervisors guide a number of trainees through the training programme and need to be suitably qualified to do so. A sample person specification for an Educational Supervisor is given in table 5.1 as a guide.
5.5.6 The IBTPHEM will review training programme applications and liaise with the GMC and Deaneries. In some circumstances, and in the context of the Quality Management framework illustrated in figure 3.1, a team from the IBTPHEM will conduct a review visit, the structure and function of which will mirror existing processes for Emergency Medicine, Anaesthetic, Acute Medicine or Intensive Care Medicine programme approval by the College of Emergency Medicine, Royal College of Anaesthetists or Royal College of Physicians respectively.
5.5.7 PHEM Training Programme Directors are supported by a number of Educational Supervisors usually based with local education providers. Educational Supervisors guide a number of trainees through the training programme and need to be suitably qualified to do so. A sample person specification for an Educational Supervisor is given in table 5.1 as a guide.
58SECTION 5. GUIDANCE FOR TRAINERS, EDUCATION PROVIDERS AND EMPLOYERS
Factor Essential Criteria Desirable Criteria How assessed
Attainments• GMC full registration
• Hold Specialist registration in Anaesthetics or Emergency Medicine
• PG qualification in education Application Form
Knowledge and Interests
• Knowledge of management and governance structures in medical education and training and awareness of recent changes in the delivery of medical education and training nationally and locally.
• Interest and enthusiasm for improving delivery of medical education and training and continuing professional development.
• Knowledge of assessment methods.
• Extensive experience in PHEM service provision
• Evidence of relevant research and/or publications.
• Evidence of experience at strategic level of national or international education organisations.
Interview
Special Aptitudes
• Effective leadership and communications skills, motivating and developing others, approachability, good interpersonal skills.
• Evidence of delivering well evaluated teaching sessions/tutorials.
• Evidence of personal development in medical education.
• Evidence of supporting trainees .
• Evidence of audit/research in medical education.
Interview
Table 5.1 A sample person specification for an Educational Supervisor.
Good Medical Practice
Working in Emergency
Medical Systems
Providing pre-hospital
Emergency Medical Care
Using pre-hospital
equipment
Supporting rescue and extrication
Supporting safe patient
transfer
Supporting emergency
preparedness and response
Part TwoCurriculum Framework and
Assessment Blueprint
59
61CONTENTS
CONTENTS
Part Two - Curriculum Framework and Assessment Blueprint
Cross-Cu ng Theme. Good Medical Practice ........................................................................63
Theme 1. Working in emergency medical systems .................................................................71
Theme 2. Providing Pre-hospital Emergency Medical Care ....................................................79
Theme . Using Pre-hospital E uipment ..............................................................................1 7
Theme . Supporting Rescue and E trication ......................................................................115
Theme 5. Supporting Safe Patient Transfer ..........................................................................121
Theme 6. Supporting Emergency Preparedness and Response ............................................127
Cross-cu ng Theme A. Operational Practice .......................................................................1 5
Cross-cu ng Theme B. Team Resource Management .........................................................1
Cross-cu ng Theme C. Clinical Governance ........................................................................1
62
Please note a detailed description of the Assessment Blueprint can be found in section 4.5.
63CROSS-CUTTING THEME GOOD MEDICAL PRACTICE
CROSS-CUTTING THEME - GOOD MEDICAL PRACTICE Good Medical Practice (GMP) is the term given to the core ethical guidance provided to doctors by the General Medical Council (GMC). This was published by the GMC in a guidance document called ‘Good Medical Practice’ in March 2013. GMP sets out the principles and values on which good practice is founded; these principles together describe medical professionalism in action. The four domains and 14 principles within GMP are all relevant to the clinical practice of PHEM and have been reproduced to create the table describing cross cutting theme 1.
DOMAINS AND PRINCIPLES1. Knowledge skills and performance
1.1 Develope and maintain your professional performance1.2 Apply knowledge and experience to practice1.3 Record your work clearly, accurateely and legibly
2. Safety and quality2.1 Contribute to and comply with systems to protect patients2.2 Respond to risks to safety2.3 Protect patients and colleagues from any risk posed by your health
3. Communication, partnership and teamwork3.1 Communicate effectively3.2 Work collaboratively with colleagues to maintain or improve patient care3.3 Teaching, training, supporting and assessing3.4 Continuity and coordination of care3.5 Establish and maintain partnerships with patients
4. Maintaining Trust4.1 Show respect for patients4.2 Treat patients and colleagues fairly and without discrimination4.3 Act with honesty and integrity
CROSS-CUTTING THEME GOOD MEDICAL PRACTICEThroughout the remainder of the PHEM Curriculum Framework, each element within all themes has been assigned a relevant GMP domain. This assignment ensures that the assessment tools used for those particular groups of elements incorporate the relevant aspect of GMP.
CROSS-CUTTING THEME - GOOD MEDICAL PRACTICE 64
Dom
ain
Prin
cipl
eSt
anda
rd (e
lem
ent)
GMC
Guid
ance
Refe
renc
e pa
ragr
aph
Dom
ain
1Kn
owle
dge,
skill
s and
perfo
rman
ce
1.1
Deve
lop
and
mai
ntai
n yo
ur
prof
essio
nal
perfo
rman
ce
You
mus
t be
com
pete
nt in
all
aspe
cts o
f you
r wor
k, in
clud
ing
man
agem
ent,
rese
arch
and
teac
hing
7
You
mus
t kee
p yo
ur p
rofe
ssio
nal k
now
ledg
e an
d sk
ills u
p to
dat
e8
You
mus
t reg
ular
ly ta
ke p
art i
n ac
tiviti
es th
at m
aint
ain
and
deve
lop
your
com
pete
nce
and
perfo
rman
ce9
You
shou
ld b
e w
illin
g to
take
par
t in
stru
ctur
ed su
ppor
t opp
ortu
nitie
s offe
rerf
by
your
em
ploy
er o
r con
trac
ting
body
. You
shou
ld d
o th
is w
hen
you
join
an
orga
nisa
tion
and
whe
neve
r you
r rol
e ch
ange
sign
ifica
ntly
thou
ghou
t yo
ur c
aree
r.10
You
mus
t be
fam
iliar
with
gui
delin
es a
nd d
evel
opm
ents
that
affe
ct y
our w
ork
11
You
mus
t kee
p up
to d
ate
with
, and
follo
w, th
e la
w, o
ur g
uida
nce
and
othe
r reg
ulati
ons r
elev
ant t
o yo
ur w
ork
12
You
mus
t tak
e st
eps t
o m
onito
r and
impr
ove
the
qual
ity o
f you
r wor
k13
1.2
Appl
y kn
owle
dge
and
expe
rienc
e to
pr
actic
e
You
mus
t rec
ogni
se a
nd w
ork
with
in th
e lim
its o
f you
r com
pete
nce
14
You
mus
t pro
vide
a g
ood
stan
dard
of p
racti
ce a
nd c
are.
If y
ou a
sses
s, d
iagn
ose
or tr
eat p
atien
ts, y
ou m
ust
adeq
uatle
y as
sess
the
patie
nts c
ondi
tions
, tak
ing
acco
unt o
f the
ir hi
stor
y, th
eir v
iew
s and
val
ues;
whe
re n
eces
sary
ex
amin
e th
e pa
tient
.15
a
You
mus
t pro
mpt
ly p
rovi
de o
r arr
ange
suita
ble
advi
ce, i
nves
tigati
ons o
r tre
atm
ents
whe
re n
eces
sary
.15
b
You
mus
t ref
er a
pati
ent t
o an
othe
r pra
ctitio
ner w
hen
this
serv
es th
e pa
tient
s nee
ds.
15c
In p
rovi
ding
clin
ical
car
e yo
u m
ust p
resc
ribe
drug
s or t
reat
men
t, in
clud
ing
repe
at p
resc
riptio
ns, o
nly
whe
n yo
u ha
ve a
dequ
ate
know
ledg
e of
the
patie
nts h
ealth
and
are
satis
fied
that
the
drug
s or t
reat
mne
t ser
ve th
e pa
tient
s ne
eds
16a
You
mus
t pro
vide
effe
ctive
trea
tmen
ts b
ased
on
the
best
ava
ilabl
e ev
iden
ce16
b
You
mus
t tak
e al
l pos
sible
step
s to
alle
viat
e pa
in a
nd d
istre
ss w
heth
er o
r not
a c
ure
may
be
poss
ible
16c
You
mus
t con
sult
colle
ague
s whe
re a
ppro
pria
te16
d
You
mus
t res
pect
the
patie
nts r
ight
to se
ek a
seco
nd o
pini
on16
e
You
mus
t che
ck th
at th
e ca
re o
r tre
atm
ent y
ou p
rovi
de fo
r eac
h pa
tient
is c
ompa
tible
with
any
oth
er tr
eatm
ents
th
e pa
tient
is re
ceiv
ing
incl
udin
g (w
here
pos
sible
) sel
f pre
scrib
ed o
ver t
he c
ount
er m
edic
ation
s.16
f
You
mus
t whe
reve
r pos
sible
, avo
id p
rovi
ding
med
ical
car
e to
you
rsel
f or a
nyon
e w
ith w
hom
you
hav
e a
clos
e pe
rson
al re
latio
nshi
p.16
g
You
mus
t be
satis
fied
that
you
hav
e co
nsen
t or o
ther
val
id a
utho
rity
befo
re y
ou c
arry
out
any
exa
min
ation
or
inve
stiga
tion,
pro
vide
trea
tmen
t or i
nvol
ve p
atien
ts o
r vol
unte
ers i
n te
achi
ng o
r res
earc
h.17
You
mus
t mak
e go
od u
se o
f the
reso
urce
s ava
ilabl
e to
you
18
CROSS-CUTTING THEME - GOOD MEDICAL PRACTICE 65
Dom
ain
Prin
cipl
eSt
anda
rd (e
lem
ent)
GMC
Guid
ance
Refe
renc
e pa
ragr
aph
“Dom
ain
1Kn
owle
dge,
skill
s and
perfo
rman
ce”
(con
t)
1.3
Reco
rd y
our w
ork
clea
rly, a
ccur
atel
y an
d le
gibl
y
Docu
men
ts y
ou m
ake
(incl
udin
g cl
inic
al re
cord
s) to
form
ally
reco
rd y
our w
ork
mus
t be
clea
r, ac
cura
te a
nd le
gibl
e.
You
shou
ld m
ake
reco
rds a
t the
sam
e tim
e as
the
even
ts y
ou a
re re
cord
ing
or a
s soo
n as
pos
sible
afte
rwar
ds.
19
You
mus
t kee
p re
cord
s tha
t con
tain
per
sona
l inf
orm
ation
abo
ut p
atien
ts, c
olle
ague
s or o
ther
s sec
urel
y, an
d in
line
w
ith a
ny d
ata
prot
ectio
n re
quire
men
ts.
20
Clin
ical
reco
rds s
houl
d in
clud
e re
leva
nt c
linic
al fi
ndin
gs21
a
Clin
ical
reco
rds s
houl
d in
lcud
e th
e de
cisio
ns m
ade
and
actio
ns a
gree
d, a
nd w
ho is
mak
ing
the
deci
sions
and
ag
reei
ng th
e ac
tions
.21
b
Clin
ical
reco
rds s
houl
d in
clud
e th
e in
form
ation
giv
en to
pati
ents
21c
Clin
ical
reco
rds s
houl
d in
clud
e an
y dr
ugs p
resc
ribed
or o
ther
inve
stiga
tion
or tr
eatm
ent
21d
Clin
ical
reco
rds s
houl
d in
clud
e w
ho is
mak
ing
the
reco
rd a
nd w
hen
21e
“Dom
ain
2Sa
fety
and
Qua
lity”
2.1
Cont
ribut
e to
an
d co
mpl
y w
ith
syst
ems t
o pr
otec
t pa
tient
s
You
mus
t tak
e pa
rt in
syst
ems o
f qua
lity
assu
ranc
e an
d qu
ality
impr
ovem
ent t
o pr
omot
e pa
tient
safe
ty. T
his
incl
udes
taki
ng p
art i
n re
gula
r rev
iew
s and
aud
its o
f you
r wor
k an
d th
at o
f you
r tea
m, r
espo
ndin
g co
nstr
uctiv
ely
to th
e ou
tcom
es, t
akin
g st
eps t
o ad
dres
s any
pro
blem
s and
car
ryin
g ou
t fur
ther
trai
ning
whe
re n
eces
sary
.22
a
You
mus
t tak
e pa
rt in
syst
ems o
f qua
lity
assu
ranc
e an
d qu
ality
impr
ovem
ent t
o pr
omot
e pa
tient
safe
ty. T
his
incl
udes
regu
larly
refle
cting
on
your
stan
dard
s of p
racti
ce a
nd th
e ca
re y
ou p
rovi
de.
22b
You
mus
t tak
e pa
rt in
syst
ems o
f qua
lity
assu
ranc
e an
d qu
ality
impr
ovem
ent t
o pr
omot
e pa
tient
safe
ty. T
his
incl
udes
revi
ewin
g pa
tient
feed
back
whe
re it
is a
vaila
ble.
22c
To h
elp
keep
pati
ents
safe
you
mus
t con
trib
ute
to c
onfid
entia
l inq
uirie
s23
a
To h
elp
keep
pati
ents
safe
you
mus
t con
trib
ute
to a
dver
se e
vent
reco
gniti
on23
b
To h
elp
keep
pati
ents
safe
you
mus
t rep
ort a
dver
se in
cide
nts i
nvol
ving
med
ical
dev
ices
that
put
or h
ave
the
pote
ntial
to p
ut th
e sa
fety
of a
pati
ent,
or a
noth
er p
erso
n, a
t risk
23c
To h
elp
keep
pati
ents
safe
you
mus
t rep
ort s
uspe
cted
adv
erse
dru
g re
actio
ns23
d
To h
elp
keep
pati
ents
safe
you
mus
t res
pond
to re
ques
ts fr
om o
rgan
isatio
ns m
onito
ring
publ
ic h
ealth
.23
e
2.2
Resp
ond
to ri
sks
to sa
fety
You
mus
t pro
mot
e an
d en
cour
age
a cu
lture
that
allo
ws a
ll st
aff to
raise
con
cern
s ope
nly
and
safe
ly24
You
mus
t tak
e pr
ompt
acti
on if
you
thin
k th
at p
atien
t saf
ety,
dign
ity o
r com
fort
is o
r may
be
serio
usly
co
mpr
omise
d. If
a p
atien
t is n
ot re
ceiv
ing
basic
car
e to
mee
t the
ir ne
eds,
you
mus
t im
med
iate
ly te
ll so
meo
ne
who
is in
a p
ositi
on to
act
stra
ight
aw
ay.
25a
CROSS-CUTTING THEME - GOOD MEDICAL PRACTICE 66
Dom
ain
Prin
cipl
eSt
anda
rd (e
lem
ent)
GMC
Guid
ance
Refe
renc
e pa
ragr
aph
“Dom
ain
2Sa
fety
and
Qua
lity”
(con
t)
2.2
Resp
ond
to ri
sks
to sa
fety
If pa
tient
s are
at r
isk b
ecau
se o
f ina
dequ
ate
prem
ises,
equ
ipm
ent*
or o
ther
reso
urce
s, p
olic
ies o
r sys
tem
s, y
ou
shou
ld p
ut th
e m
atter
righ
t if t
hat i
s pos
sible
. You
mus
t rai
se y
our c
once
rn in
line
with
ou
r gui
danc
e 11
and
you
r wor
kpla
ce p
olic
y. Y
ou sh
ould
also
mak
e a
reco
rd o
f the
step
s you
hav
e ta
ken.
”25
b
If yo
u ha
ve c
once
rns t
hat a
col
leag
ue m
ay n
ot b
e fit
to p
racti
se a
nd m
ay b
e pu
tting
pati
ents
at r
isk, y
ou m
ust a
sk
for a
dvic
e fr
om a
col
leag
ue, y
our d
efen
ce b
ody
or u
s. If
you
are
still
conc
erne
d yo
u m
ust r
epor
t thi
s, in
line
with
ou
r gui
danc
e an
d yo
ur w
orkp
lace
pol
icy,
and
mak
e a
reco
rd o
f the
step
s you
hav
e ta
ken.
125
c
You
mus
t offe
r hel
p if
emer
genc
ies a
rise
in c
linic
al se
tting
s or i
n th
e co
mm
unity
, tak
ing
acco
unt o
f you
r ow
n sa
fety
, you
r com
pete
nce
and
the
avai
labi
lity
of o
ther
opti
ons f
or c
are.
26
Whe
ther
or n
ot y
ou h
ave
vuln
erab
le a
dults
or c
hild
ren
and
youn
g pe
ople
as p
atien
ts, y
ou sh
ould
con
sider
thei
r ne
eds a
nd w
elfa
re a
nd o
ffer t
hem
hel
p if
you
thin
k th
eir r
ight
s hav
e be
en a
buse
d or
den
ied.
27
2.3
Prot
ect p
atien
ts a
nd
colle
ague
s fro
m a
ny
risk
pose
d by
you
r he
alth
If yo
u kn
ow o
r sus
pect
that
you
hav
e a
serio
us c
ondi
tion
that
you
cou
ld p
ass o
n to
pati
ents
, or i
f you
r jud
gem
ent
or p
erfo
rman
ce c
ould
be
affec
ted
by a
con
ditio
n or
its t
reat
men
t, yo
u m
ust c
onsu
lt a
suita
bly
qual
ified
col
leag
ue.
You
mus
t fol
low
thei
r adv
ice
abou
t any
cha
nges
to y
our p
racti
ce th
ey c
onsid
er n
eces
sary
. You
mus
t not
rely
on
your
ow
n as
sess
men
t of t
he ri
sk to
pati
ents
.
28
You
shou
ld b
e im
mun
ised
agai
nst c
omm
on se
rious
com
mun
icab
le d
iseas
es (u
nles
s oth
erw
ise c
ontr
aind
icat
ed).
29
You
shou
ld b
e re
gist
ered
with
a g
ener
al p
racti
tione
r out
side
your
fam
ily.
30
“Dom
ain
3Co
mm
unic
ation
,pa
rtne
rshi
p an
dte
amw
ork”
3.1
“Com
mun
icat
eEff
ectiv
ely”
You
mus
t list
en to
pati
ents
, tak
e ac
coun
t of t
heir
view
s, a
nd re
spon
d ho
nest
ly to
thei
r que
stion
s.31
You
mus
t giv
e pa
tient
s* th
e in
form
ation
they
wan
t or n
eed
to k
now
in a
way
they
can
und
erst
and.
You
shou
ld
mak
e su
re th
at a
rran
gem
ents
are
mad
e, w
here
ver p
ossib
le, t
o m
eet p
atien
ts’ l
angu
age
and
com
mun
icati
on
need
s.32
You
mus
t be
cons
ider
ate
to th
ose
clos
e to
the
patie
nt a
nd b
e se
nsiti
ve a
nd re
spon
sive
in g
ivin
g th
em in
form
ation
an
d su
ppor
t.33
Whe
n yo
u ar
e on
dut
y yo
u m
ust b
e re
adily
acc
essib
le to
pati
ents
and
col
leag
ues s
eeki
ng in
form
ation
, adv
ice
or
supp
ort.
34
3.2
Wor
k co
llabo
rativ
ely
with
col
leag
ues t
o m
aint
ain
or im
prov
e pa
tient
car
e
You
mus
t wor
k co
llabo
rativ
ely
with
col
leag
ues,
resp
ectin
g th
eir s
kills
and
con
trib
ution
s.35
You
mus
t tre
at c
olle
ague
s fai
rly a
nd w
ith re
spec
t.36
You
mus
t be
awar
e of
how
you
r beh
avio
ur m
ay in
fluen
ce o
ther
s with
in a
nd o
utsid
e th
e te
am.”
37
Patie
nt sa
fety
may
be
affec
ted
if th
ere
is no
t eno
ugh
med
ical
cov
er. S
o yo
u m
ust t
ake
up a
ny p
ost y
ou h
ave
form
ally
acc
epte
d, a
nd w
ork
your
con
trac
tual
noti
ce p
erio
d be
fore
leav
ing
a jo
b, u
nles
s the
em
ploy
er h
as
reas
onab
le ti
me
to m
ake
othe
r arr
ange
men
ts.
38
CROSS-CUTTING THEME - GOOD MEDICAL PRACTICE 67
Dom
ain
Prin
cipl
eSt
anda
rd (e
lem
ent)
GMC
Guid
ance
Refe
renc
e pa
ragr
aph
“Dom
ain
3Co
mm
unic
ation
,pa
rtne
rshi
p an
dte
amw
ork”
3.3
Teac
hing
, tra
inin
g,
supp
ortin
g an
d as
sess
ing
You
shou
ld b
e pr
epar
ed to
con
trib
ute
to te
achi
ng a
nd tr
aini
ng d
octo
rs a
nd st
uden
ts.
39
You
mus
t mak
e su
re th
at a
ll st
aff y
ou m
anag
e ha
ve a
ppro
pria
te su
perv
ision
.40
You
mus
t be
hone
st a
nd o
bjec
tive
whe
n w
riting
refe
renc
es, a
nd w
hen
appr
aisin
g or
ass
essin
g th
e pe
rform
ance
of
colle
ague
s, in
clud
ing
locu
ms a
nd st
uden
ts. R
efer
ence
s mus
t inc
lude
all
info
rmati
on re
leva
nt to
you
r col
leag
ues’
co
mpe
tenc
e, p
erfo
rman
ce a
nd c
ondu
ct.
41
You
shou
ld b
e w
illin
g to
take
on
a m
ento
ring
role
for m
ore
juni
or d
octo
rs a
nd o
ther
hea
lthca
re p
rofe
ssio
nals.
42
You
mus
t sup
port
col
leag
ues w
ho h
ave
prob
lem
s with
thei
r per
form
ance
or h
ealth
. But
you
mus
t put
pati
ent
safe
ty fi
rst a
t all
times
.43
3.4
Conti
nuity
and
co
ordi
natio
n of
car
e
You
mus
t con
trib
ute
to th
e sa
fe tr
ansf
er o
f pati
ents
bet
wee
n he
alth
care
pro
vide
rs a
nd b
etw
een
heal
th a
nd so
cial
ca
re p
rovi
ders
. Thi
s mea
ns y
ou m
ust s
hare
all
rele
vant
info
rmati
on w
ith c
olle
ague
s inv
olve
d in
you
r pati
ents
’ car
e w
ithin
and
out
side
the
team
, inc
ludi
ng w
hen
you
hand
ove
r car
e as
you
go
off d
uty,
and
whe
n yo
u de
lega
te c
are
or re
fer p
atien
ts to
oth
er h
ealth
or s
ocia
l car
e pr
ovid
ers
44a
You
mus
t con
trib
ute
to th
e sa
fe tr
ansf
er o
f pati
ents
bet
wee
n he
alth
care
pro
vide
rs a
nd b
etw
een
heal
th a
nd
soci
al c
are
prov
ider
s. T
his m
eans
you
mus
t che
ck, w
here
pra
ctica
l, th
at a
nam
ed c
linic
ian
or te
am h
as ta
ken
over
resp
onsib
ility
whe
n yo
ur ro
le in
pro
vidi
ng a
pati
ent’s
car
e ha
s end
ed. T
his m
ay b
e pa
rticu
larly
impo
rtan
t for
pa
tient
s with
impa
ired
capa
city
or w
ho a
re v
ulne
rabl
e fo
r oth
er re
ason
s.
44b
Whe
n yo
u do
not
pro
vide
you
r pati
ents
’ car
e yo
urse
lf, fo
r exa
mpl
e w
hen
you
are
off d
uty,
or y
ou d
eleg
ate
the
care
of a
pati
ent t
o a
colle
ague
, you
mus
t be
satis
fied
that
the
pers
on p
rovi
ding
car
e ha
s the
app
ropr
iate
qu
alifi
catio
ns, s
kills
and
exp
erie
nce
to p
rovi
de sa
fe c
are
for t
he p
atien
t.45
3.5
Esta
blish
and
m
aint
ain
part
ners
hips
with
pa
tient
s
You
mus
t be
polit
e an
d co
nsid
erat
e.46
You
mus
t tre
at p
atien
ts a
s ind
ivid
uals
and
resp
ect t
heir
dign
ity a
nd p
rivac
y.47
You
mus
t tre
at p
atien
ts fa
irly
and
with
resp
ect w
hate
ver t
heir
life
choi
ces a
nd b
elie
fs.
48
You
mus
t wor
k in
par
tner
ship
with
pati
ents
, sha
ring
with
them
the
info
rmati
on th
ey w
ill n
eed
to m
ake
deci
sions
ab
out t
heir
care
,15
incl
udin
g th
eir c
ondi
tion,
its l
ikel
y pr
ogre
ssio
n an
d th
e op
tions
for t
reat
men
t, in
clud
ing
asso
ciat
ed ri
sks a
nd u
ncer
tain
ties
49a
You
mus
t wor
k in
par
tner
ship
with
pati
ents
, sha
ring
with
them
the
info
rmati
on th
ey w
ill n
eed
to m
ake
deci
sions
ab
out t
heir
care
,15
incl
udin
g th
e pr
ogre
ss o
f the
ir ca
re, a
nd y
our r
ole
and
resp
onsib
ilitie
s in
the
team
49b
You
mus
t wor
k in
par
tner
ship
with
pati
ents
, sha
ring
with
them
the
info
rmati
on th
ey w
ill n
eed
to m
ake
deci
sions
ab
out t
heir
care
,15
incl
udin
g w
ho is
resp
onsib
le fo
r eac
h as
pect
of p
atien
t car
e, a
nd h
ow in
form
ation
is sh
ared
w
ithin
team
s and
am
ong
thos
e w
ho w
ill b
e pr
ovid
ing
thei
r car
e49
c
CROSS-CUTTING THEME - GOOD MEDICAL PRACTICE 68
Dom
ain
Prin
cipl
eSt
anda
rd (e
lem
ent)
GMC
Guid
ance
Refe
renc
e pa
ragr
aph
“Dom
ain
3Co
mm
unic
ation
,pa
rtne
rshi
p an
dte
amw
ork”
3.5
Esta
blish
and
m
aint
ain
part
ners
hips
with
pa
tient
s
You
mus
t wor
k in
par
tner
ship
with
pati
ents
, sha
ring
with
them
the
info
rmati
on th
ey w
ill n
eed
to m
ake
deci
sions
ab
out t
heir
care
,15
incl
udin
g an
y ot
her i
nfor
mati
on p
atien
ts n
eed
if th
ey a
re a
sked
to a
gree
to b
e in
volv
ed in
te
achi
ng o
r res
earc
h.49
d
You
mus
t tre
at in
form
ation
abo
ut p
atien
ts a
s con
fiden
tial.
This
incl
udes
afte
r a p
atien
t has
die
d.50
You
mus
t sup
port
pati
ents
in c
arin
g fo
r the
mse
lves
to e
mpo
wer
them
to im
prov
e an
d m
aint
ain
thei
r hea
lth. T
his
may
, for
exa
mpl
e, in
clud
e ad
visin
g pa
tient
s on
the
effec
ts o
f the
ir lif
e ch
oice
s and
life
styl
e on
thei
r hea
lth a
nd
wel
l-bei
ng51
a
You
mus
t sup
port
pati
ents
in c
arin
g fo
r the
mse
lves
to e
mpo
wer
them
to im
prov
e an
d m
aint
ain
thei
r hea
lth. T
his
may
, for
exa
mpl
e, in
clud
e su
ppor
ting
patie
nts t
o m
ake
lifes
tyle
cha
nges
whe
re a
ppro
pria
te.
51b
You
mus
t exp
lain
to p
atien
ts if
you
hav
e a
cons
cien
tious
obj
ectio
n to
a p
artic
ular
pro
cedu
re. Y
ou m
ust t
ell t
hem
ab
out t
heir
right
to se
e an
othe
r doc
tor a
nd m
ake
sure
they
hav
e en
ough
info
rmati
on to
exe
rcise
that
righ
t. In
pr
ovid
ing
this
info
rmati
on y
ou m
ust n
ot im
ply
or e
xpre
ss d
isapp
rova
l of t
he p
atien
t’s li
fest
yle,
cho
ices
or b
elie
fs. I
f it
is no
t pra
ctica
l for
a p
atien
t to
arra
nge
to se
e an
othe
r doc
tor,
you
mus
t mak
e su
re th
at a
rran
gem
ents
are
mad
e fo
r ano
ther
suita
bly
qual
ified
col
leag
ue to
take
ove
r you
r rol
e.
52
Dom
ain
4M
aint
aini
ngtr
ust
4.1
Show
resp
ect f
or
patie
nts
You
mus
t not
use
you
r pro
fess
iona
l pos
ition
to p
ursu
e a
sexu
al o
r im
prop
er e
moti
onal
rela
tions
hip
with
a p
atien
t or
som
eone
clo
se to
them
.53
You
mus
t not
exp
ress
you
r per
sona
l bel
iefs
(inc
ludi
ng p
oliti
cal,
relig
ious
and
mor
al b
elie
fs) t
o pa
tient
s in
way
s tha
t ex
ploi
t the
ir vu
lner
abili
ty o
r are
like
ly to
cau
se th
em d
istre
ss.
54
You
mus
t be
open
and
hon
est w
ith p
atien
ts if
thin
gs g
o w
rong
. If a
pati
ent u
nder
you
r car
e ha
s suff
ered
har
m o
r di
stre
ss, y
ou sh
ould
put
matt
ers r
ight
(if t
hat i
s pos
sible
)55
a
You
mus
t be
open
and
hon
est w
ith p
atien
ts if
thin
gs g
o w
rong
. If a
pati
ent u
nder
you
r car
e ha
s suff
ered
har
m o
r di
stre
ss, y
ou sh
ould
offe
r an
apol
ogy
55b
You
mus
t be
open
and
hon
est w
ith p
atien
ts if
thin
gs g
o w
rong
. If a
pati
ent u
nder
you
r car
e ha
s suff
ered
har
m
or d
istre
ss, y
ou sh
ould
exp
lain
fully
and
pro
mpt
ly w
hat h
as h
appe
ned
and
the
likel
y sh
ort-t
erm
and
long
-term
eff
ects
.55
c
4.2
Trea
t Pati
ents
an
d Co
lleag
ues
Fairl
y an
d W
ithou
t Di
scrim
inati
on
You
mus
t giv
e pr
iorit
y to
pati
ents
on
the
basis
of t
heir
clin
ical
nee
d if
thes
e de
cisio
ns a
re w
ithin
you
r pow
er. I
f in
adeq
uate
reso
urce
s, p
olic
ies o
r sys
tem
s pre
vent
you
from
doi
ng th
is, a
nd p
atien
t saf
ety,
dign
ity o
r com
fort
may
be
serio
usly
com
prom
ised,
you
mus
t fol
low
the
guid
ance
in p
arag
raph
25b
.56
The
inve
stiga
tions
or t
reat
men
t you
pro
vide
or a
rran
ge m
ust b
e ba
sed
on th
e as
sess
men
t you
and
you
r pati
ent
mak
e of
thei
r nee
ds a
nd p
rioriti
es, a
nd o
n yo
ur c
linic
al ju
dgem
ent a
bout
the
likel
y eff
ectiv
enes
s of t
he tr
eatm
ent
optio
ns. Y
ou m
ust n
ot re
fuse
or d
elay
trea
tmen
t bec
ause
you
bel
ieve
that
a p
atien
t’s a
ction
s or l
ifest
yle
have
co
ntrib
uted
to th
eir c
ondi
tion.
