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INTRODUCTION
The critical care is a growing branch of Emergency medical services. The advancements in
medicine have developed the need of trained paramedics who are able to provide an
advanced care for critically patients.
The concept of critical care as a specialty, is relatively modern, even though there have
always been very sick and severely injured patients. Given the advances in medicine and
technology, the pre-hospital care of patients has become more complex. To provide
appropriate care, paramedics require specialized knowledge and skills as the mechanisms of
delivering care evolve to support patients needs for continuous monitoring and treatment.
The practice of paramedic critical care has improved over the past decades. Knowledge of
the pathophysiology of life-threatening conditions and the technological capacity to monitor
and treat patient’s pre-hospital and within the hospital, have advanced rapidly during this
period. Currently, in the Kingdom of Saudi Arabia, there is a need for pre-hospital critical
conditions to be adhered to correctly to prevent deaths.
To meet the national and international standards of paramedic critical care, the Saudi
Commission for Health Specialties (SCFHS) will offer an evidence-based training and
educational program, tailored specifically to critical care in the pre-hospital and within
hospital. The expected outcomes of this program include the generation of research
investigations and dissemination of research findings related to this specialized area of
practice.
This program will focus on the paramedic critical care with acute and complex health
problems. The emphasis is on enhancing the critical thinking skills necessary to make sound
judgments and promote self-directed care of patients with acute and complex health
problems. Furthermore, this program will synthesize evidence-based data to deliver
competent, culturally sensitive, and appropriate holistic care to clients with complex health
needs.
PROGRAM OVERVIEW
The Advanced Practice Program in Paramedic Critical Care is a two-year program designed
to provide opportunities for registered paramedics to acquire updated clinical knowledge
and skills, and further develop professional attitudes and behaviors, which will enable them
to work with critically ill patients.
This program will help the trainee paramedics to develop intellectual and creative abilities
to facilitate the development of independent judgment and problem-solving skills. The
ultimate goal of this program is to prepare registered paramedics with sound skills and
attitudes to perform competently in critical care settings. Upon successful completion of the
Advanced Practice Program in Paramedic Critical Care, the paramedic will be awarded a
certificate from the SCFHS to practice as a Senior Specialist in Paramedic Critical Care.
Program Objectives
Upon completion of the Advanced Practice Program in Paramedic Critical Care, the learner
will be able to:
- Integrate knowledge of paramedic science and related sciences with the care of
critically ill patients.
- Identify common risk factors that may adversely affect the physical and psychosocial
well- being of patients with acute life-threatening diseases and injuries
- Utilize the paramedic process in the care of patients with acute life-threatening
condition.
- Demonstrate the interpersonal and psycho-motor skills needed to implement
effective care of critically ill patients.
- Utilize critical thinking skills to improve the health outcomes of patients with acute
life- threatening condition.
- Provide health education and counseling to patients and their families.
- Manage sudden or acute deteriorations in the conditions of patients who are ill with
acute life-threatening diseases and injuries.
- Apply infection control and safe-patient care standards when caring for patients with
acute life-threatening diseases and injuries.
- Utilize an evidence-based approach to evaluating paramedic practice.
- Apply concepts of quality improvement to the evaluation of paramedic care.
- Manage ethical issues concerning the care of patients and their families in
accordance with Islam, Saudi culture, and their regulations.
- Participate in professional development activities, including self-directed learning
and continuing professional education.
- Assess and facilitate patients’ and families’ use of effective coping mechanisms in
times of crisis.
- Provide safe and effective practice in the administration and disposal of drugs used
in the care of the critically ill patient; assess the effects of drug therapy and initiate
action according to the clinical unit’s protocols.
- Analyze management and leadership using relevant theories and demonstrate their
application to professional practice.
Reflect and critically evaluate their own practice in the application of an appropriate model
of paramedic.
Apply knowledge demonstrate knowledge and request of patient’s rights in professional
clinical practice.
General Training Requirements
The trainee shall abide by the regulations and obligations established by the Saudi
Commission for Health Specialties (SCFHS).
Training is a full-time commitment. The trainee shall be enrolled on a full-time, continuous
basis for the entire duration of the program.
Training is to be conducted in institutions accredited for paramedics’ training by the Saudi
Commission for Health Specialties.
The training will be comprehensive in the specialty of the critical care of patient.
The trainee shall be actively involved in patient care with gradual progression of
responsibility.
