Emergency Medical Services: Fieldwork
Fieldwork requirements
EMT expectations
OAR 333-265-0014 mandates a minimum of at least eight hours in a hospital or acute care department and a minimum of at least eight hours of prehospital experience where the skills within an EMT scope of practice are performed under the supervision of a preceptor.
The EMS program strongly recommends the student arrive at all clinical or field internship sites in full compliance with the dress code and at least 15 minutes before the start of the assigned shift. The clinical facilities and internship sites have been instructed to send students home who are tardy, out of compliance with the dress code, and/or demonstrate inappropriate or unprofessional behavior.
Please be advised that failure to report to the correct location or at the designated time, as well as displaying unprofessional conduct or not adhering to the uniform guidelines, will be considered an absence. It is important to obtain express permission from PCC EMS staff before directly contacting the clinical or field site for any reason, as doing so is a violation of program standards and could have a negative impact on the student’s course grade.
If a student is unable to attend a clinical or field internship rotation, it is imperative to promptly contact the clinical at the office. It is important to note that even with timely notification, an absence will not be exempt and may have an adverse effect on the student’s grade. Failure to complete missed rotation(s) may lead to failure of the course or prompt a dismissal review process (see Due process for violations).
For the paramedic courses, successful completion of clinical rotations is competency-based, not hourly-based. These competencies are provided and reviewed in EMS 238.
The purpose of clinical education is to provide students with opportunities to reinforce knowledge, skills, and abilities acquired in the classroom and laboratory settings. When provided with opportunities to practice with actual patients, students transition from a basic understanding to an advanced level of comprehensive application and analysis. During this cognitive and psychomotor transition from simplistic tasks to those that are more complex, the student will develop a valuable and functional index of care modalities to be used when treating patients as a provider. Upon completion of the clinical rotation requirements, student proficiency will increase in the following performance areas:
- Clinical behavior/judgment
- Assessment
- Therapeutic communication and cultural competency
- Psychomotor skills
- Professionalism
- Decision-making and prioritization
- Documentation and accurate record-keeping
- Patient complaints
- Patient management and safety-related issues
Throughout the scheduled clinical rotations, students will interact with representatives from various EMS and medical agencies. Students are expected to display professional behavior whenever they participate in program-sponsored activities. This includes all clinical rotations, mandatory clinical skills labs, and any assigned specialized rotations. Students are responsible for the following behaviors:
- To respect and maintain confidentiality with all patient information, including verbal discussion and written records.
- To behave professionally and to accept responsibility for one’s actions and behaviors in the clinical areas, to and from clinical rotations (in uniform), and clinical labs.
- To avoid, at all costs, any verbal confrontation with staff, patients, and other medical and health care providers.
- To follow the grievance process outlined in this handbook when attempting to resolve problems or conflicts with staff or fellow students, or when attempting to effect changes in program policies.
Scope of practice in the learning environment
EMS students may perform any skill or ability identified in the scope of practice of emergency medical services providers while in the clinical setting under the direct supervision of a registered nurse, physician, physician’s assistant, or other paramedic preceptor. When the paramedic student is not participating in course-related activities, they are permitted to perform only skills within their current licensure scope of practice. Students who practice the paramedic scope of practice while not under the direct supervision of a preceptor are in violation of their existing license. This violation can prompt a program dismissal review process (see Due process for violations) and may be reported to the Oregon Health Authority.
Health profession student clinical training administrative requirements
In order for students to complete the required clinical training, PCC requires all students to meet the Oregon Administrative Rule (OAR) Chapter 409 – Division 30 for students in clinical training prior to clinical placement. Students are to meet any requirements mandated by their clinical site as well. A detailed description of these requirements are listed in Requirements for Clinical & Field Education. They include:
- Successfully pass a criminal background check
- Successfully pass a ten-panel drug screen
- Submit proof of current immunizations
- CPR Certification: Students are required to obtain and maintain current certification in BLS (CPR) for Healthcare Providers by the American Heart Association.
- Complete Health Insurance Portability and Accountability Act (HIPAA) and OSHA Bloodborne Pathogen compliance training modules.
