Terminal Objective:
At the completion of Clinical Medicine, the paramedic student will be able to integrate principles of general incident management to include multiple casualty incidents, rescue awareness, hazardous materials emergencies and terrorism through chemical or biological weapons, while exhibiting readiness to enter the hospital setting through understanding of hospital procedures.

Course Outline:
I. Ambulance Operations
II. Medical Incident Command
III. Rescue Awareness and Operations
IV. Hazardous Material Incidents
V. Assessment Based Management
VI. Navigation**
VII. Pre-Clinical OR Rotation

PROGRAM BEHAVIORAL OBJECTIVES**
Behavioral attributes of the MICT student and certified MICT are very important. Because of this, we have developed behavioral objectives for the Cowley MICT student. These objectives are based on what is required of an MICT and employer expectations.
At the conclusion of the program, the MICT student must exhibit appropriate behavior in the following areas:

• Integrity
• Empathy
• Self-Motivation
• Appearance and Personal Hygiene
• Self-Confidence
• Communications
• Time Management
• Teamwork and Diplomacy
• Respect
• Patient Advocacy
• Careful Delivery of Service

Other behavioral objectives, found in specific curricular areas, have also been developed as well (these are found in the specific class objectives). We strongly believe that the entry level MICT must have the knowledge, ability to perform and have obtained appropriate professional behaviors.

KEY TO CLASSIFICATION OF OBJECTIVES
(B) - Denotes a behavioral objective
(C) - Denotes a cognitive objective
(M) - Denotes a psychomotor objective
** Denotes objectives added to curriculum by Cowley

I. Ambulance Operations
Unit Objective: At the completion of this unit, the paramedic student will understand standards and guidelines that help ensure safe and effective ground and air medical transport.
*Identify current local and state standards which influence ambulance design, equipment requirements and staffing of ambulances.(C)
*Discuss the importance of completing an ambulance equipment/ supply checklist.(C)
*Discuss the factors to be considered when determining ambulance stationing within a community.(C)
*Describe the advantages and disadvantages of air medical transport.(C)
*Identify the conditions/ situations in which air medical transport should be considered.(C)
*Assess personal practices relative to ambulance operations which may affect the safety of the crew, the patient and bystanders.(B)
*Serve as a role model for others relative to the operation of ambulances.(B)
*Value the need to serve as the patient advocate to ensure appropriate patient transportation via ground or air.(B)
*Demonstrate how to place a patient in, and remove a patient from, an ambulance.(M)

