Training | Units of Competency | (HLT07) Health | HLTAMBCR401A - Deliver basic clinical care

SKILL KNOWLEDGE SAFETY

HLTAMBCR401A - Deliver basic clinical care

Description	This unit describes the knowledge and skills required to deliver ‘basic’ client care in the out-of-hospital (or equivalent) environment by planning and administering procedures and monitoring the state of the client based on assessment of client needs
Pre/Co-Requisites	This unit is to be assessed after successful achievement of the following competency unit, which includes specification of underpinning knowledge required for delivery of client care services at this level: HLTAP401B Confirm physical health status
Application	Workers involved directly in providing out-of-hospital care in the ambulance environment typically require the knowledge and skills specified in this unit. These workers must be able to apply a broad knowledge of anatomy, physiology, pathophysiology and pharmacology to delivery of client care. Successful assessment of essential knowledge described in this competency unit (and its co-requisite) is required before undertaking independent application of skills described by this competency unit. Application of skills and knowledge described by this competency standard is to be undertaken within relevant State/Territory clinical practice guidelines/protocols.
Performance Criteria	1. Make initial client assessment 1.1 Conduct pre-planning before arrival at scene based on information communicated in request for service 1.2 Conduct scene survey according to local ambulance standard operation procedure 1.3 Conduct primary survey according to local ambulance standard operation procedure 1.4 Check and monitor vital signs in accordance with local ambulance standard operation procedure 1.5 Obtain history of the event 1.6 Conduct secondary survey, incorporating a systematic physical examination of the whole body 1.7 Identify chief complaints, including pattern and mechanism of illness or injury as a basis for prioritising treatment 1.8 Obtain client’s medical history to ensure appropriate treatment is selected 1.9 Determine client’s potential or actual time criticality versus transport criticality 1.10 Assess transport requirements and appropriate destination, considering client’s condition and the type of resources needed to ensure that requirements of urgency and client care are met 2. Plan basic out-of-hospital client care 2.1 Establish priorities of care based on initial client assessment according to local ambulance standard operation procedure 2.2 Develop contingency plans based on mechanisms of injury and potential for client deterioration according to local ambulance standard operation procedure 3. Implement basic client care procedures 3.1 Commence all client care procedures and drug therapies within the individual’s level of expertise and authority to practise and limits of the local ambulance clinical practice guidelines/protocols 3.2 Where the situation or client’s condition requires treatment that is outside the scope or authority to practise of the attending officer, immediately recognise the need for assistance and seek help 3.3 Correctly operate ambulance equipment as required for client management according to manufacturer/supplier’s instructions and local clinical guidelines/protocols 3.4 Implement client care techniques in accordance with infection control procedures and techniques 3.5 Use safe lifting and client handling techniques in accordance with OHS requirements and organisation policy and procedures 4. Monitor basic client care and modify as required 4.1 Re-assess client and presenting conditions at appropriate intervals and modify treatment as required according to local ambulance standard operation procedure 4.2 Modify drug therapy noting effectiveness of treatment regime and amend according to client’s condition 4.3 Identify and initiate need for advanced levels of intervention and action 5. Hand over client requiring basic care 5.1 Document relevant client details according to local ambulance standard operation procedure 5.2 Maintain client confidentiality at all times 5.3 Ensure documentation for handover procedures conveys all necessary information 5.4 Convey information appropriately to those individuals involved in ongoing client care to facilitate understanding and optimise continuing care 5.5 Maintain client care until responsibility for client care is taken over by staff of the receiving agency
Required Skills & Knowledge	Essential Knowledge: Basic physiology and anatomy as defined in unit HLTAP401A Confirm physical healthstatus Procedures and equipment used for Basic (or Advanced) Life Support, as specified within authorised limits defined by legal requirements and organisation policies Receiving facility requirements or how to access these requirements Clinical Practice Guidelines/Protocols and ambulance equipment Organisation policies for basic client care Understanding of client psychology Significance of assessment findings Organisation administrative policies and procedures Function of documentation being provided Essential Skills: Apply the clinical problem solving process as it applies to basic client care Apply knowledge to recognise the patterns of illness and injury relevant to the delivery of basic client care Apply knowledge and understanding in both familiar and unfamiliar situations Correctly use approved documents Correctly document client and incident details Interact with receiving facility personnel Conduct initial client assessment to detect and correct any immediate life threatening conditions, including primary survey of: danger response airway breathing circulation Accurately complete all documentation and supply all relevant client information to receiving facility staff under a variety of conditions and circumstances Implement basic clinical procedures Collect and document relevant information Use oral communication skills (language competence) required to fulfil job roles as specified by the organisation, including: asking questions active listening asking for clarification from client or other persons at the scene negotiating solutions acknowledging and responding to a range of views. Use written communication skills (literacy competence) required to fulfil job roles as specified by organisation, including: reading and understanding incident reports, case management materials and manufacturers’ specifications for the use of materials and equipment, preparing handover reports for receiving agency staff Use interpersonal skills, including: working with others showing empathy with client and relatives relating to persons from differing cultural, social and religious backgrounds.