Admission Requirements
Eligible applicants must fulfill the application requirements of the SCFHS and meet the
following criteria:
- Be a graduate from an accredited degree program with an Associate of Applied
Science (AAS).
- Pass the interview for admission.
- Provide a letter from an employer supporting a full-time enrollment in the program.
- Provide evidence of current certification in Basic Life Support (BLS).
To obtain a certificate of the Advanced Practice Program in Paramedic Critical Care, the
candidate must fulfill the following requirements:
- The required period for the completion of this program is two calendar years.
- The program consists of a 44 weeks per calendar year, excluding examination weeks
and annual vacation. A total of 88 weeks must be completed during the entire study
period.
- A total of 40 hours of didactic and clinical hours must be completed each week.
- The trainee rotation consists of an 8-hour shift, excluding lunchtime or a 12-hours
shift to complete the required total of 40 hours per week.
- The program’s language of instruction is English.
Leaves
Trainees are entitled to an annual leave of thirty days in addition to one of the Eid leaves.
Trainees are also entitled to sick leaves, maternity leaves, and emergency leaves for a
period not exceeding ninety days. Trainees shall compensate for such leaves with an
equivalent number of days before being awarded the program’s certificate of completion.
Leaves that are not utilized in due time within the year shall not be shifted to the coming
year.
Trainees may be granted special leave for scientific purposes not to exceed seven days per
training year to attend scientific conferences, seminars, or workshops in the same specialty
area. The trainee is required to provide proof of attending such activities.
Year
Modules
Number of
Weeks
Orientation: 1 week
MODULES OF FIRST YEAR
TRAINING
Module I:Critical Care Interfacility Transport
4
Module II: Ground Transport Safety and Air
Medical
5
Module III: Medical-Legal and Ethical Aspects 5
of CCIT
Module IV: Diagnostic Studies: Laboratory
Interpretation, Radiology
6
Module V: Vascular Access, Fluid and Blood
Administration
5
Module VI: Pharmacology
5
Module VII:Trauma, Multi-system Trauma
and Burn Injuries
6
Annual Vacation: 4 weeks
MODULES OF SECOND YEAR
TRAINING:
Module VIII Cardiovascular System
4
Module IX: Respiratory System
4
Module X: Nervous System
4
Module XI: Gastrointestinal System
4
Module XII: Endocrine System
4
Module XIII: Hematology, Immunology and
Infectious Disease
4
Module XIV: Obstetrical Patient and Care of
the Newborn
4
4
Module XV: Leadership and Management
Eid Vacations: 2 Weeks (One Week for Each Eid)
INSTRUCTIONAL METHODS
1) Interactive lectures and discussions
2) Computer assisted interactive instructional programs
3) Weekly reading assignments
4) Simulations and clinical skills demonstrations
5) Presentations
6) Group discussion of case studies
7) Clinical practicums to include:
Theory to precede related clinical assignments (as needed).
Post clinical debriefing: 1-2 times per week, as needed, and the development of paramedics
plans of care for selected patients.
Case presentations: Guidelines: Each trainee will present a case study of a patient cared for
in the clinical setting. The case presentation should include: the patient’s past medical
history, disease diagnosis/treatment history, current medical/surgical diagnosis, and his/her
diagnosis with appropriate assessment findings, and current plans of care with identification
of optimal outcomes. Presentations are to be approximately 15 minutes with the trainee
facilitating the post-presentation discussion. The discussion should include a comparison of
plans of care with the current International Association of Flight &Critical-Care (IAFCC)
Clinical Practice guidelines, Standards of Care, and any other evidence-based practice
standards.
This program contains fifteen modules that address topics relevant to the education and
training of paramedic enrolled in an advanced practice program with a focus on paramedic
critical care. Each module targets specific competencies. The program’s clinical
competencies have been adopted from Mosby’s skills database, with some modifications to
meet the outcomes of this program. Each trainee is issued a username and a password to
access Mosby’s database. The trainee is expected to perform the competency exams online.
The assigned clinical instructor monitors the test results and schedules trainees for
competency checks in the paramedic skills laboratory, based on the trainees’ online-exam
scores.
The checklist is used as a tool to monitor the competency checks of each trainee.