57
CROSS-CUTTING THEME - GOOD MEDICAL PRACTICE 69
Dom
ain
Prin
cipl
eSt
anda
rd (e
lem
ent)
GMC
Guid
ance
Refe
renc
e pa
ragr
aph
Dom
ain
4M
aint
aini
ngtr
ust
(con
t)
4.2
Trea
t Pati
ents
an
d Co
lleag
ues
Fairl
y an
d W
ithou
t Di
scrim
inati
on
You
mus
t not
den
y tr
eatm
ent t
o pa
tient
s bec
ause
thei
r med
ical
con
ditio
n m
ay p
ut y
ou a
t risk
. If a
pati
ent p
oses
a
risk
to y
our h
ealth
or s
afet
y, yo
u sh
ould
take
all
avai
labl
e st
eps t
o m
inim
ise th
e ris
k be
fore
pro
vidi
ng tr
eatm
ent o
r m
akin
g ot
her s
uita
ble
alte
rnati
ve a
rran
gem
ents
for p
rovi
ding
trea
tmen
t.58
You
mus
t not
unf
airly
disc
rimin
ate
agai
nst p
atien
ts o
r col
leag
ues b
y al
low
ing
your
per
sona
l vie
ws*
to a
ffect
yo
ur p
rofe
ssio
nal r
elati
onsh
ips o
r the
trea
tmen
t you
pro
vide
or a
rran
ge. Y
ou sh
ould
cha
lleng
e co
lleag
ues i
f the
ir be
havi
our d
oes n
ot c
ompl
y w
ith th
is gu
idan
ce, a
nd fo
llow
the
guid
ance
in p
arag
raph
25c
(see
pag
e 11
) if t
he
beha
viou
r am
ount
s to
abus
e or
den
ial o
f a p
atien
t’s o
r col
leag
ue’s
right
s.
59
You
mus
t con
sider
and
resp
ond
to th
e ne
eds o
f disa
bled
pati
ents
and
shou
ld m
ake
reas
onab
le a
djus
tmen
ts to
yo
ur p
racti
ce so
they
can
rece
ive
care
to m
eet t
heir
need
s.60
You
mus
t res
pond
pro
mpt
ly, fu
lly a
nd h
ones
tly to
com
plai
nts a
nd a
polo
gise
whe
n ap
prop
riate
. You
mus
t not
allo
w
a pa
tient
’s co
mpl
aint
to a
dver
sely
affe
ct th
e ca
re o
r tre
atm
ent y
ou p
rovi
de o
r arr
ange
.61
You
shou
ld e
nd a
pro
fess
iona
l rel
ation
ship
with
a p
atien
t onl
y w
hen
the
brea
kdow
n of
trus
t bet
wee
n yo
u an
d th
e pa
tient
mea
ns y
ou c
anno
t pro
vide
goo
d cl
inic
al c
are
to th
e pa
tient
.62
You
mus
t mak
e su
re y
ou h
ave
adeq
uate
insu
ranc
e or
inde
mni
ty c
over
so th
at y
our p
atien
ts w
ill n
ot b
e di
sadv
anta
ged
if th
ey m
ake
a cl
aim
abo
ut th
e cl
inic
al c
are
you
have
pro
vide
d in
the
UK.
63
If so
meo
ne y
ou h
ave
cont
act w
ith in
you
r pro
fess
iona
l rol
e as
ks fo
r you
r reg
ister
ed n
ame
and/
or G
MC
refe
renc
e nu
mbe
r, yo
u m
ust g
ive
this
info
rmati
on to
them
.64
4.3
Act w
ith H
ones
ty
and
Inte
grity
You
mus
t mak
e su
re th
at y
our c
ondu
ct ju
stifie
s you
r pati
ents
’ tru
st in
you
and
the
publ
ic’s
trus
t in
the
prof
essio
n65
You
mus
t alw
ays b
e ho
nest
abo
ut y
our e
xper
ienc
e, q
ualifi
catio
ns a
nd c
urre
nt ro
le.
66
You
mus
t act
with
hon
esty
and
inte
grity
whe
n de
signi
ng, o
rgan
ising
or c
arry
ing
out r
esea
rch,
and
follo
w n
ation
al
rese
arch
gov
erna
nce
guid
elin
es a
nd o
ur g
uida
nce.
67
You
mus
t be
hone
st a
nd tr
ustw
orth
y in
all
your
com
mun
icati
on w
ith p
atien
ts a
nd c
olle
ague
s. T
his m
eans
you
m
ust m
ake
clea
r the
lim
its o
f you
r kno
wle
dge
and
mak
e re
ason
able
che
cks t
o m
ake
sure
any
info
rmati
on y
ou g
ive
is ac
cura
te.
68
Whe
n co
mm
unic
ating
pub
licly,
incl
udin
g sp
eaki
ng to
or w
riting
in th
e m
edia
, you
mus
t mai
ntai
n pa
tient
co
nfide
ntial
ity. Y
ou sh
ould
rem
embe
r whe
n us
ing
soci
al m
edia
that
com
mun
icati
ons i
nten
ded
for f
riend
s or
fam
ily m
ay b
ecom
e m
ore
wid
ely
avai
labl
e.69
Whe
n ad
verti
sing
your
serv
ices
, you
mus
t mak
e su
re th
e in
form
ation
you
pub
lish
is fa
ctua
l and
can
be
chec
ked,
an
d do
es n
ot e
xplo
it pa
tient
s’ v
ulne
rabi
lity
or la
ck o
f med
ical
kno
wle
dge.
70
You
mus
t be
hone
st a
nd tr
ustw
orth
y w
hen
writi
ng re
port
s, a
nd w
hen
com
pleti
ng o
r sig
ning
form
s, re
port
s and
ot
her d
ocum
ents
.16
You
mus
t mak
e su
re th
at a
ny d
ocum
ents
you
writ
e or
sign
are
not
false
or m
islea
ding
. You
m
ust t
ake
reas
onab
le st
eps t
o ch
eck
the
info
rmati
on is
cor
rect
.71
a
CROSS-CUTTING THEME - GOOD MEDICAL PRACTICE 70
Dom
ain
Prin
cipl
eSt
anda
rd (e
lem
ent)
GMC
Guid
ance
Refe
renc
e pa
ragr
aph
Dom
ain
4M
aint
aini
ngtr
ust
(con
t)
4.3
Act w
ith H
ones
ty
and
Inte
grity
You
mus
t be
hone
st a
nd tr
ustw
orth
y w
hen
writi
ng re
port
s, a
nd w
hen
com
pleti
ng o
r sig
ning
form
s, re
port
s and
ot
her d
ocum
ents
.16
You
mus
t mak
e su
re th
at a
ny d
ocum
ents
you
writ
e or
sign
are
not
false
or m
islea
ding
. You
m
ust n
ot d
elib
erat
ely
leav
e ou
t rel
evan
t inf
orm
ation
.71
b
You
mus
t be
hone
st a
nd tr
ustw
orth
y w
hen
givi
ng e
vide
nce
to c
ourt
s or t
ribun
als.
20 Y
ou m
ust m
ake
sure
that
any
ev
iden
ce y
ou g
ive
or d
ocum
ents
you
writ
e or
sign
are
not
false
or m
islea
ding
.You
mus
t tak
e re
ason
able
step
s to
chec
k th
e in
form
ation
.72
a
You
mus
t be
hone
st a
nd tr
ustw
orth
y w
hen
givi
ng e
vide
nce
to c
ourt
s or t
ribun
als.
20 Y
ou m
ust m
ake
sure
that
any
ev
iden
ce y
ou g
ive
or d
ocum
ents
you
writ
e or
sign
are
not
false
or m
islea
ding
. You
mus
t not
del
iber
atel
y le
ave
out
rele
vant
info
rmati
on.
7b
You
mus
t coo
pera
te w
ith fo
rmal
inqu
iries
and
com
plai
nts p
roce
dure
s and
mus
t offe
r all
rele
vant
info
rmati
on
whi
le fo
llow
ing
the
guid
ance
in C
onfid
entia
lity.
73
You
mus
t mak
e cl
ear t
he li
mits
of y
our c
ompe
tenc
e an
d kn
owle
dge
whe
n gi
ving
evi
denc
e or
acti
ng a
s a w
itnes
s.74
You
mus
t tel
l us w
ithou
t del
ay if
, any
whe
re in
the
wor
ld y
ou h
ave
acce
pted
a c
autio
n fr
om th
e po
lice
or b
een
criti
cise
d by
an
offici
al in
quiry
”75
a
You
mus
t tel
l us w
ithou
t del
ay if
, any
whe
re in
the
wor
ld y
ou h
ave
been
cha
rged
with
or f
ound
gui
lty o
f a c
rimin
al
offen
ce75
b
You
mus
t tel
l us w
ithou
t del
ay if
, any
whe
re in
the
wor
ld a
noth
er p
rofe
ssio
nal b
ody
has m
ade
a fin
ding
aga
inst
yo
ur re
gist
ratio
n as
a re
sult
of fi
tnes
s to
prac
tise
proc
edur
es.
75c
If yo
u ar
e su
spen
ded
by a
n or
gani
satio
n fr
om a
med
ical
pos
t, or
hav
e re
stric
tions
pla
ced
on y
our p
racti
ce, y
ou
mus
t, w
ithou
t del
ay, i
nfor
m a
ny o
ther
org
anisa
tions
you
car
ry o
ut m
edic
al w
ork
for a
nd a
ny p
atien
ts y
ou se
e in
depe
nden
tly.
76
You
mus
t be
hone
st in
fina
ncia
l and
com
mer
cial
dea
lings
with
pati
ents
, em
ploy
ers,
insu
rers
and
oth
er
orga
nisa
tions
or i
ndiv
idua
ls.”
77
You
mus
t not
allo
w a
ny in
tere
sts y
ou h
ave
to a
ffect
the
way
you
pre
scrib
e fo
r, tr
eat,
refe
r or c
omm
issio
n se
rvic
es
for p
atien
ts.
78
If yo
u ar
e fa
ced
with
a c
onfli
ct o
f int
eres
t, yo
u m
ust b
e op
en a
bout
the
confl
ict,
decl
arin
g yo
ur in
tere
st fo
rmal
ly,
and
you
shou
ld b
e pr
epar
ed to
exc
lude
you
rsel
f fro
m d
ecisi
on m
akin
g.79
You
mus
t not
ask
for o
r acc
ept –
from
pati
ents
, col
leag
ues o
r oth
ers –
any
indu
cem
ent,
gift
or h
ospi
talit
y th
at m
ay
affec
t or b
e se
en to
affe
ct th
e w
ay y
ou p
resc
ribe
for,
trea
t or r
efer
pati
ents
or c
omm
issio
n se
rvic
es fo
r pati
ents
. Yo
u m
ust n
ot o
ffer t
hese
indu
cem
ents
.80
71
THEME 1. WORKING IN EMERGENCY MEDICAL SYSTEMS Specialist practitioners in PHEM operate within wider Emergency Medical Services (EMS) Systems. These systems have a number of inter-dependent components. Having an understanding of these components, the way in which they interact and the wider regulatory framework surrounding them is essential for effective professional medical practice in this field.
UNITS1.1 Understand Emergency Medical Services (EMS) Systems models and components1.2 Understand pre-hospital operational environments1.3 Understand the training and regulation of pre-hospital healthcare personnel1.4 Understand the process of ambulance emergency call handling, prioritisation, dispatch
categorisation and resource management1.5 Understand the role of pre-hospital emergency medical services within EMS1.6 Understand the law relevant to Pre-hospital Emergency Medicine practice1.7 Work effectively with emergency services 1.8 Work effectively with acute hospital services1.9 Provide EMS clinical advice, support and co-ordination 1.10 Understand the pre-hospital and acute sector management structures within the wider
healthcare system
Related GMP domains are assigned to each group of elements within units as follows:1. Knowledge skills and performance2. Safety and quality3. Communication, partnership and teamwork4. Maintaining trust
THEME 1
Good Medical Practice
Working in Emergency
Medical Systems
Providing pre-hospital
Emergency Medical Care
Using pre-hospital
equipment
Supporting rescue and extrication
Supporting safe patient
transfer
Supporting emergency
preparedness and response
72THEME 1
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Them
e 1.
Wor
king
in E
mer
genc
y M
edic
al S
yste
ms
1.1
Und
erst
and
Emer
genc
y M
edic
al
Serv
ices
(EM
S)
Syst
ems m
odel
s and
co
mpo
nent
s
1.1.
1De
fine
an E
mer
genc
y M
edic
al S
ervi
ce (E
MS)
syst
emU
K
DR, L
T, CL
, EL
1 (a
)•
•1
1.1.
2Ca
tego
rise
the
com
pone
nts o
f an
EMS
syst
emU
K1
(a)
••
1
1.1.
3Co
ntra
st d
iffer
ing
regi
onal
, nati
onal
and
inte
rnati
onal
m
odel
s of E
MS
syst
ems
UK
1 (b
)•
•1
1.1.
4Co
ntra
st E
MS
syst
ems i
n de
velo
ped
and
deve
lopi
ngna
tions
UK
2•
•1
1.2
Und
erst
and
pre-
hosp
ital o
pera
tiona
l en
viro
nmen
ts
1.2.
1Ca
tego
rise
the
diffe
rent
env
ironm
ents
in w
hich
PHE
Mis
prac
ticed
UK
DR, L
T,
CL, E
L
1 (b
)•
•1
1.2.
2Co
ntra
st E
MS
syst
ems i
n ur
ban,
rura
l and
rem
ote
setti
ngs
UK
1 (b
)•
•1
1.2.
3
Criti
ue th
e im
pact
of d
ier
ent o
pera
tion
al
envi
ronm
ents
on
(a) R
isk to
per
sonn
elU
K
DR, L
T,
CL, E
L
1 (b
)•
•2
(b) P
atien
t saf
ety
UK
1 (b
)•
•2
(c) C
linic
al c
are
UK
1 (b
)•
•1
(d) P
atien
t tra
nspo
rtU
K1
(b)
••
1
1.2.
4De
mon
stra
te re
silie
nce
in a
dver
se p
re-h
ospi
tal
cond
ition
s N
TSRM
, RP
EL, S
L
1 (b
)•
••
2
1.2.
5De
mon
stra
te ju
dici
ous u
se o
f res
ourc
es
NTS
2•
••
2
73THEME 1
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Them
e 1.
Wor
king
in E
mer
genc
y M
edic
al S
yste
ms
1.3
Und
erst
and
the
trai
ning
and
re
gula
tion
of p
re-
hosp
ital h
ealth
care
pr
ofes
siona
ls
1.3.
1Li
st th
e ra
nge
of p
re-h
ospi
tal h
ealth
care
per
sonn
elU
K
DR, L
T,
CL, E
L
1 (a
)•
•3
1.3.
2Co
ntra
st t
he d
iffer
ence
s in
trai
ning
of p
re-h
ospi
tal
heal
thca
re p
erso
nnel
UK
1 (a
)•
•3
1.3.
3De
scrib
e th
e m
edic
al c
apab
ilitie
s of p
re-h
ospi
tal
heal
thca
re p
erso
nnel
with
in th
e EM
S sy
stem
UK
1 (b
)•
•3
1.3.
4De
scrib
e th
e ro
le o
f the
rele
vant
regu
lato
ry b
odie
s for
he
alth
care
pro
fess
iona
lsU
K2
••
2
1.3.
5De
mon
stra
te re
spec
t for
indi
vidu
als w
ithin
the
mul
ti-
prof
essio
nal w
orkf
orce
NTS
RM, E
LSL
, RP
1 (b
)•
••
••
4
1.4
Und
erst
and
the
proc
ess o
f am
bula
nce
emer
genc
yca
ll ha
ndlin
g,
prio
ritisa
tion,
disp
atch
ca
tego
risati
onan
d re
sour
ce
man
agem
ent
1.4.
1
Des
crib
e th
e pr
oces
s of
am
bula
nce
serv
ice
emer
genc
y
(a) C
all h
andl
ing
UK
DR, L
T,
SL, C
L,
EL
1 (a
)•
•1
(b) C
all p
rioriti
satio
n U
K1
(a)
••
1
(c) D
ispat
chU
K1
(a)
••
1
(d) R
esou
rce
activ
ation
UK
1 (a
)•
•1
(e) R
esou
rce
man
agem
ent
UK
1 (a
)•
•1
1.4.
2
Epl
ain
the
conc
epts
und
erpi
nnin
g am
bula
nce
serv
ice
emer
genc
y
(a) C
all p
rioriti
satio
nU
K
DR, L
T,
SL, C
L,
EL
1 (b
)•
•1
(b) R
esou
rce
man
agem
ent
UK
1 (b
)•
•1
1.4.
3De
mon
stra
te re
spon
se d
ecisi
ons o
n th
e ba
sis o
f am
bula
nce
serv
ice
emer
genc
y ca
ll in
form
ation
TS1
(b)
••
••
3
DRDi
rect
ed R
eadi
ngLT
Lect
ures
and
Tut
oria
lsDP
Delib
erat
e Pr
actic
eSL
Sim
ulati
on L
earn
ing
RPRe
flecti
ve P
racti
ceRM
Role
Mod
elin
gCL
Colla
bora
tive
Lear
ning
ELEx
perie
ntial
Lea
rnin
g
74THEME 1
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Them
e 1.
Wor
king
in E
mer
genc
y M
edic
al S
yste
ms
1.5
Und
erst
and
the
role
of p
re-h
ospi
tal
emer
genc
y m
edic
al
serv
ices
with
in E
MS
1.5.
1De
fine
the
role
of p
re-h
ospi
tal e
mer
genc
y m
edic
alse
rvic
esU
K
DR, L
T,
SL, C
L,
EL
1 (a
)•
•1
1.5.
2Ca
tego
rise
the
activ
ities
of p
re-h
ospi
tal e
mer
genc
ym
edic
al se
rvic
esU
K1
(a)
••
1
1.5.
3Cr
itiqu
e th
e ro
le o
f phy
sicia
ns o
pera
ting
with
in p
re-
hosp
ital e
mer
genc
y m
edic
al se
rvic
esU
K1
(b)
••
1
1.6
Und
erst
and
the
law
rele
vant
toPr
e-ho
spita
l Em
erge
ncy
Med
icin
e pr
actic
e
1.6.
1Di
ffere
ntiat
e la
wfu
l con
sent
to tr
eatm
ent b
etw
een
adul
tsan
d ch
ildre
nU
K
DR, L
T,
SL, C
L,
EL
1 (a
)•
•3
1.6.
2Di
ffere
ntiat
e la
wfu
l ref
usal
of t
reat
men
t bet
wee
n ad
ults
and
child
ren
UK
1 (a
)•
•3
1.6.
3Ex
plai
n th
e le
gal b
asis
for t
he e
mer
genc
y tr
eatm
ent o
fth
e in
capa
cita
ted
patie
ntU
K1
(a)
••
3
1.6.
4
Des
crib
e th
e em
erge
ncy
prov
isio
ns in
legi
slati
on fo
r
(a) p
rote
cting
and
safe
guar
ding
pati
ents
with
men
tal
illne
ssU
KDR
, LT,
SL
, CL,
EL
1 (a
)•
•2
(b) p
rote
cting
and
safe
guar
ding
chi
ldre
nU
K1
(a)
••
2
(c) p
rote
cting
and
safe
guar
ding
vul
nera
ble
adul
tsU
K1
(a)
••
2
1.6.
5
Des
crib
e th
e em
erge
ncy
prov
isio
ns in
legi
slati
on fo
r
(a) E
mer
genc
y dr
ivin
g pr
oced
ure
UK
DR, L
T,
SL, C
L,
EL
1 (a
)•
•1
(b) H
elic
opte
r em
erge
ncy
med
ical
serv
ices
UK
1 (a
)•
•1
(c) A
ir am
bula
nce
serv
ices
UK
1 (a
)•
•1
1.6.
6An
alys
e sit
uatio
ns w
here
con
fiden
tialit
y m
ay la
wfu
lly b
e br
each
ed in
pre
-hos
pita
l em
erge
ncy
med
ical
pra
ctice
UK
1 (a
)•
•4
1.6.
7De
scrib
e th
e le
gal r
equi
rem
ents
rela
ted
to d
eath
s out
side
of h
ospi
tal
UK
1 (a
)•
•1
75THEME 1
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Them
e 1.
Wor
king
in E
mer
genc
y M
edic
al S
yste
ms
1.7
Wor
k eff
ectiv
ely
with
em
erge
ncy
serv
ices
1.7.
1
Des
crib
e th
e ro
les
and
resp
onsi
biliti
es o
f
(a) A
mbu
lanc
e au
thor
ities
and
serv
ices
U
K
DR, L
T, SL
, CL,
EL
1 (b
)•
•1
(b) P
olic
e au
thor
ities
and
serv
ices
UK
1 (b
)•
•1
(c) F
ire a
utho
rities
and
serv
ices
U
K1
(b)
••
1
(d) R
escu
e au
thor
ities
and
serv
ices
UK
1 (b
)•
•1
(e) S
peci
alist
resc
ue se
rvic
es
UK
1 (b
)•
•1
(e) V
olun
tary
em
erge
ncy
serv
ices
UK
1 (b
)•
•1
1.7.
2
Cont
rast
the
inci
dent
com
man
d st
ruct
ures
of
(a) M
edic
al se
rvic
esU
K
DR, L
T, SL
, CL,
EL
1 (a
)•
•1
(b) A
mbu
lanc
e se
rvic
esU
K1
(a)
••
1
(c) P
olic
e se
rvic
esU
K1
(a)
••
1
(d) F
ire se
rvic
esU
K1
(a)
••
(e) R
escu
e se
rvic
esU
K1
(a)
••
1
1.7.
3
Epl
ain
the
med
ical
cap
abili
ties
of
(a) P
olic
e pe
rson
nel
UK
DR, L
T, SL
, CL,
EL
1 (b
)•
•1
(b) F
ire p
erso
nnel
UK
1 (b
)•
•1
(c) R
escu
e pe
rson
nel
UK
1 (b
)•
•1
DRDi
rect
ed R
eadi
ngLT
Lect
ures
and
Tut
oria
lsDP
Delib
erat
e Pr
actic
eSL
Sim
ulati
on L
earn
ing
RPRe
flecti
ve P
racti
ceRM
Role
Mod
elin
gCL
Colla
bora
tive
Lear
ning
ELEx
perie
ntial
Lea
rnin
g
76THEME 1
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Them
e 1.
Wor
king
in E
mer
genc
y M
edic
al S
yste
ms
1.7.
3 co
nt.
(d) S
peci
alist
resc
ue p
erso
nnel
UK
DR, L
T, SL
, CL,
EL
1 (b
)•
•1
(e) V
olun
tary
em
erge
ncy
serv
ices
per
sonn
elU
K1
(b)
••
1
1.7.
4De
mon
stra
te e
ngag
emen
t with
loca
l, re
gion
al a
nd
natio
nal e
mer
genc
y se
rvic
es im
prov
emen
t pro
cess
esN
TSRP
, RM
, EL
1 (b
)•
••
•2
1.8
Wor
k eff
ectiv
ely
with
acu
te h
ospi
tal
serv
ices
1.8.
1Ca
tego
rise
acut
e ho
spita
l ser
vice
sU
KDR
, LT,
CL, E
L1
(a)
••
1
1.8.
2
Di
eren
tiat
e, w
ithi
n an
EM
S Sy
stem
, the
pro
cess
for
acce
ssin
g
(a) E
mer
genc
y de
part
men
tsU
K
DR, L
T, CL
, EL
1 (a
)•
•1
(b) M
ajor
trau
ma
serv
ices
UK
1 (a
)•
•1
(c) B
urns
serv
ices
UK
1 (a
)•
•1
(d) S
pina
l inj
ury
serv
ices
UK
1 (a
)•
•1
(e) P
erin
atal
serv
ices
UK
1 (a
)•
•1
(f) C
hild
ren’
s ser
vice
sU
K1
(a)
••
1
(g) M
enta
l hea
lth se
rvic
esU
K1
(a)
••
1
(h) S
peci
alist
Med
ical
serv
ices
UK
1 (a
)•
•1
1.8.
3De
mon
stra
te e
ngag
emen
t with
acu
te h
ospi
tal e
mer
genc
yac
cess
impr
ovem
ent p
roce
sses
NTS
RM, E
L,
CL1
(b)
••
••
2
1.9
Prov
ide
EMS
clin
ical
adv
ice,
su
ppor
t and
co-o
rdin
ation
1.9.
1De
scrib
e th
e pr
oced
ures
, pro
toco
ls an
d gu
idel
ines
for
prov
idin
g EM
S cl
inic
al a
dvic
e, su
ppor
t and
co-
ordi
natio
nU
K
LT, S
L
1 (b
)•
•3
1.9.
2De
scrib
e th
e eq
uipm
ent a
vaila
ble
to p
rovi
de E
MS
clin
ical
ad
vice
, sup
port
and
co-
ordi
natio
nU
K1
(b)
••
3
77THEME 1
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Them
e 1.
Wor
king
in E
mer
genc
y M
edic
al S
yste
ms
1.9
Prov
ide
EMS
clin
ical
adv
ice,
su
ppor
t and
co-
ordi
natio
n
(con
t.)
1.9.
3Co
ntra
st ‘o
n-lin
e’ (r
emot
e te
leph
one/
radi
o su
ppor
t)
and
‘off-
line’
(doc
umen
ts th
at g
uide
pra
ctice
) med
ical
di
recti
onU
KLT
, SL
1 (b
)•
••
3
1.9.
4
Dis
play
eec
tive
on-
line
clin
ical
sup
port
by
(a) C
omm
unic
ating
in a
n ap
prop
riate
and
pro
fess
iona
lm
anne
rTS
SL, E
L,
RM
1 (b
)•
••
••
3
(b) O
btai
ns re
leva
nt in
form
ation
in a
tim
ely
man
ner
TS1
(b)
••
••
•3
(c) D
raw
ing
appr
opria
te c
oncl
usio
nsTS
1 (b
)•
••
••
3
(d) R
elay
ing
the
deci
sion
to th
e cl
inic
ian
at sc
ene,
ensu
ring
thei
r und
erst
andi
ng.
TS1
(b)
••
••
•3
1.9.
5De
mon
stra
te a
will
ingn
ess t
o re
view
and
lear
n fr
om
any
EMS
clin
ical
adv
ice,
supp
ort a
nd c
o-or
dina
tion
activ
ityN
TS1
(b)
••
••
•1
1.10
Und
erst
and
the
pre-
hosp
ital
and
acut
e se
ctor
m
anag
emen
t st
ruct
ures
with
inth
e w
ider
hea
lthca
resy
stem
1.10
.1
Des
crib
e th
e cl
inic
al a
nd o
pera
tion
al m
anag
emen
tst
ruct
ures
rele
vant
to e
mer
genc
y ca
re w
ithi
n
(a) T
he a
mbu
lanc
e se
rvic
esU
K
DR, L
T, EL
1 (b
)•
•1
(b) T
he p
re-h
ospi
tal e
mer
genc
y m
edic
al se
rvic
eU
K1
(b)
••
1
(c) T
he a
cute
hos
pita
l em
erge
ncy
serv
ices
UK
1 (b
)•
•1
(d) T
he h
ealth
serv
ice,
aut
horit
y or
boa
rdU
K1
(b)
••
1
1.10
.2De
scrib
e th
e in
ter-a
genc
y an
d in
ter-s
ervi
ce li
aiso
n an
d m
anag
emen
t str
uctu
res f
or e
mer
genc
y ca
re
with
in th
e w
ider
hea
lthca
re sy
stem
UK
2•
•1
1.10
.3Co
ntra
st th
e co
mm
issio
ning
and
fund
ing
of E
MS
syst
ems n
ation
ally
and
inte
rnati
onal
lyU
K2
••
1
DRDi
rect
ed R
eadi
ngLT
Lect
ures
and
Tut
oria
lsDP
Delib
erat
e Pr
actic
eSL
Sim
ulati
on L
earn
ing
RPRe
flecti
ve P
racti
ceRM
Role
Mod
elin
gCL
Colla
bora
tive
Lear
ning
ELEx
perie
ntial
Lea
rnin
g
79
THEME 2. PROVIDING PRE-HOSPITAL EMERGENCY MEDICAL CARE Sub-specialist training in PHEM commences after completion of ST4 in Emergency Medicine or Anaesthesia, Intensive Care Medicine or Acute Internal Medicine. Trainees therefore have experience of emergency clinical care in the hospital environment. The established principles and techniques used in those settings often need to be modified for effective pre-hospital emergency use. In addition, the provision of emergency medical care in a relatively unsupported environment requires a greater in-depth knowledge of resuscitation in all age groups. The units within this theme reinforce resuscitation concepts learned during higher specialist training and relate them to the pre-hospital operational environment.
UNITS2.1 Assess patients in the pre-hospital phase2.2 Provide immediate pre-hospital clinical care2.3 Provide cardiopulmonary resuscitation in the pre-hospital environment2.4 Manage acute medical emergencies in the pre-hospital environment2.5 Manage injury in the pre-hospital environment2.6 Provide analgesia, procedural sedation and anaesthesia in the pre-hospital environment2.7 Manage obstetric emergencies in the pre-hospital environment2.8 Manage the newborn in the pre-hospital environment 2.9 Manage injured or ill children in the pre-hospital environment2.10 Manage the bariatric patient in the pre-hospital environment2.11 Manage elderly patients in the pre-hospital environment2.12 Manage acute behavioural disturbance in the pre-hospital environment2.13 Provide end-of-life care and immediate management of bereavement
THEME 2
Good Medical Practice
Working in Emergency
Medical Systems
Providing pre-hospital
Emergency Medical Care
Using pre-hospital
equipment
Supporting rescue and extrication
Supporting safe patient
transfer
Supporting emergency
preparedness and response
80
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Them
e 2.
Pro
vidi
ng p
re-h
ospi
tal e
mer
genc
y m
edic
al c
are
2.1
Asse
ss p
atien
ts
in th
e pr
e-ho
spita
l ph
ase
2.1.
1De
scrib
e ho
w in
terp
reta
tion
of a
n in
cide
nt sc
ene
may
in
fluen
ce a
pati
ent a
sses
smen
tU
KDR
, LT,
SL
CL, E
L1
(a)
••
•3
2.1.
