SKILL  KNOWLEDGE  SAFETY

HLTAMBCR603A - Deliver intensive clincal care

Description

 This unit describes the skills and knowledge required to deliver pre-hospital client care at a specialised level, by assessing specialised needs of a client, planning and administering procedures, and monitoring the state of the client

Pre/Co-Requisites

 This unit is to be assessed after successful achievement of the following competency units:

This unit is to be assessed in conjunction with the following competency unit:

Application

 The knowledge and skills specified in this unit are typically required by a person involved directly in the provision of advanced clinical care at the level of an intensive care paramedic in a state or territory ambulance service

The unit involves application of specialised knowledge of pathophysiology and pharmacology for advanced clinical care

The application of knowledge and skills described in this competency unit relate to functioning independently to plan and practise advanced client care within relevant state/territory clinical practice and application of skills guidelines

Successful assessment of the essential knowledge described in this competency unit (and its co-requisite) is required before undertaking independent client assessment and delivery of care at the level of skill described

Performance Criteria

 1. Assess need for specialised intervention
1.1 Assess client on the basis of a high level of clinical knowledge and a high level of contemporary clinical evidence based practice
1.2 Ensure assessment of the need for specialised intervention is based on a demonstrable and clearly thought out series of problem solving steps or linkages
1.3 Ensure that client assessment process can be analysed and explained when subject to clinical audit

2. Analyse information from clinical assessment to make a judgement about specialised pre- hospital client care
2.1 Use systematic evaluation of client assessment to interpret and make judgements regarding specialised client care requirements
2.2 Ensure judgement is in line with high level contemporary evidence based practice and organisation clinical practice guidelines/protocols
2.3 Ensure the judgment, which forms the basis on which specialised treatment is planned, can be reasonably justified in terms of the information available at the time

3. Plan specialised pre-hospital client care
3.1 Establish priorities of care based on assessment of the total scene and drawing on specialised knowledge and experience
3.2 Recognise and interpret mechanisms of injury and potential for client deterioration in conjunction with a broad range of factors inherent in client’s condition, environment and potential impact of procedures or movement
3.3 Develop contingency plans, based on mechanisms of injury and potential for client deterioration
3.4 Establish client management plan, based on analysis of the scene and the client and drawing on high level clinical knowledge
3.5 Determine client’s potential or actual time criticality versus transport criticality

4. Implement procedures for specialised pre- hospital client care
4.1 Commence all client care procedures and drug therapies as client’s presenting condition determines, with reference to local clinical and legislative guidelines and pharmacological requirements
4.2 Ensure all actions are in accordance with organisation standard operating procedure and clinical practice guidelines/protocols
4.3 Consult and collaborate with designated medical authorities as required

5. Monitor specialised prehospital client care and modify as required
5.1 Monitor all aspects of client’s condition including vital signs at appropriate intervals to establish trends in terms of specialised procedures, interventions or knowledge
5.2 Assess potential effects of procedures implemented on client’s condition
5.3 Monitor drug therapy noting effectiveness of treatment regime and amend according to client’s condition
5.4 Recognise changes in client’s condition and adapt management according to the scope or authority to practise of the attending officer
5.5 Recognise the need for assistance and seek help immediately where the situation or client’s condition requires treatment outside the scope or authority to practise of the attending officer
5.6 Maintain and/or modify treatment, according to client need as determined by the re-assessment process

6. Hand over client requiring specialised care
6.1 Document relevant client details according to organisation clinical practice guidelines/protocols
6.2 Maintain client confidentiality at all times
6.3 Ensure documentation for handover procedures conveys all necessary information
6.4 Convey information appropriately to those individuals involved in ongoing client care to facilitate understanding and optimise continuing client care
6.5 Maintain client care until responsibility for client care is taken over by staff of the receiving agency

