Elements and Performance Criteria

RANGE STATEMENT

The Range Statement relates to the unit of competency as a whole. It allows for different work environments and situations that may affect performance. Add any essential operating conditions that may be present with training and assessment depending on the work situation, needs of the candidate, accessibility of the item, and local industry and regional contexts.


Pathophysiological concepts include:
Cellular injury and change:
physical, chemical, and infectious agents
inflammatory process
hypertrophy, hyperplasia, atrophy, necrosis, and gangrene
tumour, neoplasm, benign, malignant, metastasis, and anaplasia
Immunology:
immune response and immunoglobulins, including:
hypersensitivity
anaphylaxis
tissue rejection
blood mismatch
Acquired Immune Deficiency Syndrome
Hepatitis B
oncogenes
auto-immunity
malignant disease


Fluid and electrolyte imbalance includes:
'Electrolyte', 'non electrolyte', 'solvent' and 'solute'
Role of electrolytes
Potential problems of electrolyte imbalance:
sodium, potassium, calcium, phosphate, magnesium and chloride
Mechanisms of fluid movement through the body:
Tonicity
diffusion, active transport, osmosis, hydrostatic pressure, facilitated diffusion, and filtration
Maintenance of normal fluid volume:
antidiuretic hormone, sodium, negative feedback, sex hormones and thirst
Oedema
States of fluid imbalance:
normovolaemia', 'hypovolaemia' and 'hypervolaemia'
burns, sweating, 3rd space shift, diarrhoea and vomiting


Acid base imbalance includes:
pH, acidosis, alkalosis, physiological acidosis
Physiological effects of acidosis and alkalosis
Buffer systems and compensation
pH imbalances:
Respiratory acidosis
respiratory alkalosis
metabolic acidosis
metabolic alkalosis


Advanced assessment includes:
Capture, interpret and record comprehensive information regarding a client's health status to support advanced clinical care.


Standard methods and protocols may include:
Clinical practice guidelines
Organisation protocols
Skills manuals
State/territory ambulance authority regulations and/or operational procedures
Internationally recognised scales, charts, guidelines and surveys (e.g. Glasgow coma scale, dermatome charts, blood pressure reading scales, National Asthma Guidelines)


Pharmacodynamics includes but is not limited to:
Drug interactions
Pharmacological response of drugs associated with the state/territory ambulance service protocols/ guidelines
Duration and magnitude of response associated with the state/territory ambulance service protocols/ guidelines


Critical questioning refers to:
Purposeful, informed open questioning in the clinical setting to make sense of the information presented at the scene of injury or illness


Diagnostic reasoning refers to:
Using critical questioning and interpretation in the clinical setting which requires careful identification of key problems, issues, and the risks involved in responding to client needs


Poor states of perfusion involves:
Shock:
pathophysiology of shock
aerobic to anaerobic metabolism
classifications of shock
stages of shock


Specific client conditions, disorders and injuries to be assessed must include but are not limited to:
Burns:
burn classification
assessing burn area
potential systemic complications
assessment of time criticality
burns of different aetiology
Head injuries:
types and causes of head injuries
primary and secondary injury
aetiology of head injuries including Monroe-Kellie doctrine
cerebral perfusion and blood flow
assessment of a client with a head injury
Maxillofacial trauma:
levels of mortality and morbidity
specialised knowledge of associated structures
Thoracic, abdominal and pelvic trauma:
detailed knowledge of internal and external thoracic, abdominal and pelvic structures
detailed assessment of blunt vs penetrating trauma
Environmental:
cold and heat disorders
pressure disorders e.g. barotrauma
drowning and near drowning
lightning injuries
Acute coronary syndrome:
progression of coronary artery disease
ischaemic disorders:
angina
unstable angina
Prinzmetal angina
myocardial infarction
heart failure
valvular disease
hypertensive emergencies
other cardiovascular emergencies, e.g. peripheral vascular disease, pericarditis and endocarditis
ECG recognition:
specialised knowledge of cardiac conduction
comprehensive ECG rhythm analysis
12 lead ECG capture and assessment:
axis determination
bundle branch and fascicular blocks
STEMI/non-STEMI
Infarct imposters
continued ...