2
Cate
gori
se th
e fa
ctor
s w
hich
impa
ct o
n cl
inic
alas
sess
men
t of p
atien
ts in
the
follo
win
g si
tuati
ons
(a) p
rivat
e do
mes
ticU
K
DR, L
T, SL
CL
, EL
1 (b
)•
•2
(b) c
row
ded
publ
icU
K1
(b)
••
2
(c) g
eogr
aphi
cally
isol
ated
U
K1
(b)
••
2
(d) e
nviro
nmen
tally
exp
osed
U
K1
(b)
••
2
(e) m
ultip
le p
atien
ts
UK
1 (b
)•
•2
(f) p
atien
t is n
ewbo
rn, i
nfan
t or c
hild
UK
1 (b
)•
•2
(g) h
azar
dous
, uns
afe
or u
nsta
ble
UK
1 (b
)•
•2
(h) h
igh
expr
esse
d em
otion
UK
1 (b
)•
•2
(i) p
erso
nally
em
otive
U
K1
(b)
••
4
2.1.
3
Des
crib
e st
rate
gies
to o
ptim
ise
clin
ical
ass
essm
ent
in4
(a) p
rivat
e do
mes
tic si
tuati
onU
K
DR, L
T, SL
CL
, EL
2•
•2
(b) c
row
ded
publ
ic si
tuati
onU
K2
••
2
(c) g
eogr
aphi
cally
isol
ated
situ
ation
UK
2•
•2
(d) e
nviro
nmen
tally
exp
osed
situ
ation
UK
2•
•2
(e) m
ultip
le p
atien
t situ
ation
UK
2•
•2
(f) h
azar
dous
, uns
afe
or u
nsta
ble
situa
tion
UK
2•
•2
THEME 2
81THEME 2
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Them
e 2.
Pro
vidi
ng p
re-h
ospi
tal e
mer
genc
y m
edic
al c
are
2.1
Asse
ss p
atien
ts in
th
e pr
e-ho
spita
l pha
se(c
ont.)
(g) h
igh
expr
esse
d em
otion
situ
ation
UK
DR, L
T, SL
CL
, EL
2•
•2
(h) p
erso
nally
em
otive
situ
ation
UK
2•
•4
2.1.
4De
scrib
e th
e fa
ctor
s whi
ch im
pact
on
the
tem
po o
f cl
inic
al a
sses
smen
t in
a dy
nam
ic si
tuati
onU
K1
(b)
••
•1
2.1.
5De
scrib
e th
e ris
ks o
f lon
e w
orki
ng fo
r hea
lthca
repr
ofes
siona
lsU
K2
••
2
2.1.
6De
scrib
e w
ays i
n w
hich
the
acut
e ill
ness
itse
lf, a
nd th
e an
xiet
y ca
used
by
it, c
an in
fluen
ce p
atien
t ass
essm
ent
UK
2•
•1
2.1.
7Cr
itiqu
e th
e ro
le o
f pre
-hos
pita
l mon
itorin
g in
ass
essin
g pa
tient
s of a
ll ag
esU
K2
••
1
2.1.
8Cr
itiqu
e th
e ro
le o
f pre
-hos
pita
l inv
estig
ation
s in
asse
ssin
g pa
tient
s of a
ll ag
esU
K2
••
1
2.1.
9De
mon
stra
te a
bilit
y to
per
form
an
orga
nise
d, st
ruct
ured
,re
leva
nt a
nd fo
cuse
d as
sess
men
t acr
oss t
he ra
nge
ofpr
e-ho
spita
l situ
ation
s in
infa
nts,
chi
ldre
n an
d ad
ults
TS
LT, D
P,
SL, C
L,
EL
1 (b
)•
••
1
2.1.
10De
mon
stra
te a
bilit
y to
acc
urat
ely
inte
rpre
t clin
ical
hist
ory
and
phys
ical
sign
s in
the
pre-
hosp
ital e
nviro
nmen
t in
infa
nts,
chi
ldre
n an
d ad
ults
TS1
(b)
••
•1
2.1.
11De
mon
stra
te a
ppro
pria
te u
se a
nd in
terp
reta
tion
ofpr
e-ho
spita
l mon
itorin
g in
infa
nts,
chi
ldre
n an
d ad
ults
TS1
(b)
••
•1
2.1.
12De
mon
stra
te a
ppro
pria
te u
se a
nd in
terp
reta
tion
ofpr
e-ho
spita
l inv
estig
ation
s in
infa
nts,
chi
ldre
n an
d ad
ults
TS2
••
1
2.1.
13De
mon
stra
te a
bilit
y to
bal
ance
risk
and
ben
efits
of
actio
ns p
rior t
o fu
ll pa
tient
ass
essm
ent
TS1
(b)
••
1
2.1.
14De
mon
stra
te re
spec
t for
pati
ents
priv
acy
and
dign
ity
durin
g pa
tient
ass
essm
ent
NTS
RM, R
P,
SL, C
L,
EL
1 (b
)•
••
•4
2.1.
15De
mon
stra
te a
ppro
pria
te p
erse
vera
nce
in u
nder
taki
ng
patie
nt a
sses
smen
tN
TS1
(b)
••
••
4
2.1.
16De
mon
stra
te e
ffecti
ve c
omm
unic
ation
with
pati
ents
and
thei
r fam
ily d
urin
g cl
inic
al a
sses
smen
tN
TS1
(b)
••
••
3
DRDi
rect
ed R
eadi
ngLT
Lect
ures
and
Tut
oria
lsDP
Delib
erat
e Pr
actic
eSL
Sim
ulati
on L
earn
ing
RPRe
flecti
ve P
racti
ceRM
Role
Mod
elin
gCL
Colla
bora
tive
Lear
ning
ELEx
perie
ntial
Lea
rnin
g
THEME 2 82
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Them
e 2.
Pro
vidi
ng p
re-h
ospi
tal e
mer
genc
y m
edic
al c
are
2.2
Prov
ide
imm
edia
te p
re-
hosp
ital c
linic
al c
are
2.2.
1Cr
itiqu
e th
e se
quen
ce a
nd o
bjec
tives
of i
mm
edia
te
clin
ical
acti
ons i
n m
anag
ing
criti
cally
unw
ell p
atien
tsU
KDR
, LT,
SL
CL, E
L2
••
1
2.2.
2
Criti
ue th
e im
med
iate
pre
-hos
pita
l clin
ical
acti
ons
in a
ll ag
e gr
oups
for
man
agin
g an
d su
ppor
ting
(a) t
he a
irway
UK
DR, L
T, SL
CL
, EL
2•
••
1
(b) v
entil
ation
UK
2•
••
1
(c) c
ircul
ation
UK
2•
••
1
2.2.
3Cr
itiqu
e th
e cu
rren
t bes
t pra
ctice
in m
anag
ing
acut
epa
in a
nd d
istre
ss in
the
pre-
hosp
ital e
nviro
nmen
tU
K2
••
•1
2.2.
4Co
ntra
st th
e de
liver
y of
clin
ical
car
e be
twee
n th
eac
ute
hosp
ital a
nd p
re-h
ospi
tal e
nviro
nmen
tsU
K2
••
1
2.2.
5De
scrib
e st
rate
gies
to o
ptim
ise th
e de
liver
y of
im
med
iate
clin
ical
car
e in
the
reso
urce
lim
ited
pre-
hosp
ital e
nviro
nmen
tU
K1
(b)
••
•1
2.2.
6De
scrib
e th
e ap
plie
d ph
arm
acol
ogy
of c
omm
only
us
ed m
edic
ines
giv
en in
the
pre-
hosp
ital e
nviro
nmen
t to
all
age
grou
psU
K2
••
2.2.
7De
mon
stra
te a
stru
ctur
ed p
rimar
y as
sess
men
tTS
LT, D
P, S
L,
CL, E
L2
••
••
1
2.2.
8
Dem
onst
rate
the
imm
edia
te c
linic
al in
terv
enti
ons
in
all a
ge g
roup
s fo
r m
anag
ing
and
supp
orti
ng
(a) t
he a
irway
TS
LT, D
P, S
L,
CL, E
L
1 (b
)•
••
1
(b) v
entil
ation
TS1
(b)
••
•1
(c) c
ircul
ation
TS1
(b)
••
•1
2.2.
9De
mon
stra
te th
e m
anag
emen
t of a
cute
pai
n an
d di
stre
ss in
all
age
grou
ps in
the
pre-
hosp
ital
envi
ronm
ent
TS1
(b)
••
•1
2.2.
10De
mon
stra
te a
bilit
y to
pro
vide
safe
and
effe
ctive
im
med
iate
clin
ical
car
e in
all
age
grou
ps in
the
pre-
hosp
ital e
nviro
nmen
tTS
1 (b
)•
••
1
2.2.
11Di
spla
y a
calm
and
met
hodi
cal a
ppro
ach
to p
rovi
ding
im
med
iate
clin
ical
car
eN
TSRM
, RP,
SL
, EL
1 (b
)•
••
•3
THEME 2 83
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Them
e 2.
Pro
vidi
ng p
re-h
ospi
tal e
mer
genc
y m
edic
al c
are
2.3
Prov
ide
card
iopu
lmon
ary
resu
scita
tion
in
the
pre-
hosp
ital
envi
ronm
ent
2.3.
1De
scrib
e th
e cl
inic
al fe
atur
es o
f im
pend
ing
card
iac
arre
stU
K
DR, L
T,
SL, C
L,
EL
1 (b
)•
•1
2.3.
2Cr
itiqu
e th
e ro
le o
f CPR
in p
re-h
ospi
tal c
are
UK
2•
••
1
2.3.
3De
scrib
e th
e ep
idem
iolo
gy o
f pre
-hos
pita
l car
diac
arr
est
with
in th
e EM
S sy
stem
UK
2•
•1
2.3.
4Co
ntra
st th
e de
liver
y of
CPR
bet
wee
n th
e ho
spita
l and
pre-
hosp
ital e
nviro
nmen
tsU
K2
••
1
2.3.
5De
scrib
e th
e cu
rren
t Uni
ted
King
dom
Res
usci
tatio
n Co
unci
l gui
danc
e on
CPR
and
em
erge
ncy
card
iova
scul
ar
care
for a
ll ag
e gr
oups
UK
1 (b
)•
•1
2.3.
6Cr
itiqu
e th
e ev
iden
ce su
ppor
ting
deci
sion
mak
ing
rela
ted
to o
utco
mes
of C
PRU
K2
••
1
2.3.
7De
scrib
e th
e m
echa
nism
s for
indu
cing
ther
apeu
tic
hypo
ther
mia
in th
e pr
e-ho
spita
l pha
se a
fter r
etur
n of
ci
rcul
ation
UK
2•
•1
2.3.
8
Des
crib
e in
dica
tion
s fo
r pr
e-ho
spit
al
(a) O
pen
ches
t car
diac
com
pres
sions
UK
DR, L
T,
SL, C
L,
EL
2•
•1
(b) R
esus
cita
tive
thor
acot
omy
UK
2•
•1
(c) P
eri-m
orte
m c
aesa
rean
secti
onU
K2
••
1
2.3.
9De
scrib
e po
licie
s and
pro
cedu
res f
or o
rgan
and
tiss
ue
dona
tion
with
in th
e EM
S sy
stem
TS2
••
2
2.3.
10De
mon
stra
te a
bilit
y to
reco
gnise
risk
of i
mpe
ndin
gca
rdia
c ar
rest
TS
LT, D
P,
SL, C
L,
EL
1 (b
)•
••
1
2.3.
11De
mon
stra
te a
pplic
ation
of s
trat
egie
s to
prev
ent c
ardi
acar
rest
TS1
(b)
••
1
2.3.
12De
mon
stra
te e
ffecti
ve m
anag
emen
t of p
re-h
ospi
tal
card
iac
arre
stTS
1 (b
)•
•1
2.3.
13De
mon
stra
te th
e ab
ility
to in
itiat
e an
d m
anag
e th
erap
eutic
hyp
othe
rmia
whe
n in
dica
ted
TS2
••
•1
2.3.
14De
mon
stra
te a
ppro
pria
te a
pplic
ation
of t
he c
urre
nt
Uni
ted
King
dom
Res
usci
tatio
n Co
unci
l gui
delin
es in
pre
-ho
spita
l env
ironm
ent
TS1
(b)
••
1
DRDi
rect
ed R
eadi
ngLT
Lect
ures
and
Tut
oria
lsDP
Delib
erat
e Pr
actic
eSL
Sim
ulati
on L
earn
ing
RPRe
flecti
ve P
racti
ceRM
Role
Mod
elin
gCL
Colla
bora
tive
Lear
ning
ELEx
perie
ntial
Lea
rnin
g
THEME 2 84
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Them
e 2.
Pro
vidi
ng p
re-h
ospi
tal e
mer
genc
y m
edic
al c
are
2.3.
15De
mon
stra
te a
bilit
y to
lead
a c
ardi
ac a
rres
t tea
m in
th
e pr
e-ho
spita
l env
ironm
ent
NTS
RM, R
P SL
, CL,
EL
1 (b
)•
•1
2.3.
16De
mon
stra
te a
bilit
y to
insp
ire c
onfid
ence
in a
mul
ti-di
scip
linar
y pr
e-ho
spita
l car
diac
arr
est t
eam
NTS
1 (b
)•
••
3
2.3.
17De
mon
stra
tes a
bilit
y to
mak
e ra
tiona
l end
of l
ifede
cisio
nsN
TS1
(b)
••
•3
2.4
Man
age
acut
e m
edic
al e
mer
genc
ies
in th
e pr
e-ho
spita
l en
viro
nmen
t
2.4.
1De
scrib
e th
e ep
idem
iolo
gy o
f acu
te m
edic
alem
erge
ncie
s with
in th
e EM
S sy
stem
UK
DR, L
T, SL
, CL,
EL
1 (b
)•
•1
2.4.
2
Des
crib
e th
e im
med
iate
pre
-hos
pita
l em
erge
ncy
man
agem
ent
of th
e fo
llow
ing
acut
e m
edic
al
pres
enta
tion
s
(a) A
irway
obs
truc
tion/
chok
ing/
strid
orU
K
DR, L
T, SL
, CL,
EL
1 (b
)•
••
1
(b) A
cute
bre
athl
essn
ess
UK
1 (b
)•
••
1
(c) A
cute
che
st p
ain
UK
1 (b
)•
••
1
(d) H
ypot
ensio
n an
d sh
ock
UK
1 (b
)•
••
1
(e) P
alpi
tatio
ns a
nd c
ardi
ac a
rrhy
thm
iaU
K1
(b)
••
•1
(f) A
cute
hea
dach
eU
K1
(b)
••
•1
(g) A
cute
vom
iting
UK
1 (b
)•
••
1
(h) A
cute
abd
omin
al/lo
in/s
crot
al p
ain
UK
1 (b
)•
••
1
(i) A
cute
con
fusio
nal s
tate
UK
1 (b
)•
••
1
(j) C
olla
pse/
Tran
sient
loss
of c
onsc
ious
ness
UK
1 (b
)•
••
1
(k) T
he u
ncon
scio
us p
atien
tU
K1
(b)
••
•1
THEME 2 85
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Them
e 2.
Pro
vidi
ng p
re-h
ospi
tal e
mer
genc
y m
edic
al c
are
2.4
Man
age
acut
e m
edic
al e
mer
genc
ies
in th
e pr
e-ho
spita
l en
viro
nmen
t(c
ont.)
2.4.
2co
nt.
(l) In
toxi
catio
n an
d po
isoni
ngU
K
DR, L
T, SL
, CL,
EL
1 (b
)•
••
1
(m) T
he fi
tting
pati
ent
UK
1 (b
)•
••
1
(n) A
cute
alle
rgic
reac
tion
UK
1 (b
)•
••
1
(o) A
cute
non
-tra
umati
c ne
ck/b
ack
pain
U
K1
(b)
••
•1
(p) S
udde
n w
eakn
ess/
para
lysis
/abn
orm
al se
nsati
onU
K1
(b)
••
•1
(q) A
cute
visu
al d
istur
banc
e/re
d ey
e U
K1
(b)
••
•1
(r) A
cute
febr
ile il
lnes
s U
K1
(b)
••
•1
(s) A
cute
gas
troi
ntes
tinal
hae
mor
rhag
e U
K1
(b)
••
•1
(t) A
cute
lim
b pa
in a
nd/o
r sw
ellin
g U
K1
(b)
••
•1
(u) A
cute
rash
U
K1
(b)
••
•1
(v) A
cute
hae
mop
tysis
U
K1
(b)
••
•1
(w) A
cute
epi
stax
is U
K1
(b)
••
•1
(x) A
cute
pai
n U
K1
(b)
••
•1
(y) A
cute
ther
mal
illn
ess
UK
1 (b
)•
••
1
(z) B
ites,
sting
s and
env
enom
ation
UK
1 (b
)•
••
1
2.4.
3
Des
crib
e th
e ap
plie
d ph
arm
acol
ogy
of m
edic
ines
co
mm
only
use
d in
the
imm
edia
te m
anag
emen
t of
(a) A
irway
obs
truc
tion/
chok
ing/
strid
or
UK
DR, L
T, SL
, CL,
EL
1 (b
)•
•1
DRDi
rect
ed R
eadi
ngLT
Lect
ures
and
Tut
oria
lsDP
Delib
erat
e Pr
actic
eSL
Sim
ulati
on L
earn
ing
RPRe
flecti
ve P
racti
ceRM
Role
Mod
elin
gCL
Colla
bora
tive
Lear
ning
ELEx
perie
ntial
Lea
rnin
g
THEME 2 86
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Them
e 2.
Pro
vidi
ng p
re-h
ospi
tal e
mer
genc
y m
edic
al c
are
2.4
Man
age
acut
e m
edic
al e
mer
genc
ies
in th
e pr
e-ho
spita
l en
viro
nmen
t(c
ont.)
2.4.
3co
nt.
(b) A
cute
bre
athl
essn
ess
UK
DR, L
T, SL
, CL,
EL
1 (b
)•
•1
(c) A
cute
che
st p
ain
UK
1 (b
)•
•1
(d) H
ypot
ensio
n an
d sh
ock
UK
1 (b
)•
•1
(e) P
alpi
tatio
ns a
nd c
ardi
ac a
rrhy
thm
iaU
K1
(b)
••
1
(f) A
cute
hea
dach
e U
K1
(b)
••
1
(g) A
cute
vom
iting
U
K1
(b)
••
1
(h) A
cute
abd
omin
al/lo
in/s
crot
al p
ain
UK
1 (b
)•
•1
(i) A
cute
con
fusio
nal s
tate
U
K1
(b)
••
1
(j) C
olla
pse/
Tran
sient
loss
of c
onsc
ious
ness
U
K1
(b)
••
1
(k) T
he u
ncon
scio
us p
atien
t U
K1
(b)
••
1
(l) In
toxi
catio
n an
d po
isoni
ngU
K1
(b)
••
1
(m) T
he fi
tting
pati
ent
UK
1 (b
)•
•1
(n) A
cute
alle
rgic
reac
tion
UK
1 (b
)•
•1
(o) A
cute
non
-tra
umati
c ne
ck/b
ack
pain
U
K1
(b)
••
1
(p) S
udde
n w
eakn
ess/
para
lysis
/abn
orm
al se
nsati
onU
K1
(b)
••
1
(q) A
cute
visu
al d
istur
banc
e/re
d ey
e U
K1
(b)
••
(r) A
cute
febr
ile il
lnes
s U
K1
(b)
••
1
THEME 2 87
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Them
e 2.
Pro
vidi
ng p
re-h
ospi
tal e
mer
genc
y m
edic
al c
are
2.4
Man
age
acut
e m
edic
al e
mer
genc
ies
in th
e pr
e-ho
spita
l en
viro
nmen
t(c
ont.)
(s) A
cute
gas
troi
ntes
tinal
hae
mor
rhag
e U
K
DR, L
T, SL
, CL,
EL
1 (b
)•
•1
(t) A
cute
lim
b pa
in a
nd/o
r sw
ellin
g U
K1
(b)
••
1
(u) A
cute
rash
U
K1
(b)
••
1
(v) A
cute
hae
mop
tysis
U
K1
(b)
••
1
(w) A
cute
epi
stax
is U
K1
(b)
••
1
(x) A
cute
pai
n U
K1
(b)
••
1
(y) A
cute
ther
mal
illn
ess
UK
1 (b
)•
•1
(z) B
ites,
sting
s and
env
enom
ation
UK
1 (b
)•
•1
2.4.
4Cr
itiqu
e th
e di
agno
stic
tech
nolo
gies
that
can
be
used
to
ass
ist in
diff
eren
tiatin
g th
e ca
uses
of a
cute
med
ical
pr
esen
tatio
ns in
the
pre-
hosp
ital p
hase
UK
2•
•1
2.4.
5
Criti
ue th
e cu
rren
t bes
t pr
acti
ce in
the
pre
-hos
pita
lm
anag
emen
t of
(a) A
naph
ylax
isU
K
DR, L
T, SL
, CL,
EL
2•
••
1
(b) A
sthm
aU
K2
••
•1
(c) C
oron
ary
hear
t dise
ase
UK
2•
••
1
(d) S
epsis
UK
2•
••
1
(e) M
enin
goen
ceph
aliti
sU
K2
••
•1
(f) S
trok
eU
K2
••
•1
(g) D
iabe
tic k
etoa
cido
sisU
K2
••
•1
DRDi
rect
ed R
eadi
ngLT
Lect
ures
and
Tut
oria
lsDP
Delib
erat
e Pr
actic
eSL
Sim
ulati
on L
earn
ing
RPRe
flecti
ve P
racti
ceRM
Role
Mod
elin
gCL
Colla
bora
tive
Lear
ning
ELEx
perie
ntial
Lea
rnin
g
88
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Them
e 2.
Pro
vidi
ng p
re-h
ospi
tal e
mer
genc
y m
edic
al c
are
2.4
Man
age
acut
e m
edic
al e
mer
genc
ies
in th
e pr
e-ho
spita
l en
viro
nmen
t(c
ont.)
2.4.
6De
scrib
e al
tern
ative
pat
hway
s to
acce
ssin
g ur
gent
an
d un
sche
dule
d ca
re w
ithin
the
EMS
syst
em (‘
trea
t an
d re
fer’
)U
KDR
, LT,
SL, C
L,
EL
2•
••
3
2.4.
7De
scrib
e gu
idel
ines
for s
afel
y le
avin
g pa
tient
s at
hom
e or
scen
e w
ithin
the
EMS
syst
em (‘
trea
t and
le
ave’
)U
K2
••
3
2.4.
8De
mon
stra
te a
bilit
y to
form
ulat
e a
diffe
renti
al
diag
nose
s for
an
acut
e em
erge
ncy
pres
enta
tion
TSLT
, DP,
SL
, CL,
EL
1 (b
)•
••
•3
2.4.
9
Dem
onst
rate
the
imm
edia
te p
re-h
ospi
tal e
mer
genc
y m
anag
emen
t of
the
follo
win
g ac
ute
med
ical
pr
esen
tati
ons
(a) A
irway
obs
truc
tion/
chok
ing/
strid
or
TS
LT, D
P,
SL, C
L,
EL
1 (b
)•
•1
(b) A
cute
bre
athl
essn
ess
TS1
(b)
••
1
(c) A
cute
che
st p
ain
TS1
(b)
••
1
(d) H
ypot
ensio
n an
d sh
ock
TS1
(b)
••
1
(e) P
alpi
tatio
ns a
nd c
ardi
ac a
rrhy
thm
iaTS
1 (b
)•
•1
(f) A
cute
hea
dach
e TS
1 (b
)•
•1
(g) A
cute
vom
iting
TS
1 (b
)•
•1
(h) A
cute
abd
omin
al/lo
in/s
crot
al p
ain
TS1
(b)
••
1
(i) A
cute
con
fusio
nal s
tate
TS
1 (b
)•
•1
(j) C
olla
pse/
Tran
sient
loss
of c
onsc
ious
ness
TS
1 (b
)•
•1
(k) T
he u
ncon
scio
us p
atien
t TS
1 (b
)•
•1
(l) In
toxi
catio
n an
d po
isoni
ngTS
1 (b
)•
•1
THEME 2
89
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Them
e 2.
Pro
vidi
ng p
re-h
ospi
tal e
mer
genc
y m
edic
al c
are
2.4
Man
age
acut
e m
edic
al e
mer
genc
ies
in th
e pr
e-ho
spita
l en
viro
nmen
t(c
ont.)
2.4.
9co
nt.
(m) T
he fi
tting
pati
ent
TS
LT, D
P,
SL, C
L,
EL
1 (b
)•
•1
(n) A
cute
alle
rgic
reac
tion
TS1
(b)
••
1
(o) A
cute
non
-tra
umati
c ne
ck/b
ack
pain
TS
1 (b
)•
•1
(p) S
udde
n w
eakn
ess/
para
lysis
/abn
orm
al se
nsati
onTS
1 (b
)•
•1
(q) A
cute
visu
al d
istur
banc
e/re
d ey
e TS
1 (b
)•
•1
(r) A
cute
febr
ile il
lnes
s TS
1 (b
)•
•1
(s) A
cute
gas
troi
ntes
tinal
hae
mor
rhag
e TS
1 (b
)•
•1
(t) A
cute
lim
b pa
in a
nd/o
r sw
ellin
g TS
1 (b
)•
•1
(u) A
cute
rash
TS
1 (b
)•
•1
(v) A
cute
hae
mop
tysis
TS
1 (b
)•
•1
(w) A
cute
epi
stax
is TS
1 (b
)•
•1
(x) A
cute
pai
n TS
1 (b
)•
•1
(y) A
cute
ther
mal
illn
ess
TS1
(b)
••
1
(z) B
ites,
sting
s and
env
enom
ation
TS1
(b)
••
1
2.4.
10De
mon
stra
te a
ppro
pria
te u
se o
f alte
rnati
ve p
athw
ays
to a
cces
sing
urge
nt a
nd u
nsch
edul
ed c
are
(‘tre
at a
nd
refe
r’) f
or a
cute
med
ical
con
ditio
nsTS
2•
••
3
2.4.
11De
mon
stra
te u
se o
f gui
delin
es fo
r saf
ely
leav
ing
patie
nts a
t hom
e or
scen
e w
ithin
the
EMS
syst
em
(‘tre
at a
nd le
ave’
)TS
2•
••
3
2.4.
12De
mon
stra
te a
ppro
pria
tely
con
fiden
t app
roac
h to
m
anag
emen
t and
dec
ision
mak
ing
for a
cute
med
ical
em
erge
ncie
sN
TSRM
, RP,
SL
, CL,
EL
2•
••
•3
THEME 2
DRDi
rect
ed R
eadi
ngLT
Lect
ures
and
Tut
oria
lsDP
Delib
erat
e Pr
actic
eSL
Sim
ulati
on L
earn
ing
RPRe
flecti
ve P
racti
ceRM
Role
Mod
elin
gCL
Colla
bora
tive
Lear
ning
ELEx
perie
ntial
Lea
rnin
g
THEME 2 90
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Them
e 2.
Pro
vidi
ng p
re-h
ospi
tal e
mer
genc
y m
edic
al c
are
2.4.
13Di
spla
y a
calm
and
met
hodi
cal a
ppro
ach
to a
cute
m
edic
al e
mer
genc
ies
NTS
RM, R
P,
SL, C
L, E
L
2•
••
•3
2.4.
14Di
spla
y re
spec
t for
the
cont
ributi
on a
nd e
xper
tise
of
othe
r clin
icia
ns o
pera
ting
outs
ide
hosp
ital
NTS
2•
••
•3
2.5
Man
age
inju
ry
in th
e pr
e-ho
spita
l en
viro
nmen
t
2.5.
1De
fine
inju
ryU
K
DR, L
T, SL
, CL,
EL
1 (b
)•
•1
2.5.
2Co
ntra
st th
e te
rms ‘
inju
ry’ a
nd ‘t
raum
a’U
K1
(b)
••
1
2.5.
3De
scrib
e th
e ep
idem
iolo
gy o
f sev
ere
inju
ry a
nd m
ajor
tr
aum
a w
ithin
the
EMS
syst
emU
K1
(b)
••
1
2.5.
4De
scrib
e th
e fu
nctio
n an
d pr
oced
ures
of t
he lo
cal
trau
ma
syst
emU
K1
(a)
••
1
2.5.
5Co
ntra
st th
e pa
thop
hysio
logy
of d
iffer
ent t
ypes
of
inju
ry in
all
age
grou
psU
K1
(b)
••
••
1
2.5.
6De
scrib
e th
e in
fluen
ce o
f inj
ury
mec
hani
sms o
n an
atom
ical
inju
ry p
atter
nsU
K1
(b)
••
2.5.
7De
scrib
e th
e pr
inci
ples
of t
he p
re-h
ospi
tal
man
agem
ent o
f pati
ents
acr
oss t
he sp
ectr
um o
f in
jury
seve
rity
UK
1 (b
)•
••
1
2.5.
8Co
ntra
st th
e m
anag
emen
t of t
he tr
aum
a pa
tient
inpr
e-ho
spita
l and
acu
te h
ospi
tal e
nviro
nmen
tsU
K1
(b)
••
•1
2.5.
9
Des
crib
e th
e im
med
iate
pre
-hos
pita
l man
agem
ent
in
all a
ge g
roup
s of
the
follo
win
g
(a) I
njur
ies t
o th
e he
adU
K
DR, L
T, SL
, CL,
EL
1 (a
)•
••
•1
(b) I
njur
ies t
o th
e fa
ceU
K1
(a)
••
••
1
(c) I
njur
ies t
o th
e ne
ckU
K1
(a)
••
••
1
(d) I
njur
ies t
o th
e th
orax
UK
1 (a
)•
••
•1
(e) I
njur
ies t
o th
e ab
dom
enU
K1
(a)
••
••
1
(f) In
jurie
s to
the
spin
eU
K1
(a)
••
••
1
THEME 2 91
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Them
e 2.
Pro
vidi
ng p
re-h
ospi
tal e
mer
genc
y m
edic
al c
are
2.5
Man
age
inju
ry
in th
e pr
e-ho
spita
l en
viro
nmen
t(c
ont.)
(g) I
njur
ies t
o th
e pe
lvis
UK
DR, L
T, SL
, CL,
EL
1 (a
)•
••
•1
(h) I
njur
ies t
o th
e lim
bsU
K1
(a)
••
••
1
(i) In
jurie
s inv
olvi
ng m
ultip
le b
ody
regi
ons
UK
1 (a
)•
••
•1
(j) T
herm
al in
jury
UK
1 (a
)•
••
•1
(k) E
lect
rocu
tion
UK
1 (a
)•
••
•1
(l) B
allis
tic a
nd b
last
inju
ryU
K1
(a)
••
••
1
(m) T
raum
atic
asph
yxia
UK
1 (a
)•
••
•1
(n) D
ysba
rism
UK
1 (a
)•
••
•1
(o) C
rush
inju
ryU
K1
(b)
••
••
1
2.5.