Required Skills & Knowledge

 Essential Knowledge:
• Detailed knowledge to enable accurate judgement and delivery of specialised client care in the field of emergency out of hospital care
• Detailed understanding of the structure and function of major organs (appropriate to this level) including a detailed understanding of heart structure and function (including electrophysiology, dysrrhythmias)
• Cell transport systems
• An understanding of pharmacological processes and drug actions, indications and contraindications (appropriate to this level)
• Understanding of cellular respiration (glycolysis, Kreb’s Cycle, electron transport chain) and ATP production
• Recognition of the signs and symptoms of a broad range of clinical conditions and the (provisional) diagnosis of same
• An advanced comprehension of trauma issues
• An advanced understanding of medical emergencies (including diving, altitude, temperature, OD and poisoning, crush injuries and obstetrics)
• Understanding of the effects of intrinsic (age, health etc) and extrinsic (environment, medications etc) factors on client condition and treatment
• Maintenance systems (including immunity and haemostasis)
• Procedures and equipment in accordance with organisation policies relating to specialised client care
• Client psychology related to trauma
• Receiving facility requirements or how to access these requirements
• Function of documentation being provided

Essential Skills:
  • Assess client and implement procedures needed for client care under a variety of conditions and circumstances
  • Demonstrate the capacity to take into account subtle factors affecting the client’s condition, from a broad range of areas
  • Make a sound judgement based on knowledge
  • Accurately complete all documentation and supply all relevant client information to receiving facility staff under a variety of conditions and circumstances, including routine, non-routine and emergency, including:
    • correct use of approved documents
    • correct documentation of client and incident details
    • interaction with receiving facility personnel
  • Apply a wide range of detailed knowledge and advanced skills (eg. ECG interpretation) to diagnose and deliver appropriate care for an extensive range of clinical conditions.
  • Apply knowledge and understanding to familiar and unfamiliar situations.
  • Apply the clinical problem solving process as it applies to specialised client care
  • Use problem solving skills including:
    • using available resources
    • analysing information
    • making decisions that ensure the safe access/egress and client welfare in a lifethreatening situation
  • 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 and case management materials
    • 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

 Specialised intervention may include, but is not limited to:
  • Those procedures approved for specialised client care based upon organisation policies and procedures and assessment of the knowledge and understanding of the officer involved.

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

Mechanism of injury is obtained from a detailed description of what specifically happened physically to the client  uring an incident, such as:
  • High speed vehicle accidents
  • Falls
  • Being struck by a vehicle
  • Being thrown from a moving vehicle
  • Penetrating injury eg gunshot, stabbing
  • Electrocution

Drug therapy used in the treatment of a client’s condition may include but is not limited to:
  • • Advanced pharmacological agents for the management of:
    • cardiac arrest
    • cardiac dysrhythmias
    • pain relief
    • airway management
    • hypoglycaemia
    • hypovolaemia
    • sedation

Techniques which client’s condition indicates would be of some benefit, may include, but are not limited to:
  • Airway management eg endotracheal intubation
  • Intravenous and intraosseous cannulation
  • Tension pneumothorax decompression
  • Other techniques as indicated by organisation clinical practice guidelines/protocols

Reports may be verbal (oral or written) or non-verbal (with gestures), and 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
  • Police officers
  • Legal practitioners

Other acts and regulations are those specified in each state/territory that relate to:
  • Confidentiality
  • Freedom of information Policy and procedures are organisation policies and procedures that relate to:
  • Documentation
  • Reporting of client medical information, where approved as acting in the best interests of the client

Evidence Guide

 Critical aspects for assessment and evidence required to demonstrate this competency unit:
  • Assessment must establish acquisition of Essential Knowledge 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)
  • After successful completion of initial assessment, further assessment is to be conducted during workplace application under direct supervision
  • Assessment must include evidence of competence in dealing with all situations outlined in Essential Skills section of this competency unit
  • Evidence must include demonstration over a period of time to ensure consistency of performance
  • Candidates must demonstrate their ability to apply essential knowledge and skills identified for this competency unit before undertaking independent workplace application
  • Candidates must provide evidence of their ability to apply all clinical competencies consistently (over a minimum period of 4 months) as part of supervised clinical practice

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










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