II. Medical Incident Command
Unit Objective: At the completion of this unit, the paramedic student will be able to integrate the principles of general incident management and multiple casualty incident (MCI) management techniques in order to function effectively at major incidents.
*Explain the need for the incident management system (IMS)/ incident command system (ICS) in managing emergency medical services incidents.(C)
*Define the term multiple casualty incident (MCI).(C)
*Define the term disaster management.(C)
*Describe essential elements of scene size-up when arriving at a potential MCI.(C)
*Describe the role of the paramedics and EMS systems in planning for MCIs and disasters.(C)
*Define the following types of incidents and how they affect medical management:(C)
a. Open or uncontained incident
b. Closed or contained incident
*Describe the functional components of the incident management system in terms of the following:(C)
a. Command
b. Finance
c. Logistics
d. Operations
e. Planning
*Differentiate between singular and unified command and when each is most applicable.(C)
*Describe the role of command.(C)
*Describe the need for transfer of command and procedures for transferring it.(C)
*Differentiate between command procedures used at small, medium and large scale medical incidents.(C)
*Explain the local/ regional threshold for establishing command and implementation of the incident management system including threshold MCI declaration.(C)
*List and describe the functions of the following groups and leaders in ICS as it pertains to EMS incidents:(C)
a. Safety
b. Logistics
c. Rehabilitation (rehab)
d. Staging
e. Treatment
f. Triage
g. Transportation
h. Extrication/ rescue
i. Disposition of deceased (morgue)
j. Communications
*Describe the methods and rationale for identifying specific functions and leaders for these functions in ICS.(C)
*Describe the role of both command posts and emergency operations centers in MCI and disaster management.(C)
*Describe the role of the physician at multiple casualty incidents.(C)
*Define triage and describe the principles of triage.(C)
*Describe the START (simple triage and rapid treatment) method of initial triage.(C)
*Given a list of 20 patients with various multiple injuries, determine the appropriate triage priority with 90% accuracy.(C)
*Given color coded tags and numerical priorities, assign the following terms to each:(C)
a. Immediate
b. Delayed
c. Hold
d. Deceased
*Define primary and secondary triage.(C)
*Describe when primary and secondary triage techniques should be implemented.(C)
*Describe the need for and techniques used in tracking patients during multiple casualty incidents.(C)
*Describe techniques used to allocate patients to hospitals and track them.(C)
*Describe modifications of telecommunications procedures during multiple casualty incidents.(C)
*List and describe the essential equipment to provide logistical support to MCI operations to include:(C)
a. Airway, respiratory and hemorrhage control
b. Burn management
c. Patient packaging/ immobilization
*List the physical and psychological signs of critical incident stress.(C)
*Describe the role of critical incident stress management sessions in MCIs.(C)
*Describe the role of the following exercises in preparation for MCIs:(C)
a. Table top exercises
b. Small and large MCI drills
*Understand the rationale for initiating incident command even at a small MCI event.(B)
*Explain the rationale for having efficient and effective communications as part of an incident command/ management system.(B)
*Explain why common problems of an MCI can have an adverse effect on an entire incident.(B)
*Explain the organizational benefits for having standard operating procedures (SOPs) for using the incident management system or incident command system.(B)
*Demonstrate the use of local/ regional triage tagging system used for primary and secondary triage.(M)
*Given a simulated tabletop multiple casualty incident, with 5-10 patients:(M)
a. Establish unified or singular command
b. Conduct a scene assessment
c. Determine scene objectives
d. Formulate an incident plan
e. Request appropriate resources
f. Determine need for ICS expansion and groups
g. Coordinate communications and groups leaders
h. Coordinate outside agencies
*Demonstrate effective initial scene assessment and update (progress) reports.(M)
*Given a classroom simulation of a MCI with 5-10 patients, fulfill the role of triage group leader.(M)
*Given a classroom simulation of a MCI with 5-10 patients, fulfill the role of treatment group leader.(M)
*Given a classroom simulation of a MCI with 5-10 patients, fulfill the role of transportation group leader.(M)

