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Scopes of Practice reference guide

- Based on NHS Trust 2015 guidelines. Please be aware that there will be a slight variation between Trusts but as a general rule these are the scopes of practice (and implied training) for the following grades registered on HPA.

Community First Responder (CFR)

1.

Responsibility


1.1. Respond as a first responder to any emergency call other than:

· Fire

· Severe Trauma

· Spinal Injuries

· Road Traffic Accidents

· Industrial Accidents

· Any incident involving abuse/violence or aggression

· Alcohol or drug related incidents including overdoses, except where the

· overdose is unintentional by a minor

· Maternity or Gynaecological emergencies

1.2. Community First Responders must not under any circumstances respond using blue lights or sirens.

1.3. CFRs have a responsibility and duty of care to provide a high standard of care commensurate to their skill set.

2.

Skill set


2.1. Primary Survey only

2.1.1. Community responders will not be required to examine intimate areas of a patient, except where not doing so would put the patient at further risk.

2.1.2. Community responders will not carry out any invasive1 or internal2 examinations or procedures

2.2. Administration of specified medications (see list below)

2.3. Semi-automatic defibrillation

2.4. Basic Life Support

2.5. Assisting other clinicians in carrying out Advanced life support (RCUK/ERC Guidelines) – Adult, Child, Infant, Newborn

2.6. Approved equipment list

2.6.1. CFRs must only utilise clinical equipment and consumables as stated in the Responder Policy

2.6.2. CFRs must not work outside their Scope of Practice in relation to equipment or consumables.

2.6.3. Any local agreements must be in place with the Voluntary Services Department relating to

any pre-existing equipment owned by a CFR scheme, not currently on the approved

1 Invasive procedures can be defined at those which require interrupting the continuity of skin or insertion into body cavities (excluding the oral or nasal cavity)

2 Internal & intimate examinations relate specifically to rectal or vaginal investigations.

equipment list.

2.6.4. The Clinical Quality Working Group will approve or reject any additional equipment proposed for inclusion as part of the Approved Equipment List or Local Agreements.

2.6.5.

Referral rights

3.1. Community First Responders must always seek to hand-over patients to qualified operational Ambulance Personnel.

3.2. CFRs must be backed up with qualified operational Trust staff when attending emergency calls.

3.2.1. It is accepted that in exceptional circumstances, back-up may be delayed or not be possible (i.e. adverse weather)

3.3. CFRs cannot stand down other resources

3.4. CFRs cannot make referrals to other health professionals. Any referrals will be made by the operational clinician(s) attending the incident, or in EOC.

3.5. CFRs are not authorised to discharge patients. In exceptional circumstances, a discharge decision may be made by a clinician remotely, but this must not be considered routine

3.6. CFRs cannot make conveyance decisions and must defer to the attending clinician(s).

4.

Drugs and preparations authorised for use


4.1. JRCALC Drugs3 or other medicines authorised by the Trust.

4.1.1. Please refer to Appendix M

4.2. PGDs

4.2.1. Lay CFRs are not registered health professionals and therefore not legally entitled to issue drugs under a patient group direction

4.3. Medicine management responsibilities

4.3.1. CFRs are responsible for the safe keeping of medications in their possession and must report damage, theft or losses.

4.3.2. Use of medicines must be recorded on the PCR on arrival of NHS equivalent clinician, and must include the CFRs unique PP Number

4.3.3. CFRs must record all drug administration on their Drugs Issue Card (see Medicines Management Manual)

4.4. Medicines administration responsibilities

4.4.1. Medicines must only be administered at the dose stated and via the route stated in the

3 JRCALC Drugs are authorised for use via legal mechanisms (depending on grade) – see Appendix M for information.


CFR medicines Prompt Card.

4.4.2. CFRs cannot deviate from training.

4.4.3. CFRs must act as the patients advocate and must make any concerns known to others involved in patient care where a potential and/or imminent drug error could occur.

5.

Supervision


5.1. Supervises:

5.1.1. Community responders do not provide formal supervision, but may provide mentorship and support to new members of the Community First Responder scheme

5.1.2. Community responders may also provide supervision as part of a training action plan.

5.2. Supervised by:

5.2.1. CFR Team Leader

5.2.2. CFR Senior Team Leader

5.2.3. CFR Associate Trainer

5.2.4. CFR Senior Associate Trainer

5.2.5. NHS equivalent Operational clinicians and managers.

5.2.6. Volunteer Development Coordinators

6.

Documents related to grade


6.1. JRCALC Clinical Practice Guidelines

6.2. Resuscitation Guidelines

6.3. CFR Drugs Prompt Card

6.4. CFR Foundation Course

6.5. CFR Drug Issue Card

7.

Pre-requisites for continued voluntary membership of CFR scheme


7.1. DBS on appointment

7.2. Occupational health check on appointment

7.3. Full, valid UK driving licence held for at least 12 months (up to 3 penalty points)

7.3.1. Appropriate insurance for vehicle being used for responding as a CFR

7.4. Up to date evidence for right to work and reside in the UK.

7.5. References.

7.6. Evidence of competency through Trust-approved process

8.

Specialist Roles and Special Conditions


8.1. CFRs do not have any specialist roles or conditions

Immediate Emergency Care Responders (IECR) (Fire Service)

Clinical Practice Areas

Grade of Staff: Immediate Emergency Care Responder (IECR) Background of personnel

Firefighters are familiar with dealing with emergency situations, and are ideally placed to support NHS equivalent in a limited number of clinical presentations. Firefighters are not registered health professionals, and are therefore not familiar with the day to day delivery of clinical services. This appendix describes the scope of practice required to facilitate the benefits of IECR, and to ensure that patient care and safety is optimised.