10
Criti
ue th
e cu
rren
t bes
t pr
acti
ce fo
r al
l age
s in
pr
e-ho
spit
al
(a) A
irway
man
agem
ent
UK
DR, L
T, SL
, CL,
EL
2•
••
1
(b) V
entil
ator
y su
ppor
tU
K2
••
•1
(c) H
aem
orrh
age
cont
rol
UK
2•
••
1
(d) F
luid
resu
scita
tion
UK
2•
••
1
(e) S
pina
l im
mob
iliza
tion
UK
2•
••
1
(f) N
euro
prot
ectio
nU
K2
••
•1
2.5.
11De
scrib
e ap
proa
ches
to in
jury
pre
venti
on a
nd c
ontr
ol
in a
ll ag
e gr
oups
UK
1 (b
)•
••
1
2.5.
12De
mon
stra
te a
bilit
y to
form
ulat
e a
diffe
renti
al
diag
nose
s for
the
inju
red
patie
ntTS
LT, D
P SL
, CL,
EL
1 (b
)•
••
1
DRDi
rect
ed R
eadi
ngLT
Lect
ures
and
Tut
oria
lsDP
Delib
erat
e Pr
actic
eSL
Sim
ulati
on L
earn
ing
RPRe
flecti
ve P
racti
ceRM
Role
Mod
elin
gCL
Colla
bora
tive
Lear
ning
ELEx
perie
ntial
Lea
rnin
g
THEME 2 92
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Them
e 2.
Pro
vidi
ng p
re-h
ospi
tal e
mer
genc
y m
edic
al c
are
2.5
Man
age
inju
ry
in th
e pr
e-ho
spita
l en
viro
nmen
t(c
ont.)
2.5.
13
Dem
onst
rate
the
imm
edia
te p
re-h
ospi
tal
man
agem
ent
of th
e fo
llow
ing
in p
atien
ts o
f all
age
grou
ps
(a) I
njur
ies t
o th
e he
adTS
LT, D
P SL
, CL,
EL
1 (b
)•
•1
(b) I
njur
ies t
o th
e fa
ceTS
1 (b
)•
•1
(c) I
njur
ies t
o th
e ne
ckTS
1 (b
)•
•1
(d) I
njur
ies t
o th
e th
orax
TS1
(b)
••
1
(e) I
njur
ies t
o th
e ab
dom
enTS
1 (b
)•
•1
(f) In
jurie
s to
the
spin
eTS
1 (b
)•
•1
(g) I
njur
ies t
o th
e pe
lvis
TS1
(b)
••
1
(h) I
njur
ies t
o th
e lim
bsTS
1 (b
)•
•1
(i) In
jurie
s inv
olvi
ng m
ultip
le b
ody
regi
ons
TS1
(b)
••
1
(j) T
herm
al in
jury
TS1
(b)
••
1
(k) E
lect
rocu
tion
TS1
(b)
••
1
(l) B
allis
tic a
nd b
last
inju
ryTS
1 (b
)•
•1
(m) T
raum
atic
asph
yxia
TS1
(b)
••
1
(n) D
ysba
rism
TS1
(b)
••
1
(o) C
rush
inju
ryTS
1 (b
)•
•
2.5.
14De
mon
stra
te a
ppro
pria
te u
se o
f alte
rnati
ve p
athw
ays
to a
cces
sing
urge
nt a
nd u
nsch
edul
ed c
are
(‘tre
at a
nd
refe
r’) f
or in
jury
TS2
••
•3
2.5.
15De
mon
stra
te u
se o
f gui
delin
es fo
r saf
ely
leav
ing
patie
nts w
ith in
jurie
s at h
ome
or sc
ene
with
in th
e EM
S sy
stem
(‘tr
eat a
nd le
ave’
)TS
2•
••
3
THEME 2 93
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Them
e 2.
Pro
vidi
ng p
re-h
ospi
tal e
mer
genc
y m
edic
al c
are
2.5
Man
age
inju
ry
in th
e pr
e-ho
spita
l en
viro
nmen
t(c
ont.)
2.5.
16De
mon
stra
te p
artic
ipati
on in
inju
ry p
reve
ntion
prog
ram
mes
TSLT
, DP
SL,
CL, E
L2
••
•2
2.5.
17De
mon
stra
te a
ppro
pria
tely
con
fiden
t and
met
hodi
cal
appr
oach
to m
anag
emen
t and
dec
ision
mak
ing
for
inju
ries
NTS
RM, R
P,
SL, C
L,
EL
2•
••
•3
2.5.
18De
mon
stra
te a
bilit
y to
lead
a tr
aum
a te
am in
the
pre-
ho
spita
l env
ironm
ent
NTS
2•
••
•3
2.5.
19De
mon
stra
te a
bilit
y to
insp
ire c
onfid
ence
with
in a
mul
ti-di
scip
linar
y pr
e-ho
spita
l tra
uma
team
NTS
2•
••
•3
2.6
Prov
ide
anal
gesia
, pr
oced
ural
seda
tion
and
anae
sthe
sia
in th
e pr
e-ho
spita
l en
viro
nmen
t
2.6.
1De
scrib
e th
e po
licie
s and
pro
cedu
res r
elat
ed to
ana
lges
ia,
proc
edur
al se
datio
n an
d pr
e-ho
spita
l em
erge
ncy
anae
sthe
sia w
ithin
the
EMS
syst
emU
KDR
, LT,
SL
, CL,
EL
1 (b
)•
•1
2.6.
2
Des
crib
e th
e ap
plie
d ph
arm
acol
ogy
of m
edic
ines
co
mm
only
use
d in
all
age
grou
ps fo
r
(a) A
nalg
esia
UK
DR, L
T,
SL, C
L,
EL
1 (b
)•
•1
(b) P
roce
dura
l sed
ation
UK
1 (b
)•
•1
(c) E
mer
genc
y an
aest
hesia
UK
1 (b
)•
•1
2.6.
3
Criti
ue th
e cu
rren
t be
st p
racti
ce in
all
age
grou
ps fo
rth
e pr
ovis
ion
of p
re-h
ospi
tal
(a) A
nalg
esia
UK
DR, L
T,
SL, C
L,
EL
2•
••
1
(b) P
roce
dura
l sed
ation
UK
2•
••
1
(c) E
mer
genc
y an
aest
hesia
UK
2•
••
1
2.6.
4Cr
itiqu
e th
e ro
le o
f reg
iona
l ana
esth
etic
tech
niqu
es
rele
vant
to p
re-h
ospi
tal p
racti
ceU
K2
••
1
2.6.
5Cr
itiqu
e th
e te
chni
que
of ra
pid
sequ
ence
indu
ction
of
anae
sthe
sia in
the
pre-
hosp
ital e
nviro
nmen
tU
K2
••
1
2.6.
6
Des
crib
e th
e ap
plie
d ph
ysio
logy
of a
nalg
esia
, pro
cedu
ral
seda
tion
and
pre
-hos
pita
l em
erge
ncy
anae
sthe
sia
in a
ll ag
e gr
oups
rela
ting
to
(a) A
irway
inst
rum
enta
tion
UK
DR, L
T,
SL, C
L,
EL1
(b)
••
1
DRDi
rect
ed R
eadi
ngLT
Lect
ures
and
Tut
oria
lsDP
Delib
erat
e Pr
actic
eSL
Sim
ulati
on L
earn
ing
RPRe
flecti
ve P
racti
ceRM
Role
Mod
elin
gCL
Colla
bora
tive
Lear
ning
ELEx
perie
ntial
Lea
rnin
g
THEME 2 94
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Them
e 2.
Pro
vidi
ng p
re-h
ospi
tal e
mer
genc
y m
edic
al c
are
2.6
Prov
ide
anal
gesia
, pr
oced
ural
seda
tion
and
anae
sthe
sia
in th
e pr
e-ho
spita
l en
viro
nmen
t(c
ont.)
(b) V
entil
ation
UK
DR, L
T,
SL, C
L,
EL
1 (b
)•
•1
(c) C
ardi
ovas
cula
r sta
tus
UK
1 (b
)•
•1
(d) N
euro
prot
ectio
nU
K1
(b)
••
1
2.6.
7
Cont
rast
the
pro
visi
on o
f pre
-hos
pita
l em
erge
ncy
anae
sthe
sia
betw
een
(a) I
nfan
ts a
nd c
hild
ren
UK
DR, L
T,
SL, C
L,
EL
2•
••
•1
(b) B
aria
tric
pati
ents
UK
2•
••
•1
(c) P
regn
ant p
atien
tsU
K2
••
••
1
(d) E
lder
ly p
atien
tsU
K2
••
••
1
2.6.
8De
scrib
e th
e m
anag
emen
t of t
he d
ifficu
lt ai
rway
in
the
pre-
hosp
ital e
nviro
nmen
tU
K1
(a)
••
1
2.6.
9
Ana
lyse
the
impa
ct o
f the
pre
-hos
pita
l env
iron
men
t on
dec
isio
n m
akin
g in
all
age
grou
ps re
late
d to
(a) A
nalg
esia
UK
DR, L
T,
SL, C
L,
EL
1 (b
)•
•1
(b) P
roce
dura
l sed
ation
UK
1 (b
)•
•1
(c) P
re-a
naes
theti
c as
sess
men
tU
K1
(b)
••
1
(d) T
he p
redi
cted
diffi
cult
airw
ayU
K1
(b)
••
1
(e) T
he fa
iled
airw
ayU
K1
(b)
••
1
(f) M
aint
enan
ce o
f ana
esth
esia
UK
1 (b
)•
•1
2.6.
10D
escr
ibe
the
pre-
hosp
ital
man
agem
ent
of
anae
sthe
tic-
rela
ted
com
plic
ation
s
THEME 2 95
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Them
e 2.
Pro
vidi
ng p
re-h
ospi
tal e
mer
genc
y m
edic
al c
are
2.6
Prov
ide
anal
gesia
, pr
oced
ural
seda
tion
and
anae
sthe
sia
in th
e pr
e-ho
spita
l en
viro
nmen
t(c
ont.)
2.6.
10
(a) H
yper
/hyp
oten
sion
UK
DR, L
T,
SL, C
L,
EL
1 (b
)•
•1
(b) H
ypox
iaU
K1
(b)
••
1
(c) H
yper
/Hyp
ocar
bia
UK
1 (b
)•
•1
(d) H
igh
infla
tion
pres
sure
sU
K1
(b)
••
1
(e) L
ow in
flatio
n pr
essu
res
UK
1 (b
)•
•1
(f) T
rach
eal t
ube
disp
lace
men
tU
K1
(b)
••
1
(g) G
astr
ic in
suffl
ation
UK
1 (b
)•
•1
(h) R
egur
gita
tion
/ vom
iting
UK
1 (b
)•
•1
(i) U
npla
nned
ext
ubati
onU
K1
(b)
••
1
2.6.
11De
scrib
e th
e re
gula
tory
fram
ewor
k un
derp
inni
ng p
re-
hosp
ital e
mer
genc
y an
aest
hesia
.U
K1
(b)
••
1
2.6.
12Cr
itiqu
e pu
blish
ed g
uide
lines
rela
ted
to th
e cl
inic
al
prac
tice
of p
re-h
ospi
tal p
roce
dura
l sed
ation
and
em
erge
ncy
anae
sthe
siaU
K2
••
1
2.6.
13
Dem
onst
rate
app
ropr
iate
ris
k/be
nefit
ana
lysi
s fo
r
all a
ge g
roup
s fo
r pr
e-ho
spit
al
(a) A
nalg
esia
TS
LT, D
P,
SL, C
L,
EL
1 (b
)•
••
•1
(b) r
egio
nal a
naes
thes
iaTS
1 (b
)•
••
•1
(c) p
roce
dura
l sed
ation
TS1
(b)
••
••
1
(d) e
mer
genc
y an
aest
hesia
TS1
(b)
••
••
1
DRDi
rect
ed R
eadi
ngLT
Lect
ures
and
Tut
oria
lsDP
Delib
erat
e Pr
actic
eSL
Sim
ulati
on L
earn
ing
RPRe
flecti
ve P
racti
ceRM
Role
Mod
elin
gCL
Colla
bora
tive
Lear
ning
ELEx
perie
ntial
Lea
rnin
g
THEME 2 96
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Them
e 2.
Pro
vidi
ng p
re-h
ospi
tal e
mer
genc
y m
edic
al c
are
2.6
Prov
ide
anal
gesia
, pr
oced
ural
seda
tion
and
anae
sthe
sia
in th
e pr
e-ho
spita
l en
viro
nmen
t(c
ont.)
2.6.
14
Dem
onst
rate
, in
pati
ents
of a
ll ag
e gr
oups
, saf
e
pre-
hosp
ital
(a) a
nalg
esia
TS
LT, D
P,
SL, C
L,
EL
1 (b
)•
••
1
(b) r
egio
nal a
naes
thes
iaTS
1 (b
)•
••
1
(c) p
roce
dura
l sed
ation
TS1
(b)
••
•1
(d) e
mer
genc
y an
aest
hesia
TS1
(b)
••
•1
2.6.
15De
mon
stra
te te
chni
ques
for m
anag
ing
faile
d di
rect
la
ryng
osco
pyTS
1 (b
)•
••
1
2.6.
16De
mon
stra
te te
chni
ques
for m
anag
ing
a di
fficu
lt ai
rway
TS1
(b)
••
•1
2.6.
17
Dem
onst
rate
the
pre
-hos
pita
l man
agem
ent
of
com
mon
ana
esth
etic-
rela
ted
com
plic
ation
s
(a) H
yper
/hyp
oten
sion
TS
LT, D
P,
SL, C
L,
EL
1 (b
)•
••
1
(b) H
ypox
iaTS
1 (b
)•
••
1
(c) H
yper
/Hyp
ocar
bia
TS1
(b)
••
•1
(d) H
igh
infla
tion
pres
sure
sTS
1 (b
)•
••
1
(e) L
ow in
flatio
n pr
essu
res
TS1
(b)
••
•1
(f) T
rach
eal t
ube
disp
lace
men
tTS
1 (b
)•
••
1
(g) G
astr
ic in
suffl
ation
TS1
(b)
••
1
(h) R
egur
gita
tion
/ vom
iting
TS1
(b)
••
1
(i) U
npla
nned
ext
ubati
onTS
1 (b
)•
•1
THEME 2 97
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Them
e 2.
Pro
vidi
ng p
re-h
ospi
tal e
mer
genc
y m
edic
al c
are
2.6
Prov
ide
anal
gesia
, pr
oced
ural
seda
tion
and
anae
sthe
sia
in th
e pr
e-ho
spita
l en
viro
nmen
t(c
ont.)
2.6.
18
Dem
onst
rate
, in
pati
ents
of a
ll ag
e gr
oups
, an
appr
opri
atel
y co
nfide
nt a
nd m
etho
dica
l app
roac
h to
(a) a
nalg
esia
NTS
RM, R
P,
SL, E
L
1 (b
)•
••
•3
(b) r
egio
nal a
naes
thes
iaN
TS1
(b)
••
••
3
(c) p
roce
dura
l sed
ation
NTS
1 (b
)•
••
•3
(d) e
mer
genc
y an
aest
hesia
.N
TS1
(b)
••
••
3
2.7
Man
age
obst
etric
em
erge
ncie
s in
the
pre-
hosp
ital
envi
ronm
ent
2.7.
1De
scrib
e th
e an
atom
ic a
nd p
hysio
logi
c ch
ange
s of
preg
nanc
y U
KDR
, LT,
SL, C
L,
EL
1 (b
)•
•1
2.7.
2De
scrib
e th
e st
ages
of l
abou
r, th
e pr
oces
s of d
eliv
ery
and
the
com
mon
com
plic
ation
sU
K1
(b)
••
1
2.7.
3
Di
eren
tiat
e ac
ute
pre-
hosp
ital
pre
sent
ation
s re
late
d
(a) d
irect
ly to
pre
gnan
cyU
K
DR, L
T, SL
, CL,
EL
1 (b
)•
•1
(b) t
o la
bour
and
chi
ldbi
rth
UK
1 (b
)•
•1
(c) t
o ac
ute
med
ical
em
erge
ncie
s in
a pr
egna
nt
patie
ntU
K1
(b)
••
1
(d) t
o in
jury
in a
pre
gnan
t pati
ent
UK
1 (b
)•
•1
2.7.
4
Criti
ue p
re-h
ospi
tal m
anag
emen
t st
rate
gies
for
(a) a
nte-
part
um h
aem
orrh
age
UK
DR, L
T, SL
, CL,
EL
1 (b
)•
•1
(b) p
ost-p
artu
m h
aem
orrh
age
UK
1 (b
)•
•1
(c) o
bstr
ucte
d la
bour
UK
1 (b
)•
•1
DRDi
rect
ed R
eadi
ngLT
Lect
ures
and
Tut
oria
lsDP
Delib
erat
e Pr
actic
eSL
Sim
ulati
on L
earn
ing
RPRe
flecti
ve P
racti
ceRM
Role
Mod
elin
gCL
Colla
bora
tive
Lear
ning
ELEx
perie
ntial
Lea
rnin
g
THEME 2 98
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Them
e 2.
Pro
vidi
ng p
re-h
ospi
tal e
mer
genc
y m
edic
al c
are
2.7
Man
age
obst
etric
em
erge
ncie
s in
the
pre-
hosp
ital
envi
ronm
ent
(con
t.)
(d) c
ardi
ac a
rres
tU
K
DR, L
T,
SL, C
L,
EL
1 (b
)•
•1
2.7.
5De
scrib
e th
e ap
plie
d ph
arm
acol
ogy
of e
mer
genc
y ca
re o
f the
pre
gnan
t pati
ent
UK
1 (b
)•
•1
2.7.
6Co
ntra
st th
e op
tions
for e
mer
genc
y pr
e-ho
spita
l de
liver
yU
K1
(b)
••
1
2.7.
7De
mon
stra
te th
e as
sess
men
t of t
he p
regn
ant p
atien
t in
the
pre-
hosp
ital e
nviro
nmen
tTS
LT, D
P, S
L,
CL, E
L2
••
1
2.7.
8
Dem
onst
rate
pre
-hos
pita
l man
agem
ent
of
(a) a
pati
ent w
ith a
pre
gnan
cy re
late
d em
erge
ncy
TS
LT, D
P,
SL,C
L,
EL
2•
•1
(b) e
mer
genc
y ch
ildbi
rth
TS2
••
•1
(c) a
n ac
ute
med
ical
em
erge
ncy
in a
pre
gnan
t pati
ent
TS2
••
1
(d) m
ajor
trau
ma
in a
pre
gnan
t pati
ent
TS2
••
1
2.7.
9De
mon
stra
te e
ffecti
ve p
hysic
al m
anoe
uvre
s in
abno
rmal
labo
ur a
nd p
ost-p
artu
m h
aem
orrh
age
TS2
••
•1
2.7.
10De
mon
stra
te th
e te
chni
que
for r
esus
cita
tive
hyst
erot
omy
TS2
••
•1
2.7.
11De
mon
stra
te th
e te
chni
que
for e
mer
genc
y ep
isiot
omy
TS2
••
•1
2.8
Man
age
the
new
born
in th
e
pre-
hosp
ital
envi
ronm
ent
2.8.
1De
scrib
e th
e ap
plie
d ph
ysio
logy
and
ana
tom
y of
the
new
born
bab
y U
KDR
, LT,
SL
, CL,
EL
1 (b
)•
•1
2.8.
2De
scrib
e th
e in
itial
car
e of
the
new
born
U
K1
(b)
••
1
2.8.
3De
scrib
e co
nditi
ons o
f the
new
born
com
mon
ly
enco
unte
red
in th
e pr
e-ho
spita
l setti
ngU
K1
(b)
••
1
THEME 2 99
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Them
e 2.
Pro
vidi
ng p
re-h
ospi
tal e
mer
genc
y m
edic
al c
are
2.8
Man
age
the
new
born
in th
e pr
e-ho
spita
l env
ironm
ent
(con
t.)
2.8.
4Co
ntra
st th
e di
ffere
nces
in g
ener
al c
are
betw
een
term
an
d pr
e-te
rm n
ewbo
rns
UK
DR, L
T, SL
, CL,
EL
1 (b
)•
••
1
2.8.
5Cr
itiqu
e th
e ro
le o
f new
born
life
supp
ort i
n th
e
pre-
hosp
ital e
nviro
nmen
tU
K1
(b)
••
1
2.8.
6De
mon
stra
te p
rovi
sion
of c
are
to th
e ne
w b
orn
inth
e pr
e-ho
spita
l env
ironm
ent
TSLT
, DP,
SL
, CL,
EL
1 (b
)•
•1
2.8.
7De
mon
stra
te re
susc
itatio
n of
the
new
born
TS
1 (b
)•
••
1
2.8.
8De
mon
stra
te th
e ab
ility
to re
cogn
ise th
e em
otion
al
need
s of t
he m
othe
r and
fam
ilyN
TSRM
, RP,
SL
CL, E
L1
(b)
••
4
2.9
Man
age
inju
red
or
ill c
hild
ren
in
the
pre-
hosp
ital
envi
ronm
ent
2.9.
1De
scrib
e th
e ep
idem
iolo
gy o
f sev
ere
illne
ss in
the
paed
iatr
ic p
re-h
ospi
tal p
opul
ation
UK
DR, L
T, SL
, CL,
EL
1 (b
)•
•1
2.9.
2De
scrib
e th
e ap
plie
d an
atom
y an
d ph
ysio
logy
of t
he
infa
nt a
nd c
hild
UK
1 (b
)•
•1
2.9.
3
Des
crib
e th
e im
med
iate
pre
-hos
pita
l em
erge
ncy
man
agem
ent
of th
e fo
llow
ing
acut
e m
edic
al
pres
enta
tion
s in
infa
nts
and
child
ren
(a) A
irway
obs
truc
tion/
chok
ing/
strid
orU
K
DR, L
T, SL
, CL,
EL
1 (b
)•
•1
(b) A
cute
resp
irato
ry d
istre
ssU
K1
(b)
••
1
(c) C
entr
al c
yano
sisU
K1
(b)
••
1
(d) S
hock
UK
1 (b
)•
•1
(e) A
bnor
mal
pul
se ra
te o
r rhy
thm
UK
1 (b
)•
•1
(f) D
ecre
ased
con
scio
us le
vel
UK
1 (b
)•
•1
(g) S
eizu
res
UK
1 (b
)•
•1
(h) S
udde
n w
eakn
ess/
para
lysis
/abn
orm
al se
nsati
onU
K1
(b)
••
1
DRDi
rect
ed R
eadi
ngLT
Lect
ures
and
Tut
oria
lsDP
Delib
erat
e Pr
actic
eSL
Sim
ulati
on L
earn
ing
RPRe
flecti
ve P
racti
ceRM
Role
Mod
elin
gCL
Colla
bora
tive
Lear
ning
ELEx
perie
ntial
Lea
rnin
g
THEME 2 100
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Them
e 2.
Pro
vidi
ng p
re-h
ospi
tal e
mer
genc
y m
edic
al c
are
2.9
Man
age
inju
red
or
ill c
hild
ren
in th
e pr
e-ho
spita
l env
ironm
ent
(con
t.)
2.9.
3co
nt.
(i) In
toxi
catio
n an
d po
isoni
ngU
K
DR, L
T, SL
, CL,
EL
1 (b
)•
•1
(j) H
ypog
lyca
emia
UK
1 (b
)•
•1
(k) A
cute
vom
iting
UK
1 (b
)•
•1
(l) A
cute
abd
omin
al/lo
in/s
crot
al p
ain
UK
1 (b
)•
•1
(m) A
cute
febr
ile il
lnes
sU
K1
(b)
••
1
(n) A
cute
rash
UK
1 (b
)•
•1
(o) A
cute
pai
nU
K1
(b)
••
1
(p) B
ites,
sting
s and
env
enom
ation
UK
1 (b
)•
•1
(q) A
cute
alle
rgic
reac
tion
UK
1 (b
)•
•1
(r) N
on-a
ccid
enta
l inj
ury
UK
1 (b
)•
•4
2.9.
4
Criti
ue th
e cu
rren
t bes
t pr
acti
ce in
the
pr
e-ho
spit
al m
anag
emen
t of
(a) I
nfec
tious
upp
er a
irway
com
prom
iseU
K
DR, L
T, SL
, CL,
EL
2•
••
1
(b) A
sthm
aU
K2
••
•1
(c) A
naph
ylax
isU
K1
(b)
••
•1
(d) S
epsis
UK
1 (b
)•
••
1
(e) M
enin
goen
ceph
aliti
sU
K1
(b)
••
•1
(f) S
tatu
s epi
lepti
cus
UK
1 (b
)•
••
1
(g) D
iabe
tic k
etoa
cido
sisU
K2
••
•1
THEME 2 101
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Them
e 2.
Pro
vidi
ng p
re-h
ospi
tal e
mer
genc
y m
edic
al c
are
2.9.
5De
scrib
e th
e ap
plie
d ph
arm
acol
ogy
of c
omm
only
use
d m
edic
ines
giv
en in
the
pre-
hosp
ital e
nviro
nmen
t to
new
born
s, in
fant
s and
chi
ldre
nU
K
DR, L
T, SL
, CL,
EL
2•
••
1
2.9.
6Ex
plai
n w
hy d
rug
pres
crib
ing
in c
hild
ren
shou
ld b
e ba
sed
on a
pae
diat
ric sp
ecifi
c fo
rmul
ary
UK
1 (b
)•
•2
2.9.
7De
scrib
e flu
id m
anag
emen
t in
criti
cal i
llnes
s or i
njur
y in
al
l age
gro
ups
UK
1 (b
)•
•1
2.9.
8De
scrib
e th
e po
licie
s and
pro
cedu
res f
or sa
fegu
ardi
ng
child
ren
with
in th
e EM
S sy
stem
UK
1 (b
)•
•2
2.9.
9Di
ffere
ntiat
e th
e ty
pes o
f chi
ld a
buse
(neg
lect
, em
otion
al,
phys
ical
and
sexu
al a
buse
)U
K1
(a)
••
2
2.9.
10Cr
itiqu
e sig
ns o
f phy
sical
abu
se su
gges
tive
of n
on-
acci
dent
al in
jury
UK
1 (a
)•
••
•1
2.9.
11An
alys
e th
e or
gani
satio
n of
pae
diat
ric c
ritica
l car
e an
d ho
w th
is m
ay in
fluen
ce p
re-h
ospi
tal d
estin
ation
tria
ge
deci
sions
UK
1 (b
)•
••
•1
2.9.
12De
mon
stra
te th
e ab
ility
to fo
rmul
ate
a di
ffere
ntial
di
agno
ses f
or a
n ac
ute,
und
iffer
entia
ted
emer
genc
y pr
esen
tatio
n in
all
age
grou
psTS
LT, D
P, S
L,
CL, E
L1
(b)
••
•1
2.9.
13
Dem
onst
rate
the
imm
edia
te p
re-h
ospi
tal e
mer
genc
y m
anag
emen
t of t
he fo
llow
ing
acut
e m
edic
al
pres
enta
tion
s in
chi
ldre
n
(a) A
irway
obs
truc
tion/
chok
ing/
strid
orTS
LT, D
P,
SL, C
L,
EL
1 (b
)•
•1
(b) A
cute
resp
irato
ry d
istre
ssTS
1 (b
)•
•1
(c) C
entr
al c
yano
sisTS
1
(b)
••
1
(d) S
hock
TS1
(b)
••
1
(e) A
bnor
mal
pul
se ra
te o
r rhy
thm
TS1
(b)
••
1
(f) D
ecre
ased
con
scio
us le
vel
TS1
(b)
••
1
(g) S
eizu
res
TS1
(b)
••
1
DRDi
rect
ed R
eadi
ngLT
Lect
ures
and
Tut
oria
lsDP
Delib
erat
e Pr
actic
eSL
Sim
ulati
on L
earn
ing
RPRe
flecti
ve P
racti
ceRM
Role
Mod
elin
gCL
Colla
bora
tive
Lear
ning
ELEx
perie
ntial
Lea
rnin
g
THEME 2 102
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Them
e 2.
Pro
vidi
ng p
re-h
ospi
tal e
mer
genc
y m
edic
al c
are
2.9
Man
age
inju
red
or
ill c
hild
ren
in th
e pr
e-ho
spita
l env
ironm
ent
(con
t.)
2.9.
13co
nt.
(h) S
udde
n w
eakn
ess/
para
lysis
/abn
orm
al se
nsati
onTS
LT, D
P,
SL, C
L,
EL
1 (b
)•
•1
(i) In
toxi
catio
n an
d po
isoni
ngTS
1 (b
)•
•1
(j) H
ypog
lyca
emia
TS1
(b)
••
1
(k) A
cute
vom
iting
TS1
(b)
••
1
(l) A
cute
abd
omin
al/lo
in/s
crot
al p
ain
TS1
(b)
••
1
(m) A
cute
febr
ile il
lnes
sTS
1 (b
)•
•1
(n) A
cute
rash
TS1
(b)
••
1
(o) A
cute
pai
nTS
1 (b
)•
•1
(p) B
ites s
tings
and
env
enom
ation
TS1
(b)
••
1
(q) A
cute
alle
rgic
reac
tion
TS1
(b)
••
1
(r) N
on-a
ccid
enta
l inj
ury
TS1
(b)
••
1
2.9.
14
Dem
onst
rate
the
pre
-hos
pita
l man
agem
ent
of
(a) I
nfec
tious
upp
er a
irway
com
prom
iseTS
LT, D
P,
SL, C
L,
EL
1 (b
)•
•1
(b) A
sthm
aTS
1 (b
)•
•1
(c) A
naph
ylax
isTS
1 (b
)•
•1
(d) S
epsis
TS1
(b)
••
1
(e) M
enin
goen
ceph
aliti
sTS
1 (b
)•
•1
(f) S
tatu
s epi
lepti
cus
TS1
(b)
••
1
(g) D
iabe
tic k
etoa
cido
sisTS
1 (b
)•
•1
THEME 2 103
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Them
e 2.
Pro
vidi
ng p
re-h
ospi
tal e
mer
genc
y m
edic
al c
are
2.9
Man
age
inju
red
or
ill c
hild
ren
in
the
pre-
hosp
ital
envi
ronm
ent
(con
t.)
2.9.
15De
mon
stra
te a
dapt
ation
s to
clin
ical
pra
ctice
ne
cess
ary
for p
erfo
rmin
g eff
ectiv
e cl
inic
al
exam
inati
on a
nd in
terv
entio
ns in
all
age
grou
psTS
LT, D
P,
SL, C
L,
EL
1 (b
)•
••
1
2.9.
16De
mon
stra
te th
e ab
ility
to m
anag
e a
child
refu
sing
trea
tmen
t for
a p
ossib
le li
fe th
reat
enin
g co
nditi
onN
TS1
(b)
••
•4
2.9.
