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Critical Care Emergency Medical Transport Program
Course Learning Objectives
Module A
CONCEPTS AND COMPONENTS OF CRITICAL CARE TRANSPORT
Describe the history of ambulance transports. Name three examples of
Critical Care Transport Team composition configuration. Identify and describe
the preferred qualifications of a Critical Care Transport Paramedic. Name six
advanced procedures performed by a Critical Care Transport Team.
Differentiate between routine and specialty equipment found on a Critical Care
Transport unit. Discuss the three modes of transport for the critically ill
or injured. Identify indications for critical care transport. Describe the interfacility transfer process.
MEDICOLEGAL ASPECTS OF CRITICAL CARE TRANSPORT
Apply the essential legal principles necessary to the practice of
emergency medicine to the job of the critical care paramedic. Recognize and
discuss the legal risks and liabilities involved in critical care
transportation. Apply basic risk management principles to critical care
transport. Discuss the fundamental elements of litigation, hearings and
peer-review proceedings. Understand EMTALA and the implications for EMS
State the appropriate steps for accepting a patient transfer State the
appropriate steps in assessing and preparing for transfer State CCEMT-P
responsibilities during transfer State the role of other health care
providers who accompany the patient State the appropriate steps to transfer
care to the receiving facility Appropriately document the transfer
Identify areas of potential liability State methods to minimize risk Be
familiar with current case law regarding transport
LABORATORY DATA INTERPRETATION
Describe the relationship between laboratory medicine and the diagnosis
and treatment of patients. Describe the common problems associated with
specimen collection and ways to avoid these problems. Identify mean lab
values and deviations for the complete blood count, the differential blood
count, and platelet values. Interpret arterial blood gas data. Interpret
chemistry studies. Interpret urinalysis. Describe the purpose of culture
and sensitivity tests. Interpret miscellaneous lab studies.
SHOCK
Define shock. Discuss the major pathophysiologies of shock. Describe
how assessment techniques can help identify shock. Describe the general
management principles for the patient in shock. Describe pharmacological
intervention in different types of shock.
MULTI-SYSTEM ORGAN FAILURE
Define multisystem
organ failure. List the history, signs, and symptoms of the patient with
sepsis. Describe the management of the patient with sepsis. List the
history, signs, and symptoms of the patient with acute respiratory distress
syndrome (ARDS). Describe the management of the patient with ARDS. List
the history, signs, and symptoms of the patient with disseminated intravascular
coagulation (DIC). Describe the management of the patient with the management
of the patient with DIC.
INFECTION CONTROL & COMMUNICABLE DISEASES
Describe proper infection control procedures that the Critical Care
Transport Paramedic should take when treating patients. Identify the mode of
transmission and precautions to follow when treating a patient with the
following infectious diseases: HIV Hepatitis Multiple-Antibiotic
Resistant Bacteria Tuberculosis Meningitis
Module B
BREATHING ASSESSMENT AND PULMONARY PHYSIOLOGY
Assess oxygen saturation using a pulse oximeter. Assess carbon dioxide
levels using an end tidal C02detector. Identify the categories of information
obtained through an ABG analysis. Describe the technique for drawing an ABG. Describe important landmarks and anatomical structures of the chest wall and
respiratory system. Describe two factors important. in the generation of
breath sounds. Describe how to assess breath sounds for duration, pitch, and
intensity. Identify auscultatory sites for breath sounds assessment.
Define normal and adventitious breath sounds. Define consolidation.
Perform vocal and tactile fremitus assessments of lung fields. Define and
describe abnormal respiratory patterns. Define and describe respiration and
ventilation abnormalities. Perform a complete respiratory assessment.
PLEURAL DECOMPRESSION
Identify indications
for pleural decompression. Discuss methods for pleural decompression
assessment. Describe the procedure for pleural decompression.
Differentiate between normal and abnormal assessment findings. Identify
transport complications associated wiffi pleural decompression.
CHEST TUBE MANAGEMENT
Identify indications and purpose for chest tubes. Discuss methods for
chest tube assessment. Differentiate between normal and abnormal assessment
findings. Describe the procedure for chest tube placement. Identify
transport complications for chest tubes.
PORTABLE VENTILATORS
Identify indications and purpose for portable ventilators. Discuss
methods for ventilator assessment. Differentiate between normal and abnormal
assessment findings. Describe the procedure for placing a patient on a
portable ventilator. Identify transport complications of portable
ventilators.
ET TUBE AND TRACHEAL SUCTIONING
Identify indications for ET tube and tracheal suctioning. Describe the
procedure for ET tube and tracheal suctioning. Identify complications of ET
tube and tracheal suctioning.