Operational deployment

IECR is a different system to other co-responding schemes involving Fire & Rescue Services (FRS) due to having a wider scope of practice than a standard CFR or co-responder, and they can also use their care skills in their own organisation. They also respond to incidents under emergency conditions.

Previous and current schemes across the region use personnel from other services, such as FRS, but in a traditional Community First Responder mode. These include;

· Fire & Rescue Services, Coastguard etc.

o Co-responders from other agencies operate to training levels set within their own organisation by agreed with NHS equivalent.

o Immediate Emergency Care (IEC) is based on a national profile and NHS equivalent has added the CFR aspect (IECR) to this in order to make it fit for purpose locally.

· IECRs will always be backed up to 999 calls immediately and cannot make conveyance



9.1. Respond as a first responder to any emergency call other than (and with the exception of incidents suggestive of including cardiac arrest of clear threat to life):

· Any incident involving abuse/violence or aggression

· Alcohol or drug related incidents including overdoses, except where the overdose is unintentional by a minor

· Maternity or Gynaecological emergencies

· Incidents involving mental health crises

9.2. IECRs have a responsibility and duty of care to provide a high standard of care commensurate to their skill set.

9.3. IECRs will document any treatment provided on NHS equivalent patient clinical record (PCR) documents. Any PCRs started by an IECR must be handed to the attending NHS equivalent clinician on their arrival as part of the formal handover process

9.3.1. IECRs/FRS’s will not retain any patient identifiable information relating to



10.1. The Scope of Practice for IECRs has been broken down into three areas;

10.1.1. Directly applied interventions (i.e. oxygen therapy)

10.1.2. Interventions assisted (i.e. assisting paramedic with applying splintage)

10.1.3. Interventions they are given awareness of only (i.e. chest drainage)

10.2. Primary Survey

10.2.1. IECRs will not be required to examine intimate areas of a patient, except where not doing so would put the patient at further risk.

10.2.2. IECRs will not carry out any invasive4 or internal5 examinations or procedures

4 Invasive procedures can be defined at those which require interrupting the continuity of skin or insertion into body cavities (excluding the oral or nasal cavity)

5 Internal & intimate examinations relate specifically to rectal or vaginal investigations.


10.3. Administration of specified medications (see appendix M)

10.4. Semi-automatic defibrillation

10.5. Basic and Intermediate Life Support

10.6. Assisting other clinicians in carrying out Advanced life support (RCUK/ERC Guidelines) – Adult, Child, Infant, Newborn

10.7. Approved equipment list

10.7.1. IECRs must only utilise clinical equipment and consumables as stated in appendix 5 within the Memorandum of Understanding with each FRS

10.7.2. IECRs must not work outside their Scope of Practice in relation to equipment or consumables and must follow directions given by a healthcare professional (i.e. paramedic) at all times.

10.7.3. The Clinical Quality Working Group will approve or reject any additional equipment proposed for inclusion as part of the Approved Equipment List within appendix 5 of the MoU.

11.

Referral rights


11.1. IECRs will always seek to hand-over patients to qualified operational Ambulance Personnel.

11.2. IECRs must be backed up with qualified operational Trust staff when attending emergency calls.

11.2.1. It is accepted that in exceptional circumstances, back-up may be delayed or not be possible (i.e. adverse weather) in which case, telephone support will be provided

11.2.2. The MoU provides information on when and how to contact the NHS equivalent clinical support desk in the event of delayed or unavailability of back up

11.3. IECRs cannot stand down other resources

11.4. IECRs cannot make referrals to other health professionals. Any referrals will be made by the operational clinician(s) attending the incident, or in EOC.

11.5. IECRs are not authorised to discharge patients. In exceptional circumstances, a discharge


decision may be made by a clinician remotely, but this must not be considered routine

11.6. IECRs cannot make conveyance decisions and must defer to the attending clinician(s). Patients must not be transported to hospital in FRS vehicles unless specifically agreed by a NHS equivalent clinician and only where there is sufficient insurance by the FRS to facilitate patient movements. FRS patient movements would also be considered an exceptional event and would require completion of an IWR-1 and Bronze level investigation

11.6.1. In the unlikely event of FRS patient transportation, a PCR must have been completed by a NHS equivalent clinician prior to the patient leaving scene.

12.

Drugs and preparations authorised for use


12.1. JRCALC Drugs6 or other medicines authorised by the Trust.

12.1.1. Please refer to Appendix M

12.2. PGDs

12.2.1. IECRs are not registered health professionals and therefore not legally entitled to issue drugs under a patient group direction

        JRCALC Drugs are authorised for use via legal mechanisms (depending on grade) – see Appendix M for information.


12.3. Medicine management responsibilities

12.3.1. IECRs are responsible for the safe keeping of medications in their possession and must report damage, theft or losses.

12.3.2. Use of medicines must be recorded on the PCR on arrival of NHS equivalent clinician, and must include the IECRs unique identity number

12.3.3. IECRs must record all drug administration on their Drugs Issue Card (see Medicines Management Manual)

12.4. Medicines administration responsibilities

12.4.1. Medicines must only be administered at the dose stated and via the route stated in the IECR medicines Prompt Card.