17De
mon
stra
te a
ppro
pria
tely
con
fiden
t and
met
hodi
cal
appr
oach
to m
anag
emen
t and
dec
ision
mak
ing
for
paed
iatr
ic m
edic
al e
mer
genc
ies
NTS
RM, R
P,
SL, C
L,
EL
1 (b
)•
••
3
2.9.
18De
mon
stra
tes a
bilit
y to
trea
t chi
ldre
n w
ith p
atien
ce,
dign
ity a
nd re
spec
tN
TS1
(b)
••
••
4
2.10
Man
age
the
baria
tric
pati
ent
in th
e pr
e-ho
spita
l en
viro
nmen
t
2.10
.1De
scrib
e th
e ap
plie
d an
atom
y an
d ph
ysio
logy
of t
he
baria
tric
pati
ent
UK
DR, L
T, SL
, CL,
EL
2•
•1
2.10
.2Cr
itiqu
e th
e lim
itatio
ns o
f sta
ndar
d cl
inic
al e
quip
men
t an
d m
onito
ring
in th
e ba
riatr
ic p
atien
tU
K2
••
2
2.10
.3De
scrib
e th
e ap
plie
d ph
arm
acol
ogy
of c
omm
only
us
ed p
re-h
ospi
tal d
rugs
in b
aria
tric
pati
ents
UK
2•
•1
2.10
.4Cr
itiqu
e ve
ntila
tion
stra
tegi
es in
bar
iatr
ic p
atien
tsU
K2
••
1
2.10
.5Cr
itiqu
e th
e lim
itatio
ns o
f res
cue
equi
pmen
t and
ve
hicl
es fo
r bar
iatr
ic p
atien
ts
UK
2•
•2
2.10
.6De
scrib
e th
e po
licie
s and
pro
cedu
res f
or th
e tr
ansp
ort
of b
aria
tric
pati
ents
with
in th
e EM
S sy
stem
UK
2•
••
1
2.10
.7De
scrib
e st
rate
gies
to fa
cilit
ate
resc
ue a
nd e
xtric
ation
of
the
baria
tric
pati
ent
UK
2•
••
1
2.10
.8De
mon
stra
te a
cal
cula
tion
of id
eal b
ody
wei
ght i
n ba
riatr
ic p
atien
tsTS
LT, D
P,
SL, C
L,
EL
2•
••
1
2.10
.9Se
lect
app
ropr
iate
man
ual h
andl
ing
adju
ncts
for
mov
ing
baria
tric
pati
ents
TS2
••
••
2
DRDi
rect
ed R
eadi
ngLT
Lect
ures
and
Tut
oria
lsDP
Delib
erat
e Pr
actic
eSL
Sim
ulati
on L
earn
ing
RPRe
flecti
ve P
racti
ceRM
Role
Mod
elin
gCL
Colla
bora
tive
Lear
ning
ELEx
perie
ntial
Lea
rnin
g
104THEME 2
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Them
e 2.
Pro
vidi
ng p
re-h
ospi
tal e
mer
genc
y m
edic
al c
are
2.11
Man
age
elde
rly
patie
nts i
n th
e pr
e-ho
spita
l env
ironm
ent
2.11
.1De
scrib
e th
e ap
plie
d an
atom
y an
d ph
ysio
logy
of a
gein
gU
K
DR, L
T, SL
, CL,
EL
1 (b
)•
•1
2.11
.2De
scrib
e th
e ep
idem
iolo
gy o
f inj
ury
and
illne
ss in
the
elde
rly p
opul
ation
UK
1 (b
)•
•1
2.11
.3Cr
itiqu
e th
e eff
ect o
f pol
ypha
rmac
y in
the
elde
rlyU
K1
(b)
••
•1
2.11
.4De
scrib
e th
e ap
plie
d ph
arm
acol
ogy
of c
omm
only
use
d dr
ugs u
sed
in th
e pr
e-ho
spita
l env
ironm
ent i
n el
derly
pa
tient
sU
K1
(b)
••
1
2.11
.5De
scrib
e th
e po
licie
s and
pro
cedu
res f
or p
rote
cting
vu
lner
able
adu
lts w
ithin
the
EMS
syst
emU
K1
(b)
••
2
2.11
.6An
alys
e w
ider
psy
chos
ocia
l iss
ues i
n pr
e-ho
spita
l tria
ge
and
deci
sion
mak
ing
for e
lder
ly p
atien
tsU
K1
(b)
••
••
4
2.12
Man
age
acut
e be
havi
oura
l di
stur
banc
e in
th
e pr
e-ho
spita
l en
viro
nmen
t
2.12
.1Ca
tego
rise
the
rang
e of
men
tal h
ealth
diso
rder
s pr
esen
ting
as p
re-h
ospi
tal e
mer
genc
ies
UK
2•
••
1
2.12
.2De
scrib
e ac
ute
men
tal h
ealth
serv
ice
prov
ision
with
in th
e EM
S sy
stem
UK
2•
•1
2.12
.3Ex
plai
n th
e m
ulti-
disc
iplin
ary
natu
re o
f chi
ld a
nd
adol
esce
nt m
enta
l hea
lth se
rvic
esU
K2
••
1
2.12
.4Di
ffere
ntiat
e or
gani
c br
ain
synd
rom
es fr
om a
cute
ps
ychi
atric
illn
ess
UK
2•
••
1
2.12
.5Ex
plai
n w
hy a
cute
beh
avio
ural
dist
urba
nce
can
be a
cau
se
or c
onse
quen
ce o
f inj
ury
UK
2•
••
•1
2.12
.6
Des
crib
e st
rate
gies
for
unde
rtak
ing
a pr
e-ho
spit
al
(a) m
enta
l sta
te e
xam
inati
onU
KDR
, LT,
SL, C
L,
EL
2•
•1
(b) s
elf h
arm
risk
ass
essm
ent
UK
2•
•2
(c) s
uici
de ri
sk a
sses
smen
tU
K2
••
2
(d) v
iole
nce
risk
asse
ssm
ent
UK
2•
•2
2.12
.7
Des
crib
e st
rate
gies
for
(a) c
ontr
ol a
nd re
stra
int
UK
DR, L
T, SL
, CL,
EL
2•
•2
(b) r
apid
tran
quili
satio
nU
K2
••
2
THEME 2 105
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Them
e 2.
Pro
vidi
ng p
re-h
ospi
tal e
mer
genc
y m
edic
al c
are
2.12
Man
age
acut
e be
havi
oura
l di
stur
banc
e in
th
e pr
e-ho
spita
l en
viro
nmen
t(c
ont.)
2.12
.8
Des
crib
e st
rate
gies
for
unde
rtak
ing
a pr
e-ho
spit
al
(a) m
enta
l sta
te e
xam
inati
onN
TS
LT, D
P, S
L,
CL, E
L
2•
••
1
(b) s
elf h
arm
risk
ass
essm
ent
NTS
2•
••
2
(c) s
uici
de ri
sk a
sses
smen
tN
TS2
••
•2
(d) v
iole
nce
risk
asse
ssm
ent
NTS
2•
••
2
2.12
.9
Dem
onst
rate
str
ateg
ies
for
(a) c
ontr
ol a
nd re
stra
int
TSLT
, DP,
SL,
CL
, EL
2•
••
2
(b) r
apid
tran
quili
satio
nTS
2•
••
2
2.13
Pro
vide
en
d-of
-life
car
e an
d im
med
iate
m
anag
emen
t of
bere
avem
ent
2.13
.1
Des
crib
e th
e m
anag
emen
t of
a p
re-h
ospi
tal d
eath
in
volv
ing
(a) A
n ad
ult
UK
DR, L
T, SL
, CL
, EL
2•
•4
(b) A
n in
fant
or c
hild
UK
2•
•4
(c) M
ultip
le c
asua
lties
UK
2•
•4
2.13
.2De
scrib
e th
e va
riatio
ns in
app
roac
h to
dea
th a
mon
g di
ffere
nt c
ultu
ral a
nd re
ligio
us g
roup
sU
K2
••
4
2.13
.3De
mon
stra
te th
e ab
ility
to c
ompl
ete
the
adm
inist
rativ
e re
quire
men
ts p
erta
inin
g to
a d
eath
in
the
pre-
hosp
ital e
nviro
nmen
t.TS
LT, S
L, D
P,
CL, E
L2
••
•1
2.13
.4De
mon
stra
te th
e ab
ility
to m
anag
e en
d of
life
de
cisio
ns in
the
pre-
hosp
ital e
nviro
nmen
tN
TS
RM, R
P,
SL, E
L
2•
••
3
2.13
.5Di
spla
y a
prof
essio
nal a
nd se
nsiti
ve a
ppro
ach
to
rela
tives
and
col
leag
ues f
ollo
win
g a
deat
h ou
tsid
e of
ho
spita
l.N
TS2
••
•3
DRDi
rect
ed R
eadi
ngLT
Lect
ures
and
Tut
oria
lsDP
Delib
erat
e Pr
actic
eSL
Sim
ulati
on L
earn
ing
RPRe
flecti
ve P
racti
ceRM
Role
Mod
elin
gCL
Colla
bora
tive
Lear
ning
ELEx
perie
ntial
Lea
rnin
g
THEME 3 107
THEME 3. USING PRE-HOSPITAL EQUIPMENTPre-hospital and in-transit emergency care requires use of a wide range of medicines, devices and portable equipment. Practitioners must be competent in both the application and operation of specific equipment items and the principles underlying their function and design.
UNITS3.1 Apply equipment governance principles and practice3.2 Understand and use personal protective equipment3.3 Operate all types of commonly used pre-hospital emergency medical device3.4 Operate common non-medical pre-hospital equipment3.5 Manage and administer medicines
Related GMP domains are assigned to each group of elements within units as follows:1. Knowledge skills and performance2. Safety and quality3. Communication, partnership and teamwork4. Maintaining trust
Good Medical Practice
Working in Emergency
Medical Systems
Providing pre-hospital
Emergency Medical Care
Using pre-hospital
equipment
Supporting rescue and extrication
Supporting safe patient
transfer
Supporting emergency
preparedness and response
108
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Them
e . U
sing
pre
-hos
pita
l eui
pmen
t
3.1
Appl
y eq
uipm
ent
gove
rnan
ce p
rinci
ples
an
d pr
actic
e
3.1.
1Ca
tego
rise
pre-
hosp
ital e
quip
men
t U
KDR
, LT,
SL, E
L,
CL
1 (a
)•
•1
3.1.
2De
scrib
e th
e pr
inci
ples
of e
quip
men
t gov
erna
nce
U
K1
(b)
••
2
3.1.
3De
scrib
e th
e re
leva
nce
of th
e re
gula
tory
fram
ewor
k fo
r med
ical
dev
ices
UK
1 (b
)•
•1
3.1.
4
Dem
onst
rate
eui
pmen
t gov
erna
nce
proc
edur
es
(a) i
n th
e pr
e-de
ploy
men
t pha
seTS
DR, L
T, SL
, EL,
DP
1 (b
)•
••
2
(b) d
urin
g de
ploy
men
t and
clin
ical
car
eTS
1 (b
)•
••
•2
(c) o
n co
mpl
etion
of d
eplo
ymen
tTS
1 (b
)•
••
•2
3.1.
5De
mon
stra
te a
pro
fess
iona
l app
roac
h to
equ
ipm
ent
gove
rnan
ce
NTS
RM, E
L,
SL1
(b)
••
•2
3.2
Und
erst
and
and
use
pers
onal
pr
otec
tive
equi
pmen
t
3.2.
1Ca
tego
rise
pers
onal
pro
tecti
ve e
quip
men
t (PP
E)
UK
DR, L
T, SL
, EL,
CL
1 (a
)•
••
1
3.2.
2De
scrib
e th
e pr
inci
ples
und
erly
ing
PPE
func
tion
and
desig
n U
K1
(a)
••
1
3.2.
3De
scrib
e w
hen
PPE
mus
t be
used
U
K1
(a)
••
2
3.2.
4De
scrib
e pr
oced
ures
for c
heck
ing
and
mai
ntai
ning
PP
EU
K1
(a)
••
2
3.2.
5De
mon
stra
te th
e co
rrec
t use
of P
PE
TSDR
, LT,
SL, E
L,
DP
1 (a
)•
••
2
3.2.
6De
mon
stra
te th
e ab
ility
to o
pera
te w
hilst
usin
g PP
E TS
1 (a
)•
••
2
3.2.
7De
mon
stra
te a
pro
fess
iona
l app
roac
h to
use
of P
PE
NTS
RM, E
L, S
L1
(b)
••
•2
Des
crib
e th
e pr
inci
ples
und
erly
ing
the
func
tion
and
de
sign
of p
re-h
ospi
tal
(a) A
irway
man
agem
ent d
evic
esU
KDR
, LT,
SL, E
L, C
L1
(a)
••
••
1
THEME 3
109
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Them
e . U
sing
pre
-hos
pita
l eui
pmen
t
3.3
Ope
rate
all
type
s of c
omm
only
us
ed p
re-h
ospi
tal
emer
genc
y m
edic
al
devi
ces
3.3.
1
(b) V
entil
ator
y su
ppor
t dev
ices
UK
DR, L
T, SL
, EL,
CL
1 (a
)•
••
•1
(c) D
evic
es fo
r con
trol
ling
haem
orrh
age
UK
1 (a
)•
••
•1
(d) D
evic
es fo
r acc
essin
g th
e ci
rcul
ation
U
K1
(a)
••
••
1
(e) D
evic
es fo
r sup
porti
ng th
e ci
rcul
ation
U
K1
(a)
••
••
1
(f) D
evic
es fo
r adm
inist
erin
g m
edic
ines
and
blo
od
prod
ucts
UK
1 (a
)•
••
•1
(g) D
evic
es fo
r man
agin
g so
ft tis
sue
inju
ries,
wou
nds
and
burn
sU
K1
(a)
••
••
1
(h) D
evic
es fo
r im
mob
ilizin
g jo
ints
, lim
bs a
nd p
atien
tsU
K1
(a)
••
••
1
(i) D
evic
es fo
r nea
r pati
ent t
estin
g U
K1
(b)
••
••
1
(j) D
evic
es fo
r tem
pera
ture
man
agem
ent
UK
1 (b
)•
••
•1
(k) D
evic
es fo
r non
-inva
sive
patie
nt m
onito
ring
UK
1 (a
)•
••
•1
(l) D
evic
es fo
r inv
asiv
e pa
tient
mon
itorin
gU
K1
(b)
••
••
1
(m) D
evic
es fo
r im
agin
g an
d di
agno
sisU
K2
••
••
1
(n) D
evic
es fo
r mov
ing
and
hand
ling
patie
nts
UK
1 (b
)•
••
•1
3.3.
2
Cont
rast
the
eec
tive
ness
of d
ier
ent
devi
ces
wit
hin
each
of
(a) A
irway
man
agem
ent d
evic
esU
K
DR, L
T, SL
, EL,
CL
1 (b
)•
••
•1
(b) V
entil
ator
y su
ppor
t dev
ices
U
K1
(b)
••
••
1
(c) D
evic
es fo
r con
trol
ling
haem
orrh
age
UK
1 (b
)•
••
•1
(d) D
evic
es fo
r acc
essin
g th
e ci
rcul
ation
U
K1
(b)
••
••
1
(e) D
evic
es fo
r sup
porti
ng th
e ci
rcul
ation
U
K1
(b)
••
••
1
(f) D
evic
es fo
r adm
inist
erin
g m
edic
ine
and
bloo
d pr
oduc
tsU
K1
(b)
••
••
1
(g) D
evic
es fo
r man
agin
g so
ft tis
sue
inju
ries,
wou
nds
and
burn
sU
K1
(b)
••
••
1
THEME 3
DRDi
rect
ed R
eadi
ngLT
Lect
ures
and
Tut
oria
lsDP
Delib
erat
e Pr
actic
eSL
Sim
ulati
on L
earn
ing
RPRe
flecti
ve P
racti
ceRM
Role
Mod
elin
gCL
Colla
bora
tive
Lear
ning
ELEx
perie
ntial
Lea
rnin
g
THEME 3 110
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Them
e . U
sing
pre
-hos
pita
l eui
pmen
t
3.3
Ope
rate
all
type
s of c
omm
only
us
ed p
re-h
ospi
tal
emer
genc
y m
edic
al
devi
ces
(con
t)
3.3.
2
(h) D
evic
es fo
r im
mob
ilizin
g jo
ints
, lim
bs a
nd p
atien
tsU
K
DR, L
T, SL
, EL,
CL
1 (b
)•
••
•1
(i) D
evic
es fo
r nea
r pati
ent t
estin
g U
K2
••
••
1
(j) D
evic
es fo
r tem
pera
ture
man
agem
ent
UK
2•
••
•1
(k) D
evic
es fo
r non
-inva
sive
patie
nt m
onito
ring
UK
1 (a
)•
••
•1
(l) D
evic
es fo
r inv
asiv
e pa
tient
mon
itorin
gU
K1
(b)
••
••
1
(m) D
evic
es fo
r im
agin
g an
d di
agno
sisU
K2
••
••
1
(n) D
evic
es fo
r mov
ing
and
hand
ling
patie
nts
UK
1 (a
)•
••
•1
3.3.
3
Dem
onst
rate
con
fiden
t an
d te
chni
cally
cor
rect
op
erati
on o
f
(a) A
irway
man
agem
ent d
evic
esTS
DR, L
T, SL
, EL,
CL
1 (a
)•
••
••
1
(b) V
entil
ator
y su
ppor
t dev
ices
TS
1 (a
)•
••
••
1
(c) D
evic
es fo
r con
trol
ling
haem
orrh
age
TS1
(a)
••
••
•1
(d) D
evic
es fo
r acc
essin
g th
e ci
rcul
ation
TS
1 (a
)•
••
••
1
(e) D
evic
es fo
r sup
porti
ng th
e ci
rcul
ation
TS
1 (a
)•
••
••
1
(f) D
evic
es fo
r adm
inist
erin
g m
edic
ine
and
bloo
d pr
oduc
tsTS
1 (a
)•
••
••
1
(g) D
evic
es fo
r man
agin
g so
ft tis
sue
inju
ries,
wou
nds
and
burn
sTS
1 (b
)•
••
••
1
(h) D
evic
es fo
r im
mob
ilizin
g jo
ints
, lim
bs a
nd p
atien
tsTS
1 (a
)•
••
••
1
(i) D
evic
es fo
r nea
r pati
ent t
estin
g TS
1 (b
)•
••
••
1
(j) D
evic
es fo
r tem
pera
ture
man
agem
ent
TS1
(b)
••
••
•1
(k) D
evic
es fo
r non
-inva
sive
patie
nt m
onito
ring
TS1
(a)
••
••
•1
(l) D
evic
es fo
r inv
asiv
e pa
tient
mon
itorin
gTS
1 (b
)•
••
••
1
(m) D
evic
es fo
r im
agin
g an
d di
agno
sisTS
2•
••
••
1
(n) D
evic
es fo
r mov
ing
and
hand
ling
patie
nts
TS1
(a)
••
••
•1
THEME 3 111
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Them
e . U
sing
pre
-hos
pita
l eui
pmen
t
3.3
Ope
rate
all
type
s of c
omm
only
us
ed p
re-h
ospi
tal
emer
genc
y m
edic
al
devi
ces
(con
t)
3.3.
4
Dem
onst
rate
cor
rect
man
agem
ent o
f cri
tica
l dev
ice
failu
res
and,
whe
re re
leva
nt, a
larm
s w
ithi
n ea
ch o
f
(a) A
irway
man
agem
ent d
evic
esTS
DR, L
T, SL
, EL,
CL
1 (a
)•
••
••
1
(b) V
entil
ator
y su
ppor
t dev
ices
TS
1 (a
)•
••
••
1
(c) D
evic
es fo
r con
trol
ling
haem
orrh
age
TS1
(a)
••
••
•1
(d) D
evic
es fo
r acc
essin
g th
e ci
rcul
ation
TS
1 (a
)•
••
••
1
(e) D
evic
es fo
r sup
porti
ng th
e ci
rcul
ation
TS
1 (a
)•
••
••
1
(f) D
evic
es fo
r adm
inist
erin
g m
edic
ine
and
bloo
d pr
oduc
tsTS
1 (a
)•
••
••
1
(g) D
evic
es fo
r man
agin
g so
ft tis
sue
inju
ries,
wou
nds
and
burn
sTS
1 (b
)•
••
••
1
(h) D
evic
es fo
r im
mob
ilizin
g jo
ints
, lim
bs a
nd p
atien
tsTS
1 (a
)•
••
••
1
(i) D
evic
es fo
r nea
r pati
ent t
estin
g TS
1 (b
)•
••
••
1
(j) D
evic
es fo
r tem
pera
ture
man
agem
ent
TS2
••
••
•1
(k) D
evic
es fo
r non
-inva
sive
patie
nt m
onito
ring
TS1
(a)
••
••
•1
(l) D
evic
es fo
r inv
asiv
e pa
tient
mon
itorin
gTS
1 (b
)•
••
••
1
(m) D
evic
es fo
r im
agin
g an
d di
agno
sisTS
2•
••
••
1
(n) D
evic
es fo
r mov
ing
and
hand
ling
patie
nts
TS1
(a)
••
••
•1
3.3.
5De
mon
stra
te a
pro
fess
iona
l app
roac
h to
mai
ntai
ning
kn
owle
dge
and
skill
s in
the
oper
ation
of m
edic
al
equi
pmen
tN
TSRM
, CL,
EL
, SL
1 (b
)•
••
1
DRDi
rect
ed R
eadi
ngLT
Lect
ures
and
Tut
oria
lsDP
Delib
erat
e Pr
actic
eSL
Sim
ulati
on L
earn
ing
RPRe
flecti
ve P
racti
ceRM
Role
Mod
elin
gCL
Colla
bora
tive
Lear
ning
ELEx
perie
ntial
Lea
rnin
g
THEME 3 112
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Them
e . U
sing
pre
-hos
pita
l eui
pmen
t
3.4
Ope
rate
com
mon
no
n-m
edic
al
pre-
hosp
ital
equi
pmen
t
3.4.
1
Des
crib
e th
e op
erati
on o
f com
mon
pre
-hos
pita
l
(a) C
omm
unic
ation
s equ
ipm
ent
UK
DR, L
T, SL
, Cl
, EL
1 (a
)•
••
•1
(b) A
udio
visu
al re
cord
ing
equi
pmen
t U
K1
(b)
••
••
1
(c) I
ncid
ent m
anag
emen
t equ
ipm
ent
UK
1 (b
)•
••
•1
(d) N
avig
ation
equ
ipm
ent
UK
1 (a
)•
••
•1
(e) I
nfor
mati
on m
anag
emen
t equ
ipm
ent
UK
1 (b
)•
••
•1
3.4.
2
Dem
onst
rate
con
fiden
t an
d te
chni
cally
cor
rect
op
erati
on o
f
(a) C
omm
unic
ation
s equ
ipm
ent
TS
LT, S
L, C
L,
EL, R
P
1 (a
)•
••
1
(b) A
udio
visu
al re
cord
ing
equi
pmen
t TS
1 (b
)•
••
1
(c) I
ncid
ent m
anag
emen
t equ
ipm
ent
TS1
(b)
••
•1
(d) N
avig
ation
equ
ipm
ent
TS1
(a)
••
•1
(e) I
nfor
mati
on m
anag
emen
t equ
ipm
ent
TS1
(b)
••
•1
3.4.
3De
mon
stra
te a
pro
fess
iona
l app
roac
h to
mai
ntai
ning
sk
ills a
nd k
now
ledg
e in
the
oper
ation
of n
on-m
edic
al
equi
pmen
tN
TSRM
, SL,
EL
1 (b
)•
••
•1
THEME 3 113
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Them
e . U
sing
pre
-hos
pita
l eui
pmen
t
3.5
Man
age
and
adm
inist
er m
edic
ines
3.5.
1De
scrib
e th
e pr
inci
ples
of g
ood
pre-
hosp
ital m
edic
ines
m
anag
emen
tU
K
DR, L
T, SL
, CL,
EL
1 (a
)•
••
1
3.5.
2De
scrib
e th
e pr
inci
ples
of s
afe
pre-
hosp
ital p
resc
ribin
gU
K1
(b)
••
1
3.5.
3Ca
tego
rise
med
icin
es u
sed
in P
re-h
ospi
tal E
mer
genc
y M
edic
ine
UK
1 (a
)•
•1
3.5.
4De
scrib
e th
e re
leva
nce
of th
e re
gula
tory
fram
ewor
k fo
r m
edic
ines
in p
re-h
ospi
tal p
racti
ce
UK
1 (b
)•
•2
3.5.
5De
scrib
e th
e ap
plic
ation
of c
ontr
olle
d dr
ugs l
egisl
ation
an
d pr
oced
ures
to p
re-h
ospi
tal p
racti
ceU
K1
(b)
••
•1
3.5.
6Li
st m
edic
al g
ases
in c
omm
on p
re-h
ospi
tal u
seU
K1
(a)
••
•1
3.5.
7De
scrib
e th
e da
nger
s of m
edic
al g
ases
use
d in
pr
e-ho
spita
l car
e an
d th
e pr
ecau
tions
that
ens
ure
safe
ty
durin
g ad
min
istra
tion
UK
1 (a
)•
••
2
3.5.
8Li
st b
lood
pro
duct
s in
pre-
hosp
ital u
seU
K1
(b)
••
•1
3.5.
9De
mon
stra
te sa
fe p
resc
riptio
n an
d di
spen
sing
of
med
icin
esTS
LT, S
L,
CL, E
L
1 (b
)•
••
•1
3.5.
10De
mon
stra
te p
repa
ratio
n of
med
icin
es fo
r par
ente
ral u
seTS
1 (a
)•
••
•1
3.5.
11De
mon
stra
te sa
fe a
nd e
ffecti
ve a
dmin
istra
tion
of
med
icin
es b
y al
l rou
tes
TS1
(a)
••
••
1
3.5.
12De
mon
stra
te c
ompl
ianc
e w
ith le
gisla
tion
rela
ted
to
Cont
rolle
d Dr
ugs
TS1
(a)
••
••
2
3.5.
13De
mon
stra
te sa
fe u
se o
f a m
edic
al g
as c
ylin
der
TS1
(a)
••
••
1
3.5.
14De
mon
stra
te sa
fe h
andl
ing,
tran
spor
t and
stor
age
of
med
ical
gas
cyl
inde
rs in
the
pre-
hosp
ital e
nviro
nmen
tTS
1 (b
)•
••
•1
3.5.
15De
mon
stra
te sa
fe a
nd e
ffecti
ve a
dmin
istra
tion
of b
lood
pr
oduc
tsTS
1 (b
)•
••
•1
3.5.
16De
mon
stra
te a
pro
fess
iona
l app
roac
h to
man
agem
ent
and
adm
inist
ratio
n of
med
icin
esN
TSRM
, SL,
CL
, EL
1 (b
)•
••
•1
DRDi
rect
ed R
eadi
ngLT
Lect
ures
and
Tut
oria
lsDP
Delib
erat
e Pr
actic
eSL
Sim
ulati
on L
earn
ing
RPRe
flecti
ve P
racti
ceRM
Role
Mod
elin
gCL
Colla
bora
tive
Lear
ning
ELEx
perie
ntial
Lea
rnin
g
THEME 4 115
THEME 4. SUPPORTING RESCUE AND EXTRICATIONPre-hospital emergency medical services are frequently targeted at patients who, because of physical entrapment, physical geography or functional geographic constraints, cannot just be taken to the nearest appropriate hospital. This competence theme focuses on the underpinning knowledge, technical skills and non-technical skills required to manage a trapped patient and effectively interact with professional rescue service personnel at common pre-hospital rescue situations.
UNITS4.1 Work within the rescue environment4.2 Understand entrapment4.3 Support Extrication4.4 Clinically manage the trapped patient
Related GMP domains are assigned to each group of elements within units as follows:1. Knowledge skills and performance2. Safety and quality3. Communication, partnership and teamwork4. Maintaining trust
Good Medical Practice
Working in Emergency
Medical Systems
Providing pre-hospital
Emergency Medical Care
Using pre-hospital
equipment
Supporting rescue and extrication
Supporting safe patient
transfer
Supporting emergency
preparedness and response
116
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Them
e . S
uppo
rting
resc
ue a
nd e
tric
ation
4.1
Wor
k w
ithin
the
resc
ue e
nviro
nmen
t
4.1.
1
Des
crib
e th
e sp
ecifi
c ha
ards
to re
scue
in t
he
follo
win
g si
tuati
ons
(a) R
oad
traffi
c co
llisio
nsU
K
DR, L
T, SL
, CL,
EL
1 (b
)•
•1
(b) I
ndus
tria
l site
inci
dent
sU
K1
(b)
••
1
(c) A
ircra
ft re
late
d in
cide
nts
UK
1 (b
)•
•1
(d) A
gric
ultu
ral s
ite in
cide
nts
UK
1 (b
)•
•1
(e) R
emot
e ar
ea in
cide
nts
UK
2•
•1
(f) C
onfin
ed sp
ace
inci
dent
sU
K2
••
1
(g) C
olla
psed
stru
ctur
esU
K2
••
1
(h) E
xplo
sive
devi
ce in
cide
nts
UK
1 (b
)•
•1
(i) F
irear
ms i
ncid
ents
UK
1 (b
)•
•1
(j) S
cene
s of v
iole
nt a
ssau
ltU
K1
(b)
••
1
(k) H
azar
dous
mat
eria
ls in
cide
nts
UK
2•
•1
(l) In
cide
nts a
t hei
ght
UK
1 (b
)•
•1
(m) I
ncid
ents
on
stee
p slo
pes
UK
2•
•1
(n) W
ater
rela
ted
inci
dent
sU
K2
••
1
(o) F
ires
UK
1 (b
)•
•1
4.1.
2
Epl
ain
the
resc
ue c
apab
iliti
es o
f
(a) P
olic
e pe
rson
nel
UK
DR, L
T, SL
, CL,
EL
1 (b
)•
•1
(b) F
ire p
erso
nnel
UK
1 (b
)•
•1
THEME 4
117
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Them
e . S
uppo
rting
resc
ue a
nd e
tric
ation
4.1
Wor
k w
ithin
the
resc
ue e
nviro
nmen
t
4.1.
2(c
ont)
(c) M
edic
al p
erso
nnel
UK
DR, L
T, SL
, CL,
EL
1 (b
)•
•1
(d) S
peci
alist
resc
ue p
erso
nnel
UK
2•
•1
(e) V
olun
tary
em
erge
ncy
serv
ices
per
sonn
elU
K2
••
1
4.1.
3Cr
itiqu
e th
e ro
le o
f pre
-hos
pita
l em
erge
ncy
med
icin
e sp
ecia
lists
in re
scue
UK
2•
•1
4.1.
4Ex
plai
n th
e co
ncep
t of g
ener
ic ri
sk a
sses
smen
ts fo
r re
scue
ope
ratio
nsU
K1
(b)
••
2
4.1.