RAPID SEQUENCE INDUCTION/ INTUBATION
Identify indications and purpose for rapid sequence induction (RSI).
Identify pharmacologic agents utilized in RSI. Describe why sedative
medications should usually accompany the use of paralytic agents. Outline the
technique for RSI. Identify transport considerations for patients intubated
with the RSI technique.
Module C
TRACHEOSTOMIES
Identify indications and purposes for a tracheostomy. Identify criteria
for tracheostomy assessment. Differentiate between normal and abnormal
assessment findings Describe the procedure for tracheostomy placement.
Identify transport complications of tracheostomies.
NEEDLE CRICOTHYROTOMY
Identify indications and purpose for needle cricothyrotomy. Identify
criteria for needle cricothyrotomy assessment Describe the procedure for
needle cricothyrotomy. Differentiate between normal and abnormal assessment
findings. Identify transport complications for needle cricothyrotomy.
SURGICAL CRICOTHYROTOMY
Identify indications and purpose for surgical cricothyrotomy. Identify
criteria for surgical cricothyrotomy assessment Describe the procedure for
surgical cricothyrotomy. Differentiate between normal and abnormal assessment
findings. Identify transport complications for surgical cricothyrotomy.
RETROGRADE INTUBATION
Discuss the indications and purpose for retrograde intubation. Identify
criteria for retrograde incubation. Describe the procedure for retrograde
intubation. Differentiate between normal and abnormal assessment findings.
Identify transport complications for retrograde intubation.
Module D
INVASIVE LINES
Differentiate between types of invasive lines Identify indications for
invasive lines Discuss methods for assessing invasive lines Differentiate
between normal and abnormal assessment findings Identify transport
complications of invasive lines
HEMODYNAMIC MONITORING
|Identify hemodynamic monitor controls Interpret hemodynamic readings
Identify alarm indications Discuss alarm troubleshooting procedures
Identify transport complications of hemodynamic monitors Define: preload,
afterload, contractility, systemic vascular resistance, cardiac output, cardiac
index List two purposes for invasive hemodynamic monitoring Identify the
function of each component of a PA catheter including: length markings, balloon
inflation port, thermistor port, PA distal port, RA proximal port, auxiliary RA
port List normal hemodynamic pressures and identify normal pressure waveforms
for the RA, RV, PA, PCWP, LA and peripheral arterial sites Interpret SVO2
monitoring data and discuss appropriate theraputic modalities to treat abnormal
values Discuss indications of measuring cardiac output and cardiac index
Describe problems commonly encountered in measuring PA pressures and state
appropriate interventions List at least 5 potential complications associated
with PA insertion
BLOOD ADMINISTRATION
Differentiate between antigens, natural antibodies and acquired antibodies Identify antibodies and antigens associated with specific blood types
Define Rh factor Identify seven types of blood component therapy Identify
indications for blood administration Describe the procedure for blood
administration Identify the signs and symptoms of transfusion reactions
Describe the management procedures for transfusion reactions Describe the
indications for administration of whole blood and packed red blood cells
Describe the indications for typing, screening and cross matching blood
Describe the ABO system for matching blood Describe the characteristics of
blood products Describe the procedure for administration of whole blood or
packed red blood cells.
Module E
12-LEAD ELECTROCARDIOLOGY
Describe the difference between monitoring and assessing a patient using
an ECG machine Demonstrate proper lead placement for a 12 Lead ECG Using a
simple chart and leads I,II,and III, determine the electrical axis and the
presence of fascicular blocks (hemiblocks) Using lead V1(MCL1), determine
bundle branch blocks Describe the clinical significance of hemiblocks and
bundle branck blocks in the cardiac patient Describe the strategy for
identifying V-Tach in wide complex tachycardia On a 12-Lead or Multi-Lead ECG,
identify ST and T wave changes relative to myocardial ischemia, injury and
infarction. Describe a systematic "assessment" of a 12-Lead ECG
Describe possible complications of various infarct locations
IMPLANTABLE CARDIOVERTER DEFIBRILLATORS
Discuss the incidence of sudden cardiac death and the population at risk Describe how and Implantable Cardioverter Defibrillator (ICD) works, its
components and its functions Identify the potential complications associated
with the ICD and location of placement in the chest wall Describe the
procedure for deactivating an ICD with a magnet
CARDIAC PACEMAKERS
Understand the basic concepts underlying cardiac pacemaker technology
Understand the current code system used for cardiac pacing Understand and
troubleshoot the potential rhythms that indicate forms of pacemaker malfunctions
INTRA-AORTIC BALLOON PUMPS
Identify indications for IABP Define the primary physiological effects
achieved by the inflation and deflation of the IAB Describe the set up and