Hospital Rotations
Most hospitals’ critically ill patients are in the intensive care units. Therefore, to experience
the role of the Paramedic critical care medic, trainees are provided with adequate specialty
experience. The purpose is to enable them to have confidence and gain competence in
terms of the assessment and overall holistic management of critically ill patients in varied
critical care settings. Some hospitals have several ICUs, such as a Trauma, Surgical, and Burn
ICUs. Additionally, some critically ill patients arrive in the Emergency Department and then
transfer to another hospital or die. Therefore, trainees are advised to see these cases with
his/her clinical instructor.
FIRST-YEAR TRAINING MODULES
Critical Care Interfacility Transport
The participant shall be able to:
1. Understand the role of the critical care interfacility transport teams in the patient care
continuum.
2. Understand the importance of providing the highest quality of care in a timely and safe
manner.
3. Understand how the needs and characteristics of patients influence and drive the
competencies of critical care interfacility transport professionals.
1- Define and differentiate between the following:
a. Emergency Medical Services (EMS)
b. Interfacility EMS transport
c. Critical Care and Critical Care Transport
2. Compare and contrast the role of Emergency Medical Services pre-hospital system with
critical care interfacility transportation
4. Describe how existing critical care professional organizations help shape the
characteristics of the critical care transport professional
5. Differentiate between critically ill trauma and medical patient transport theories
a. Scoop and run
b. Stay and play/resuscitate
6. Describe safe transport techniques
7. Describe appropriate transport equipment necessary for various critical care interfacility
transports
8. Describe the Scope of Practice for Critical Care-Paramedic and pertinent rules and
regulations for critical care paramedics in interfacility transports
9. Describe the components needed to provide the highest quality of care during critical
care interfacility transport
10. Describe the importance of initial stabilization of the patient prior to transport
a. EMTALA and COBRA laws
11. Describe how disaster and mass casualty events will affect critical care interfacility
transport
Ground Transport Safety and Air Medical
The participant shall be able to:
1. Integrate pathophysiological principles and assessment findings to manage the
treatment and transport of the critical care patient to assist with the decision making
regarding air medical transport vs. ground transport.
1. Describe ways of creating and maintaining a safe work environment
Vehicle checks
● Equipment checks
● Safety equipment
● Identify potential hazards during vehicle operations and ways to avoid or minimize
them
- Physical hazards
- Stress hazards (thermal, humidity, noise, vibration, fatigue)
● Ensure safety of passengers and patient during transport
2. Identify different classes of aircraft
● Fixed wing vs. rotor wing
● Twin vs. single-engine aircraft
● Weight considerations and aircraft performance
3. Describe air medical transport safety awareness
- Landing zone
- Communications
- Coordination
4. Understand basic gas laws
❖ Four basic variables
- Temperature
- Mass
- Volume
- Pressure
❖ Boyle’s law
❖ Dalton’s law
❖ Henry’s law
❖ Graham’s law
6. Identify flight stressors and interventions during air transport
a. Decreased partial pressure of oxygen
❖ Hypoxia
b. Barometric pressure
c. Thermal regulation
d. Humidity
e. Gravitation forces
f. Dehydration
7. Identify the effects, causes and emergency procedures for rapid decompression
8. Identify differences in patient care and equipment considerations during transport
Compare and contrast patient preparation activities for air transport vs. ground transport
11. Compare and contrast the benefits and limitations of air vs. ground transportation for
critical care transport
Psychomotor Objectives:
In this unit, the participant shall be able to:
1. Perform reassessment techniques and interventions specific to flight physiology
Medical-Legal and Ethical Aspects of Critical Care
The participant will be able to comprehend basic legal issues pertaining to critical care
1. Explain the legal responsibilities of EMS Rules, Regulations and Statutes regarding:
a. Patient, medical director, and public
b. Set by legal system
- Statutes enacted by legislature
- Rules and Regulations by governmental agencies
- Scope of practice
Explain laws and regulations of ambulance services in Saudi Arabia
a. Describe the Rules of ambulance services including minimum qualifications of required
personnel
b. Explain the legal definition and objective for the scope of practice in critical care
c. Explain the role of the medical control and medical director as it pertains to critical care
3. Review legal and ethical responsibilities of paramedics
4. Define and describe the Emergency Medical Treatment and Active Labor Law (EMTALA)
for ambulance services
5. Explain the role, requirements and obligations of:
a. Sending facility
- Medical examination
- Stabilization of patient
- Communication
⮚ Doctor to doctor
⮚ Nurse to nurse
- Documentation
- Physician Transfer orders
b. Transport team and associated medical direction
i. Protocol specific
c. Receiving facility
1. Defend the value of advanced medical directives
2. Support the roles, requirements and obligations of the transport team Rules, Regulations
and Statutes, including scope of practice
3. Understand the evolving legal process for development and implementation of Saudi’s
Rules, Regulations and Statutes, including scope of practice
4. Justify the need for specialized personnel and equipment in critical care of neonatal to
geriatric patients with special monitoring needs from the legal and ethical perspectives
Demonstrate ability to complete required documentation before, during and after a critical
care
Diagnostic Studies: Laboratory Interpretation, Radiology
The participant shall be able to:
1. Gain a fundamental understanding of the diagnostic studies pertinent to critical care
patients.