- The EMS program uses the third-party vendor, CastleBranch to collect immunization and CPR certification documentation and conduct the background check and drug screen. Package order codes are found on the EMS application website and in the EMT advising guide. All CastleBranch requirements must be completed before entry into EMS 105 and EMS 244.
Clinical preparatory tasks
Prior to arriving at any clinical site, the student is responsible for completing the following preparatory tasks:
- Read the objectives for that clinical site/department, available in Platinum Planner. Review the skills for the clinical shift. Pay special attention to skills that contribute to the summative clinical competencies.
- Review medications that may be administered at the clinical site. Expect the clinical preceptor to evaluate the student’s knowledge of any medications that may be administered during the clinical shift. If students are unable to demonstrate knowledge, the clinical preceptor will not allow students to demonstrate skills.
- Promptly report to the clinical site at the designated date/time and in appropriate attire as outlined in this handbook (see the Dress code section).
- Review policies and procedures specific to the clinical site and area.
- Be cognizant of opportunities to fulfill course requirements as they pertain to skills, patient age, complaint, and impression.
- Be prepared to review and discuss treatments and procedures that are observed and performed.
- Ask the preceptor questions away from the patient about treatments and procedures that are observed and performed but be cognizant of the preceptor’s time.
- In most cases, it is acceptable to ask questions, but not question a physician’s clinical decisions or orders.
Clinical experience conduct expectations
The opportunities to practice professional behavior are an integral part of the clinical experience. Derogatory conduct; e.g., public criticism of faculty or preceptors, or affiliates, disruptive behavior in any setting, or insubordination; will not be tolerated. Any such behavior can prompt a disciplinary review process.
If any clinical or field preceptor/agency asks a student to leave or dismisses them for non-professional behavior, including but not limited to inappropriate presentation, dress code/grooming/hygiene issues, etc., the college is not required to place the student in another agency for that term. If the student is placed in another agency, a probationary review process will be considered and the student must fulfill any requirements arising from the result of this process to achieve a passing grade. If the requirements are not fulfilled, the result will be a non-passing grade for that portion of the course, which will prohibit the student from continuing in the program. Learning the role of the EMT, as well as the required skills, are students’ primary responsibility. Pay careful attention to health facility and ambulance protocols. Use of cell phones, texting, etc. is typically not allowed during the clinical/ambulance experience and may violate the professional expectations of that agency. See Due process for violations.
Capstone field requirements and expectations
Successful completion of capstone field rotations is competency-based, not hourly-based. The capstone field rotations are the Advanced Life Support (ALS) paramedic team lead experience. During this experience, the student should be able to integrate all cognitive, psychomotor, and affective domains to function as an entry-level paramedic. The student should no longer be provided with instruction but mentored as a functioning team leader. Although the Paramedic preceptor remains ultimately responsible for all patient care, the student should be performing as the lead paramedic for most patient contacts. All paramedic students must successfully complete their required ALS contacts with their program-assigned preceptor. The program may authorize a substitute, as needed, if the preceptor is unavailable for any rotations. Competencies should be completed during this time; however, the capstone leadership experience may be extended if needed for the student to complete competencies.
Students should be strictly evaluated on their ability to perform as the team leader of an ALS EMS team. Students must successfully lead the required number and type of ambulance responses in Platinum Planner (PP). To classify a patient as ALS in PP, patients must have IV access and ECG monitoring (12-lead acquisition is highly encouraged as this is a field competency). See below for additional competencies and preceptor expectations.
Capstone field objectives
Serve as the team lead for the majority of responses, and for all responses towards the end of the capstone field internship, ensuring that the required number of calls are marked as a “successful lead”.
- Act as a team lead throughout the shift.
- Perform all radio/telephone patient care report transmissions.
- Complete patient care report documentation for all patient contacts.
- Perform comprehensive patient assessments and formulate treatment plans for all patients without guidance from the preceptor.
- Perform skills under stressful situations.
- Establish rapport with patients, families, and team members.
- Demonstrate professionalism and confidence at all times.
- Professionally delegate tasks to team members and professionally follow up on each task delegated.
- Perform other duties as assigned within the paramedic scope of practice
Preceptor expectations
- Read/review student capstone field competencies to be demonstrated.
