PHECC Advanced Paramedic cheat sheet

PHECC CPGs are published as separate Clinical Practice Guidelines by care level; the Advanced Paramedic is authorised to perform only the interventions listed for that level.

Advanced Paramedic skills beyond Paramedic level include advanced airway management, IV cannulation and fluid administration, and administration of additional listed medications.

Patient report forms must record the care level of the attending practitioner, the interventions performed, and the clinical rationale for any deviation from CPG.

CPG-directed care requires the practitioner to confirm indication, contraindication, dose and route before administration; any one criterion failing stops the intervention.

Clinical handover to receiving staff uses a structured format covering presenting problem, assessment findings, interventions, response and outstanding needs.

Advanced Paramedics may assist a patient with the patient's own prescribed medication only where the CPG or medical oversight authorises it.

Refusal of care by a competent adult requires documented capacity assessment, explanation of risks, and a signed refusal where the patient agrees to sign.

On-scene time should be justified by clinical need; prolonged scene times require documented reasons in the patient care record.

Any adverse incident or medication error must be reported through the PHECC/employer incident reporting process, separate from the clinical record.

Primary survey sequence: catastrophic haemorrhage control, airway, breathing, circulation, disability, exposure (cABCDE).

GCS is scored eye (1-4) + verbal (1-5) + motor (1-6); total 3-15; GCS <=8 indicates a need for airway protection.

NEWS-style early warning scoring aggregates respiratory rate, SpO2, oxygen use, systolic BP, pulse, temperature and consciousness to flag deterioration.

Sample history: Signs/symptoms, Allergies, Medications, Past medical history, Last oral intake, Events leading to presentation.

OPQRST for pain: Onset, Provocation/palliation, Quality, Radiation, Severity, Time.

Shock index = heart rate / systolic blood pressure; a value above 0.9 in adults suggests significant occult hypoperfusion.

Capillary refill, skin temperature and mentation changes are late but reliable field indicators of poor perfusion.

Reassessment after every intervention or change in condition; trend direction is more informative than a single set of observations.

Clinical decision-making must weigh patient capacity, refusal risk, transport options and time-critical conditions before choosing a destination.

Adult CPR: compressions at 100-120/min, depth 5-6 cm, full recoil, ratio 30:2 without an advanced airway; continuous compressions with 10-12 ventilations/min once an advanced airway is placed.

Defibrillation is indicated for VF and pulseless VT; shock energy is device-specific (typically 150-200 J biphasic or 360 J monophasic) and compressions resume immediately after each shock.

Adrenaline in adult cardiac arrest is 1 mg IV/IO of 1:10,000 every 3-5 minutes; amiodarone 300 mg IV/IO is given after the third shock in refractory VF/VT.

Reversible causes of cardiac arrest (4 Hs and 4 Ts): hypoxia, hypovolaemia, hypo/hyperkalaemia and metabolic, hypothermia; tension pneumothorax, tamponade, toxins, thrombosis.

Supraglottic airway insertion is attempted only after basic airway manoeuvres and suction; confirm placement by waveform capnography plus chest rise and auscultation.

Waveform capnography is the standard confirmation of endotracheal tube placement; a persistent flat trace means oesophageal placement or absent perfusion.

In cardiac arrest, oxygen delivery is maximised by high-quality compressions; hyperventilation raises intrathoracic pressure and reduces coronary perfusion.

Paediatric CPR uses a compression:ventilation ratio of 15:2 for two rescuers and 30:2 for a lone rescuer, with compressions at one-third of chest depth.

Post-ROSC care targets SpO2 94-98%, normocapnia, systolic BP at least 90 mmHg, 12-lead ECG and transport to a percutaneous coronary intervention-capable centre where indicated.

The 'rights' of administration: right patient, drug, dose, route, time, documentation, and reason; any doubt requires independent double-check.

Adrenaline 1:10,000 (100 micrograms/mL) is used IV/IO in cardiac arrest; 1:1,000 (1 mg/mL) is the IM anaphylaxis preparation, 0.5 mg IM adult.

Anaphylaxis: IM adrenaline into the anterolateral thigh, repeated every 5 minutes as needed; IV adrenaline is reserved for refractory cases under medical oversight.

Glyceryl trinitrate is contraindicated in hypotension (systolic BP below 90 mmHg), suspected right ventricular infarction and recent PDE5 inhibitor use.

Aspirin 300 mg chewed is indicated in suspected acute coronary syndrome unless true allergy or active bleeding is present.

Naloxone reverses opioid-induced respiratory depression; its duration may be shorter than the opioid, so repeat dosing and observation are required.

Glucose 10% IV or oral glucose is used for symptomatic hypoglycaemia; recheck blood glucose after administration and document the response.

Drug doses in children are weight-based (mg/kg); use a length-based tape or estimated weight and verify the calculated dose before drawing up.

Every medication administration is documented with drug, dose, route, time, indication, effect and any adverse reaction.

Scope of practice is defined by PHECC registration level and current CPGs; acting outside it without delegation is a fitness-to-practise matter.

Informed consent requires capacity, adequate information, and voluntariness; treatment may proceed without consent only under necessity to save life or prevent serious harm.

Confidentiality: patient information is shared only on a need-to-know basis for care, and disclosure otherwise requires consent or a legal obligation.

Capacity assessment examines whether the patient can understand, retain, weigh and communicate a decision; a decision is not invalid merely because it is unwise.

Mandatory reporting obligations include suspected abuse of children or vulnerable adults and certain notifiable incidents defined by law and employer policy.

Professional boundaries prohibit personal or financial relationships with patients and require declining gifts that could create obligation.

Delegation of tasks to lower-trained responders is permitted only for tasks within the delegate's competence and with the delegator remaining accountable.

Documentation must be contemporaneous, factual, legible and free of speculation; errors are corrected with a single line, signature and date, not erased.

Duty of care continues until a formal handover to an equivalent or higher level of care is completed and accepted.