Medical Emergency Services (Intermediate)

Recipients of the Medical Emergency Services credential have demonstrated concept proficiency and completed  the following tasks:

Activity 1 – Sterilization

Medical Asepsis
(a) Put on hospital gown (disposable mask and hat as desired). Stand in front of sink and turn on water to warm temperature.
(b) Hold hands and forearms lower than elbows. Wet hands and applied soap.
(c) Washed palm and back of each hand, counting to ten as scrubbing.
(d) Cleaned around fingernails with fingernail brush and under nails with nail file.
(e) Washed fingers rubbing together and counting to ten.
(f) Rinsed hands well. Dried hands with disposable towel using separate towel for each hand. Turned off water using disposable towel.
(g) Practiced using hand sanitizer according to procedures.
(h) Practiced putting on disposable gloves.
(i) Properly disposed of gloves according to teacher instructions.
(j) Put away all materials.

Fingerprint Germs
(a) Placed dressing forceps on clean disposable towel. Put paint on paper plate and lightly dabbed fingertips in paint.
(b) Picked up dressing forceps in one hand and set back on disposable towel.
(c) Looked at forceps to evaluate where fingerprints/germs were represented on them.
(d) Used soap and water to wash forceps. Dried with clean disposable towel.
(e) Washed hands using medical asepsis method learned earlier.
(f) Picked up dressing forceps and noted if free of germs.
(g) Showed instructor clean forceps.
(h) Put away all materials.

Activity 2 – Patient Vital Signs

Part 1 – Taking Temperature
(a) Washed hands using sterilization techniques from Activity 1.
(b) Reviews parts of temple thermometer.
(c) Cleaned tip with cotton ball and isopropyl alcohol. Allowed thermometer to dry two minutes before using again.
(d) Pressed on/off button once and released; waited two seconds.
(e) Asked patient to hold back hair and found patient’s temple. Used cotton ball or tissue to wipe away dirt or hair. Held sensor to temple and listened for long beep.
(f) Removed thermometer and looked at display window.
(g) Accurately recorded temperature on Hospital Reporting Form, including both whole number and tenths of a degree.
(h) Turned off thermometer and cleaned end with cotton ball and isopropyl alcohol. Allowed to dry two minutes before using again.

Part 2 – Taking the Pulse
(a) Washed hands using sterilization techniques from Activity 1.
(b) Greeted patient and explained procedure.
(c) Placed patient’s hand in comfortable resting position, not holding arm up or bending it.
(d) Placed tips of first two fingers on artery on inside of wrist just below thumb.
(e) Pressed fingers firmly enough to feel pulse.
(f) When felt pulse, looked at second hand and counted beats for 60 seconds.
(g) Noticed if pulse beats were strong or weak and took note of rhythm in patient’s pulse.
(h) Accurately recorded pulse on Hospital Reporting Form

Part 3 – Taking Respiration
(a) Washed hands using sterilization techniques from Activity 1.
(b) Observed rise and fall of chest and counted respirations for one minute.
(c) Accurately recorded respiration on Hospital Reporting Form.

Part 4 – Taking Blood Pressure
(a) Listened to audio of human heartbeat.
(b) Washed hands using sterilization techniques from Activity 1.
(c) Greeted patient and explained procedure.
(d) Used cotton ball and alcohol to clean stethoscope; used stethoscope to listen to heartbeat.
(e) Placed the deflated cuff snugly and evenly around the arm, placing the lower edge of the cuff about 1 or 2 inches above the antecubital space with the tubes hanging on the inside of the elbow.
(f) Made sure tubes were not twisted or being leaned upon.
(g) Put gauge in slit on cuff; found brachial artery by placing fingers on inside of arm and feeling for pulse.
(h) Firmly placed earpiece of stethoscope in ears.
(i) Placed end piece of stethoscope (the bell) directly over artery where pulse was found.
(j) Closed the valve on the rubber bulb; squeezed the bulb to inflate the cuff until dial read 170-180 mm or until no pulse heard (not exceeding 180).
(k) Opened valve very slowly, deflating the cuff; watching dial and listening for pulse beat again. Noted systolic pressure reading.
(l) Continued to release pressure slowly until last clear pulse beat heard and then noted diastolic pressure.
(m) Removed cuff; cleaned stethoscope.
(n) Correctly recorded systolic and diastolic values in correct format on Hospital Reporting Form.
(o) Showed work to instructor; put away materials properly disposing of gloves.