5De
scrib
e th
e re
latio
nshi
p be
twee
n ge
neric
risk
as
sess
men
t and
dyn
amic
risk
ass
essm
ent f
or re
scue
op
erati
ons
UK
1 (b
)•
•2
4.1.
6De
scrib
e th
e ph
ysio
logi
cal,
psyc
holo
gica
l and
phy
sical
eff
ects
on
patie
nts o
f res
cue
oper
ation
s in
diffe
rent
se
tting
sU
K2
••
1
4.1.
7De
scrib
e th
e ph
ysio
logi
cal,
psyc
holo
gica
l and
phy
sical
eff
ects
of r
escu
e op
erati
ons o
n re
scue
and
hea
lthca
re
pers
onne
l U
K2
••
1
4.1.
8De
scrib
e st
rate
gies
to o
ptim
ise th
e re
scue
en
viro
nmen
t for
clin
ical
ass
essm
ent a
nd c
are
UK
1 (b
)•
•2
4.1.
9De
mon
stra
te a
gen
eric
risk
ass
essm
ent f
or m
edic
al
pers
onne
l sup
porti
ng a
typi
cal r
escu
e op
erati
on
with
in th
e EM
S sy
stem
TSLT
, SL,
CL
, EL,
DP
1 (b
)•
•2
4.1.
10De
mon
stra
te a
dyn
amic
risk
ass
essm
ent i
n pr
actic
e at
a
resc
ue o
pera
tion
TS2
••
•2
4.1.
11De
mon
stra
te re
silie
nce
acro
ss th
e sp
ectr
um o
f res
cue
envi
ronm
ents
NTS
RM, S
L,
CL, E
L1
(b)
••
••
1
4.2
Und
erst
and
entr
apm
ent
4.2.
1Ca
tego
rise
entr
apm
ent ‘
mec
hani
sms’
UK
DR, L
T, SL
, CL
, EL
1 (b
)•
••
1
THEME 4
DRDi
rect
ed R
eadi
ngLT
Lect
ures
and
Tut
oria
lsDP
Delib
erat
e Pr
actic
eSL
Sim
ulati
on L
earn
ing
RPRe
flecti
ve P
racti
ceRM
Role
Mod
elin
gCL
Colla
bora
tive
Lear
ning
ELEx
perie
ntial
Lea
rnin
g
THEME 4 118
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Them
e . S
uppo
rting
resc
ue a
nd e
tric
ation
4.2
Und
erst
and
entr
apm
ent
4.2.
2
Des
crib
e th
e ty
pica
l m
echa
nism
s o
f ent
rapm
ent
in
the
follo
win
g si
tuati
ons
(a) R
oad
traffi
c co
llisio
nsU
K
DR, L
T,
SL, C
L,
EL
1 (b
)•
•1
(b) I
ndus
tria
l site
inci
dent
sU
K1
(b)
••
1
(c) A
ircra
ft re
late
d in
cide
nts
UK
1 (b
)•
•1
(d) A
gric
ultu
ral s
ite in
cide
nts
UK
1 (b
)•
•1
(e) R
emot
e ar
ea in
cide
nts
UK
2•
•1
(f) C
onfin
ed sp
ace
inci
dent
sU
K2
••
1
(g) C
olla
psed
stru
ctur
esU
K2
••
1
(h) E
xplo
sive
devi
ce in
cide
nts
UK
1 (b
)•
•1
(i) F
irear
ms i
ncid
ents
UK
1 (b
)•
•1
(j) S
cene
s of v
iole
nt a
ssau
ltU
K1
(b)
••
1
(k) H
azar
dous
mat
eria
ls in
cide
nts
UK
2•
•1
(l) In
cide
nts a
t hei
ght
UK
1 (b
)•
•1
(m) I
ncid
ents
on
stee
p slo
pes
UK
2•
•1
(n) W
ater
rela
ted
inci
dent
sU
K2
••
1
(o) F
ires
UK
1 (b
)•
•1
THEME 4 119
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Them
e . S
uppo
rting
resc
ue a
nd e
tric
ation
4.3
Supp
ort
Extr
icati
on
4.3.
1De
scrib
e th
e pr
inci
ples
of e
xtric
ation
UK
DR, L
T, DP
, SL,
RP
, CL,
EL
1 (b
)•
•1
4.3.
2Cr
itiqu
e th
e ro
le o
f med
ical
inte
rven
tions
in fa
cilit
ating
ex
tric
ation
UK
2•
•1
4.3.
3De
scrib
e te
chni
cal e
xtric
ation
pro
cess
es fo
r roa
d tr
affic
rela
ted
entr
apm
ent
UK
1 (b
)•
•1
4.3.
4Cr
itiqu
e th
e ca
pabi
lities
and
lim
itatio
ns o
f com
mon
ly
used
resc
ue a
nd e
xtric
ation
equ
ipm
ent
UK
2•
•1
4.3.
5De
scrib
e st
rate
gies
for e
xped
iting
ext
ricati
onU
K2
••
1
4.3.
6De
mon
stra
te a
bilit
y to
mak
e a
rapi
d as
sess
men
t of t
he
extr
icati
on n
eeds
of a
trap
ped
patie
ntTS
DR, L
T, DP
, SL,
RP
,
1 (b
)•
••
•1
4.3.
7De
mon
stra
te a
bilit
y to
man
age
clin
ical
equ
ipm
ent d
urin
g th
e ex
tric
ation
pro
cess
TS
1 (b
)•
••
•1
4.3.
8De
mon
stra
te a
bilit
y to
faci
litat
e ex
tric
ation
thro
ugh
med
ical
inte
rven
tion
TS1
(b)
••
••
1
4.3.
9De
mon
stra
te h
ow c
linic
al ju
dgem
ent i
nflue
nces
the
tem
po o
f res
cue
oper
ation
sTS
2•
••
•1
4.3.
10Di
spla
y co
nfide
nce
in su
ppor
ting
extr
icati
onN
TSRM
, EL,
SL,
RP
, DP
1 (b
)•
••
1
4.3.
11Di
spla
y m
edic
al le
ader
ship
in c
o-or
dina
ting
med
ical
and
re
scue
inte
rven
tions
NTS
2•
••
3
4.4
Clin
ical
ly m
anag
e th
e tr
appe
d pa
tient
4.4.
1De
scrib
e th
e ad
vers
e ph
ysio
logi
cal e
ffect
s spe
cific
ally
as
soci
ated
with
ent
rapm
ent
UK
DR, L
T, SL
, RP,
CL
, EL
1 (b
)•
•1
4.4.
2De
scrib
e pa
in m
anag
emen
t str
ateg
ies f
or th
e tr
appe
d pa
tient
UK
1 (b
)•
•1
4.4.
3Cr
itiqu
e th
e ro
le o
f pati
ent m
onito
ring
durin
g en
trap
men
t an
d ex
tric
ation
UK
2•
•1
4.4.
4Cr
itiqu
e cl
inic
al st
rate
gies
for i
njur
y m
anag
emen
t in
the
trap
ped
patie
nt c
ompa
red
to th
e no
n-tr
appe
d pa
tient
UK
2•
•1
4.4.
5Cr
itiqu
e cl
inic
al st
rate
gies
for o
rgan
and
/or s
yste
m
supp
ort i
n th
e tr
appe
d pa
tient
com
pare
d to
the
no
n-tr
appe
d pa
tient
UK
2•
•1
DRDi
rect
ed R
eadi
ngLT
Lect
ures
and
Tut
oria
lsDP
Delib
erat
e Pr
actic
eSL
Sim
ulati
on L
earn
ing
RPRe
flecti
ve P
racti
ceRM
Role
Mod
elin
gCL
Colla
bora
tive
Lear
ning
ELEx
perie
ntial
Lea
rnin
g
THEME 4 120
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Them
e . S
uppo
rting
resc
ue a
nd e
tric
ation
4.4
Clin
ical
ly m
anag
e th
e tr
appe
d pa
tient
(con
t.)
4.4.
6
Des
crib
e cl
inic
al s
trat
egie
s fo
r th
e m
anag
emen
t of
tr
appe
d pa
tien
ts w
ith
(a) i
mpa
lem
ent
UK
DR, L
T, SL
, RP,
CL
, EL
2•
••
1
(b) c
rush
inju
ryU
K2
••
•1
(c) h
ypot
herm
iaU
K2
••
•1
(d) p
rolo
nged
ent
rapm
ent
UK
2•
••
1
(e) s
ever
e lim
b en
trap
men
tU
K2
••
•1
4.4.
7 De
scrib
e th
e im
pact
of m
edic
al in
terv
entio
n on
re
scue
tim
esca
les a
nd te
chni
ques
UK
2•
••
1
4.4.
8Di
ffere
ntiat
e th
e le
vel a
nd n
atur
e of
clin
ical
in
terv
entio
ns a
t diff
eren
t sta
ges o
f ext
ricati
onU
K2
••
1
4.4.
9De
scrib
e st
rate
gies
for m
anag
ing
entr
apm
ent o
f mor
e th
an o
ne p
atien
t at a
n in
cide
ntU
K2
••
1
4.4.
10De
mon
stra
te a
bilit
y to
mak
e a
rapi
d as
sess
men
t of
the
clin
ical
nee
ds o
f a tr
appe
d pa
tient
TSLT
, DP,
SL
, RP,
RM
, CL,
EL
2•
••
1
4.4.
11De
mon
stra
te e
ffecti
ve m
anag
emen
t of t
he tr
appe
d pa
tient
TS2
••
•1
4.4.
12Di
spla
y co
nfide
nce
in m
anag
ing
the
trap
ped
patie
ntN
TS
RM, E
L,
SL, R
P,
DP
2•
••
••
3
4.4.
13Di
spla
y le
ader
ship
in c
o-or
dina
ting
mul
ti-pr
ofes
siona
l m
edic
al c
are
of tr
appe
d pa
tient
sN
TS2
••
••
•3
4.4.
14De
mon
stra
te a
com
pass
iona
te p
atien
t-foc
usse
d ap
proa
ch th
roug
hout
resc
ue a
nd e
xtric
ation
NTS
2•
••
••
4
DRDi
rect
ed R
eadi
ngLT
Lect
ures
and
Tut
oria
lsDP
Delib
erat
e Pr
actic
eSL
Sim
ulati
on L
earn
ing
RPRe
flecti
ve P
racti
ceRM
Role
Mod
elin
gCL
Colla
bora
tive
Lear
ning
ELEx
perie
ntial
Lea
rnin
g
THEME 5 121
THEME 5. SUPPORTING SAFE PATIENT TRANSFERThis theme covers the competences required to make destination hospital triage decisions, select the most appropriate transport platform, provide safe, effective and focused in-transit critical care and ensure that the patients’ condition and immediate needs are communicated to receiving hospital clinical staff. As with other competence themes, many of the elements are common across all clinical services. The constituent Units within this theme are:
UNITS5.1 Understand the concepts underpinning transfer medicine5.2 Understand the applied physiology of patient transfer5.3 Co-ordinate and plan patient transfer5.4 Prepare patients for transport5.5 Utilise a range of patient transport modalities 5.6 Clinically manage patients during transport
Related GMP domains are assigned to each group of elements within units as follows:1. Knowledge skills and performance2. Safety and quality3. Communication, partnership and teamwork4. Maintaining trust
Good Medical Practice
Working in Emergency
Medical Systems
Providing pre-hospital
Emergency Medical Care
Using pre-hospital
equipment
Supporting rescue and extrication
Supporting safe patient
transfer
Supporting emergency
preparedness and response
THEME 5 122
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Them
e 5.
Sup
porti
ng s
afe
pati
ent t
rans
fer
5.1
Und
erst
and
the
conc
epts
un
derp
inni
ng tr
ansf
er
med
icin
e(c
ont.)
5.1.
1De
scrib
e th
e po
licie
s and
pro
cedu
res f
or p
re-h
ospi
tal a
nd
emer
gent
inte
r-fac
ility
(int
er-h
ospi
tal)
tran
sfer
with
in th
e EM
S sy
stem
U
K
DR, L
T, SL
, CL,
EL
1 (b
)•
•2
5.1.
2Cr
itiqu
e th
e ne
ed fo
r pre
-hos
pita
l and
em
erge
nt
inte
r-fac
ility
tran
sfer
with
in th
e EM
S sy
stem
U
K1
(b)
••
1
5.1.
3Co
ntra
st th
e ris
ks a
nd b
enefi
ts a
ssoc
iate
d w
ith e
xten
ded
pre-
hosp
ital a
nd e
mer
gent
inte
r-fac
ility
tran
sfer
UK
1 (b
)•
•1
5.1.
4An
alys
e th
e ev
iden
ce re
late
d to
the
risks
and
ben
efits
of
ext
ende
d pr
e-ho
spita
l tra
nsfe
r (fa
cilit
y by
-pas
s) a
nd
emer
genc
y in
ter-f
acili
ty tr
ansf
er
UK
2•
•1
5.1.
5De
scrib
e lin
es o
f acc
ount
abili
ty a
nd re
spon
sibili
ty in
re
latio
n to
pre
-hos
pita
l tra
nsfe
r and
em
erge
nt
inte
r-fac
ility
tran
sfer
U
K1
(b)
••
1
5.1.
6De
scrib
e th
e ro
les a
nd re
spon
sibili
ties o
f all
staff
ac
com
pany
ing
the
patie
nt d
urin
g tr
ansf
erU
K1
(b)
••
1
5.1.
7An
alys
e th
e et
hica
l and
lega
l iss
ues r
elat
ed to
pati
ent
tran
sfer
UK
2•
••
1
5.1.
8De
mon
stra
te a
pro
fess
iona
l app
roac
h to
tran
sfer
m
edic
ine
NTS
RM, S
L, R
P1
(b)
••
••
••
4
5.2
Und
erst
and
the
appl
ied
phys
iolo
gy o
f pa
tient
tran
sfer
5.2.
1De
scrib
e th
e ph
ysio
logi
cal a
nd p
hysic
al e
ffect
s of
mov
emen
t of p
atien
tsU
KDR
, LT,
SL, C
L,
EL
1 (b
)•
••
1
5.2.
2De
scrib
e th
e ph
ysio
logi
cal a
nd p
hysic
al e
ffect
s of t
rans
fer
on a
ttend
ants
UK
1 (b
)•
•1
5.2.
3De
scrib
e th
e ph
ysio
logi
cal e
ffect
s of a
ltitu
de o
n pa
tient
s du
ring
tran
sfer
UK
1 (b
)•
•1
5.2.
4De
mon
stra
te a
bilit
y to
inte
grat
e pa
tient
dia
gnos
is w
ith
the
phys
iolo
gica
l effe
cts o
f tra
nspo
rt
TSDR
, LT,
SL
CL, E
L1
(b)
••
••
1
5.2.
5De
mon
stra
te re
silie
nce
whe
n un
dert
akin
g pa
tient
tran
sfer
NTS
RM, E
L, S
L2
•4
5.3
Co-o
rdin
ate
and
plan
pati
ent t
rans
fer
5.3.
1De
scrib
e th
e pr
inci
ples
of p
lann
ing
and
co-o
rdin
ating
pa
tient
tran
sfer
UK
DR, L
T, SL
, DP,
CL
, EL
1 (b
)•
•1
5.3.
2De
scrib
e th
e pr
inci
ples
det
erm
inin
g de
stina
tion
hosp
ital
sele
ction
UK
1 (a
)•
•1
THEME 5 123
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Them
e 5.
Sup
porti
ng s
afe
pati
ent t
rans
fer
5.3
Co-o
rdin
ate
and
plan
pati
ent t
rans
fer
(con
t.)
5.3.
3Li
st th
e eq
uipm
ent r
equi
red
for p
re-h
ospi
tal a
nd in
ter-
faci
lity
tran
sfer
UK
DR, L
T, SL
, DP
, CL,
EL
1 (a
)•
•1
5.3.
4De
mon
stra
te th
e ab
ility
to re
conc
ile th
e ris
ks a
nd
bene
fits o
f tra
nsfe
rTS
LT, S
L,
DP, C
L,
EL
1 (b
)•
••
•1
5.3.
5De
mon
stra
te th
e ab
ility
to d
eter
min
e co
nsum
able
re
sour
ce re
quire
men
ts fo
r tra
nsfe
rTS
1 (b
)•
••
•1
5.3.
6De
mon
stra
te c
o-or
dina
tion
of e
xten
ded
pre-
hosp
ital
tran
sfer
TS2
••
••
1
5.3.
7De
mon
stra
te c
o-or
dina
tion
of e
mer
genc
y in
ter-f
acili
ty
tran
sfer
TS2
••
••
1
5.3.
8De
mon
stra
te a
pro
fess
iona
l app
roac
h to
the
plan
ning
an
d co
-ord
inati
on o
f pati
ent t
rans
fer
NTS
RM, E
L,
SL, R
P
1 (b
)•
••
•4
5.3.
9De
mon
stra
te th
e ab
ility
to a
ckno
wle
dge
futil
ity a
nd
avoi
d in
appr
opria
te in
ter-f
acili
ty tr
ansf
erN
TS1
(b)
••
••
4
5.4
Prep
are
patie
nts
for t
rans
port
5.4.
1Li
st st
rate
gies
for o
ptim
ising
a p
atien
t’s p
hysio
logy
pr
ior t
o tr
ansf
erU
KDR
, LT,
SL, C
L,
EL
1 (b
)•
•1
5.4.
2De
scrib
e pr
e-tr
ansf
er m
easu
res t
o m
inim
ise ri
sks t
o pa
tient
s dur
ing
tran
sfer
U
K1
(b)
••
2
5.4.
3De
mon
stra
te a
bilit
y to
det
erm
ine
whe
n pa
tient
s are
in
thei
r opti
mum
clin
ical
con
ditio
n fo
r tra
nsfe
r TS
LT, S
L,
CL, D
P,
EL
1 (b
)•
••
1
5.4.
4De
mon
stra
te c
orre
ct p
repa
ratio
n of
pati
ents
for s
afe
pre-
hosp
ital t
rans
fer
TS2
••
•1
5.4.
5De
mon
stra
te c
orre
ct p
repa
ratio
n of
pati
ents
for s
afe
inte
r-fac
ility
tran
sfer
TS2
••
•1
5.4.
6De
mon
stra
te a
pro
fess
iona
l app
roac
h to
pre
para
tion
of p
atien
ts fo
r tra
nsfe
rN
TSRM
, SL,
EL
, RP
1 (b
)•
••
•4
DRDi
rect
ed R
eadi
ngLT
Lect
ures
and
Tut
oria
lsDP
Delib
erat
e Pr
actic
eSL
Sim
ulati
on L
earn
ing
RPRe
flecti
ve P
racti
ceRM
Role
Mod
elin
gCL
Colla
bora
tive
Lear
ning
ELEx
perie
ntial
Lea
rnin
g
THEME 5 124
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Them
e 5.
Sup
porti
ng s
afe
pati
ent t
rans
fer
5.5
Util
ise a
rang
e of
pati
ent t
rans
port
m
odal
ities
5.5.
1Ca
tego
rise
patie
nt tr
ansp
ort m
odal
ities
UK
DR, L
T, SL
, CL,
EL
1 (b
)•
•1
5.5.
2Di
ffere
ntiat
e th
e ris
ks a
nd b
enefi
ts o
f roa
d, h
elic
opte
r, fix
ed w
ing
and
othe
r tra
nspo
rt m
odal
ities
UK
2•
•1
5.5
Util
ise a
rang
e of
pati
ent t
rans
port
m
odal
ities
(con
t.)
5.5.
3De
scrib
e th
e tr
aini
ng re
quire
men
ts fo
r per
sonn
el
esco
rting
pati
ents
acc
ordi
ng to
tran
spor
t mod
ality
UK
DR, L
T, SL
, CL,
EL
1 (b
)•
•1
5.5.
4De
scrib
e th
e ris
ks, b
enefi
ts a
nd le
gal c
onst
rain
ts
pert
aini
ng to
tra
nspo
rting
rela
tives
UK
2•
•1
5.5.
5De
mon
stra
te th
e ab
ility
to tr
ansf
er p
atien
ts u
sing
a ra
nge
of tr
ansp
ort m
odal
ities
TSLT
, SL,
EL
, DP
2•
••
1
5.5.
6De
mon
stra
te a
pro
fess
iona
l app
roac
h to
the
use
of
diffe
rent
tran
spor
t mod
aliti
esN
TSRM
, SL,
EL,
CL
, RP
2•
••
4
5.6
Clin
ical
ly m
anag
e pa
tient
s dur
ing
tran
spor
t
5.6.
1 Cr
itiqu
e th
e m
inim
um st
anda
rds f
or m
onito
ring
durin
g tr
ansf
er
UK
DR, L
T, SL
, CL,
EL
1 (b
)•
••
•1
5.6.
2De
scrib
e th
e in
terv
entio
ns w
hich
can
be
unde
rtak
en
durin
g tr
ansf
er
UK
1 (b
)•
•1
5.6.
3De
scrib
e th
e co
mm
on p
robl
ems e
xper
ienc
ed d
urin
g pa
tient
tran
sfer
U
K1
(b)
••
1
5.6.
4
Des
crib
e th
e sp
ecifi
c cl
inic
al m
anag
emen
t of
the
fo
llow
ing
pati
ent g
roup
s be
fore
and
dur
ing
pre-
hosp
ital
or
emer
genc
y in
ter-
faci
lity
tran
sfer
(a) P
atien
ts w
ith m
ajor
hea
d in
jurie
sU
K
DR, L
T, SL
, CL,
EL
1 (b
)•
••
•1
(b) P
atien
ts w
ith c
onta
giou
s dise
ases
UK
2•
••
•1
(c) P
atien
ts w
ith u
nsta
ble
spin
al o
r pel
vic
frac
ture
sU
K1
(b)
••
••
1
(d) P
atien
ts w
ith m
ajor
bur
nsU
K1
(b)
••
••
1
(e) P
atien
ts w
ith si
ngle
org
an/s
yste
m fa
ilure
UK
1 (b
)•
••
•1
(f) P
atien
ts w
ith m
ultip
le o
rgan
/sys
tem
failu
reU
K2
••
••
1
(g) P
atien
ts w
ho a
re p
regn
ant
UK
2•
••
•1
(h) P
atien
ts w
ho a
re c
hild
ren
UK
2•
••
•1
THEME 5 125
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Them
e 5.
Sup
porti
ng s
afe
pati
ent t
rans
fer
5.6
Clin
ical
ly m
anag
e pa
tient
s dur
ing
tran
spor
t(c
ont.)
5.6.
4co
nt.
(i) P
atien
ts w
ho a
re in
fant
sU
KDR
, LT,
SL, C
L,
EL
2•
••
•1
(j) P
atien
ts w
ho a
re n
ewbo
rnU
K2
••
••
1
(k) P
atien
ts w
ith a
cute
beh
avio
ural
dist
urba
nce
UK
2•
••
•1
5.6.
5De
mon
stra
te a
ppro
pria
te c
hoic
es o
f sed
ation
, mus
cle
rela
xatio
n an
d an
alge
sia to
mai
ntai
n th
e pa
tient
’s cl
inic
al st
atus
dur
ing
tran
sfer
(for
all
age
grou
ps)
TS
LT, S
L,
EL, D
P
2•
••
••
1
5.6.
6De
mon
stra
te th
e sa
fe p
re-h
ospi
tal t
rans
fer o
f all
age
grou
ps o
f ven
tilat
ed p
atien
tsTS
1 (b
)•
••
•1
5.6.
7De
mon
stra
te th
e sa
fe in
ter-f
acili
ty tr
ansf
er o
f all
age
grou
ps o
f ven
tilat
ed p
atien
tsTS
2•
••
•1
5.6.
8De
mon
stra
te a
ccur
ate
clin
ical
reco
rds b
efor
e, d
urin
g an
d aft
er tr
ansf
er
TS1
(b)
••
••
1
5.6.
9De
mon
stra
te th
e ab
ility
to m
aint
ain
mon
itorin
g of
vi
tal s
igns
thro
ugho
ut tr
ansf
er
TS1
(b)
••
••
1
5.6.
10
Dem
onst
rate
the
abi
lity
to m
anag
e su
dden
in-t
rans
it
loss
of
(a) a
irway
con
trol
TS
LT, S
L,
EL, D
P
1 (b
)•
••
•1
(b) o
xyge
nTS
1 (b
)•
••
•1
(c) v
ascu
lar a
cces
sTS
1 (b
)•
••
•1
(d) m
onito
ring
TS1
(b)
••
••
1
(e) i
nfus
ions
TS1
(b)
••
••
1
(f) p
ower
TS1
(b)
••
••
1
5.6.
11De
mon
stra
te a
pro
fess
iona
l app
roac
h to
the
clin
ical
m
anag
emen
t of p
atien
ts u
nder
goin
g pr
e-ho
spita
l or
emer
gent
inte
r-fac
ility
tran
sfer
NTS
RM, E
L,SL
, RP
1 (b
)•
••
••
4
DRDi
rect
ed R
eadi
ngLT
Lect
ures
and
Tut
oria
lsDP
Delib
erat
e Pr
actic
eSL
Sim
ulati
on L
earn
ing
RPRe
flecti
ve P
racti
ceRM
Role
Mod
elin
gCL
Colla
bora
tive
Lear
ning
ELEx
perie
ntial
Lea
rnin
g
THEME 6 127
Good Medical Practice
Working in Emergency
Medical Systems
Providing pre-hospital
Emergency Medical Care
Using pre-hospital
equipment
Supporting rescue and extrication
Supporting safe patient
transfer
Supporting emergency
preparedness and response
THEME 6. SUPPORTING EMERGENCY PREPAREDNESS AND RESPONSEThis theme encompasses the competences required to ensure that practitioners are appropriately prepared and equipped for larger scale emergency incidents in terms of their understanding of emergency planning and the principles of major incident management.
UNITS6.1 Understand principles of emergency preparedness, response and recovery6.2 Respond to emergencies at operational (bronze) level6.3 Respond to emergencies at tactical (silver) level6.4 Manage chemical, biological and radiological emergencies6.5 Understand the psychosocial and mental health aspects of multiple casualty incidents
Related GMP domains are assigned to each group of elements within units as follows:1. Knowledge skills and performance2. Safety and quality3. Communication, partnership and teamwork4. Maintaining trust
THEME 6 128
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Them
e 6.
Sup
porti
ng e
mer
genc
y pr
epar
edne
ss a
nd re
spon
se
6.1
Und
erst
and
prin
cipl
es o
f em
erge
ncy
prep
ared
ness
, re
spon
se a
nd
reco
very
6.1.
1
Defi
ne, i
n th
e co
nte
t of
em
erge
ncy
plan
ning
(a) p
repa
redn
ess,
U
K
DR, L
T,SL
, CL,
EL
1 (b
)•
•2
(b) r
espo
nse
UK
1 (b
)•
•2
(c) r
ecov
ery
UK
1 (b
)•
•2
6.1.
2De
scrib
e cu
rren
t nati
onal
gui
danc
e an
d le
gisla
tion
in
rela
tion
to e
mer
genc
y pr
epar
edne
ss a
nd re
spon
seU
K1
(b)
••
1
6.1.
3Ca
tego
rise
clas
ses o
f maj
or in
cide
ntU
K1
(b)
••
•1
6.1.
4Li
st th
e ca
pabi
lities
of s
ervi
ces a
nd a
genc
ies i
nvol
ved
in e
mer
genc
y pr
epar
edne
ss, r
espo
nse
and
reco
very
U
K1
(b)
••
1
6.1.
5
Criti
ue th
e po
ssib
le ro
les
of th
e Su
b-Sp
ecia
list
in
PHEM
at t
he
(a) o
pera
tiona
l (br
onze
) lev
el
UK
DR, L
T,SL
, CL,
EL
1 (b
)•
•1
(b) t
actic
al (s
ilver
) lev
elU
K1
(b)
••
1
(c) s
trat
egic
(gol
d) le
vel
UK
1 (b
)•
•1
6.1.
6Cr
itiqu
e le
sson
s ide
ntifie
d fr
om h
istor
ical
maj
or
inci
dent
s U
K2
••
•1
6.1.
7Cr
itiqu
e th
e ro
le o
f the
hea
lth se
rvic
es in
the
mul
ti-ag
ency
maj
or in
cide
ntU
K2
••
•1
6.1.
8Cr
itiqu
e th
e et
hica
l iss
ues s
urro
undi
ng d
ecisi
on-
mak
ing
durin
g a
heal
th m
ajor
inci
dent
UK
2•
••
4
6.1.
9De
mon
stra
te th
e ab
ility
to p
repa
re a
gen
eric
maj
or
inci
dent
pla
nTS
LT, S
L,
CL, E
L,
DP
2•
••
2
6.1.
10De
mon
stra
te th
e ap
plic
ation
of t
he p
rinci
ples
of
emer
genc
y pr
epar
edne
ss a
nd re
spon
se
TS2
••
2
THEME 6 129
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Them
e 6.
Sup
porti
ng e
mer
genc
y pr
epar
edne
ss a
nd re
spon
se
6.2
Resp
ond
to
emer
genc
ies a
t op
erati
onal
(bro
nze)
le
vel
6.2.
1Cr
itiqu
e th
e ra
nge
of sk
ills r
equi
red
by h
ealth
serv
ice
pers
onne
l for
an
effec
tive
maj
or in
cide
nt re
spon
seU
KDR
, LT,
SL,
CL, E
L2
••
3
6.2.
2
List
the
duti
es o
f the
ope
rati
onal
leve
l
(a) M
edic
al C
omm
ande
rU
K
DR, L
T, SL
, CL
, EL
1 (b
)•
•1
(b) A
mbu
lanc
e Co
mm
ande
rU
K1
(b)
••
1
(c) F
ire C
omm
ande
rU
K1
(b)
••
1
(d) P
olic
e Co
mm
ande
rU
K1
(b)
••
1
6.2.
3De
scrib
e th
e po
licie
s and
pro
cedu
res r
elati
ng to
op
erati
onal
leve
l med
ical
staff
with
in th
e EM
S sy
stem
UK
1 (b
)•
•1
6.2.
4De
scrib
e th
e pr
inci
ples
of t
riage
UK
1 (b
)•
•1
6.2.
5Cr
itiqu
e co
mm
only
use
d tr
iage
tool
sU
K1
(b)
••
•1
6.2.
6De
scrib
e th
e co
mpo
nent
s of i
ncid
ent d
ebrie
fing
UK
1 (b
)•
•1
6.2.
7De
mon
stra
te fa
mili
arity
with
pol
icie
s and
pro
cedu
res
for o
pera
tiona
l lev
el m
edic
al c
omm
and
TS
DR, L
T, DP
, SL
, EL
1 (b
)•
••
•1
6.2.
8De
mon
stra
te th
e ab
ility
to m
aint
ain
a co
mpr
ehen
sive
deci
sion
log
TS1
(b)
••
•1
6.2.