operation of an IABP Discuss the hemodynamic effects of proper balloon
inflation and deflation Identify the factors that affect diastolic
augmentation and appropriate troubleshooting considerations Identify proper
timing and appropriate corrective action Identify transport complications of
IABP
Module F - Pharmacology
SEDATIVES
Identify the indications, mechanism
of action, pharmacokinetics, dosing and side effects of haloperidol Identify
the mechanism of action of benzodiazepine drugs Compare the dosing and side
effects of diazepam, lorazepam and midazolam Identify the indications,
mechanism of action, pharmacokenetics, dosing and side effects of flumazenil
Identify the indications, mechanism of action, pharmacokinetics, dosing, side
effects, drug interactions and administration considerations of propofol
ANALGESICS
Identify the mechanism of action, pharmacokinetics, and side effects of
morphine Identify the mechanism of action, pharmacokinetics, and side effects
of naloxone
PARALYTICS
Identify the mechanism of action, pharmacokinetics, and toxicity of
Succinylcholine Identify the indications, mechanism of action,
pharmacokinetics, side effects and drug interactions of pancuronium, vecuronium
and atracurium Identify the order of paralysis Discuss the adverse effects
of prolonged paralysis Identify the role of "train of four"
monitoring when using paralytics
ANTIHYPERTENSIVES
Compare the mechanism of action, dosing, pharmacokinetics, and adverse
effects of captopril, nifedipine and clonidine Identify the mechanism of
action, pharmacokinetics, dosing, toxicity and administration considerations of
nitroprusside Identify the mechanism of action, pharmacokinetics, dosing and
adverse effects of labetalol Identify the pharmacology, pharmacokinetics,
dosing and toxicity of diazoxide
VOLUME EXPANDERS
Compare the advantages and disadvantages of crystalloids and colloids
Compare the use, dose and adverse effects of albumin, plasma protein fraction,
Hetastarch and Dextran
VASOPRESSORS
Identify the indications for vasopressors Compare the effects, dosing
and adverse effects of dopamine, epinephrine, norepinephrine (Levophed),
phenylephrine and dobutamine
BRONCHODILATORS
Identify the pharmacology and effects of beta receptor stimulation for
beta agonists Compare the pharmacokinetics, dosing, delivery, and adverse
effects of albuterol, epinephrine and terbutaline Identify the pharmacology,
metabolism, adverse effects, drug interaction and dosing of metoproterenol and
theophylline Identify the pharmacology and dosing of anticholinergics
Compare and contrast anticholinergics and beta agonists Identify the
pharmacology and uses of magnesium
ANTIARRHYTHMICS
Identify the mechanism of action, ECG effects, uses, pharmacokinetics,
dosing and toxicity of Class IA antiarrhythmic drugs Identify the mechanism
of action, ECG effects, uses, pharmacokinetics, dosing and toxicity of Class IB
antiarrhythmic drugs Identify the mechanism of action, ECG effects, and uses
of Class IC antiarrythmic drugs Identify the mechanism of action, ECG
effects, and uses of Class II antiarrythmic drugs Identify the mechanism of
action, ECG effects, uses, pharmacokinetics, adverse effects and drug
interactions of Class III antiarrhythmic drugs Identify the mechanism of
action, ECG effects, and uses of Class IV antiarrythmic drugs Compare the
pharmacokinetics, dosing and adverse effects of verapamil and diltiazem
Identify the mechanism of action, ECG effects, uses, pharmacokinetics,
administration considerations, drug interactions and toxicity of adenosine
ANTIANGINALS
Identify the pharmacology, dosage forms, pharmacokinetics, administration
considerations, adverse effects, and tolerance considerations of nitrates
Identify the uses, side effects and patient selection criteria for beta blockers Identify the uses, contraindications, and side effects of calcium channel
blockers
THROMBOLYTICS
Identify the absolute and relative contraindications to thrombolytic
therapy Compare the pharmacology, pharmacokinetics, dosing and adverse
effects of TPA, streptokinase and APSAC Discuss the benefits of thrombolytic
therapy
ANTICOAGULANTS
Identify the mechanism of action, dosing, and clinical trial findings of
aspirin as an anticoagulant Identify the mechanism of action, dosing,
monitoring parameters, adverse effects and clinical trial results of heparin
Identify the pharmacology, indications, monitoring parameters, drug interactions
and adverse effects of warfarin
ANTIBIOTICS
Identify the pharmacology and uses of antibiotics
ETOMIDATE
Identify the indications, mechanism of action, pharmacokinetics, and side
effects of etomidate
Module G
GI, GU and RENAL ASSESSMENT
Identify GI/GU assessment criteria Differentiate between normal and
abnormal assessment findings
NG and OG FEEDING TUBES
Identify the indications for a nasogastric and oragastric tube Discuss
methods for nasogastric and orogastric assessment Differentiate between
normal and abnormal assessment findings Describe procedure for placement of
nasogastric and orogastric tubes Identify transport complications associated
with nasogastric and orogastric tubes.