Specific client conditions, disorders and injuries to be assessed must include but are not limited to:(contd)
Visceral disorders:
specialised knowledge of the thoracic, pelvic, gastrointestinal and associated organs and related disorders
detailed knowledge of urogenital and reproductive disorders
Special circumstances:
medico-legal and ethical considerations
Neurological:-
diseases: e.g. dementia, ms, motor neurone, cerebral palsy,
behavioural emergencies
pathogenesis:
common pharmacolog
Infections e.g. meningitis, encephalitis, tetanus
Conditions: e.g. seizures and epilepsy, CVA, tumours, brain abscess
Spinal injury:
Specialised knowledge of sensory and motor functions
Reflex arc e.g. autonomic dysreflexia
Cardio-vascular changes
Respiratory impairment
Respiratory:
detailed knowledge of the respiratory system and its function e.g. mechanics of ventilation, inspiration and expiration, respiratory control and impact of gas laws
Ventilation perfusion (V/Q)
conditions and diseases e.g. asthma, chronic airways Limitation, pneumonia, PE, hyperventilation.
respiratory assessment
Pain:
pain pathways and perception
physiological and psychological effects associated with pain
therapeutic effect of drugs e.g. narcotics, steroidals and non-steroidals, anxiolytics, anti-emetics, over the counter medications
pain assessment and documentation according to standard methods and protocols
chronic pain management


Specific categories of clients to be assessed must include but are not limited to:
Adult client (male and female)
Obstetric client:
specialised knowledge of foetal development:
foetal distress
neonatal physiology
congenital abnormalities
abnormal pregnancy:
pregnancy induced hypertension, gestational diabetes, eclampsia, ectopic pregnancy, hyperemesis gravidarum
threatened abortion, spontaneous abortion, supine hypotensive syndrome, ante-partum bleeding
pre-existing congestive cardiac failure, pre-existing hypertension, pre-existing diabetes
stages of labour
normal presentation:
pre/post haemorrhage
normal at-term infantt/premature infant
abnormal presentation:
multiple/breech/still birth
limb presentation
prolapsed cord
assessment of the newborn:
APGAR
post delivery treatment and evaluation
other obstetric problems and gynaecology:
post partum bleeding, dysmenorrhoea, menorrhagia, pelvic infections, displacement of pelvic organs, urinary problems, endometriosis
paediatric client:
detailed knowledge of differences in paediatric and adult anatomy and physiology as related to assessment of the paediatric client
developmental stages of childhood e.g. psychosocial issues
issues surrounding paediatric assessment
specific paediatric conditions e.g. croup, epiglottitis, febrile convulsions
geriatric client:
detailed knowledge of the normal anatomical and physiological changes associated with ageing as related to assessment of the geriatric client
pre-existing medical problems and pharmacology are considered

EVIDENCE GUIDE

The evidence guide provides advice on assessment and must be read in conjunction with the Performance Criteria, Required Skills and Knowledge, the Range Statement and the Assessment Guidelines for this Training Package.

Critical aspects for assessment and evidence required to demonstrate this competency unit:
Assessment must establish acquisition of Essential Knowledge across the Range Statement outlined in this unit prior to assessment of skills application
Skills involving advanced client care are to be assessed initially in a simulated clinical setting (practical session, laboratory)
As a minimum, initial assessment must include appropriate written/oral/practical examinations to address Essential Knowledge and Skills as outlined in this unit
After successful completion of initial assessment, further assessment is to be conducted during workplace application under direct supervision
The application of skills and knowledge described in this competency unit should be assessed in conjunction with competency unit(s) related to specific ambulance care services, including HLTAMB603A Deliver advanced clinical care
Candidates must demonstrate their ability to apply essential knowledge and skills identified for this competency unit before undertaking independent workplace application
Candidates must provide evidence of their ability to apply all clinical competencies consistently (over a minimum period of 4 months) as part of supervised clinical practice


Access and equity considerations:
All workers in the health industry should be aware of access and equity issues in relation to their own area of work
All workers should develop their ability to work in a culturally diverse environment
In recognition of particular health issues facing Aboriginal and Torres Strait Islander communities, workers should be aware of cultural, historical and current issues impacting on health of Aboriginal and Torres Strait Islander people
Assessors and trainers must take into account relevant access and equity issues, in particular relating to factors impacting on health of Aboriginal and/or Torres Strait Islander clients and communities


Related units:
This unit should be assessed in conjunction with:
HLTAMBCR603B Deliver intensive clinical care