III. Rescue Awareness and Operations
Unit Objective: At the completion of this unit, the paramedic student will be able to integrate the principles of rescue awareness and operations to safely rescue a patient from water, hazardous atmospheres, trenches, highways, and hazardous terrain.
*Define the term rescue.(C)
*Explain the medical and mechanical aspects of rescue situations.(C)
*Explain the role of the paramedic in delivering care at the site of the injury, continuing through the rescue process and to definitive care.(C)
*Describe the phases of a rescue operation.(C)
*List and describe the types of personal protective equipment needed to safely operate in the rescue environment to include:(C)
a. Head protection
b. Eye protection
c. Hand protection
d. Personal flotation devices
e. Thermal protection/ layering systems
f. High visibility clothing
g. Specialized footwear
*Explain the differences in risk between moving water and flat water rescue.(C)
*Explain the effects of immersion hypothermia on the ability to survive sudden immersion and self rescue.(C)
*Explain the phenomenon of the cold protective response in cold water drowning situations.(C)
*Identify the risks associated with low head dams and the rescue complexities they pose.(C)
*Given a picture of moving water, identify and explain the following features and hazards associated with:(C)
a. Hydraulics
b. Strainers
c. Dams/ hydro-electric sites
*Explain why water entry or go techniques are methods of last resort.(C)
*Explain the rescue techniques associated with reach-throw-row-go.(C)
*Given a list of rescue scenarios, identify the victim survivability profile and which are rescue versus body recovery situations.(C)
*Explain the self rescue position if unexpectedly immersed in moving water.(C)
*Given a series of pictures identify which would be considered "confined spaces" and potentially oxygen deficient.(C)
*Identify the hazards associated with confined spaces and risks posed to potential rescuers to include:(C)
a. Oxygen deficiency
b. Chemical/ toxic exposure/ explosion
c. Engulfment
d. Machinery entrapment
e. Electricity
*Identify components necessary to ensure site safety prior to confined space rescue attempts.(C)
*Identify the poisonous gases commonly found in confined spaces to include:(C)
a. Hydrogen sulfide (H2S)
b. Carbon dioxide (C02)
c. Carbon monoxide (CO)
d. Low/ high oxygen concentrations (Fi02)
e. Methane (CH4)
f. Ammonia (NH3)
g. Nitrogen dioxide (NO2)
*Explain the hazard of cave-in during trench rescue operations.(C)
*Describe the effects of traffic flow on the highway rescue incident including limited access superhighways and regular access highways.(C)
*List and describe the following techniques to reduce scene risk at highway incidents:(C)
a. Apparatus placement
b. Headlights and emergency vehicle lighting
c. Cones, flares
d. Reflective and high visibility clothing
*List and describe the hazards associated with the following auto/ truck components:(C)
a. Energy absorbing bumpers
b. Air bag/ supplemental restraint systems
c. Catalytic converters and conventional fuel systems
d. Stored energy
e. Alternate fuel systems
*Given a diagram of a passenger auto, identify the following structures:(C)
a. A, B, C, D posts
b. Fire wall
c. Unibody versus frame designs
*Describe methods for emergency stabilization using rope, cribbing, jacks, spare tire, and come- a-longs for vehicles found on their:(C)
a. Wheels
b. Side
c. Roof
d. Inclines
*Describe the electrical hazards commonly found at highway incidents (above and below ground).(C)
*Explain the difference between tempered and safety glass, identify its locations on a vehicle and how to break it safely.(C)
*Explain typical door anatomy and methods to access through stuck doors.(C)
*Explain SRS or "air bag" systems and methods to neutralize them.(C)
*Define the following terms:(C)
a. Low angle
b. High angle
c. Belay
d. Rappel
e. Scrambling
f. Hasty rope slide
*Describe the procedure for stokes litter packaging for low angle evacuations.(C)
*Explain the procedures for low angle litter evacuation to include:(C)
a. Anchoring
b. Litter/ rope attachment
c. Lowering and raising procedures
*Explain techniques to be used in non-technical litter carries over rough terrain.(C)
*Explain non-technical high angle rescue procedures using aerial apparatus.(C)
*Develop specific skill in emergency stabilization of vehicles and access procedures and an awareness of specific extrication strategies.(C)
*Explain assessment procedures and modifications necessary when caring for entrapped patients.(C)
*List the equipment necessary for an "off road" medical pack.(C)
*Explain specific methods of improvisation for assessment, spinal immobilization and extremity splinting.(C)
*Explain the indications, contraindications and methods of pain control for entrapped patients.(C)
*Explain the need for and techniques of thermal control for entrapped patients.(C)
*Explain the pathophysiology of "crush trauma" syndrome.(C)
*Develop an understanding of the medical issues involved in providing care for a patient in a rescue environment.(C)
*Develop proficiency in patient packaging and evacuation techniques that pertain to hazardous or rescue environments.(C)
*Explain the different types of "stokes" or basket stretchers and the advantages and disadvantages associated with each.(C)
*Using cribbing, ropes, lifting devices, spare tires, chains, and hand winches, demonstrate the following stabilization procedures:(M)
a. Stabilization on all four wheels
b. Stabilization on its side
c. Stabilization on its roof
d. Stabilization on an incline/ embankments
*Using basic hand tools demonstrate the following:(M)
a. Access through a stuck door
b. Access through safety and tempered glass
c. Access through the trunk
d. Access through the floor
e. Roof removal
f. Dash displacement/ roll-up
g. Steering wheel/ column displacement
h. Access through the roof
*Demonstrate methods of "stokes" packaging for patients being:(M)
a. Vertically lifted (high angle)
b. Horizontally lifted (low angle)
c. Carried over rough terrain
*Demonstrate methods of packaging for patients being vertically lifted without stokes litter stretcher packaging.(M)
*Demonstrate the following litter carrying techniques:(M)
a. Stretcher lift straps
b. "Leap frogging"
c. Passing litters over and around obstructions
*Demonstrate litter securing techniques for patients being evacuated by aerial apparatus.(M)
*Demonstrate in-water spinal immobilization techniques.(M)
*Demonstrate donning and properly adjusting a PFD.(M)
*Demonstrate use of a throw bag.(M)