URINARY CATHETERS
Identify indications and purpose for Foley catheters Discuss assessment
methods for Foley catheters Differentiate between normal and abnormal
assessment findings Describe procedure for Foley catheter placement
Identify transport complications for Foley catheters
OSTOMIES
Identify indications for an ostomy Discuss methods for ostomy
assessment Differentiate between normal and abnormal assessment findings
Discuss methods for ostomy placement Identify transport complications for
ostomies
HEMODIALYSIS and PERITONEAL DIALYSIS
Identify indications and purpose for dialysis Differentiate between
hemodialysis and peritoneal dialysis Describe the procedure for accessing
arteriovenous shunts Identify transport complications of dialysis patients
RECTAL CONSIDERATIONS
Describe the rectal anatomy and structures Classify rectal bleeding:
red, bright red, melena Discuss incontinence, diarrhea and constipation
management techniques Demonstrate rectal temperature assessment technique
Describe decubitus ulcers
Module H
NEUROLOGICAL ASSESSMENT
Describe the major components of a neurological examination Describe
the differences in the neurological assessment between a brain injured or spinal
injured patient Perform a neurological examination Describe the findings
of a normal and abnormal neurological examination Describe vital signs
changes noted with neurological injuries Identify transportation
considerations for patients with neurological injuries
NEUROLOGICAL ASSESSMENT LAB
Correctly perform a neurological assessment Document the findings of a
neurological examination
INTRACRANIAL PRESSURE
Describe intracranial
pressure (ICP) Describe the pathophysiology of ICP Define compliance
Explain herniation of the brain Describe how to calculate cerebral perfusion
pressure (CPP) Identify signs and symptoms of increasing ICP Identify
factors that will increase ICP Identify consequences of increased ICP on
patient outcome Identify strategies and methods for decreasing ICP during
critical care transport
INTRACRANIAL PRESSURE MONITORING
Describe the reasons for ICP monitoring Differentiate between normal
and abnormal findings with ICP monitoring Describe the advantages,
disadvantages, and transport considerations for the following ICP monitoring
devices: Intraventricular catheter Epidural catheter Subdural/
subarachnoid monitoring devices Fiber optic transducer tipped probe
Describe ICP waveform Explain therapies to manage ICP
Module I
TRANSPORTS: START TO FINISH
Differentiate operational aspects of critical care transport and
conventional prehospital care Identify four major opportunities for positive
interaction that exist during a critical care transport Incorporate
prospective medical control into the care of critical patients Identify
critical decision points in a transport event Develop an event flowsheet
Identify essential patient perceptions of quality service Understand the role
of family members in critical care transport Recognize situations warranting
diversion or interception Incorporate unique management tactics with moribund
patients and families
AEROMEDICAL PHYSIOLOGY
Define Boyle's Law Name the eight stressor's of flight Name and
describe three types of barotrauma Explain how an unpressurized medical cabin
can affect equipment Explain "time of useful consciousness" List
the objective signs and symptoms of hypoxia List the subjective signs and
symptoms of hypoxia Name six special considerations that should be taken with
patients being air transported Explain how a negative G-force affects the
body Define Dalton's law Name three considerations in preventing hearing
loss List four contributing factors to crew member fatigue
Module J
CASE STUDIES
Integrate topics learned with case scenarios
PEDIATRIC CONSIDERATIONS
Identify various histories and general principles for pediatric assessment Define the primary cause of cardiac arrest and list several risk factors
Describe principles of general treatment before and during the transport of a
pediatric patient
OBSTETRICAL/GYNECOLOGICAL CONSIDERATIONS
Identify various histories and general principles for OB/GYN assessment
Define the primary cause of cardiac arrest and list several risk factors
Describe principles of general treatment before and during the transport of a
OB/GYN patient
BURN MANAGEMENT
Identify and describe burn types, depth and
estimate Body Surface Area according to Rule-of-Nines, "palm" scale
and age appropriate guidelines. Identify principles and methods of burn
treatment, analgesia, airway care and patient packaging for transport. Utilize
American Burn Association categorizing for minor, moderate and severe burns.
Describe the importance of maintaining fluid volume and body temperature.
Describe methods to assure adequate fluid volume and body temp, describe theory
and practice methods of pharmacologic therapy in burns
For more information, please contact John Martin at 706-721-3548 or .
Page updated: October 12, 2007