12.4.2. IECRs cannot deviate from training.

12.4.3. IECRs must act as the patients advocate and must make any concerns known to others involved in patient care where a potential and/or imminent drug error could occur.

13.

Supervision


13.1. Supervises:

13.1.1. IECRs do not provide formal supervision, but may provide mentorship and support to new members of the IECR scheme

13.1.2. IECRs may also provide supervision as part of a training action plan.

13.2. Supervised by:

13.2.1. FRS IECR Train the Trainer Leads

13.2.2. NHS equivalent Operational clinicians and managers.

13.2.3. Volunteer Development Coordinators

14.

Documents related to grade


14.1. JRCALC Clinical Practice Guidelines

14.2. Resuscitation Guidelines

14.3. IECR Drugs Prompt Card


14.4.

14.5.

IECR Curriculum IECR Drug Issue Card

15.

Pre-requisites for continuing practice within IECR scheme


15.1.

DBS on appointment

15.2.

Occupational health check on appointment

15.3.

References.

15.4.

Evidence of competency through Trust-approved process

16.

Specialist Roles and Special Conditions


16.1.

IECRs are authorised to use their enhanced care skills on incidents not originating from a


999 call to NHS equivalent

16.2.

In these circumstances where care is instigated, NHS equivalent attendance must be requested.

Emergency Care Assistant (ECA)

First Response Emergency Care 


The First Response Emergency Care (FREC) qualifications were designed to focus on the knowledge and skills required to provide patient care within the prehospital environment. The qualifications start with the QA Level 3 Certificate in First Response Emergency Care (RQF) and progress up to the QA Level 5 Diploma in First Response Emergency and Urgent Care (RQF). The qualifications are progressive in terms of level of difficulty, duration, content, autonomy and skills and knowledge.

The QA Level 3 Certificate in First Response Emergency Care (RQF) provides Learners with a foundation level of prehospital care knowledge and skills to deal with a range of prehospital care situations. This qualification is suited for people who have a specific responsibility at work, or in voluntary and community activities, to provide prehospital care to patients requiring emergency care/treatment. This qualification is currently undertaken by Learners from a variety of different employment sectors including heavy industry, high risk workplaces, patient transport, security sector and event medical providers. It is also used by organisations with a requirement to provide an emergency medical response including the military, ambulance (combined with a recognised qualification as an emergency response driver), police and fire and rescue services.

The QA Level 4 Certificate in First Response Emergency Care (RQF) qualification is for people who have a specific responsibility at work, or in voluntary and community activities, to provide prehospital care to patients requiring emergency and urgent care/treatment. It is the ideal baseline for those looking to progress their careers within the ambulance services as an emergency care assistant, intermediate ambulance practitioner, event medical provider, associate practitioner, healthcare assistant and supports specialist medical roles within the military, police and fire and rescue services. Although this qualification provide Learners the ability to meet a licence to practice requirement that allows them to act within their scope of practice to administer safe, prompt, effective prehospital care in situations which can arise when providing emergency and urgent treatment and/or management. It is important to highlight some sectors require specific training to fulfil a role, for example in the ambulance sector to be an emergency care assistant are required to undergo training in safeguarding, information governance, moving and conflict resolution.

Emergency Care Support Worker (ECSW)

Clinical Practice Areas

The ECSW role is intended to be one that is supervised by a paramedic in the emergency response role. ECSWs can, in exceptional circumstances respond solo, but do so under the scope of practice of a Community First Responder.

ECSWs can work as a crew with another ECSW on Intermediate Tier Vehicles. When working on an Intermediate Tier Vehicles they work with another ECSW to undertake planned transfer work. ITV work is considered supervised, as the patient has already received a diagnosis (working or definitive) and requires only high standards of care and monitoring whilst en-route to a pre-planned care facility. This includes patients who are being taken to hospital as an HCP call, or 999 calls which are being conveyed by ITV as a delayed conveyance.

ITVs may in exceptional circumstances be tasked as a primary response to 999 calls, and the Scope of Practice when doing so remains that of a Community First Responder in broad terms, but some exemptions exist to ensure that when working without direct clinical supervision, observations can be carried out.

1.

Responsibility


1.1. Work in line with the Trust Job Description for the role and adhere to any conditions.

1.2. Provide emergency response

1.3. Crew response (DCA)

1.4. A&E duties

1.5. PTS duties

1.6. Intermediate Tier Vehicle duties (see ITV procedure document)


1.7. Maintain and be able to produce evidence of Continuous Professional Development

2.

Skill set


2.1. Primary and Secondary Survey`s

2.1.1. ECSWs will not be required to examine intimate areas of a patient, expect where not doing so would put the patient at further risk.

ECSWs will not carry out any invasive or internal examinations or procedures

2.1.2. ECSWs may be required to assist paramedics with intimate or invasive procedures (such as administration of rectal diazepam, or assisting with childbirth)

2.2. Undertake clinical observations

2.2.1. ECSWs are authorised to carry out non-invasive clinical observations on patients when working the ITV role, or when making a first-response to a 999 call.

2.2.1.1. The intention of permitting ECSWs to carry out observations when attending 999 calls is to ensure that once back-up arrives, a more complete handover can be undertaken.