Range Statement	Pre-planning may include, but is not limited to: Potential resources required such as equipment, personnel, other services Access and egress requirements Identification of potential safety issues Scene survey may include, but is not limited to: Identification of dangers and hazards Operational safety Confirmation of location and initial case details Determination of access, egress and initial equipment requirements Client assessment must include but is not limited to: Integration of principles of anatomy and physiology, primary, vital sign and secondary surveys, including non-obvious clinical signs, using applied clinical knowledge at the basic level of client care Primary survey must include, but is not limited to: Dangers Response Airway Breathing Circulation Vital signs may include, but are not limited to: Conscious state assessment eg Glasgow Coma Score, AVPU — alert, voice, pain, unconscious Respiratory status assessment, eg rate, rhythm, effort and breath sounds Perfusion status assessment, eg pulse, blood pressure, capillary refill and skin Secondary survey may include, but is not limited to: • Systematic head to toe physical body examination • Assessment of time criticality as indicated by physiological status or pattern and mechanism of injury History of event includes present history and may be elicited from: Client Bystanders Primary carers Medical personnel Medi-alert bracelet Evidence at the scene Client history includes: Pre-existing conditions Allergies Current medication or treatment Chief complaints, including pattern and mechanism of illness or injury must include, but are not limited to: Kinematics of trauma Burns trauma Extremity trauma Neurological insult Mental health disorders Metabolic disorders Poisoning or overdose emergency Cardio-vascular insult Hypoperfusion Immunological disorders Respiratory disorders Thoracic trauma Abdominal disorders or trauma Urogenital disorders or trauma Gynaecological disorders Medical or traumatic obstetric disorders Paediatric medical or traumatic disorders Medical or traumatic geriatric disorders Situation involves a client in need and may include, but is not limited to: Transfer of client with pre-diagnosed illness or injury Transfer of client with sudden undiagnosed illness or injury Management of client in trauma or with undiagnosed illness Mode of transport is selected for its availability and potential to provide the means of mobile care most suited to the needs of the client and may include, but is not limited to: Road ambulances Clinic cars Rescue or retrieval units Fixed and rotary wing aircraft Water-borne craft Four wheel drive vehicle Client management will need to take into account: Location and nature of incident Environmental conditions Number of casualties and potential casualties Use and availability of ambulance equipment and pharmaceuticals Drug therapy used in the treatment of a client’s condition may include, but is not limited to: Basic pharmacological agents for management of bronchospasm, pain (medical including cardiac) trauma and hypoglycaemia Other medications as indicated by local ambulance clinical guidelines/protocols Interventions expected to be utilised where client’s condition indicates they would be of some benefit include but are not limited to: Airway management ie manual airway techniques, oropharyngeal airway and suction Automated External Defibrillation (AED) Intramuscular injections Traction and other types of splinting Non-verbal cues may include, but are not limited to: Posturing Gait Anxiety Types of documentation may include, but are not limited to: Incident reports Handover reports Case management material Persons authorised to receive confidential information may include, but are not limited to: Medical personnel at hospitals and surgeries Police Officers Legal practitioners Others, where approved as acting in the best interests of the client Reports may include, but are not limited to: Oral or written reports Client handover Incident reports Patient Care Record Case management material Acts and regulations are those specified in each State/Territory and include, but are not limited to: Confidentiality and privacy Freedom of information Drug and poisons regulations Health Mental Health Policy and procedures may include, but are not limited to: Organisation policies and procedures Documentation Reporting of client medical information Occupational Health and safety Clinical Practice Guidelines/Protocols Operational Medico-legal
Evidence Guide	Critical aspects for assessment and evidence required to demonstrate this competency unit: Assessment must establish acquisition of Essential Knowledge across the Range Statement outlined in HLTAP401A Confirm physical health status prior to assessment of skills application for this unit Skills involving direct client care are to be assessed initially in a simulated clinical setting (laboratory/practical) After successful completion of initial assessment, a second assessment is to be conducted during workplace application under direct supervision The application of skills and knowledge described in this competency unit should be assessed in conjunction with the application of knowledge and skills identified in HLTAP401A Confirm physical health status Candidates must demonstrate their ability to apply essential knowledge and skills identified for this competency unit before undertaking independent workplace application Access and equity considerations: All workers in the health industry should be aware of access and equity issues in relation to their own area of work All workers should develop their ability to work in a culturally diverse environment In recognition of particular health issues facing Aboriginal and Torres Strait Islander communities, workers should be aware of cultural, historical and current issues impacting on health of Aboriginal and Torres Strait Islander people Assessors and trainers must take into account relevant access and equity issues, in particular relating to factors impacting on health of Aboriginal and/or Torres Strait Islander clients and communities Resource implications: Access to appropriate workplace and simulation of realistic workplace setting where assessment can be conducted Evidence must include observation of performance in the workplace and a simulated work situation Access to equipment and resources normally used in the workplace Method of assessment: Evidence must include observation of performance in an actual or simulated work setting Observations, questioning and evidence gathered from the workplace environment Demonstration over a period of time to ensure consistency of performance

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