- Evaluate the student’s capstone field decisions and provide feedback with regard to all patient contacts.
- Evaluate the student’s performance of approved skills.
- Intervene when appropriate to ensure continued safety of patient and crew.
- Offer expertise gained through previous patient contact experience.
- Correlate capstone field experience with didactic knowledge.
- Complete field performance evaluations in PP and provide students with summative observations; designate each patient contact as a “successful lead” when appropriate.
- Understand students are never to be used as agents for performing duties designated to paid staff.
Fieldwork grading
Clinical course grading
Objectives are met through integrated clinical internship rotations and clinical lab activities that allow for a gradual progression from simple to complex depth and comprehensive breadth of EMS knowledge, training, and competency. Emphasis is made on strong interpersonal skills, critical thinking abilities, good decision-making skills, and the capacity for making quick and appropriate judgments regarding patient care.
Student mastery is evaluated by psychomotor skill competency evaluation during clinical internship rotations; psychomotor skill competency evaluation during clinical labs; simulation evaluation; and affective evaluations. Additional critical activities include case study review, simulation lab competency (including virtual reality and augmented reality), small group sessions, and problem-based learning.
All components of the course grade are mandatory. Any zeros or “Not Yet Competent” will constitute a failure of clinical courses.
Determination of course grade for Clinical I and II
Refer to the syllabi for EMS 244 Clinical I and EMS 246 Clinical II for additional grade determination information.
Fieldwork attendance
Attendance – EMT
Any student who fails to complete a scheduled emergency department or ambulance rotation without advance notification to PCC EMS staff and an approved excuse will receive a one-letter grade reduction for the course (e.g. a “C” grade overall plus one missed or rescheduled or unsuccessful clinical shift equals an “F” for the course.) A minimum of six hours notice will constitute advance notification. Approved excuses will be determined on a case-by-case basis. Work conflicts do not constitute an excused absence. It may not be possible to reschedule a rotation during the same school term.
Successful completion of the practical experiences requires:
- Timely arrival at the correct agency
- Full dress code compliance, including all aspects of professional appearance and attitude
- Adherence to preceptor instruction and agency policy/expectations, including use of communication and/or recording devices (visual and/or auditory)
- Completion of the scheduled hours and proper documentation thereof
Students must make a careful selection of their hospital and ambulance rotations to avoid conflict with their personal schedule. Significant effort is made to provide a variety of shifts and days to choose from. Changing a scheduled rotation is not allowed.
Advance notification (voice message acceptable) must be to the instructor first (contact information available on the course syllabus), and then to the clinical coordinator.
Attendance – Paramedic
All students are required to attend all assigned clinical rotations. Do not attend if ill and/or showing symptoms of illness. Every attempt will be made to reschedule the clinical rotations missed. Availability of make-up rotations is not guaranteed. Students are expected to be at their assigned clinical internship rotation prior to start time, to allow for location and/or changing scrubs, etc.
Clinical labs are mandatory. Exceptions are if a student is scheduled to be in a clinical rotation, has just left a night clinical rotation, or is scheduled for a night rotation after lab. The expectation is to attend a clinical lab for a few hours if it is safe to do so. If there is an emergency situation, the clinical coordinator should be contacted first, and/or the program director, if the clinical coordinator is not available, as soon as possible.
Students must notify the clinical coordinator if they will be late for any reason. The hospital/department will send students home if late without notice. Students are expected to follow rules/guidelines for all clinical rotations, set out in PP. Additional information may be given via D2L, as needed.
Fieldwork sites
The clinical affiliates and departments within affiliates may change from cohort to cohort, and may change without notice at any given time, subject to availability.
- Emanuel Emergency Department and Airway Management
- Salmon Creek Emergency Department
- Meridian Park Emergency Department
- Mount Hood Emergency Department
- St. Vincent’s Emergency Department and Respiratory Therapy
- Hillsboro Medical Center
- Randall Children’s Hospital
- OHSU Poison Control
- Kaiser Sunnyside Medical Center Telemetry Office and Airway Management
- Multnomah Crisis Assessment and Treatment Center