2.2.1.2. Please refer to 2.2.3

2.2.1.3. This does not extend any treatments available beyond those available to CFRs, as per Appendix M.

2.2.2. ECSWs may carry out:

2.2.2.1. Manual or automatic blood pressure measurement

2.2.2.2. Pulse oximetry

2.2.2.3. 12 Lead ECG

2.2.2.4. Thermometry

2.2.2.4.1. Blood glucometry

2.2.3. ECSWs are not authorised to make clinical decisions based on these values, except in an emergency situation, or following discussion with the Clinical Desk or the originating clinician to adjust treatments based on specific values (i.e. changes to oxygen therapy in response to changes in saturation reading).

2.3. Administration of specified medications (see list below)

2.3.1. Depending on whether working under supervision or solo/double ECSW


2.3.1.1. ECSWs may use medicines indicated in Appendix M for use by ECSWs only when receiving direct supervision

2.3.1.2. When responding solo (in exceptional circumstances) or attending a 999 call as a first response when working on an ITV, only medicines indicated for use by CFRs in Appendix M can be used, until back up arrives.

2.4. Defibrillation using automated external defibrillator only (not manual)

2.5. 3 &12 lead ECG acquisition

2.6. Basic Life Support & Intermediate Life Support

2.7. Assisting other clinicians in carrying out Advanced life support (RCUK/ERC Guidelines) – Adult, Child, Infant, Newborn

2.8. Patient immobilisation skills, under supervision from technician or above.

2.9. Care of Intravenous fluids / lines whilst on route to a care facility

2.10. Advanced driving (Blue light)

2.10.1. When responding solo (or as a double ECSW crew) as a first response to 999 calls, ECSWs can respond using blue lights and sirens, but must be backed up immediately.

2.10.2. The decision by EOC to send a solo response must fulfil the following criteria

2.10.2.1. There is a life-threatening call with no response assigned or available

2.10.2.2. There is no other member of staff available that can accompany the ECSW

2.10.2.3. Measures have been taken to locate resources (such as all calls to ambulances at hospital)

2.10.3. Instances of ECSW solo or double crewed ECSW emergency responses will be monitored by EOC and reported to the Duty Bronze manager who will contact the Duty Dispatch Manager to ensure that conditions listed above were met and the response was justified and appropriate.

2.10.3.1. A report will be sent to the Senior Clinical Operations Team meetings will all instance of Solo or Double crewed ECSW response.

2.10.3.2. These reports are not required for planned work or providing backup within the role of the

Intermediate Tier Vehicle system

2.10.4. Solo response of an ECSW to an emergency call will be considered an extraordinary event and will require investigation to ensure that the criteria is met, except:

2.10.5. Where a member of staff or manager who holds an ECSW level qualification has a strategic or tactical requirement to respond. This does not alter any other aspect of the ECSW scope of practice.

2.10.6. ECSWs do not require supervision when driving.

2.11. Manual Handling



3.

Referral rights


3.1. Emergency Care Support Workers should only be deployed with a suitably qualified and experienced clinician. Therefore, should not need to refer. However, under exceptional circumstances where an ECSW has attended an incident alone they must always refer the patient onto a suitably qualified clinician such as Technician, Paramedic, PP, CCP etc. ECSWs adopt the scope of practice of a CFR when responding solo, and this includes the principles associated with referral and discharge (please refer to the CFR appendix).

When working on an Intermediate Tier Vehicle, there should be no requirement to refer as the work undertaken will be planned and the patients’ needs already agreed.

4.

Drugs and preparations authorised for use under supervision or when working as an ITV (solo response covered as per the CFR scope of practice)


4.1. JRCALC Drugs

4.1.1. Please refer to Appendix M

4.1.2. Special instruction regarding Oxygen

4.1.2.1. Oxygen does not require supervision in an emergency

4.1.2.2. Patients on long term oxygen therapy must not have their oxygen flow increased, unless in an emergency






4.2. PGDs

4.2.1. ECSWs are not registered health professionals and therefore not legally entitled to issue drugs under a patient group direction

4.3. Medicine management responsibilities

4.3.1. ECSWs are responsible for the safe keeping of medications in their possession and must report damage, theft or losses.

4.3.2. Use of medicines must be recorded on patient documentation provided.

4.3.3. ECSWs are required to complete Patient Clinical Records legibly.

4.3.4. ECSWs are required to complete any drug audits.

4.4. Medicines administration responsibilities

4.4.1. Medicines must only be administered in the dose stated and via the route stated.

4.4.2. ECSWs cannot deviate from training.

4.4.3. ECSWs must act as the patients advocate and must make any concerns known to others involved in patient care where a potential and/or imminent drug error could occur.

4.5. ECSWs can assist Technicians, Paramedics and Drs with the preparation and administration of other drugs only under direction of that clinician.

4.5.1. “Preparation” is defined as the assembly of syringes/needles, and the selection and checking of medicines (where legally appropriate, i.e. controlled drugs).

4.5.2. “Administration” is defined as giving the drug via the route intended (i.e. oral, IM, IV etc.)

4.5.3. “Under direction” is defined as: directly supervised by the clinician responsible for the patient and/or the medicine, and to the exclusion of all other tasks (i.e. the paramedic cannot direct administration whilst driving the ambulance)

5.

Supervision


5.1. Supervises:

5.1.1. ECSW do not provide managerial supervision in their clinical role. It is recognised there are managers within the Trust who hold the clinical grade of ECSW.

5.1.2. Specific guidance in relation to situations where an undergraduate student paramedic is on placement in NHS equivalent.

