Medical Director Clearance

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Speedylifsavr

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I am trying to gain some insight as to what other departments are doing do clear their paramedics to be "In Charge".

Our process includes:
* 12 lead competency
* Scenarios with the training department involving differential diagnosis and critical thinking skills
* Protocol test
* A face to face with the Medical Director which includes a megacode scenario and a multi patient trauma scenario.

We are always looking to improve upon our process and I would like to see what others are doing.

Thanks!
 
I'm in charge around here. What seems to be the problem?




Kidding, I'm not really in charge. But can you elaborate what you mean by "in charge" in your context?
 
Sounds like the orientation/new hire process right? The big thing to remember is that every place is going to go about this slightly differently.

New employees at my organization go through a ~4-6 month long "process" progressing towards state licensure as a paramedic. During that time, they are a third person on the truck with an FTO at all times. Before they ever get to the street, they take a state protocol test, review certain clinical skills with our education coordinator, have an airway class, and undergo equipment familiarization for what we carry. Later in the process, all candidates meet with one of our two medical directors for a review on RSI concepts and separately shadow one of them for a shift in the ED.

The first stage is known as Observation. This only lasts a couple shifts, and as you would likely guess, involves the candidate observing the FTO and his partner running all calls and then watching as his FTO provides primary treatment during transport. The candidate is not being scored on these calls but may perform basic skills with the FTO. Basically, this stage is to demonstrate how our system operates and get their feet wet as we tend to do things slightly differently operationally than most other places.

The next stage is known as Mentoring. In this stage, the candidate is running every call with the FTO monitoring and providing input as required. They are allowed up to two "prompts" from the FTO during this stage to still "pass" the call. A prompt can be anything from a reminder to use capnography during treatment of a patient with SOB to protocol violations or problems in assessments or scene management. Each call is graded as pass/fail with comments from the FTO and an evaluation form filled out with an opportunity for the candidate to respond.

Once the candidate and their FTO feels they are ready, the candidate moves on to the Evaluation phase. At this point, the FTO steps back a little bit more and provides less input to the candidate on the call. They only step in if something egregious is going wrong or there is somehow true need for an additional set of hands on a critical patient. The candidate functions with their paramedic partner as the FTO simply observes on scene and during transport. The candidate is now required to pass each call with a maximum of one prompt. The candidate has to have an overall pass rate of 90% I believe with a certain number of "high priority" calls before they are ready to move on.

The final stage before release to function independently moves the candidate to being the second person on a truck rather than a third (extra) person. They still work with an FTO exclusively for this portion, but they transport calls alone without their FTO accompanying them. This step is primarily focused on the operational component and ability to function as a single medic. At the conclusion of this portion, the FTO, FTO supervisor, and medical director all agree that this candidate is ready and they are released for normal shift work.

Edited to add: I forgot our scenario component. There are various times throughout the process where the candidate goes through various scenarios with our simulation team and sim man mannequin. We're still getting this part figured out as we go.
 
Sorry Sanpit. I should have been more clear. Basically looking for what process do you have in place as an ALS 911 provider to clear that paramedic who will be in charge of the truck.

Chaz....thank you for that information. You have a phenomenal process in place.
 
For us, its which ever medic is on scene. More than one on scene is rare.

We have 2 ALS engines in the county. In that case the transporting paramedic is in charge.
 
NPO said:
For us, its which ever medic is on scene. More than one on scene is rare.

We have 2 ALS engines in the county. In that case the transporting paramedic is in charge.
Click to expand...
I think the OP means "in charge" more as being cleared as a paramedic in the system.

Our process includes a standard paramedic "final exam" type test, 12 lead interpretation test, and a few scenarios with the education captain. Once the candidate is hired, they'll do nine third shifts (three with each shift). Following that they'll be assigned to the shift that has an opening. They'll spend the next two months at the main station with another paramedic for a partner. As we only have 12 paramedics, we do not have FTOs and it is expected that all full time staff be capable of this role. Each day the new hire self evaluates along with his partner. There are a variety of categories with everything from ambulance checkoffs to airway management to mapping. There is no set scoring, it is up to the training captain to read each evaluation and determine if the new-hire is performing satisfactorily. At the end of those two months the new-hire meets with the medical director and does a few scenarios including an RSI and that is that.
 
