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EXTENDED PRE-HOSPITAL CARE IN REMOTE LOCATIONS SYLLABUS Introduction to Course Welcome to course, introduction of faculty, introduction of candidates, housekeeping: time-keeping, fire, toilets, smoking, phones & pagers, accidents, lost property, Aims & Objectives, Topics to be covered Post Incident Stabilisation Evacuation to sick bay; scene clear up - safety, effects on morale, schedule, assets etc; secondary survey, establishing an observations base-line. Activities of Daily Living Assessment of needs, planning the care, implement , evaluate Team management Enlisting help, delegation technique- authority & responsibility, overloading the decision maker, the Adair model of Action Centred Leadership Planning Use of SWOT, establishing a time-line Medical needs assessment Oxygenation, cardiac status, circulatory status, fluid balance, energy balance, gastrointestinal function, thermoregulation, skin and care of injury site, prevention of infection, pain relief, palliative & therapeutic medication. Nursing needs assessment Nursing procedures to support ADL’s, nursing devices to support ADL’s, observations Patient examination Examination of structure & function, use of diagnostic equipment, analysing what is found Planning the care Who does it, What do they do, When do they do it, Why do they do it, How do they do it, and Where do they do it? Patient observations General (BP, T, RR, P, GCS, PERL, CRT etc) and specific (distal pulses, girth, SpO2, EtCO2, glucose, urinary SG, urinary volume etc) Aspects of respiration SpO2 & EtCO2 as gauge of ventilation, minute volume, management of ventilation, humidification of oxygen, endotracheal tube cuff pressure, aspiration of airways, chest drains, cricothyrotomy care, sedation and ventilation Practical use of respiratory care equipment Intubation masterclass & ventilation after care Ryles tubes The concept of drip & suck, reintroducing oral fluids, how to pass a Ryles tube Catheterisation & Excretion Male catheterisation technique, manual evacuation, rectal fluid administration Chest drains & cricothyrotomy Chest drain technique and after care, managing haemothorax, Escharotomy Management of burns, rule of nines, local treatment, fluid balance, practical escharotomy Wounds & Infection, Wound care, Wound care practical Principles of wound healing, debridement, delayed primary closure, wound cleaning technique, infection control. Identification of infection, and management of infection theory Fluid balance & circulation Effects of dehydration and types of shock. Acute renal failure, causes, prevention and management. Nutrition Calorie consumption, calorie replacement, orally & intravenously, issues Pain Control Concepts of pain relief, paracetamol, NSAI’s, opiates, partial opiates, ketamine, local and regional anaesthesia, dental anaesthesia, anaesthesia of the eye. Pressure areas & skin care Explanation of causes, prevention, 2 hourly turns, passive exercises, prevention of contractures, washing Oral hygiene Practical procedure Eye care Practical procedure Temperature control Temperature sites, management of hypothermia, management of fever, and heat stroke Psychological aspects Personal, team and patient Haemorrhage, internal Management of internal haemorrhage without surgical facilities Haemorrhage, external Management of scalp haemorrhage, amputation, arterial bleeding Infection control Methods of infection transmission, isolation, barrier nursing, quarantine, disposal of biohazard materials Pre-planning Stores and supplies, training issues, management issues Radio medical advice Format for information transmission, radio advice format Organising care teams Shifts, handover, continuity of care, task allocation Evacuation methods Road, boat, plane, helicopter, ground team Helicopter awareness Landing site selection, signals, approach, loading, winching, travelling in helicopters Aeromedical issues Pressure issues, oxygen, elimination, battery life Handover Structure, attention span, ASHICE, CUPS, records
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