5.1.2.1. Student paramedics are encouraged to remain with the patient en-route to hospital, and this may mean whilst the patient is being monitored by an ECSW.

5.1.2.2. ECSWs have no supervisory role in these circumstances and must not permit the student paramedic to undertake and interventions/skills

5.1.2.3. The paramedic supervisor remains responsible for the student paramedic at all times, and if they elect to drive the ambulance must ensure that the ECSW is not supervising or permitted interventions by the student paramedic

5.2. Supervised by:

5.2.1. Paramedics (Inc. PPs & CCPs)

5.2.2. Clinical Team Leader

5.2.3. Clinical Operations Managers

5.3. ECSWs provide support to any higher grade of staff working with them. This allows ECSWs to work alongside Technicians in order to uphold their duty of care to promote safe patient care.

6.

Documents related to grade


6.1. JRCALC Clinical Practice Guidelines

7.

Pre-requisites for continued employment


7.1. DBS on appointment

7.2. Occupational health check on appointment


7.3. Full, valid UK driving licence (up to 9 penalty points; will be monitored by line manager)

7.4. Up to date evidence for right to work and reside in the UK.

7.5. Maintain and be able to produce evidence of Continuous Professional Development

8.

Specialist Roles and Special Conditions


8.1. Under exceptional circumstances an ECSW may be tasked to incidents alone as a last resort and this must not be a pre-planned deployment.

8.2. ECSWs may be asked to crew CCP ambulances with a qualified CCP. This does not

extend the ECSW scope of practice, but will expose them to higher acuity patients.

Associate Practitioner (AAP)

Clinical Practice Areas

Grade of Staff: Associate Practitioner

Staff who operate at the Associate Practitioner grade (including Trainee Paramedics*) must be either enrolled, or preparing to enrol, in a recognised paramedic science education programme.

This clinical grade is based largely on the Technician scope of practice and is provided as an extended role for Emergency Care Support Workers who are developing towards a paramedic science award. It excludes ALL additional skills associated with Advanced Technicians. The Associate Practitioners role also has different requirements relating to the discharge of patients from scene and must be noted accordingly.

*The term paramedic is a legally protected professional title Staff must not represent themselves as qualified paramedics or give patients/public any reason to suggest so, as this would contrary to the legal protection provided to the term “paramedic”.

Responsibility


1.1. Work in line with the Trust Job Description for the role and adhere to any conditions.

1.2. Provide emergency response

1.3. Single response (car)

1.4. Crew response (DCA)

1.5. A&E duties

1.6. PTS duties

1.7. Maintain and be able to produce evidence of Continuous Professional Development (In line with University entry requirements and APEL (Accreditation of Prior Experiential Learning))


Skill set



2.1. Manual defibrillation

2.2. 12 lead acquisition

2.3. Advanced life support (RCUK/ERC Guidelines) – Adult, Child, Infant, Newborn

2.4. IM injections

2.5. Advanced driving (Blue light)

2.6. Manual Handling

2.7. Physical assessment skills at BTLS level (auscultation and percussion)

2.7.1. Associate Practitioners are permitted to visually examine intimate areas of a patient as part of essential care (such as childbirth).

2.7.2. Associate Practitioners will not carry out any intimate physical and/or internal examinations (rectal or vaginal)

2.7.3. Associate Practitioners may be required to assist paramedics with intimate or invasive procedures (such as administration of rectal diazepam) but not actually administering any medicines or performing treatment.

3.

Referral rights


3.1. Conveyed patients

3.1.1. Unlimited authority to convey to hospital any patient calling 999.

3.1.2. Consideration must be given to advance directives or other care plans relating to preferred place of care

3.1.3. Authorised to convey to appropriate alternative facility (i.e. Minor injury unit)

3.2. Discharge and Referral

3.2.1. Associate Practitioners are encouraged to consider alternative care pathways

3.2.2. For non-conveyed patients the clinician is authorised to:

3.2.2.1. Refer patients back to their own GP

3.2.2.2. Refer patient to a specialist or advanced paramedic (i.e. PP)


3.2.2.3. Referral to community teams (either supported by PP or via local pathway arrangements)

3.2.3. For non-conveyed patients the clinician may not (depending on location) be authorised to:

3.2.3.1. Refer patients to Out of Hours providers. (This is due to contractual limitations relating to OOH providers taking referrals from non-registered clinicians – AP’s can still contact the PP Desk to discuss care pathways and to arrange a PP referral if required in these situations)

3.3. For non-conveyed patients the Associate Practitioner is not authorised to:

3.3.1. Discharge patients from scene without first discussing with, and seeking agreement from, an appropriate registered clinician (usually, but not limited to, a PP or Clinical Supervision in EOC) even if the patient appears uninjured or without illness7.

3.3.1.1. All advice and follow-up details must be documented on the PCR

3.3.1.2. Where circumstances prevent contacting a clinician prior to discharge (i.e. due to unsafe environment) this must done as soon as possible after leaving the patients side, and prior to booking clear. Consideration must be given to a clinician calling the patient back in due course.

3.3.1.3. Where telephone contact is not possible, Associate Practitioners must request immediate

clinician call-back via a radio call to their Dispatcher.

7 Unless the patient refuses care plan against the wishes of the crew, and has mental capacity.


3.4. For all patients who are not conveyed, the following convention must be followed on the PCR/ePCR

· Worsening care advice: Specific documented advice relating to anticipated signs or symptoms relating to their condition (i.e. headache, nausea etc.)