For our agency and under our Medical Director - for ALS - we have to do 240 hours of riding precepting, 8 or 10 written tests, on various protocols, in addition to verbal discussions on the protocols. Multiple preceptors, picked by our Medical Director, and a primary preceptor. First and Last shifts are done with your primary preceptor, to evaluate your start and how you've done and completed the program. All preceptors write an evaluation of you for the shift you rode, and it goes out to each preceptor you had and the Medical Director.
And before starting precepting, each preceptee must have their Intermediate/Paramedic, CPR, ACLS, PHTLS, and PALS.
 
In the system I came from, if it was a Paramedic that has field experience and already gone through a FTO program with another agency, they rode as a 3rd for a few shifts (Determination was on how fast they picked up on the protocols and SWO). There partner for the first couple months was someone who was familiar with the Response Area. If it was someone with no Paramedic Experience than they would actually go through a full FTO program which normally was 6-8 weeks (48 hrs a week). Sometimes this was shorter depending on how fast they could manage the scene and patient care. Everyone met with the Medical Director prior to being released to work as the PIC.
 
At the service where I work we have clinically "Senior" and "Junior" providers. In order to be hired, paramedics must pass a 12-lead (strangely focusing on mimics), protocol and simulation exams. From there, they ride with an FTO until cleared as a "Jr" to work with a "Sr". All ALS trucks are supposed to have a "Sr. medic" at all times (and can either be Sr/Jr medics, Sr/Sr medics, or if PB, a Sr medic and Sr EMT). "Jr" medics are generally upgraded to "Sr" after about two years, following a review by QA (of PCRs), shift supervisors, and a signoff from Clinical Services. "Jr", medics are supposed to tech as many calls as possible, and get ongoing feedback from their partners. The intent is for a new medic's first partner to be an FTO (Sr.) at least for several months.

The upgrade from "Jr" to "Sr" is as close as we get to clearance to operate independently, and takes an average of 2 years.
 
For Emergency Medical Technician, you are automatically issued authority to practice (ATP) upon completion of the National Diploma.

For Paramedic and Intensive Care Paramedic, there is a three-stage graduate internship once you are employed with the BHSc degree or PGDip (for ICP).

1) Precepting
The Intern is crewed with a Preceptor and supported and practice under direct supervision to their desired ATP level. The Intern and Preceptor work together for up to 40 shifts to achieve learning goals. Regular feedback is reported and shared with the Intern’s line manager. The Preceptor has a significant say in the Intern’s ability to progress to Clinical Supervision

2) Clinical supervision
On completion of Precepting, the Intern is granted provisional ATP at their desired practice level. Regular contact with a Preceptor is continued, for ongoing feedback. During these sessions, cases are discussed with the Preceptor seeking rationale for clinical decision making, and offering feedback. Regular reports are completed and shared with the Intern’s line manager. This lasts for up to 40 shifts

3) Clinical assessment day
The Clinical Assessment Day (CAD) is the final step for an Intern to gain ATP at their desired practice level. Assessments focus on safe application and understanding of the Clinical Procedures and Guidelines (CPGs) at the level of ATP being sought. The assessment will not focus on academic knowledge but focus on ensuring the person is operationally ready and safe to practice at their desired ATP. The components of the CAD are skill stations, clinical simulations and clinical interview.

The internship program is very new and it has taken years to develop. It's one thing the ambulance service has, in my experience, really struggled with i.e. the employment of degree graduates and transitioning them to Paramedic and ICP level. The "assessment day" format for Paramedic-to-ICP level has been running for a few months and roughly half those who attend will pass first time. It is extremely thorough and very demanding.
 
I wish our system was more involved. For us we start off with doing a written test and skills test. For new employees they go thru a 2 week company orientation with EVOC. Once we pass those we do two 8 hour lecture days covering 12-leads, CPAP, ETCO2, go thru every single protocol, and practice some skills.

From there we are sent to our local area for a 4-8 hour local orientation. After that we are sent into field training time. Each area is different on how many shifts you will have to complete. For employees who are new to the company they will have to do 15+ shifts until their FTO feels comfortable releasing them to the field.

For employees who were EMTS for the company and are just switching to medic the process is a little different.
 
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