IV. Hazardous Material Incidents
Unit Objective: At the completion of this unit, the paramedic student will be able to evaluate hazardous materials emergencies, call for appropriate resources, and work in the cold zone.
*Explain the role of the paramedic/ EMS responder in terms of the following:(C)
a. Incident size-up
b. Assessment of toxicologic risk
c. Appropriate decontamination methods
d. Treatment of semi-decontaminated patients
e. Transportation of semi-decontaminated patients
*Size-up a hazardous materials (haz-mat) incident and determine the following:(C)
a. Potential hazards to the rescuers, public and environment
b. Potential risk of primary contamination to patients
c. Potential risk of secondary contamination to rescuers
*Identify resources for substance identification, decontamination and treatment information including the following:(C)
a. Poison control center
b. Medical control
c. Material safety data sheets (MSDS)
d. Reference textbooks
e. Computer databases (CAMEO)
f. CHEMTREC
g. Technical specialists
h. Agency for toxic substances and disease registry
*Explain the following terms/ concepts:(C)
a. Primary contamination risk
b. Secondary contamination risk
*List and describe the following routes of exposure:(C)
a. Topical
b. Respiratory
c. Gastrointestinal
d. Parenteral
*Explain the following toxicologic principles:(C)
a. Acute and delayed toxicity
b. Route of exposure
c. Local versus systemic effects
d. Dose response
e. Synergistic effects
*Explain how the substance and route of contamination alters triage and decontamination methods.(C)
*Explain the limitations of field decontamination procedures.(C)
*Explain the use and limitations of personal protective equipment (PPE) in hazardous material situations.(C)
*List and explain the common signs, symptoms and treatment for the following substances:(C)
a. Corrosives (acids/ alkalis)
b. Pulmonary irritants (ammonia/ chlorine)
c. Pesticides (carbamates/ organophosphates)
d. Chemical asphyxiants (cyanide/ carbon monoxide)
e. Hydrocarbon solvents (xylene, methylene chloride)
*Explain the potential risk associated with invasive procedures performed on contaminated patients.(C)
*Given a contaminated patient determine the level of decontamination necessary and :(C)
a. Level of rescuer PPE
b. Decontamination methods
c. Treatment
d. Transportation and patient isolation techniques
*Identify local facilities and resources capable of treating patients exposed to hazardous materials.(C)
*Determine the hazards present to the patient and paramedic given an incident involving hazardous materials.(C)
*Define the following and explain their importance to the risk assessment process:(C)
a. Boiling point
b. Flammable/ explosive limits
c. Flash point
d. Ignition temperature
e. Specific gravity
f. Vapor density
g. Vapor pressure
h. Water solubility
i. Alpha radiation
j. Beta radiation
k. Gamma radiation
*Define the toxicologic terms and their use in the risk assessment process:(C)
a. Threshold limit value (TLV)
b. Lethal concentration and doses (LD)
c. Parts per million/ billion (ppm/ ppb)
d. Immediately dangerous to life and health (IDLH)
e. Permissible exposure limit (PEL)
f. Short term exposure limit (TLV-STEL)
g. Ceiling level (TLV-C)
*Given a specific hazardous material be able to do the following:(C)
a. Research the appropriate information about it's physical and chemical characteristics and hazards
b. Suggest the appropriate medical response
c. Determine risk of secondary contamination
*Determine the factors which determine where and when to treat a patient to include:(C)
a. Substance toxicity
b. Patient condition
c. Availability of decontamination
*Determine the appropriate level of PPE to include:(C)
a. Types, application, use and limitations
b. Use of chemical compatibility chart
*Explain decontamination procedures when functioning in the following modes:(C)
a. Critical patient rapid two step decontamination process
b. Non-critical patient eight step decontamination process
*Explain specific decontamination procedures.(C)
*Explain the four most common decontamination solutions used to include:(C)
a. Water
b. Water and tincture of green soap
c. Isopropyl alcohol
d. Vegetable oil
*Identify the areas of the body difficult to decontaminate to include:(C)
a. Scalp/ hair
b. Ears/ ear canals/ nostrils
c. Axilla
d. Finger nails
e. Navel
f. Groin/ buttocks/ genitalia
g. Behind knees
h. Between toes, toe nails
*Explain the medical monitoring procedures of hazardous material team members to be used both pre and post entry, to include:(C)
a. Vital signs
b. Body weight
c. General health
d. Neurologic status
e. ECG
*Explain the factors which influence the heat stress of hazardous material team personnel to include:(C)
a. Hydration
b. Physical fitness
c. Ambient temperature
d. Activity
e. Level of PPE
f. Duration of activity
*Explain the documentation necessary for Haz-Mat medical monitoring and rehabilitation operations.(C)
a. The substance
b. The toxicity and danger of secondary contamination
c. Appropriate PPE and suit breakthrough time
d. Appropriate level of decontamination
e. Appropriate antidote and medical treatment
f. Transportation method
*Given a simulated hazardous substance, use reference material to determine the appropriate actions.(C)
*Integrate the principles and practices of hazardous materials response in an effective manner to prevent and limit contamination, morbidity, and mortality.(C)
**Be able to describe the unique challenges of nuclear, biological, and chemical terrorism for emergency medical service personnel.(C)