Activity 3 – Bandaging

A. Circular bandage with dressing:
(a) Washed hands using sterilization techniques from Activity 1; put on disposable gloves.
(b) Asked patient to sit in chair; placed arm on table asking patient if comfortable.
(c) Chose place to apply dressing.
(d) With dressing forceps, placed 3” wide gauze bandage pad on “injured” spot on arm.
(e) Cut 24” off 3” wide gauze bandage roll; held bandage in place and made several turns around wrist or arm.
(f) Continued making turns until gauze pad was covered.
(g) Held end of gauze and used bandage scissors to cut 2” – 3” slit up center of bandage.
(h) Brought one end around bandaged part and tied ends together securely in knot; used bandage scissors to cut off extra material.
(i) Showed work to instructor.
(j) Removed bandaging and asked instructions on proper disposal of materials.

B. Spiral – gauze bandage roll for finger:
(a) Washed hands using sterilization techniques from Activity 1; put on disposable gloves.
(b) Asked patient to sit in chair; placed arm straight on table asking patient if comfortable.
(c) Placed finger in straight position
(d) Determined size of gauze bandage roll needed based on size of finger and wound.
(e) Looped one free end of bandage roll around wrist.
(f) Removed one 3” gauze bandage pad and held in place around knuckle of finger.
(g) Brought bandage roll around the wrist up across palm of hand, wound around the finger, wrapped several times around gauze pad on the knuckle.
(h) Brought bandage back to wrist.
(i) Wrapped around the wrist three times; held end of gauze and cut gauze from roll.
(j) Cut 2” – 3” slit up center of bandage; brought one end around and tied the two ends of the bandage together.
(k) Checked bandage and determined snug fit, but not too tight.
(l) Showed work to instructor; removed bandaging and asked for instructions on proper disposal of materials

C. Figure 8 ankle bandage:
(a) Washed hands using sterilization techniques from Activity 1; put on disposable gloves.
(b) Asked patient to sit in chair; rested foot on chair; retrieved elastic bandage and clips.
(c) Started elastic bandage on the instep of the foot and made two or three turns around the foot.
(d) Brought the bandage upward across the front of the foot and then around the ankle.
(e) Brought the bandage down across the foot and under the arch.
(f) Repeated steps 5 or 6 times; used extra wrap around ankle between turns.
(g) Fastened end of bandage at the top with clips.
(h) Showed instructor work; removed bandaging and asked for instructions on proper disposal of materials.

D. Arm sling:
(a) Washed hands using sterilization techniques from Activity 1; put on disposable gloves.
(b) Held one end of the triangular bandage at the neck opposite the “injured arm” and let the other end hang down.
(c) Brought bandage up under arm and up to shoulder of injured arm.
(d) Tied the two ends of the bandage together at the back of the neck, off to one side.
(e) Brought the remaining point forward and pinned it to the front of the sling.
(f) Removed sling; asked for instructions on proper disposal of materials.
(g) As time permitted, practiced with arm sling following directions provided.

Activity 4 – Wound Care

A. A Minor Wound
(a) Secured needed items.
(b) Washed hands using sterilization techniques from Activity 1; put on disposable gloves.
(c) Asked patient to sit in chair; placed arm straight on table asking patient if comfortable.
(d) Using washable marker, drew small “wound” on arm.
(e) Simulated ”cleaning” injury with soap and water using a sterile gauze pad.
(f) Used dressing forceps to removed another sterile gauze pad from package and applied dry gauze pad directly over wound.
(g) Fastened edges of pad with adhesive tape.
(h) Showed work to instructor; removed dressing; asked for instructions on proper disposal of materials.