2. Integrate diagnostic findings into patient care decision-making for critical care transport.
1. Laboratory interpretation:
a. Identify appropriate abbreviates for blood chemistry tests.
b. The normal and abnormal values and correlate pathophysiological states for the following
blood chemistry tests:
i. Arterial blood gas
ii. Blood chemistry/metabolic panel
iii. Complete blood count
iv. Cardiac enzymes
v. Coagulation studies
vi. Routine urinalysis
vii. Cerebrospinal fluid analysis
2. Radiology / imaging
a. Identifying abnormalities on a chest x-ray such as:
❖ Pneumothorax
❖ Widened mediastinum
❖ Pulmonary contusion
❖ Consolidation
❖ Skeletal fractures
b. Discuss the clinical signal found on X-ray used for identification of:
❖ Endotracheal tube placement
❖ Naso and orogastric tubes
❖ Central lines
❖ Chest tube
c. Correlate basic CT scan abnormalities with specific pathophysiologic conditions related to:
❖ Head
❖ Chest
❖ Spine
❖ Abdomen
❖ Pelvis
Recognize the following utilizing radiologic and imaging diagnostic studies:
❖ Pneumothorax
❖ Pulmonary infiltrate
❖ Various invasive treatment device placement
❖ Endotracheal tube, naso and orogastric tubes, central lines, chest tube
❖ Skeletal fractures
❖ Various bleeds
❖ Head, chest, abdomen, pelvis
Vascular Access, Fluid and Blood Administration
Understand Compare and contrast the use of various catheters for vascular access
Conduct methods of fluid and blood administration
1. Indications for use, advantages, disadvantages, and potential
Complications of the different types of vascular access device
a. Peripheral (Midline)
b. Central
❖ Tunneled (Hickman, Broviac, Dialysis)
❖ Non-tunneled (Internal jugular, Subclavian, Femoral)
❖ Peripherally inserted central catheter (PICC)
2. Describe basic techniques in using vascular access devices
❖ Multi-lumen catheter and associated line placements
❖ Access
❖ Site care
❖ Flushing
3. Identify the indications, contraindications, precautions, complications, administration
method for neonate through geriatric patients requiring:
a. Packed red blood cells
b. Whole blood
c. Platelets
d. Albumin
e. Fresh frozen plasma
4.Describe signs and symptoms, timing and treatment for the following blood transfusion
reactions:
a. Hemolytic
b. Anaphylactic
c. Febrile
d. Circulatory overload
5. Identify indications, contraindications, precautions, complications, administration method
for adult and pediatric patients requiring non-blood volume expanders:
a. Hetastarch
b. Plasma protein factor
c. Hypertonic saline
.
Pharmacology
The participant shall be able to:
1.Determine the appropriate use of pharmacological interventions as part of the overall
patient management plan for neonate through geriatric critical care patients.
2.Demonstrate knowledge of specific medications common to patients requiring critical care
3.Demonstrate knowledge for the neonate through geriatric patient with toxic ingestion
Describe how to evaluate the actions, pharmacokinetics, indications,
contraindications, route of administration, adverse effects, and drug
incompatibilities/interactions of all medications for safe administration.
2.Explain the time response curve and dose response curve of drug use.
3.Identify the effects of drug use on the liver, in renal dysfunction, shock states, and age
extremes.
4.Articulate the different methods of mathematically calc ...
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f. Three Social Entrepreneurship Models
g. Social-Founder Identity
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Outcomes
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Identify a specific consumer product that you or your family have used for quite some time. This might be a branded smartphone (if you have used several versions over the years)
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