V. Assessment Based Management
Unit Objective: At the completion of this unit, the paramedic student will be able to integrate the principles of assessment based management to perform an appropriate assessment and implement the management plan for patients with common complaints.
*Explain how effective assessment is critical to clinical decision making.(C)
*Explain how the paramedic's attitude affects assessment and decision making.(C)
*Explain how uncooperative patients affect assessment and decision making.(C)
*Explain strategies to prevent labeling and tunnel vision.(C)
*Develop strategies to decrease environmental distractions.(C)
*Describe how manpower considerations and staffing configurations affect assessment and decision making.(C)
*Synthesize concepts of scene management and choreography to simulated emergency calls.(C)
*Explain the roles of the team leader and the patient care person.(C)
*List and explain the rationale for carrying the essential patient care items.(C)
*When given a simulated call, list the appropriate equipment to be taken to the patient.(C)
*Explain the general approach to the emergency patient.(C)
*Explain the general approach, patient assessment, differentials, and management priorities for patients with the following problems:(C)
a. Chest pain
b. Medical and traumatic cardiac arrest
c. Acute abdominal pain
d. GI bleed
e. Altered mental status
f. Dyspnea
g. Syncope
h. Seizures
i. Environmental or thermal problem
j. Hazardous material or toxic exposure
k. Trauma or multi trauma patients
l. Allergic reactions
m. Behavioral problems
n. Obstetric or gynecological problems
o. Pediatric patients
*Describe how to effectively communicate patient information face to face, over the telephone, by radio, and in writing.(C)
*Appreciate the use of scenarios to develop high level clinical decision making skills.(B)
*Defend the importance of considering differentials in patient care.(B)
*Advocate and practice the process of complete patient assessment on all patients.(B)
*Value the importance of presenting the patient accurately and clearly.(B)
*While serving as team leader, choreograph the EMS response team, perform a patient assessment, provide local/ regionally appropriate treatment, present cases verbally and in writing given a moulaged and programed simulated patient.(M)
*While serving as team leader, assess a programmed patient or mannequin, consider differentials, make decisions relative to interventions and transportation, provide the interventions, patient packaging and transportation, work as a team and practice various roles for the following common emergencies:(M)
a. Chest pain
b. Cardiac Arrest
1. Traumatic arrest
2. Medical arrest
c. Acute abdominal pain
d. GI bleed
e. Altered mental status
f. Dyspnea
g. Syncope
h. Seizure
i. Thermal/ environmental problem
j. Hazardous materials/ toxicology
k. Trauma
1. Isolated extremity fracture (tibia/ fibula or radius/ ulna)
2. Femur fracture
3. Shoulder dislocation
4. Clavicular fracture or A-C separation
5. Minor wound (no sutures required, sutures required, high risk wounds, with tendon and/ or nerve injury)
6. Spine injury (no neurologic deficit, with neurologic deficit)
7. Multiple trauma-blunt
8. Penetrating trauma
9. Impaled object
10. Elderly fall
11. Athletic injury
12. Head injury (concussion, subdural/ epidural)
l. Allergic reactions/ bites/ envenomation
1. Local allergic reaction
2. Systemic allergic reaction
3. Envenomation
m. Behavioral
1. Mood disorders
2. Schizophrenic and delusional disorders
3. Suicidal
n. Obstetrics/ gynecology
1. Vaginal bleeding
2. Childbirth (normal and abnormal)
o. Pediatric
1. Respiratory distress
2. Fever
3. Seizures

VI. Navigation**
**Unit Object: At the completion of this unit, the paramedic student will be aware of different maps, their uses and the importance of effective and efficient map reading and interpretation.
**Identify major passageways using a map.(C)
**Given a map, determine an appropriate route of travel to arrive at a given location.(C)
**Understand the value of having immediate access to maps on any ambulance call. (C)
**Recognize GPS as a navigational tool.(C)

VII. Pre-Clinical OR Rotation Objectives**
**Unit Objective: At the completion of this unit, the paramedic student will recognize the need for, and perform, all the skills involved with successful endotracheal intubation and patient ventilation in the hospital setting.
**Recognize the need for and perform endotracheal, nasopharyngeal and oropharyngeal suctioning.(C)
**Recognize the need and administer oxygen therapy using all equipment.(C)
**Perform endotracheal intubation.(C)
**Observe and assist with patient ventilation.(C)
**Utilize proper body substance isolation techniques.(C)