B. Elastic Bandage
(a) Secured needed items.
(b) Washed hands using sterilization techniques from Activity 1; put on disposable gloves.
(c) Drew small “wound” on patient’s knee or elbow.
(d) Simulated “cleaning” wound with soap and water using a sterile gauze pad.
(e) Applied dressing to injury as before.
(f) Wrapped 3” gauze bandage roll four times around arm to secure dressing.
(g) Used bandage scissors to cut off the bandage; cut 2” – 3” slit up center and brought one end around bandaged area, then tied ends to secure dressing.
(h) Wrapped elastic bandage around the injured joint as previously learned making sure bandage wasn’t too tight.
(i) Showed work to instructor; removed dressing and elastic bandage; asked for instructions on proper disposal of materials.

C. Controlling Bleeding
(a) Secured needed items.
(b) Washed hands using sterilization techniques from Activity 1; put on disposable gloves.
(c) Drew “wound” on patient’s forearm.
(d) Removed sterile gauze pads from packages using dressing forceps and applied pads to wound.
(e) Pressed the dressing firmly on the “bleeding” area
(f) Wrapped 3” gauze bandage roll around area five or six times to secure the dressing.
(g) Cut off gauze bandage roll with bandage scissors and secured with safety pin or by tying ends as previously learned.
(h) Showed work to instructor; removed dressings; asked for instructions on proper disposal of materials.

Activity 5 – Immobilization

A. Immobilizing a finger
(a) Washed hands using sterilization techniques from Activity 1; put on disposable gloves.
(b) Asked patient to sit in chair; placed arm straight on table; asked patient if comfortable.
(c) Secured items needed; placed splint directly over the patientʼs finger gently molding it to fit finger.
(d) Placed 1” gauze bandage roll over tip of finger.
(e) Wound bandage down finger overlapping each turn.
(f) Crossed over palm and wound bandage several turns around palm.
(g) Wound around wrist several times to hold in place.
(h) Used bandage scissors to cut off gauze and tied bandage using procedure as before.
(i) Showed work to instructor; removed bandaging; asked for instructions on proper disposal of materials.
(j) As time permitted, practiced with velcro on splint and with wooden splint sticks.

B. Immobilizing the forearm
(a) Washed hands using sterilization techniques from Activity 1; put on disposable gloves.
(b) Asked patient to sit in chair; placed arm straight on table; asked patient if comfortable
(c) Secured items needed; used regular scissors to cut a piece of splint material the length of the forearm from elbow to wrist.
(d) Used regular scissors to cut three pieces of 3” gauze bandage roll about 2’ or 2 1/2’ long; laid parallel on flat surface.
(e) Placed splint on top of the bandages.
(f) Placed patientʼs arm gently on the splint.
(g) Wrapped the three gauze bandage rolls around the arm and then tied each bandage as previously learned, making sure not too tight.
(h) Placed patientʼs injured arm in a sling using a triangular bandage as learned before.
(i) Showed work to instructor; removed bandaging; asked for instructions on proper disposal of materials.

C. Immobilizing a fractured elbow
(a) Washed hands using sterilization techniques from Activity 1; put on disposable gloves.
(b) Secured items needed; folded three triangular bandages per instructions.
(c) Measured splint for length of patient’s whole arm, from just past armpit to wrist, and cut splint if needed.
(d) Placed splint on top of bandages.
(e) Carefully laid arm on splint and wrapped bandages around arm.
(f) Tied each bandage as learned before.
(g) Showed work to instructor; removed bandaging; asked for instructions on proper disposal of materials.

Activity 6 – Reporting to Hospital

Part 1
(a) Reviewed Hospital Reporting Form and read through Patient Summary.
(b) Completed Hospital Reporting Form for two patients.
(c) Compared answers with classmate. Revised as necessary.
(d) Showed work to instructor.

Part 2
(a) Practiced reading and recording provided report following rubric of tips.
(b) Showed recording to instructor.
(c) Read and recorded Hospital Reporting Form for one patient.
(d) Listened to recording. Timed recording.
(e) Revised recording based on time length if too long, or any other corrections.
(f) Showed final version to instructor.
(g) Put away materials.

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