9De
mon
stra
te th
e ab
ility
to a
ppro
pria
tely
use
tria
ge
tool
sTS
1 (b
)•
••
1
6.2.
10De
mon
stra
te th
e ab
ility
to c
ompe
tent
ly p
erfo
rm th
e ro
le o
f an
oper
ation
al le
vel m
edic
al c
omm
ande
rTS
1 (b
)•
••
•3
6.2.
11De
mon
stra
te p
artic
ipati
on in
inci
dent
deb
riefin
gTS
1 (b
)•
••
•3
6.2.
12De
mon
stra
te th
e et
hica
l app
licati
on o
f tria
geN
TS
RM, E
L,
SL, R
P
1 (b
)•
••
•1
6.2.
13De
mon
stra
te c
onfid
ence
in u
nder
taki
ng tr
iage
NTS
1 (b
)•
••
•1
6.2.
14De
mon
stra
te c
onfid
ence
in th
e pe
rform
ance
of t
he
role
of t
he o
pera
tiona
l lev
el m
edic
al c
omm
ande
rN
TS1
(b)
••
••
3
DRDi
rect
ed R
eadi
ngLT
Lect
ures
and
Tut
oria
lsDP
Delib
erat
e Pr
actic
eSL
Sim
ulati
on L
earn
ing
RPRe
flecti
ve P
racti
ceRM
Role
Mod
elin
gCL
Colla
bora
tive
Lear
ning
ELEx
perie
ntial
Lea
rnin
g
THEME 6 130
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Them
e 6.
Sup
porti
ng e
mer
genc
y pr
epar
edne
ss a
nd re
spon
se
6.3
Resp
ond
to
emer
genc
ies a
t ta
ctica
l (sil
ver)
leve
l
6.3.
1
List
the
duti
es o
f the
tacti
cal l
evel
(a) M
edic
al C
omm
ande
rU
K
DR, L
T, SL
, RP,
CL
, EL
2•
•1
(b) A
mbu
lanc
e Co
mm
ande
rU
K2
••
1
(c) F
ire C
omm
ande
rU
K2
••
1
(d) P
olic
e Co
mm
ande
rU
K2
••
1
6.3.
2De
scrib
e th
e po
licie
s and
pro
cedu
res r
elati
ng to
ta
ctica
l lev
el m
edic
al st
aff w
ithin
the
EMS
syst
emU
K2
••
1
6.3.
3Cr
itiqu
e th
e ro
le p
laye
d by
the
med
ia a
t maj
or
inci
dent
s U
K2
••
1
6.3.
4Cr
itiqu
e le
sson
s ide
ntifie
d re
latin
g to
tacti
cal
com
man
d of
hist
oric
al m
ajor
inci
dent
sU
K2
••
•2
6.3.
5
Criti
ue s
trat
egie
s fo
r m
anag
ing
(a) A
mul
ti-se
ctor
inci
dent
UK
DR, L
T, SL
, RP,
CL
, EL
2•
••
3
(b) A
cas
ualty
cle
arin
g st
ation
UK
2•
••
1
(c) A
surv
ivor
rece
ption
cen
tre
UK
2•
••
3
(d) T
he d
ecea
sed
UK
2•
•4
(e) C
omm
unic
ation
UK
2•
•3
(f) M
ulti-
disc
iplin
ary
brie
fings
UK
2•
•3
(g) S
usta
inab
ility
UK
2•
•3
THEME 6 131
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Them
e 6.
Sup
porti
ng e
mer
genc
y pr
epar
edne
ss a
nd re
spon
se
6.3
Resp
ond
to
emer
genc
ies a
t ta
ctica
l (sil
ver)
leve
l (c
ont)
6.3.
6De
mon
stra
te fa
mili
arity
with
pol
icie
s and
pro
cedu
res
for t
actic
al le
vel m
edic
al c
omm
and
TS
LT, S
L,
DP, R
P,
CL, E
L
2•
••
••
1
6.3.
7De
mon
stra
te th
e ab
ility
to m
aint
ain
a co
mpr
ehen
sive
deci
sion
log
TS2
••
•1
6.3.
8De
mon
stra
te th
e ab
ility
to c
ompe
tent
ly p
erfo
rm th
e ro
le o
f a ta
ctica
l lev
el m
edic
al c
omm
ande
rTS
2•
••
1
6.3.
9
Dem
onst
rate
the
abi
lity
to m
anag
e
(a) A
mul
ti-se
ctor
inci
dent
TS
LT, S
L,
DP, R
P,
CL, E
L
2•
••
3
(b) A
cas
ualty
cle
arin
g st
ation
TS2
••
•1
(c) A
surv
ivor
rece
ption
cen
tre
TS2
••
•3
(d) T
he d
ecea
sed
TS2
••
•4
(e) C
omm
unic
ation
TS2
••
•3
(f) M
ulti-
disc
iplin
ary
brie
fings
TS2
••
•3
(g) S
usta
inab
ility
TS2
••
•3
6.3.
10De
mon
stra
te a
bilit
y to
con
duct
an
inci
dent
deb
riefin
gTS
2•
••
3
6.4
Man
age
chem
ical
, bi
olog
ical
and
ra
diol
ogic
al (C
BR)
emer
genc
ies
6.4.
1Cr
itiqu
e le
sson
s ide
ntifie
d fr
om p
revi
ous C
BR
inci
dent
s with
in th
e EM
S sy
stem
UK
DR, L
T, SL
, CL
,EL
2•
••
1
6.4.
2Li
st so
urce
s of C
BR a
gent
adv
ice
UK
2•
••
1
6.4.
3De
scrib
e th
e in
itial
app
roac
h to
a su
spec
ted
CBR
inci
dent
UK
2•
••
1
6.4.
4Co
ntra
st th
e pr
inci
ples
of d
etec
tion
and
iden
tifica
tion
of C
BR a
gent
sU
K2
••
•1
6.4.
5De
scrib
e th
e le
vels
of P
erso
nal P
rote
ctive
Equ
ipm
ent
used
for p
re-h
ospi
tal C
BR in
cide
nts
UK
2•
••
1
6.4.
6De
scrib
e th
e pr
e-ho
spita
l tria
ge p
roce
sses
for p
atien
ts
invo
lved
in C
BR in
cide
nts
UK
2•
••
1
THEME 6 132
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Them
e 6.
Sup
porti
ng e
mer
genc
y pr
epar
edne
ss a
nd re
spon
se
6.4
Man
age
chem
ical
, bi
olog
ical
and
ra
diol
ogic
al (C
BR)
emer
genc
ies
(con
t)
6.4.
7De
scrib
e th
e di
ffere
nces
in tr
iage
for C
BR in
cide
nts
UK
DR, L
T, SL
, CL
, EL
2•
••
1
6.4.
8
Desc
ribe
the
capa
biliti
es o
f pre
-hos
pita
l:
(a) C
hem
ical
det
ectio
nU
KDR
, LT,
SL,
CL, E
L
2•
••
1
(b) B
iolo
gica
l det
ectio
nU
K2
••
•1
(c) R
adia
tion
dete
ction
UK
2•
••
1
6.4.
9
Des
crib
e th
e cl
inic
al fe
atur
es o
f
(a) C
hem
ical
age
nt e
xpos
ure
synd
rom
esU
KDR
, LT,
SL,
CL, E
L
2•
••
1
(b) B
iolo
gica
l age
nt e
xpos
ure
synd
rom
esU
K2
••
•1
(c) R
adia
tion
agen
t exp
osur
e sy
ndro
mes
UK
2•
••
1
6.4.
10
Des
crib
e th
e pr
e-ho
spit
al m
anag
emen
t of
(a) C
hem
ical
age
nt e
xpos
ure
synd
rom
esU
K
DR, L
T, SL
, CL
, EL
2•
••
1
(b) B
iolo
gica
l age
nt e
xpos
ure
synd
rom
esU
K2
••
•1
(c) R
adia
tion
agen
t exp
osur
e sy
ndro
mes
UK
2•
••
1
6.4.
11De
scrib
e st
rate
gies
for p
re-h
ospi
tal d
econ
tam
inati
onU
K2
••
•2
6.4.
12De
mon
stra
te sa
fe a
ppro
ach
to a
susp
ecte
d CB
R ag
ent
inci
dent
TSLT
, DP,
SL,
CL
, EL
2•
••
2
6.4.
13De
mon
stra
te c
orre
ct se
lecti
on a
nd u
se o
f PPE
for
initi
al m
anag
emen
t of a
susp
ecte
d CB
R ag
ent i
ncid
ent
TS2
••
•2
6.4.
14
Dem
onst
rate
the
pre-
hosp
ital c
linic
al m
anag
emen
t of
(a) C
hem
ical
age
nt e
xpos
ure
synd
rom
esTS
LT, D
P, S
L,
CL, E
L
2•
••
1
(b) B
iolo
gica
l age
nt e
xpos
ure
synd
rom
esTS
2•
••
1
(c) R
adia
tion
agen
t exp
osur
e sy
ndro
mes
TS2
••
•1
6.4.
15De
mon
stra
te re
silie
nce
wor
king
with
in a
CBR
con
text
NTS
RM, R
P,
SL, E
L2
••
•3
THEME 6 133
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Them
e 6.
Sup
porti
ng e
mer
genc
y pr
epar
edne
ss a
nd re
spon
se
6.5
Und
erst
and
the
psyc
hoso
cial
and
m
enta
l hea
lth a
spec
ts
of m
ultip
le c
asua
lty
inci
dent
s
6.5.
1De
mon
stra
te u
nder
stan
ding
of k
ey te
rms u
sed
in
psyc
hoso
cial
and
men
tal h
ealth
car
e of
em
erge
ncie
s an
d m
ajor
inci
dent
sU
K
DR, L
T, SL
, CL,
EL
2•
•1
6.5.
2De
scrib
e th
e de
finin
g na
ture
of e
vent
s and
ci
rcum
stan
ces t
hat a
re p
sych
osoc
ially
trau
mati
cU
K2
••
3
6.5.
3De
scrib
e th
e co
mm
on p
sych
osoc
ial r
espo
nses
of
peop
le a
ffect
ed b
y, or
invo
lved
in, e
mer
genc
ies a
nd
maj
or in
cide
nts
UK
2•
••
1
6.5.
4De
scrib
e th
e co
mm
on c
opin
g m
echa
nism
s tha
t pe
ople
of a
ll ag
es u
se w
hen
face
d w
ith e
vent
s tha
t ca
use
seve
re st
ress
UK
2•
••
1
6.5.
5De
fine
psyc
hoso
cial
resil
ienc
e in
the
cont
ext o
f tr
aum
atic
even
ts a
nd c
ircum
stan
ces a
nd it
s per
sona
l an
d co
llecti
ve d
imen
sions
UK
2•
••
1
6.5.
6De
mon
stra
te a
n un
ders
tand
ing
of th
e na
ture
of
dist
ress
and
its d
iffer
entia
tion
from
men
tal d
isord
ers
UK
2•
••
1
6.5.
7De
scrib
e in
out
line
the
evid
ence
-bas
ed p
rinci
ples
for
psyc
hoso
cial
and
men
tal h
ealth
car
e fo
r peo
ple
who
ar
e aff
ecte
d by
em
erge
ncie
s and
maj
or in
cide
nts
UK
2•
••
1
6.5.
8Cr
itiqu
e lo
cal,
natio
nal a
nd in
tern
ation
al g
uide
lines
on
men
tal h
ealth
and
psy
chos
ocia
l sup
port
in e
mer
genc
y se
tting
sU
K2
••
•1
6.5.
9De
mon
stra
te th
e ab
ility
to co
nduc
t ini
tial p
sych
osoc
ial
asse
ssm
ents
in a
rang
e of
pre
-hos
pita
l env
ironm
ents
TSLT
, SL,
RP
, RM
, CL
, EL
2•
••
3
6.5.
10De
mon
stra
te th
e ab
ility
to id
entif
y pa
tient
s who
may
re
quire
urg
ent s
peci
alist
men
tal h
ealth
car
eTS
2•
••
3
134
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Them
e 6.
Sup
porti
ng e
mer
genc
y pr
epar
edne
ss a
nd re
spon
se
6.5
Und
erst
and
the
psyc
hoso
cial
and
m
enta
l hea
lth a
spec
ts
of m
ultip
le c
asua
lty
inci
dent
s(c
ont)
6.5.
11
Dem
onst
rate
, in
the
cont
et
of in
tera
cting
wit
h pe
rson
s in
volv
ed in
em
erge
ncie
s an
d m
aor
in
cide
nts
(a) A
ctive
list
enin
gTS
LT, S
L,
RP, R
M,
CL, E
L
2•
••
3
(b) A
bilit
y to
diff
eren
tiate
dist
ress
from
diso
rder
TS2
••
•1
(c) A
ction
s to
avoi
d ad
vers
e ps
ycho
logi
cal r
eacti
ons
(incl
udin
g pa
nic)
TS2
••
•4
6.5.
12De
mon
stra
te a
bilit
y to
gai
n ac
cess
to a
ppro
pria
te
imm
edia
te p
sych
osoc
ial s
uppo
rtTS
2•
••
2
6.5.
13Di
spla
y aw
aren
ess o
f per
sona
l psy
chos
ocia
l cop
ing
stra
tegi
es a
nd n
eeds
NTS
RM
2•
••
3
6.5.
14Di
spla
y a
prof
essio
nal a
ppro
ach
to c
onsid
erati
on o
f ps
ycho
soci
al a
nd m
enta
l hea
lth a
spec
ts o
f mul
tiple
ca
sual
ty in
cide
nts
NTS
2•
••
3
THEME 6
DRDi
rect
ed R
eadi
ngLT
Lect
ures
and
Tut
oria
lsDP
Delib
erat
e Pr
actic
eSL
Sim
ulati
on L
earn
ing
RPRe
flecti
ve P
racti
ceRM
Role
Mod
elin
gCL
Colla
bora
tive
Lear
ning
ELEx
perie
ntial
Lea
rnin
g
135CROSS-CUTTING THEME A
CROSS-CUTTING THEME A. OPERATIONAL PRACTICEMaintaining safe and effective operational practice is a generic or cross-cutting theme of professional practice within PHEM. This theme concerns the knowledge, skills and non-technical skills required to maintain safe and effective operational practice within a pre-hospital emergency medicine service provider.
UNITSA.1 Apply the curriculum framework to local operationsA.2 Respond to incidents by roadA.3 Respond to incidents by air A.4 Utilise telecommunications and voice procedureA.5 Apply principles of dynamic risk assessment at incident scenesA.6 Provide scene managementA.7 Maintain recordsA.8 Apply infection prevention and control principles and proceduresA.9 Apply moving and handling principles and proceduresA.10 Apply principles of Equality and Diversity
Related GMP domains are assigned to each group of elements within units as follows:1. Knowledge skills and performance2. Safety and quality3. Communication, partnership and teamwork4. Maintaining trust
Good Medical Practice
Working in Emergency
Medical Systems
Providing pre-hospital
Emergency Medical Care
Using pre-hospital
equipment
Supporting rescue and extrication
Supporting safe patient
transfer
Supporting emergency
preparedness and response
CROSS-CUTTING THEME A 136
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Cros
s-cu
ng T
hem
e A
. Ope
rati
onal
pra
ctice
A.1
Appl
y th
e cu
r-ric
ulum
fram
ewor
k to
lo
cal o
pera
tions
A.1.
1
Criti
ue h
ow y
our
loca
l PH
EM o
pera
tion
(a) W
orks
with
in th
e EM
S sy
stem
UK
DR, L
T, CL
1 (b
)•
••
3
(b) P
rovi
des P
re-h
ospi
tal E
mer
genc
y M
edic
al C
are
UK
1 (b
)•
••
1
(c) U
ses P
re-h
ospi
tal E
quip
men
tU
K1
(b)
••
•1
(d) S
uppo
rts R
escu
e an
d Ex
tric
ation
UK
1 (b
)•
••
1
(e) S
uppo
rts s
afe
patie
nt tr
ansf
erU
K1
(b)
••
•1
(f) S
uppo
rts e
mer
genc
y pr
epar
edne
ss a
nd re
spon
seU
K1
(b)
••
•2
A.1.
2
Des
crib
e th
e pr
ovis
ions
wit
hin
your
loca
l PH
EM
oper
ation
for
(a) T
eam
reso
urce
man
agem
ent
UK
DR, L
T, CL
1 (b
)•
••
3
(b) C
linic
al g
over
nanc
eU
K1
(b)
••
•2
A.1.
3
Des
crib
e th
e di
sting
uish
ing
feat
ures
of y
our
loca
l PH
EM o
pera
tion
wit
h re
spec
t to
(a) E
pide
mio
logy
UK
DR, L
T, CL
1 (b
)•
••
1
(b) T
he E
MS
syst
emU
K1
(b)
••
•1
(c) C
once
pt o
f ope
ratio
nsU
K1
(b)
••
•1
(d) O
pera
tiona
l env
ironm
ent
UK
1 (b
)•
••
1
(e) S
taffi
ng a
nd sk
ill m
ixU
K1
(b)
••
•3
(f) T
rans
port
pla
tform
s U
K1
(b)
••
•1
CROSS-CUTTING THEME A 137
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Cros
s-cu
ng T
hem
e A
. Ope
rati
onal
pra
ctice
A.2
Resp
ond
to
inci
dent
s by
road
A.2.
1Cr
itiqu
e th
e ris
ks a
nd b
enefi
ts o
f res
pond
ing
by ro
adU
K
DR, L
T, SL
1 (b
)•
••
•2
A.2.
2Cr
itiqu
e th
e ro
le o
f the
co-
driv
er w
hen
usin
g em
erge
ncy
driv
ing
proc
edur
eU
K1
(b)
••
••
2
A.2.
3Cr
itiqu
e th
e be
nefit
s and
lim
itatio
ns o
f diff
erin
g ro
ad
tran
spor
t pla
tform
s with
in th
e EM
S sy
stem
UK
1 (b
)•
••
•1
A.2.
4De
mon
stra
te th
e ab
ility
to a
ct a
s an
effec
tive
co-
driv
er w
hen
resp
ondi
ng b
y ro
adTS
1 (b
)•
••
2
A.2.
5De
mon
stra
te th
e ab
ility
to u
nder
take
a ri
sk
asse
ssm
ent r
elat
ed to
resp
ondi
ng b
y ro
adTS
1 (b
)•
••
2
A.3
Resp
ond
to
inci
dent
s by
air
A.3.
1Cr
itiqu
e th
e ris
ks a
nd b
enefi
ts o
f res
pond
ing
by a
irU
KDR
, LT,
SL1
(b)
••
••
2
A.3.
2
Criti
ue th
e ro
le a
nd re
spon
sibi
lities
of
(a) A
ircre
wU
K
DR, L
T, SL
1 (b
)•
••
1
(b) H
EMS
Crew
Mem
ber
UK
1 (b
)•
••
1
(c) M
edic
al P
asse
nger
UK
1 (b
)•
••
1
A.3.
3De
fine
com
mon
term
s use
d in
avi
ation
in c
onte
xt o
f ac
ting
as a
med
ical
pas
seng
erU
K1
(b)
••
•1
A.3.
4De
scrib
e th
e cr
iteria
for a
hel
icop
ter l
andi
ng si
teU
K1
(b)
••
•2
A.3.
5Di
ffere
ntiat
e th
e te
rms ‘
Air A
mbu
lanc
e’ a
nd ‘H
EMS’
UK
1 (b
)•
•1
A.3.
6De
scrib
e th
e re
gula
tions
per
tain
ing
to H
EMS
and
air
ambu
lanc
e de
ploy
men
tU
K1
(b)
••
2
A.3.
7Cr
itiqu
e th
e ev
iden
ce re
gard
ing
the
role
of h
elic
opte
rs
with
in E
MS
syst
ems
UK
2•
••
1
A.3.
8An
alys
e th
e be
nefit
s and
lim
itatio
ns o
f diff
erin
g ai
r tr
ansp
ort p
latfo
rms w
ithin
the
EMS
syst
emU
K1
(b)
••
••
1
DRDi
rect
ed R
eadi
ngLT
Lect
ures
and
Tut
oria
lsDP
Delib
erat
e Pr
actic
eSL
Sim
ulati
on L
earn
ing
RPRe
flecti
ve P
racti
ceRM
Role
Mod
elin
gCL
Colla
bora
tive
Lear
ning
ELEx
perie
ntial
Lea
rnin
g
CROSS-CUTTING THEME A 138
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Cros
s-cu
ng T
hem
e A
. Ope
rati
onal
pra
ctice
A.3
Resp
ond
to
inci
dent
s by
air
(con
t.)
A.3.
9De
scrib
e th
e co
nten
t of a
pre
-dep
loym
ent b
rief t
o a
med
ical
pas
seng
erU
KDR
, LT,
SL1
(b)
••
•2
A.3.
10De
mon
stra
te th
e sa
fe e
mba
rkati
on a
nd
dise
mba
rkati
on o
f an
airc
raft
TSSL
, RM
1 (b
)•
••
2
A.3.
11De
mon
stra
te th
e ab
ility
to a
ct a
s an
effec
tive
and
safe
m
edic
al p
asse
nger
whe
n re
spon
ding
by
air
TS1
(b)
••
••
2
A.4
Util
ise
tele
com
mun
icati
ons
and
voic
e pr
oced
ure
A.4.
1De
scrib
e th
e ph
oneti
c al
phab
etU
K
DR, L
T, DP
, SL
1 (b
)•
••
•1
A.4.
2Cr
itiqu
e th
e uti
lity
of fo
rmal
voi
ce p
roce
dure
with
in
effec
tive
tele
com
mun
icati
ons
UK
2•
•3
A.4.
3Cr
itiqu
e th
e ch
alle
nges
to e
ffecti
ve
tele
com
mun
icati
ons i
n th
e pr
e-ho
spita
l env
ironm
ent
UK
2•
•3
A.4.
4Cr
itiqu
e th
e in
frast
ruct
ure
for t
elec
omm
unic
ation
s w
ithin
the
EMS
syst
emU
K2
••
3
A.4.
5De
mon
stra
te th
e eff
ectiv
e us
e of
com
mon
stan
dard
te
leco
mm
unic
ation
pro
cedu
res w
ithin
the
EMS
syst
emTS
DP, S
L,
RM, E
L
1 (b
)•
••
3
A.4.
6De
mon
stra
te th
e ab
ility
to p
ass c
ompl
ex m
essa
ges i
n a
clea
r and
effi
cien
t man
ner
TS1
(b)
••
•3
A.5
Appl
y pr
inci
ples
of
dyn
amic
risk
as
sess
men
t at
inci
dent
scen
es
A.5.
1Ex
plai
n th
e co
ncep
t of g
ener
ic ri
sk a
sses
smen
tU
K
DR, L
T
2•
••
2
A.5.
2De
scrib
e th
e pr
inci
ples
of d
ynam
ic ri
sk a
sses
smen
tU
K2
••
•2
A.5.
3De
scrib
e th
e re
latio
nshi
p be
twee
n ge
neric
and
dy
nam
ic ri
sk a
sses
smen
tU
K2
••
•2
A.5.
4De
scrib
e ho
w d
ynam
ic ri
sk a
sses
smen
t may
influ
ence
de
cisio
n m
akin
g re
late
d to
pati
ent c
are
UK
2•
••
1
A.5.
5De
mon
stra
te th
e ap
plic
ation
of d
ynam
ic ri
sk
asse
ssm
ent t
o a
rang
e of
inci
dent
sTS
DR, L
T,
SL, E
L2
••
2
A.5.
6De
mon
stra
te th
e m
enta
l agi
lity
to p
erfo
rm d
ynam
ic
risk
asse
ssm
ent
TSDP
, RP
2•
•2
CROSS-CUTTING THEME A 139
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Cros
s-cu
ng T
hem
e A
. Ope
rati
onal
pra
ctice
A.6
Prov
ide
scen
e m
anag
emen
t
A.6.
1De
scrib
e th
e st
ages
of s
cene
man
agem
ent
UK
1 (b
)•
••
•2
A.6.
2
Des
crib
e th
e ro
les
and
resp
onsi
biliti
es o
f the
fo
llow
ing
orga
nisa
tion
s in
rela
tion
to s
cene
m
anag
emen
t
(a) A
mbu
lanc
e au
thor
ities
and
serv
ices
U
K
DR, L
T,
DP, S
L,
RP, R
M,
CL, E
L
1 (b
)•
••
3
(b) P
olic
e au
thor
ities
and
serv
ices
UK
1 (b
)•
••
3
(c) F
ire a
utho
rities
and
serv
ices
U
K1
(b)
••
•3
(d) R
escu
e au
thor
ities
and
serv
ices
UK
1 (b
)•
••
3
(e) S
peci
alist
resc
ue se
rvic
es
UK
1 (b
)•
••
3
(f) V
olun
tary
em
erge
ncy
serv
ices
UK
1 (b
)•
••
3
(g) O
ther
stat
utor
y or
gani
satio
nsU
K1
(b)
••
•3
A.6.
3Cr
itiqu
e st
rate
gies
for e
ffecti
ve sc
ene
man
agem
ent
UK
1 (b
)•
••
1
A.6.
4Cr
itiqu
e hi
stor
ical
ly id
entifi
ed le
sson
s rel
ated
to sc
ene
man
agem
ent
UK
1 (b
)•
••
2
A.6.
5De
mon
stra
te th
e ab
ility
to e
ffecti
vely
man
age
an
inci
dent
scen
eTS
DP, S
L, R
P,
RM, C
L, E
L1
(b)
••
••
1
A.7
Mai
ntai
n re
cord
s
A.7.
1De
scrib
e th
e du
ties a
nd re
spon
sibili
ties o
f the
cl
inic
ian
pert
aini
ng to
pre
-hos
pita
l med
ical
reco
rds
UK
DR, L
T, RM
1 (b
)•
•1
A.7.
2Cr
itiqu
e di
ffere
nt m
etho
ds o
f med
ical
reco
rd k
eepi
ngU
K1
(b)
••
1
A.7.
3De
scrib
e m
inim
um st
anda
rds f
or g
ood
med
ical
re
cord
sU
K1
(b)
••
1
A.7.
4De
scrib
e th
e po
licie
s and
pro
cedu
res f
or m
edic
al
reco
rds m
anag
emen
t with
in th
e EM
S sy
stem
UK
1 (b
)•
•1
A.7.
5De
mon
stra
te th
e ab
ility
to m
aint
ain
clea
r and
ap
prop
riate
ly d
etai
led
med
ical
reco
rds
TSSL
, EL
1 (b
)•
••
••
1
A.7.
6De
mon
stra
te a
pro
fess
iona
l atti
tude
to c
ritiqu
ing
med
ical
reco
rds c
reat
ed b
y se
lf an
d ot
hers
NTS
RM1
(b)
••
•4
DRDi
rect
ed R
eadi
ngLT
Lect
ures
and
Tut
oria
lsDP
Delib
erat
e Pr
actic
eSL
Sim
ulati
on L
earn
ing
RPRe
flecti
ve P
racti
ceRM
Role
Mod
elin
gCL
Colla
bora
tive
Lear
ning
ELEx
perie
ntial
Lea
rnin
g
CROSS-CUTTING THEME A 140
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Cros
s-cu
ng T
hem
e A
. Ope
rati
onal
pra
ctice
A.8
Appl
y in
fecti
on
prev
entio
n an
d co
ntro
l prin
cipl
es a
nd
proc
edur
es
A.8.
1Cr
itiqu
e th
e in
terp
lay
betw
een
the
requ
irem
ents
for
infe
ction
pre
venti
on a
nd c
ontr
ol a
nd th
e us
e of
per
sona
l pr
otec
tive
equi
pmen
tU
K
DR, L
T
2•
••
••
2
A.8.
2Cr
itiqu
e in
fecti
on p
reve
ntion
and
con
trol
mea
sure
s in
the
pre-
hosp
ital e
nviro
nmen
tU
K2
••
••
•2
A.8.
3Co
ntra
st in
-hos
pita
l and
pre
-hos
pita
l inf
ectio
n pr
even
tion
and
cont
rol m
easu
res
UK
2•
••
2
A.8.
4De
scrib
e th
e po
licie
s and
pro
cedu
res f
or in
fecti
on
prev
entio
n an
d co
ntro
l with
in th
e EM
S sy
stem
UK
2•
••
2
A.8.
5De
mon
stra
te b
est p
racti
ce in
infe
ction
pre
venti
on a
nd
cont
rol i
n th
e pr
e-ho
spita
l env
ironm
ent
TSDP
, SL
RM, E
L2
••
••
2
A.8.
6De
mon
stra
te a
pro
fess
iona
l app
roac
h to
infe
ction
pr
even
tion
and
cont
rol
NTS
RM2
••
•2
A.9
Appl
y m
ovin
g an
d ha
ndlin
g pr
inci
ples
and
pr
oced
ures
A.9.
1De
scrib
e ch
alle
nges
rela
ted
to sa
fe p
atien
t mov
ing
and
hand
ling
in th
e pr
e-ho
spita
l env
ironm
ent
UK
LT, S
L,
EL
1 (b
)•
••
•2
A.9.
2Cr
itiqu
e m
etho
ds to
ove
rcom
e ch
alle
nges
to p
atien
t m
ovin
g an
d ha
ndlin
g in
the
pre-
hosp
ital e
nviro
nmen
tU
K1
(b)
••
••
2
A.9.
3De
scrib
e eq
uipm
ent u
sed
for m
ovin
g an
d ha
ndlin
g in
the
pre-
hosp
ital e
nviro
nmen
tU
K1
(b)
••
1
A.9.
4De
scrib
e th
e po
licie
s and
pro
cedu
res f
or m
ovin
g an
d ha
ndlin
g w
ithin
the
EMS
syst
emU
K1
(b)
••
•2
A.9.
5De
mon
stra
te sa
fe m
ovin
g an
d ha
ndlin
g in
the
pre-
hosp
ital e
nviro
nmen
tTS
LT, D
P,
SL, E
L
1 (b
)•
••
•2
A.9.
6De
mon
stra
te sa
fe m
ovin
g an
d ha
ndlin
g of
equ
ipm
ent i
n th
e pr
e-ho
spita
l env
ironm
ent
TS1
(b)
••
••
2
A.9.
7De
mon
stra
te sa
fe u
se o
f mov
ing
and
hand
ling
equi
pmen
tTS
1 (b
)•
••
•2
A.9.
8De
mon
stra
te th
e ab
ility
to sa
fely
load
and
unl
oad
patie
nts
onto
tran
spor
t pla
tform
sTS
1 (b
)•
••
•2
A.9.