· Safety netting: Specific documented advice relating to what to do if the patient worsens (i.e. push careline, call back on 999)

· Left in care of: Who the patient is being cared for after discharge (if applicable)

· Shared decision making: Who was liaised with and document agreed decision

4.

Drugs and preparations authorised for use


4.1. JRCALC Drugs8

4.1.1. Please refer to Appendix M

4.1.2. There are certain parenteral medicines which must only be administered autonomously once the clinician has administered the drug five times under

supervision from a paramedic (either on scene or via the clinical desk or PP desk)

  • JRCALC Drugs are given under a set of specific POM (Prescription Only Medicine) Exemptions, issued by the


4.2. PGDs

4.2.1. Associate Practitioners are not registered health professionals and therefore not legally entitled to issue drugs under a patient group direction

4.3. Medicine management responsibilities

4.3.1. Associate Practitioners are responsible for the safe keeping of medications in their possession and must report damage, theft or losses.

4.3.2. Use of medicines must be recorded on patient documentation provided.

4.3.3. Associate Practitioners are required to complete Patient Clinical Records legibly.

4.3.4. Associate Practitioners are required to complete any drug audits.

4.3.5. Where an Associate Practitioners is the senior member of a crew, they are responsible for the recording of drug recording.

4.4. Medicines administration responsibilities

4.4.1. Medicines must only be administered in the dose stated and via the route stated.

4.4.2. Associate Practitioners cannot deviate from training.

4.4.3. Associate Practitioners must act as the patients advocate and must make any concerns known to others involved in patient care where a potential and/or imminent drug error could occur.

5.

Supervision


5.1. Associate Practitioners do not supervise staff but have a duty of care to support staff in order to promote safe patient care.

5.2. First level supervised by:

5.2.1. Clinical Team Leader



6.

Documents related to grade


6.1.

JRCALC Clinical Practice Guidelines

7.

Pre-requisites for continued employment


7.1.

7.2.

7.3.

7.4.

7.5.

DBS on appointment

Occupational health check on appointment

Full, valid UK driving licence (up to 9 penalty points; will be monitored by line manager) Up to date evidence for right to work in the UK.

Maintain and be able to produce evidence of Continuous Professional Development

8.

Specialist Roles and Special Conditions


8.1.

Single Response Vehicle working

8.1.1.

Driver training

8.1.2.

Lone working familiarisation

8.2.

Associate Practitioners Officers/Managers

8.2.1.

It is recognised that this group of staff operate predominantly in unmarked lease vehicles,


which are not as fully kitted as an SRV.

8.2.2.

The scope of practice for these staff is limited by the equipment they have in their vehicles


when responding in them.

8.2.3.

Officers/managers are required to be familiar with all equipment, drugs and vehicles


commensurate to their grade.

Ambulance Technician/Advanced Technician (Tec)

(750 preceptorship hours required - these strictly refer to practice at a trainee Technician level of responsibility mentored by either a paramedic or fully qualified IHCD or equivalent Technician. An Ambulance Technician clinical course typically takes 8 weeks of full time class room based clinical training to complete - NOTE this EXCLUDES driving related training. APL applications for EMT courses that took less than 6 weeks of full time class room based clinical training will NOT be accepted).

Clinical Practice Areas

Grade of Staff: Technician

The Technician role (including Advanced Technician) includes ALL skills practiced at ECSW/Associate Practitioner grades.

n.b. Additional Advanced Technician skills are marked with an asterix

9.

Responsibility


9.1. Work in line with the Trust Job Description for the role and adhere to any conditions.

9.2. Provide emergency response

9.3. Single response (car)

9.4. Crew response (DCA)

9.5. A&E duties

9.6. PTS duties

9.7. Maintain and be able to produce evidence of Continuous Professional Development

10

Skill set


10.1. Manual defibrillation

10.2. 12 lead acquisition

10.3. Advanced life support (RCUK/ERC Guidelines) – Adult, Child, Infant, Newborn

10.4. IM injections

10.5. Advanced driving (Blue light)

10.6. Manual Handling

10.7. Physical assessment skills at BTLS level (auscultation and percussion)

10.7.1. Technicians and Advanced Technicians are permitted to visually examine intimate areas of


a patient as part of essential care (such as childbirth).

10.7.2. Technicians and Advanced Technicians will not carry out any intimate physical and/or internal examinations (rectal or vaginal)

10.7.3. Technicians and Advanced Technicians may be required to assist paramedics with intimate or invasive procedures (such as administration of rectal diazepam) but not actually administering any medicines or performing treatment.

11

Referral rights


11.1. Conveyed patients

11.1.1. Unlimited authority to convey to hospital any patient calling 999.

11.1.2. Consideration must be given to advance directives or other care plans relating to preferred place of care

11.1.3. Consideration must be given to advance directives or other care plans relating to preferred place of care

11.1.4. Authorised to convey to appropriate alternative facility (i.e. Minor injury unit)

11.2. Discharge and Referral

11.2.1. Technicians are encouraged to consider alternative care pathways

11.2.2. For non-conveyed patients the clinician is authorised to:

11.2.2.1. Refer patients back to their own GP

11.2.2.2. Refer patient to a specialist or advanced paramedic (i.e. PP)

11.2.2.3. Referral to community teams (either supported by PP or via local pathway arrangements)


11.2.3. For non-conveyed patients the clinician may not (depending on location) be authorised to:

11.2.3.1. Refer patients to Out of Hours providers. (This is due to contractual limitations relating to OOH providers taking referrals from non-registered clinicians – Technicians can still contact the PP Desk to discuss care pathways and to arrange a PP referral if required in these situations)

11.3. For non-conveyed patients Technician/Advanced Technicians are not authorised to:

11.3.1. Discharge patients (over 12 years of age) with new/acute illness or injury without first discussing with, and seeking agreement from, an appropriate registered clinician (usually, but not limited to, a PP or Clinical Supervision in EOC).

11.3.2. Discharge can be undertaken without support where the patient has a clearly self-limiting condition requiring only simple advice or self-care treatments (i.e. low mechanism slip from chair, broken fingernail) and with no Red Flags (see Urgent Care Handbook for examples).

11.3.3. Instructions for when considering discharging children (12 and under): Please refer to the Discharge procedure

11.3.4. Please refer to the guidance given in the Urgent Care Handbook

1.1.1.1. All advice and follow-up details must be documented on the PCR

1.2. For all patients who are not conveyed, the following convention must be followed on the PCR/ePCR

· Worsening care advice: Specific documented advice relating to anticipated signs or symptoms relating to their condition (i.e. headache, nausea etc.)

· Safety netting: Specific documented advice relating to what to do if the patient worsens (i.e. push careline, call back on 999)

· Left in care of: Who the patient is being cared for after discharge (if applicable)

· Shared decision making: Who was liaised with and document agreed decision



2.

Drugs and preparations authorised for use


2.1. JRCALC Drugs9

2.1.1. Please refer to Appendix M

2.2. PGDs

2.2.1. Technicians are not registered health professionals and therefore not legally entitled to issue drugs under a patient group direction

2.3. Medicine management responsibilities

2.3.1. Technicians are responsible for the safe keeping of medications in their possession and must report damage, theft or losses.

2.3.2. Use of medicines must be recorded on patient documentation provided.

2.3.3. Technicians are required to complete Patient Clinical Records legibly.

2.3.4. Technicians are required to complete any drug audits.

2.3.5. Where a Technician is the senior member of a crew, they are responsible for the recording of drug recording.

  • JRCALC Drugs are given under a set of specific POM (Prescription Only Medicine) Exemptions, issued by the


2.4.

2.4.1.

2.4.2.

2.4.3.

Medicines administration responsibilities

Medicines must only be administered in the dose stated and via the route stated. Technicians cannot deviate from training.

Technicians must act as the patients advocate and must make any concerns known to others involved in patient care where a potential and/or imminent drug error could occur.

3.

Supervision


3.1.

3.2.

Technicians do not supervise staff but have a duty of care to support staff in order to promote safe patient care.

First level supervised by:

3.2.1. Clinical Team Leader

4.

Documents related to grade


4.1.

JRCALC Clinical Practice Guidelines

5.

Pre-requisites for continued employment


5.1.

5.2.

5.3.

5.4.

DBS on appointment

Occupational health check on appointment

Full, valid UK driving licence (up to 9 penalty points; will be monitored by line manager) Up to date evidence for right to work in the UK.


5.5. Maintain and be able to produce evidence of Continuous Professional Development

6.

Specialist Roles and Special Conditions


6.1. Single Response Vehicle working

6.1.1. Driver training

6.1.2. Lone working familiarisation

6.2. HART Technicians

6.3. Cycle Response Unit

6.3.1. Additional training in safe cycling skills and lone working.

6.4. Technician Officers/Managers

6.4.1. It is recognised that this group of staff operate predominantly in unmarked lease vehicles, which are not as fully kitted as an SRV.

6.4.2. The scope of practice for these staff is limited by the equipment they have in their vehicles when responding in them.

6.4.3. Officers/managers are required to be familiar with all equipment, drugs and vehicles

commensurate to their grade.

Medicines Administration Authorised for use, by Clinical Grade

Key:

  • PGD: Patient Group Direction
  • S17: Schedule 17 of the Human Medicines Regulations 2012
  • S19: Schedule 19 of the Human Medicines Regulations 2012
  • ALS: Persons who hold the advanced life support provider certificate issued by the Resuscitation Council (UK).
  • TA: Trust approval and authority using JRCALC guidelines
  • Diluent: Used only for diluting a medicine (water for injection)

Name of Medicine (Controlled Drugs highlighted in RED Restricted medicines highlighted AMBER)

Dose

Route(s)

Mechanism

Type of Use (administration, supply, both)

CFR / IECR

Emergency Care Support Worker

Associate Practitioner

Technician/ Advanced Technician

Activated Charcoal

1 x bottle

Oral

PGD

Administration

 

 

 

 

Adrenaline 1:10,000

1mg/10ml

IV/IO

S17 / ALS

Administration

 

 

 

 

Adrenaline 1:1000

500mcg

IM

S19

Administration

 

 

IM

IM

Only

Only

Amiodarone (pre-filled)

300mg

IV/IO

S17 / ALS

Administration

 

 

 

 

Amoxicillin

500mg

PO

PGD

Supply

 

 

 

 

Aspirin

300mg

PO

TA

Administration

Yes

Yes

Yes

Yes

Atropine 600mcg

600mcg

IV/IO

S19

Administration

 

 

 

 

Benzylpenicillin

600mg

IV/IO

S17

Administration

 

 

 

 

Calcium Chloride

10%/10ml

IV/IO

PGD

Administration

 

 

 

 