9De
mon
stra
te a
pro
fess
iona
l atti
tude
to sa
fe m
ovin
g an
d ha
ndlin
gN
TSRM
1 (b
)•
••
4
CROSS-CUTTING THEME A 141
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Cros
s-cu
ng T
hem
e A
. Ope
rati
onal
pra
ctice
A.10
App
ly p
rinci
ples
of
equ
ality
and
di
vers
ity
A.10
.1De
fine
Equa
lity
UK
DR, L
T, RM
RK
2•
••
•4
A.10
.2De
scrib
e co
nsid
erati
ons f
or a
void
ing
disc
rimin
ation
in
pre-
hosp
ital p
racti
ceU
K2
••
••
4
A.10
.3De
fine
Dive
rsity
UK
2•
••
•4
A.10
.4De
scrib
e co
nsid
erati
ons r
elati
ng to
val
uing
div
ersit
y in
pr
e-ho
spita
l pra
ctice
UK
2•
••
•4
A.10
.5De
scrib
e th
e po
licie
s and
pro
cedu
res f
or E
qual
ity a
nd
Dive
rsity
with
in th
e EM
S sy
stem
UK
2•
••
•4
A.10
.6De
mon
stra
te a
pro
fess
iona
l atti
tude
to e
qual
ity a
nd
dive
rsity
in th
e pr
e-ho
spita
l env
ironm
ent
NTS
RM2
••
•4
DRDi
rect
ed R
eadi
ngLT
Lect
ures
and
Tut
oria
lsDP
Delib
erat
e Pr
actic
eSL
Sim
ulati
on L
earn
ing
RPRe
flecti
ve P
racti
ceRM
Role
Mod
elin
gCL
Colla
bora
tive
Lear
ning
ELEx
perie
ntial
Lea
rnin
g
143
CROSS-CUTTING THEME B. TEAM RESOURCE MANAGEMENTContributing to effective Team Resource Management is a generic or cross-cutting area of professional practice within PHEM. This theme concerns the knowledge, skills and non-technical skills required to work as part of a multi-disciplinary team in the high hazard, resource limited, environmentally challenging and time pressured pre-hospital environment.
UNITSB.1 Understand human factors and their role in patient and team safety B.2 Maintain situational awarenessB.3 Understand and apply principles of decision makingB.4 Communicate effectivelyB.5 Employ effective team workingB.6 Demonstrate leadership and followershipB.7 Manage stress and fatigueB.8 Understand and apply principles of error investigation and management
Related GMP domains are assigned to each group of elements within units as follows:1. Knowledge skills and performance2. Safety and quality3. Communication, partnership and teamwork4. Maintaining trust
Good Medical Practice
Working in Emergency
Medical Systems
Providing pre-hospital
Emergency Medical Care
Using pre-hospital
equipment
Supporting rescue and extrication
Supporting safe patient
transfer
Supporting emergency
preparedness and response
CROSS-CUTTING THEME B
CROSS-CUTTING THEME B 144
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Cros
s-cu
ng T
hem
e B.
Tea
m re
sour
ce m
anag
emen
t
B.1
Und
erst
and
hum
an fa
ctor
s and
th
eir r
ole
in p
atien
t an
d te
am sa
fety
B.1.
1De
fine
the
conc
ept o
f hum
an fa
ctor
s U
KDR
, LT,
SL, C
L,
EL
1 (b
)•
•3
B.1.
2De
scrib
e th
e pr
inci
ples
of h
uman
err
or th
eory
UK
1 (b
)•
•3
B.1.
3Cr
itiqu
e th
e pl
ace
of h
uman
fact
ors w
ithin
the
cont
ext
of h
uman
err
or th
eory
UK
1 (b
)•
•3
B.1.
4
Des
crib
e th
e po
tenti
al im
pact
on
pati
ent
and
team
sa
fety
of
(a) h
uman
fact
ors
UK
DR, L
T, SL
, CL,
EL
1 (b
)•
•3
(b) s
yste
m fa
ctor
sU
K1
(b)
••
2
(c) o
rgan
isatio
nal f
acto
rsU
K1
(b)
••
2
(d) c
ultu
ral f
acto
rsU
K1
(b)
••
2
B.1.
5De
mon
stra
te th
e pr
actic
al a
pplic
ation
of h
uman
err
or
theo
ry to
pre
-hos
pita
l em
erge
ncy
med
ical
pra
ctice
TSLT
, SL,
RP,
RM
, CL,
EL
1 (b
)•
••
••
•3
B.1.
6De
mon
stra
te a
pro
fess
iona
l atti
tude
to p
atien
t saf
ety
NTS
RM, S
L,
EL, R
P1
(a)
••
••
••
4
B.2
Mai
ntai
n sit
uatio
nal a
war
enes
s
B.2.
1De
fine
situa
tiona
l aw
aren
ess
UK
DR, L
T, SL
, CL,
EL
1 (b
)•
•3
B.2.
2Cr
itiqu
e m
odel
s of s
ituati
onal
aw
aren
ess
UK
2•
•3
B.2.
3Cr
itiqu
e st
rate
gies
to m
aint
ain
situa
tiona
l aw
aren
ess
in th
e pr
e-ho
spita
l env
ironm
ent
UK
2•
•3
B.2.
4
Dem
onst
rate
, in
the
cont
et
of P
HEM
pra
ctice
, the
ab
ility
to
(a) g
athe
r inf
orm
ation
TS
LT, S
L,
CL, E
L
1 (b
)•
••
1
(b) i
nter
pret
info
rmati
onTS
1 (b
)•
••
1
(c) a
ntici
pate
like
ly e
vent
sTS
1 (b
)•
••
1
CROSS-CUTTING THEME B 145
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Cros
s-cu
ng T
hem
e B.
Tea
m re
sour
ce m
anag
emen
t
B.2.
5Di
spla
y th
e co
ncep
t of s
ituati
onal
aw
aren
ess
NTS
RM, R
P,
CL, E
L1
(b)
••
1
B.3
Und
erst
and
and
appl
y pr
inci
ples
of
deci
sion
mak
ing
B.3.
1Cr
itiqu
e pr
e-ho
spita
l dec
ision
mak
ing
and
the
often
in
com
plet
e da
ta se
tU
KDR
, LT,
SL, C
L,
EL
1 (b
)•
••
1
B.3.
2Cr
itiqu
e di
ffere
nt d
ecisi
on m
akin
g m
odel
s rel
evan
t to
pre-
hosp
ital p
racti
ceU
K2
••
1
B.3.
3
Dem
onst
rate
app
licati
on o
f str
ateg
ies
to m
ake
corr
ect
deci
sion
s in
the
pre
-hos
pita
l env
iron
men
t re
late
d to
(a) t
eam
and
pati
ent s
afet
yTS
LT, S
L,
CL, E
L,
DP
1 (b
)•
••
2
(b) c
linic
al c
are
TS1
(b)
••
•1
(c) o
pera
tiona
l asp
ects
TS1
(b)
••
•1
(d) l
ogisti
cs
TS1
(b)
••
•3
B.3.
4
Dem
onst
rate
the
abili
ty to
bal
ance
the
desir
abili
ty
of o
btai
ning
all
rele
vant
info
rmati
on w
ith th
e re
quire
men
t to
mak
e de
cisio
ns in
an
appr
opria
te ti
me
fram
e
NTS
RM, R
P,
SL, C
L,
EL
2•
••
•1
B.3.
5De
mon
stra
te w
illin
gnes
s to
utilis
e al
l sou
rces
of
info
rmati
on to
aid
dec
ision
mak
ing
NTS
1 (b
)•
••
•3
B.4
Com
mun
icat
e eff
ectiv
ely
B.4.
1De
scrib
e ve
rbal
and
non
-ver
bal t
echn
ique
s to
com
mun
icat
e eff
ectiv
ely
in th
e op
erati
onal
en
viro
nmen
tU
KDR
, LT,
SL, E
L,
CL
1 (b
)•
•3
B.4.
2De
scrib
e te
chni
ques
to c
omm
unic
ate
effec
tivel
y in
th
e te
achi
ng a
nd le
arni
ng e
nviro
nmen
t U
K1
(b)
••
3
B.4.
3
Des
crib
e co
mm
unic
ation
tech
niue
s to
(a) r
esol
ve c
onfli
ctU
K
DR, L
T, SL
, EL,
CL
1 (b
)•
•3
(b) c
onve
y as
serti
vene
ssU
K1
(b)
••
3
(c) h
ando
ver c
linic
al in
form
ation
UK
1 (b
)•
•3
(d) c
ritiqu
e pe
rform
ance
UK
1 (b
)•
•3
DRDi
rect
ed R
eadi
ngLT
Lect
ures
and
Tut
oria
lsDP
Delib
erat
e Pr
actic
eSL
Sim
ulati
on L
earn
ing
RPRe
flecti
ve P
racti
ceRM
Role
Mod
elin
gCL
Colla
bora
tive
Lear
ning
ELEx
perie
ntial
Lea
rnin
g
CROSS-CUTTING THEME B 146
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Cros
s-cu
ng T
hem
e B.
Tea
m re
sour
ce m
anag
emen
t
B.4
Com
mun
icat
e eff
ectiv
ely
(con
t.)
B.4.
3(e
) deb
rief
UK
DR, L
T, SL
, EL,
CL
1 (b
)•
•3
B.4.
4Cr
itiqu
e ba
rrie
rs to
effe
ctive
com
mun
icati
on in
PHE
M
prac
tice
UK
2•
•3
B.4.
5De
mon
stra
te th
e ab
ility
to c
omm
unic
ate
in a
n ac
cura
te, b
rief a
nd c
lear
man
ner
TSLT
, SL,
EL,
CL
, RP
1 (b
)•
••
•3
B.4.
6
Dem
onst
rate
the
use
of c
omm
unic
ation
tech
niue
s to (a
) res
olve
con
flict
TS
LT, S
L, E
L,
CL, R
P
1 (b
)•
••
3
(b) c
onve
y as
serti
vene
ssTS
1 (b
)•
••
3
(c) h
ando
ver c
linic
al in
form
ation
TS1
(b)
••
•3
(d) c
ritiqu
e pe
rform
ance
TS1
(b)
••
•3
(e) d
ebrie
fTS
1 (b
)•
••
3
B.4.
7De
mon
stra
te th
e ab
ility
to a
dapt
com
mun
icati
on
met
hods
to th
e sit
uatio
nTS
1 (b
)•
••
3
B.4.
8De
mon
stra
te th
e ab
ility
to c
omm
unic
ate
effec
tivel
y w
ith d
iffer
ent g
roup
s enc
ount
ered
in th
e pr
e-ho
spita
l en
viro
nmen
tTS
1 (b
)•
••
•3
B.4.
9De
mon
stra
te th
e im
port
ance
of e
ffecti
ve
com
mun
icati
on to
safe
and
effi
cien
t del
iver
y of
pa
tient
car
e in
the
pre-
hosp
ital e
nviro
nmen
tN
TSRM
, RP,
CL
, EL
1 (b
)•
••
•3
B.5
Empl
oy e
ffecti
ve
team
wor
king
B.5.
1De
scrib
e th
e att
ribut
es o
f an
effec
tive
team
UK
DR, S
L,
CL, E
L
1 (b
)•
•3
B.5.
2Co
ntra
st m
odel
s of t
eam
wor
kU
K2
••
3
B.5.
3De
scrib
e st
rate
gies
to su
ppor
t effe
ctive
team
wor
k U
K2
••
3
B.5.
4Cr
itiqu
e th
e fa
ctor
s tha
t infl
uenc
e te
am w
orki
ng in
th
e pr
e-ho
spita
l env
ironm
ent
UK
2•
•3
CROSS-CUTTING THEME B 147
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Cros
s-cu
ng T
hem
e B.
Tea
m re
sour
ce m
anag
emen
t
B.5
Empl
oy e
ffecti
ve
team
wor
king
(con
t.)
B.5.
5De
mon
stra
te th
e ab
ility
to w
ork
in m
ulti-
disc
iplin
ary
and
unfa
mili
ar te
ams
TS
LT, S
L,
RP, R
M,
CL, E
L
2•
••
•3
B.5.
6De
mon
stra
te a
will
ingn
ess t
o as
sum
e th
e m
ost
appr
opria
te ro
le in
a te
amN
TS1
(b)
••
••
3
B.5.
7De
mon
stra
te a
n ap
prec
iatio
n fo
r all
team
mem
bers
an
d th
eir c
ontr
ibuti
ons
NTS
1 (b
)•
••
•3
B.6
Dem
onst
rate
le
ader
ship
and
fo
llow
ersh
ip
B.6.
1Di
ffere
ntiat
e cl
inic
al, m
edic
al a
nd o
pera
tiona
l le
ader
ship
UK
DR, L
T, SL
, CL,
EL
2•
••
3
B.6.
2De
scrib
e th
e att
ribut
es o
f an
effec
tive
lead
erU
K2
••
3
B.6.
3De
scrib
e th
e att
ribut
es o
f an
effec
tive
follo
wer
UK
2•
•3
B.6.
4Co
ntra
st d
iffer
ent m
odel
s of l
eade
rshi
pU
K2
•3
B.6.
5Cr
itiqu
e th
e cl
inic
al a
nd n
on-c
linic
al le
ader
ship
role
s of
the
PHEM
pra
ctitio
ner
UK
2•
•3
B.6.
6De
mon
stra
te th
e ab
ility
to b
e an
effe
ctive
lead
er
TSSL
, DP,
RP
, RM
, EL
2•
••
3
B.6.
7De
mon
stra
te th
e ab
ility
to b
e an
effe
ctive
follo
wer
TS1
(b)
••
•3
B.6.
8De
mon
stra
te a
will
ingn
ess t
o as
sum
e an
d m
aint
ain
a le
ader
ship
role
in a
dver
se c
ircum
stan
ces
NTS
2•
••
•3
B.7
Man
age
stre
ss
and
fatig
ue
B.7.
1De
scrib
e th
e de
finiti
on a
nd c
ause
of s
tres
sU
K
DR, L
T, SL
, CL,
EL
1 (b
)•
•3
B.7.
2De
scrib
e th
e de
finiti
on a
nd c
ause
s of f
atigu
eU
K1
(b)
••
3
B.7.
3De
scrib
e th
e eff
ects
of s
tres
s and
fatig
ue o
n cl
inic
al
and
oper
ation
al p
erfo
rman
ceU
K1
(b)
••
3
B.7.
4Cr
itiqu
e fa
ctor
s tha
t red
uce
abili
ty to
man
age
stre
ss
and
fatig
ueU
K2
••
3
DRDi
rect
ed R
eadi
ngLT
Lect
ures
and
Tut
oria
lsDP
Delib
erat
e Pr
actic
eSL
Sim
ulati
on L
earn
ing
RPRe
flecti
ve P
racti
ceRM
Role
Mod
elin
gCL
Colla
bora
tive
Lear
ning
ELEx
perie
ntial
Lea
rnin
g
CROSS-CUTTING THEME B 148
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Cros
s-cu
ng T
hem
e B.
Tea
m re
sour
ce m
anag
emen
t
B.7
Man
age
stre
ss
and
fatig
ue(c
ont.)
B.7.
5Cr
itiqu
e w
ays i
n w
hich
fatiq
ue a
nd st
ress
may
be
min
imise
dU
KDR
, LT,
SL,
EL, C
L2
••
3
B.7.
6De
mon
stra
te th
e ab
ility
to re
cogn
ise th
e eff
ects
of
stre
ss a
nd fa
tigue
on
self
and
othe
rsTS
LT, S
L,
RP, C
L,
EL
1 (b
)•
••
3
B.7.
7De
mon
stra
te a
bilit
y to
insti
tute
stra
tegi
es to
min
imise
th
e eff
ects
of s
tres
s and
fatig
ue o
n se
lf an
d ot
hers
TS1
(b)
••
•3
B.7.
8De
mon
stra
te a
n op
en a
nd h
ones
t app
roac
h to
de
clar
ing
whe
n st
ress
and
/or f
atigu
e m
ay im
pact
on
own
prac
tice
NTS
RM, R
P,
EL, S
L
1 (b
)•
••
•4
B.7.
9De
mon
stra
te a
n op
en a
nd h
ones
t app
roac
h to
di
scus
sing
with
col
leag
ues w
hen
stre
ss a
nd/o
r fati
gue
may
impa
ct o
n th
eir p
racti
ceN
TS1
(b)
••
••
4
B.8
Und
erst
and
and
appl
y pr
inci
ples
of
erro
r inv
estig
ation
an
d m
anag
emen
t
B.8.
1De
scrib
e th
e po
licie
s and
pro
cedu
res f
or e
rror
in
vesti
gatio
n an
d m
anag
emen
t with
in th
e EM
S sy
stem
UK
DR, L
T, EL
, CL,
SL
2•
•2
B.8.
2De
scrib
e th
e att
ribut
es o
f a sa
fety
cul
ture
UK
2•
•2
B.8.
3De
scrib
e th
e att
ribut
es o
f a h
igh
relia
bilit
y or
gani
satio
nU
K2
••
2
B.8.
4De
scrib
e th
e te
chni
ques
for e
ffecti
ve e
rror
repo
rting
an
d in
vesti
gatio
nU
K2
••
2
B.8.
5Co
ntra
st le
sson
s ide
ntifie
d fr
om sa
fety
criti
cal
indu
strie
s oth
er th
an h
ealth
care
UK
2•
•2
B.8.
6De
mon
stra
te th
e ab
ility
to c
ompl
ete
an in
vesti
gatio
n in
to a
pot
entia
l err
orTS
LT, S
L,
CL, E
L2
••
•2
B.8.
7De
mon
stra
te a
n op
en a
nd h
ones
t app
roac
h to
err
or
inve
stiga
tion
and
man
agem
ent
NTS
RM, R
P,
SL, E
L
2•
••
•2
B.8.
8De
mon
stra
te p
rom
otion
s of a
saf
ety
cultu
reN
TS2
••
•2
DRDi
rect
ed R
eadi
ngLT
Lect
ures
and
Tut
oria
lsDP
Delib
erat
e Pr
actic
eSL
Sim
ulati
on L
earn
ing
RPRe
flecti
ve P
racti
ceRM
Role
Mod
elin
gCL
Colla
bora
tive
Lear
ning
ELEx
perie
ntial
Lea
rnin
g
CROSS-CUTTING THEME C 149
CROSS-CUTTING THEME C. CLINICAL GOVERNANCEApplication of clinical governance principles and techniques is a generic or cross-cutting area of professional practice within PHEM. This theme concerns the knowledge, skills and non-technical skills required to ensure that clinical governance principles and mechanisms are applied to clinical practice.
Units
C.1 Understand and apply principles of clinical governance as applied to pre-hospital practice C.2 Manage and support continuous professional developmentC.3 Utilise clinical evidence to support clinical practiceC.4 Utilise and prepare documents that guide practiceC.5 Support and apply clinical auditC.6 Understand and apply organisational risk management processesC.7 Support training and developmentC.8 Understand and apply quality management processes
Related GMP domains are assigned to each group of elements within units as follows:
1. Knowledge skills and performance
2. Safety and quality
3. Communication, partnership and teamwork
4. Maintaining trust
Good Medical Practice
Working in Emergency
Medical Systems
Providing pre-hospital
Emergency Medical Care
Using pre-hospital
equipment
Supporting rescue and extrication
Supporting safe patient
transfer
Supporting emergency
preparedness and response
CROSS-CUTTING THEME C 150
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Cros
s-cu
ng T
hem
e C.
Clin
ical
gov
erna
nce
C.1
Und
erst
and
and
appl
y pr
inci
ples
of
clin
ical
gov
erna
nce
as a
pplie
d to
pre
-ho
spita
l pra
ctice
C.1.
1De
scrib
e ho
w th
e m
echa
nism
s und
erpi
nnin
g cl
inic
al
gove
rnan
ce a
re a
pplie
d to
pre
-hos
pita
l pra
ctice
.U
KDR
, LT,
SL,
CL, E
L1
(b)
••
•2
C.1.
2.
Criti
ue t
he c
halle
nges
to g
ood
clin
ical
gov
erna
nce
pose
d by
(a) S
mal
l tea
m w
orki
ngU
K
DR, L
T, SL
, CL
, EL
1 (b
)•
•2
(b) L
one-
doct
or w
orki
ngU
K1
(b)
••
2
(c) H
igh-
risk
clin
ical
inte
rven
tions
UK
1 (b
)•
•2
(d) R
emot
e an
d ru
ral p
racti
ceU
K1
(b)
••
2
C.1.
3De
scrib
e th
e po
licie
s and
pro
cedu
res f
or c
linic
al
gove
rnan
ce w
ithin
the
EMS
syst
emU
K1
(b)
••
2
C.1.
4Co
ntra
st lo
cal,
regi
onal
, nati
onal
and
inte
rnati
onal
re
gula
tory
fram
ewor
ks fo
r ens
urin
g qu
ality
and
safe
ty
with
in th
e EM
S sy
stem
U
K2
••
2
C.1.
5De
mon
stra
te a
pro
fess
iona
l atti
tude
to c
linic
al
gove
rnan
ceN
TSRM
, RP,
CL
, EL
1 (b
)•
••
•2
C.2
Man
age
and
supp
ort c
ontin
uous
pr
ofes
siona
l de
velo
pmen
t
C.2.
1Li
st m
etho
ds to
supp
ort c
ontin
uous
pro
fess
iona
l de
velo
pmen
t (CP
D) in
PHE
MU
K
DR, L
T, SL
, CL,
EL
1 (b
)•
1
C.2.
2An
alys
e st
rate
gies
by
whi
ch g
roup
s of s
mal
l num
bers
of
bus
y pr
ofes
siona
ls ar
e ab
le to
mai
ntai
n eff
ectiv
e CP
DU
K2
•1
C.2.
3Cr
itiqu
e th
e ch
alle
nges
in d
eliv
erin
g re
leva
nt m
ulti-
prof
essio
nal C
PDU
K2
••
1
C.2.
4De
mon
stra
te th
e ab
ility
to fa
cilit
ate
CPD
for s
elf a
nd
othe
rsTS
LT, D
P, S
L,
RP, R
M,
CL, E
L2
••
•1
C.2.
5De
mon
stra
te a
pro
fess
iona
l atti
tude
to C
PDN
TSRM
, RP,
CL
, EL
2•
•1
CROSS-CUTTING THEME C 151
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Cros
s-cu
ng T
hem
e C.
Clin
ical
gov
erna
nce
C.3
Util
ise c
linic
al
evid
ence
to su
ppor
t cl
inic
al p
racti
ce
C.3.
1Li
st p
ossib
le so
urce
s of c
linic
al e
vide
nce
in th
e pr
e-ho
spita
l env
ironm
ent
UK
DR, L
T, SL
, CL,
EL
1 (b
)•
••
1
C.3.
2Cr
itiqu
e th
e ra
nge
and
dept
h of
rese
arch
evi
denc
e un
derp
inni
ng P
HEM
clin
ical
pra
ctice
UK
1 (b
)•
••
1
C.3.
3De
scrib
e th
e ch
alle
nges
of p
erfo
rmin
g re
sear
ch in
the
pre-
hosp
ital e
nviro
nmen
tU
K2
••
•1
C.3.
4De
mon
stra
te th
e ab
ility
to in
tegr
ate
the
late
st a
vaila
ble
evid
ence
to p
rovi
de h
igh
qual
ity c
are
to in
divi
dual
pa
tient
s TS
DP, S
L, R
P,
CL, E
L2
••
••
1
C.3.
5De
mon
stra
te a
will
ingn
ess t
o ch
ange
pra
ctice
on
the
basis
of
app
ropr
iate
rese
arch
evi
denc
eN
TSRM
, RP,
SL
, CL,
EL
2•
••
•1
C.4
Util
ise a
nd p
repa
re
docu
men
ts th
at g
uide
pr
actic
e
C.4.
1
Des
crib
e th
e ro
le, i
n th
e pr
e-ho
spit
al e
nvir
onm
ent o
f
(a) S
tand
ard
oper
ating
pro
cedu
res
UK
DR, L
T, SL
, CL,
EL
1 (b
)•
••
2
(b) R
outin
e ch
eckl
ists
UK
1 (b
)•
••
2
(c) E
mer
genc
y ac
tion
chec
klist
sU
K1
(b)
••
•2
(d) P
roce
dura
l aid
e m
emoi
res
UK
1 (b
)•
••
2
(e) P
atien
t gro
up d
irecti
ves
UK
1 (b
)•
••
2
(f) C
linic
al g
uide
lines
UK
1 (b
)•
••
2
(g) P
atien
t inf
orm
ation
leafl
ets
UK
1 (b
)•
••
2
C.4.
2Cr
itiqu
e th
e w
ays i
n w
hich
the
docu
men
ts (a
) to
(g) a
bove
co
ntrib
ute
to g
ood
clin
ical
gov
erna
nce
UK
1 (b
)•
••
••
2
C.4.
3De
mon
stra
te th
e ab
ility
to u
se a
ppro
pria
te d
ocum
ents
th
at g
uide
pra
ctice
in c
linic
al si
tuati
ons
TSSL
, RP,
CL,
EL
, DP
1 (b
)•
••
•1
C.4.
4De
mon
stra
te th
e ab
ility
con
stru
ct d
ocum
ents
that
gui
de
prac
tice
TS1
(b)
••
2
C.4.
5De
mon
stra
te a
pro
fess
iona
l atti
tude
to d
ocum
ents
that
ai
de b
est p
racti
ceN
TSRM
, RP,
SL
, EL
1 (b
)•
•1
DRDi
rect
ed R
eadi
ngLT
Lect
ures
and
Tut
oria
lsDP
Delib
erat
e Pr
actic
eSL
Sim
ulati
on L
earn
ing
RPRe
flecti
ve P
racti
ceRM
Role
Mod
elin
gCL
Colla
bora
tive
Lear
ning
ELEx
perie
ntial
Lea
rnin
g
CROSS-CUTTING THEME C 152
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Cros
s-cu
ng T
hem
e C.
Clin
ical
gov
erna
nce
C.5
Supp
ort a
nd a
pply
cl
inic
al a
udit
C.5.
1De
scrib
e th
e im
port
ance
of a
nd c
halle
nges
to c
linic
al
info
rmati
on sh
arin
g ac
ross
an
EMS
syst
emU
K
DR, L
T, SL
, CL,
EL
1 (b
)•
•3
C.5.
2De
scrib
e th
e po
licie
s and
pro
cedu
res r
elat
ed to
cl
inic
al a
udit
with
in th
e EM
S sy
stem
UK
1 (b
)•
•2
C.5.
3Cr
itiqu
e th
e re
quire
men
t to
prio
ritise
lim
ited
audi
t re
sour
ces t
o ar
eas o
f gre
ates
t nee
dU
K2
••
•2
C.5.
4De
mon
stra
te th
e ab
ility
to p
erfo
rm a
clin
ical
aud
it in
PH
EMTS
SL, C
L, E
L1
(b)
••
••
2
C.5.
5De
mon
stra
te a
will
ingn
ess t
o pa
rtici
pate
in a
nd
resp
ond
to c
linic
al a
udit
NTS
RM, R
P,
SL, E
L1
(b)
••
•2
C.6
Und
erst
and
and
appl
y or
gani
satio
nal
risk
man
agem
ent
proc
esse
s
C.6.
1Di
ffere
ntiat
e ha
zard
and
risk
UK
DR, L
T, SL
, CL,
EL
1 (b
)•
•2
C.6.
2De
scrib
e ris
k m
anag
emen
t and
its c
ompo
nent
s in
the
cont
ext o
f PHE
M
UK
1 (b
)•
••
•2
C.6.
3De
scrib
e lo
cal,
regi
onal
and
inte
rnati
onal
pro
cess
es
for m
anag
ing
risk
with
in th
e EM
S sy
stem
U
K2
••
2
C.6.
4De
mon
stra
te th
e ap
plic
ation
of r
isk m
anag
emen
t st
rate
gies
TS
LT, S
L,
CL, E
L
2•
••
•2
C.6.
5De
mon
stra
te th
e ab
ility
to c
onst
ruct
a ri
sk
asse
ssm
ent
TS2
••
2
C.6.
6De
mon
stra
te th
e ab
ility
to le
ad a
n in
vesti
gatio
n in
to
an in
cide
ntTS
2•
•2
C.6.
7De
mon
stra
te th
e ab
ility
to a
pply
the
less
ons
iden
tified
dur
ing
an in
vesti
gatio
nTS
1 (b
)•
••
2
C.6.
8De
mon
stra
te a
pro
fess
iona
l atti
tude
to ri
sk
man
agem
ent
NTS
RM, R
P,
CL, E
L, S
L1
(b)
••
2
CROSS-CUTTING THEME C 153
Uni
tEl
emen
ts
LearningMethods
AAs
sess
men
t Met
hods
GMP
KTCE
XCb
DSI
MDO
PSM
SFAC
ATLO
GPS
TO
Cros
s-cu
ng T
hem
e C.
Clin
ical
gov
erna
nce
C.7
Supp
ort t
rain
ing
and
deve
lopm
ent
C.7.
1De
scrib
e th
e pr
inci
ples
of a
dult
lear
ning
UK
DR, L
T,
SL, C
L,
EL
2•
•3
C.7.
2An
alys
e te
achi
ng m
etho
ds su
itabl
e fo
r maj
or le
arni
ng
styl
es
UK
2•
•3
C.7.
3De
mon
stra
te th
e ab
ility
to a
pply
the
prin
cipl
es o
f ad
ult l
earn
ing
to th
e te
achi
ng a
nd tr
aini
ng o
f a
mul
ti-pr
ofes
siona
l aud
ienc
eTS
SL, C
L, E
L2
••
3
C.7.
4De
mon
stra
te a
sens
itive
and
con
stru
ctive
man
ner
whe
n ap
proa
chin
g a
trai
nee
with
diffi
culti
esN
TSRM
, RP,
SL
, CL,
EL
2•
••
3
C.7.
5De
mon
stra
tes a
pro
fess
iona
l app
roac
h to
supp
ortin
g tr
aini
ng a
nd d
evel
opm
ent
NTS
2•
•3
C.8
Und
erst
and
and
appl
y qu
ality
m
anag
emen
t pr
oces
ses
C.8.
1De
scrib
e th
e pr
inci
ples
of q
ualit
y m
anag
emen
tU
K
DR, L
T, SL
, CL,
EL
2•
•1
C.8.
2Cr
itiqu
e th
e ch
alle
nges
to q
ualit
y m
anag
emen
t pr
esen
ted
by P
HEM
UK
2•
••
1
C.8.
3Cr
itiqu
es st
rate
gies
to im
plem
ent q
ualit
y m
anag
emen
t pro
cess
es in
pre
-hos
pita
l pra
ctice
UK
2•
•1
C.8.
4De
mon
stra
te th
e ab
ility
to u
tilise
qua
lity
man
agem
ent
proc
esse
s in
pre-
hosp
ital p
racti
ceTS
SL, R
P,
CL, E
L2
••
1
DRDi
rect
ed R
eadi
ngLT
Lect
ures
and
Tut
oria
lsDP
Delib
erat
e Pr
actic
eSL
Sim
ulati
on L
earn
ing
RPRe
flecti
ve P
racti
ceRM
Role
Mod
elin
gCL
Colla
bora
tive
Lear
ning
ELEx
perie
ntial
Lea
rnin
g