Chlorphenamine

10mg/1ml

IV/IO (IV

S19

Administration

 

 

IM

IM

preferred) IM

Only

Only

Clarithromycin

125mg suspension

PO

PGD

Supply

 

 

 

 

Clarithromycin

250mg tablet

PO

PGD

Supply

 

 

 

 

Clopidogrel

75mg

PO

TA

Administration

 

 

Yes

Yes

Co-Amoxiclav

625mg

PO

PGD

Supply

 

 

 

 

Co-Amoxiclav

1.2g

IV

PGD

Administration

 

 

 

 

Diazemuls IV

10mg/2ml

IV/IO

S17

Administration

 

 

 

 

Diazepam

2.5mg

PR

TA

Administration

 

 

 

 

Diazepam

5mg

PR

TA

Administration

 

 

 

 

Entonox

NA

Inhaled

TA

Administration

 

Yes

Yes

Yes

Flumazenil

100 mcg

IV/IO

PGD

Administration

 

 

 

 

Furosemide

20mg/2ml

IV

S17

Administration

 

 

 

 

Glucagon

1mg

IM/SC

S19

Administration

 

 

Yes

Yes

Glucogel

40%/23g

Buccal

TA

Administration

 

Yes

Yes

Yes

Glucose 10%

500ml

IV

S17

Administration

 

 

 

 

GTN

400mcg

Sub lingual

TA

Administration

 

 

Yes

Yes

Heparin

5000 IU

IV

S17

Administration

 

 

 

 

Hydrocortisone

100mg

IV

S19

Administration

 

 

IM

IM

(preferred

Only

Only

)   IO/IM

 

 

Ibuprofen Suspension

100mg/5ml

PO

PGD

Supply

 

 

 

 

Ibuprofen Sachet

100mg/5ml

PO

TA

Administration

 

 

Yes

Yes

Ibuprofen Tablet

200mg

PO

PGD

Supply

 

 

 

 

Ibuprofen Tablet

200mg

PO

TA

Administration

 

 

Yes

Yes

Ipratropium Bromide

250mcg

Nebulised

TA

Administration

 

 

Yes

Yes

Ketamine

10mg/1ml

IV/IO

PGD

Administration

 

 

 

 

Lidocaine (Lignocaine)

1%

SC

PGD

Administration

 

 

 

 

Magnesium Sulphate

2g or 4g (depending on PGD)

IV/IO

PGD

Administration

 

 

 

 

Magnesium Sulphate

150mg

Nebulised

PGD

Administration

 

 

 

 

Midazolam

5mg/5ml

IV/IO

PGD

Administration

 

 

 

 

Morphine Sulphate

10mg/1ml

IV/IO

S17 (PGD**)

Administration

 

 

 

 

Naloxone Hydrochloride

400mcg/1ml

IV/IO/IM/I N

S19

Administration

 

 

IM

IM

Only

Only

Naproxen

250mg

PO

PGD

Supply

 

 

 

 

Nitrofurantoin

50mg

PO

PGD

Supply

 

 

 

 

Ondansetron

2mg

IV

S17

Administration

 

 

 

 

Oxygen

NA

Inhaled

TA

Administration

Yes

Yes

Yes

Yes

Oral Rehydration Salts

Sachet

PO

TA

Supply

 

 

 

 

Paracetamol

10mg/1ml

IV

S17

Administration

 

 

 

 

Paracetamol

120mg/5ml suspension

PO

PGD

Supply

 

 

 

 

Paracetamol

250mg/5ml suspension

PO

PGD

Supply

 

 

 

 

Paracetamol

250mg (Fastmelt/ oro- dispersible)

PO

PGD

Supply

 

 

 

 

Paracetamol

500mg

PO

PGD

Supply

 

 

 

 

Paracetamol

500mg

PO

TA

Administration

 

 

Yes

Yes

Paracetamol

120mg/5ml sachet

PO

TA

Administration

 

 

Yes

Yes

(Calpol)

Penicillin V

250mg

PO

PGD

Supply

 

 

 

 

Phenytoin

250mg/5ml

IV/IO

PGD

Administration

 

 

 

 

Prednisolone

5mg

PO

PGD

Supply

 

 

 

 

Prednisolone

1mg/1ml

PO

PGD

Administration

 

 

 

 

Prednisolone

1mg/1ml

PO

PGD

Supply

 

 

 

 

Rocuronium

10mg/1ml

IV/IO

PGD

Administration

 

 

 

 

Salbutamol

2.5mg

Nebulised

TA

Administration

Yes

Yes

Yes

Yes

Salbutamol

5mg

Nebulised

TA

Administration

Yes

Yes

Yes

Yes

Sodium Chloride Ampoule

0.9% 10ml

IV/IO

S17

Administration

 

 

 

 

Sodium Chloride

0.9% 150ml

IV/IO

S17

Administration

 

 

 

 

Sodium Chloride

0.9% 500ml

IV/IO

S17

Administration

 

 

 

 

Sodium Chloride (hypertonic)

5% 500ml

IV/IO

PGD

Administration

 

 

 

 

Tenecteplase

10,000 units

IV

S17

Administration

 

 

 

 

Ticagrelor

90mg

PO

PGD

Administration

 

 

 

 

Tranexamic Acid

100mg

IV

PGD

Administration

 

 

 

 

Trimethoprim

200mg

PO

PGD

Supply

 

 

 

 

Water for Injection

NA

IV/IO

Diluent

Administration