Description:

MICT II is the second of four courses in advanced out-of-hospital emergency medical care leading to the opportunity to sit for the National Registry Examination for Paramedics. This course builds on the foundational knowledge developed in MICT I and covers advanced management of medical and trauma emergencies in the out-of-hospital environment. Much material will be covered rapidly, and emphasis is on organization, internalization, synthesis and application of the basic knowledge of the discipline in this 9-week course. Students demonstrate competency at motor skill performance, and extensive simulation practice is afforded. Students begin field observation with a paramedic ambulance crew and complete an Advanced Cardiac Life Support Course. 24 hrs. avg. lecture/wk., 12 hrs. lab/field observation avg./wk.

Supplies: Refer to the instructor's course syllabus for details about any supplies that may be required.

Textbook(s): For information see - http://bookstore.jccc.net

Course Fees: NONE

Course Objectives:

NOTE: The National Standard EMT-P curriculum was developed by the US
DOT's National Highway Traffic Safety Administration. The curriculum,
mandated for use at JCCC by the Kansas Board of Emergency Medical
Services, is a detailed, competency based curriculum containing well over
1,000 cognitive, psychomotor, and affective competencies. This course
outline rather than attempting to recreate the national standard
curriculum will provide a brief executive summary. The full curriculum
will be provided as a reference document.

Upon successful completion of this course the student should be able to:

1. (4) Integrate pathophysiological principles and assessment findings to formulate a field impression and implement the treatment plan for the trauma patient with shock or hemorrhage; soft tissue trauma; burn injury; head injury; spinal injury; thoracic injury; abdominal trauma; and musculoskeletal injury.
2. (4-1) Integrate the principles of kinematics to enhance the patient assessment and predict the likelihood of injuries based on the patient's mechanism of injury.
3. (5) Integrate pathophysiological principles and assessment findings to formulate a field impression and implement the treatment plan for the medical patient with respiratory problems; neurological problems; allergic or anaphylactic reaction; gastroenterologic problem; renal or urologic problem; toxic exposure; environmentally induced or exacerbated medical or traumatic condition; infectious and communicable diseases; behavioral emergencies; gynecological emergency; normal or abnormal labor.
4. (5-9) Integrate the pathophysiological principles of the hematopoietic system to formulate a field impression and implement a treatment plan.
5. (6) integrate pathophysiological principles and assessment findings to formulate a field impression and implement the treatment plan for neonatal, pediatric, and geriatric patients, diverse patients, and chronically ill patients.
6. (6-4) Integrate the assessment findings to formulate a field impression and implement a treatment plan for the patient who has sustained abuse or assault.
7. (6-5) Integrate pathophysiological and psychosocial principles to adapt the assessment and treatment plan for diverse patients and those who face physical, mental, social and financial challenges.
8. (6-6) Integrate the pathophysiological principles and the assessment findings to formulate a field impression and implement a treatment plan for the acute deterioration of a chronic care patient.
9. (7) Integrate pathophysiological principles and assessment findings to formulate a field impression and implement the treatment plan for patients with common complaints.
10. (7-1) integrate the principles of assessment-based management to perform an appropriate assessment and implement the management plan for patients with common complaints.

*() Indicates module-lesson in national standard curriculum

Content Outline & Competencies:

I. Medical Emergencies
   A. Alcoholism and alcohol
      1. From a list, select the signs and symptoms related to various
alcohol emergencies.
      2. List the physical characteristics of a patient suffering from
advanced alcoholism
   B. Acute abdomen and GU emergencies
      1. List the signs, symptoms, field treatment, and pathophysiology of
causes of acute abdomenal conditions. 
      2. List at least five questions that should be asked of any patient
with abdominal pain
      3. List the acute abdominal conditions most likely to cause shock
   C. Allergic reactions
      1. List the clinical presentation of anaphylaxis, from initial onset
to cause of death
      2. Given a description of a patient manifesting the signs and
symptoms of anaphylactic shock, specify the treatment.
   D. Asthma
      1. Identify the pathophysiology of asthma
      2. Given a dyspneic patient with a wheeze, identify at least four
other etiologies for the wheeze
      3. Given a patient in an acute asthma attack, identify the
mechanisms that contribute to or cause death
      4. Identify the significance pulse rate, retractions, diaphoresis,
accessory muscle use, skin color, LOC, ability to speak, respiratory rate,
and a paradoxical pulse have on assessing the severity of the asthma
attack
      5. State the questions that must be asked when eliciting an asthma
patient's history
   E. Barotrauma/hyperbaric oxygen therapy
      1. List the signs and symptoms and treatment of decompression
sickness
      2. State the physiology of nitrogen gas in the body
      3. State the mechanism by which hyperbaric oxygen therapy is
beneficial
   F. Behavioral emergencies
      1. List steps in assessment and techniques to manage behavioral
emergency patients
      2. List the factors that increase the risk of suicide
      3. Differentiate various etiologies of organic, inorganic, and
chemically induced behavioral emergencies
   G. Bites and stings
      1. Identify the pathophysiology, signs, symptoms, and treatment of a
pit viper bite
      2. From a picture or description, identify a black widow and brown
recluse spider, and list the signs, symptoms, and treatment of a bite
   H. Carbon monoxide and toxic gas poisoning
      1. Identify potential sources of toxic gasses, the signs and
symptoms of poisoning, and the treatment
   I. Chronic obstructive pulmonary disease
      1. Given a COPD patient in acute respiratory distress, list the
presenting signs and symptoms, and the treatment
      2. Given a patient with a history of COPD experiencing dyspnea, list
five factors that would allow the MICT to differentiate between COPD, CHF,
asthma, and pneumonia
      3. Define acute respiratory failure, and differentiate the various
presentations of ARF
   J. Cerebral vascular accident
      1. List the history, signs, and symptoms of CVA and TIA, and the
treatment and possible complications
      2. Given a patient with a possible non-traumatic neurological
problem, list at least five questions that should be asked during
assessment
      3. Given a hypertensive CVA patient, state why the BP should not be
aggressively lowered
   K. Diabetes
      1. List the signs, symptoms, precipitating factors, treatment, and
clinical significance of diabetic emergencies
      2. List the source and functions of insulin and glucagon in the
body
      3. Define the following terms: diabetes mellitus, diabetic
ketoacidosis, insulin shock, hypoglycemia, hyperglycemia, hyperglycemic
hyperosmolar coma, type I diabetes, type II diabetes, glycogenolysis,
gluconeogenesis
   L. Differential diagnosis of chest pain
      1. Identify the conditions capable of causing pain in the six
dermatome pain bands and differentiate their presentations from each
other
      2. List the appropriate treatment for a patient with chest pain of
probably non-cardiac etiology
   M. Endocrine emergencies
      1. List the pathophysiology, symptoms, and treatment of adrenal
crisis, thyroid storm, and myxedemic coma
   N. Environmental emergencies
      1. Identify the history, pathophysiology, clinical significance,
signs, symptoms, and treatment for heat cramps, heat exhaustion, heat
stroke, frostbite, and hypothermia
      2. Identify the normal body temperatures in degrees F and C, and the
regulatory mechanisms of temperature control
      3. Identify the hazards associated with treatment of heat stroke and
hypothermia
   O. Geriatric emergencies
      1. List the special problems to be considered when dealing with the
geriatric patient
      2. List principles of management that are unique to geriatric
patients 
   P. Hypertension
      1. Define (including numerical criteria) hypertension and
hypertensive crisis
      2. List the signs and symptoms of a hypertensive crisis and the
treatment, including specifics of blood pressure management
      3. List the common prescription medications taken for hypertension
   Q. Hyperventilation
      1. List the organic and inorganic causes of hyperventilation, the
proper field management, and complications that may result
      2. Identify the homeostatic mechanism for acid/base balance, and how
it is offset in the alkalotic state of hyperventilation
      3. Write blood gases for a patient who is in simple
hyperventilation
   R. Infectious disease
      1. Identify the pathophysiology, signs and symptoms, and management
of tuberculosis, hepatitis, meningitis, syphilis, gonorrhea, herpes
simplex type 2, AIDS, scabies, lice
      2. Identify the measures to be taken to ensure paramedic safety as
related to handling the patient with suspected infectious disease
      3. Write the major components of the immune system and describe the
function of each
   S. Near drowning
      1. List the pathophysiologies and potential causes of death in near
drowning, drowning, and secondary drowning
      2. Given a description of a patient who has been involved in a near
drowning, correctly provide the appropriate field treatment
      3. State the four factors affecting prognosis from near drowning
episodes
   T. Obstetrics and gynecology
      1. Identify the assessment procedures used when evaluating the
patient who is suspected of being pregnant, and the complications that
arise in the 1st, 2nd and 3rd trimester
      2. Identify the assessment procedures used when evaluating the
patient suspected of being in labor, and list four signs of imminent field
delivery
      3. Identify the steps necessary to assist with normal and abnormal
delivery
      4. Given a situation where the postpartum mother is bleeding,
identify if that bleeding is excessive, and the proper treatment
      5. Identify the complications of an assessment for the pregnant
patient who suffers trauma
      6. Identify the signs/symptoms of the distressed neonate and the
steps necessary for care of the newborn
      7. List the causes, signs and symptoms, histories, and treatment
priorities for five non-obstetrical causes of female abdominal pain
   U. Pediatric emergencies
      1. State age appropriate assessment techniques and vital signs for
pediatric patients
      2. Given a pediatric patient in respiratory distress, correctly
identify the etiology, signs, symptoms, classic age group, and treatment
      3. Identify the etiology, history, signs, and symptoms and treatment
of seizures, meningitis, poisoning, battered child, SIDS, dehydration,
sepsis, dysrhythmias, and congenital heart disease
      4. List the signs/symptoms and management of impending ventilatory
failure in the pediatric patient
      5. Given a child in bradycardia, tachycardia, or cardiac arrest,
identify proper treatment per ACLS/BCLS/PALS algorithms
   V. Pneumonia and atelectasis
      1. State three signs and two symptoms frequently found in patients
with pneumonia and describe appropriate treatment
   W. Pulmonary emboli -- spontaneous pneumothorax
      1. List the histories, signs, symptoms, and treatment for pulmonary
embolus
      2. List three potential etiologies for spontaneous pneumothorax and
signs, symptoms, and treatment
   X. Seizure disorders
      1. List four possible etiologies for grand mal seizures, and eight
questions that should be asked when ascertaining a history for the seizure
patient
      2. Given a description of a patient in an active grand mal seizure,
list the appropriate treatment, provide the rationale for that treatment,
and list four possible complications
      3. List the drugs that are commonly given in maintenance doses to an
epileptic to prevent seizure activity
   Y. The unconscious patient
      1. List the possible causes of unconsciousness using the AEIOU EMTPS
mnemonic
      2. List the chronological order of the steps in the assessment of an
unconscious patient, and five questions that should be asked about the
patient
      3. Define and briefly describe common causes of syncope
   Z. Toxicology
      1. List the signs, symptoms, mechanism of action that may lead to
death, street names, and field treatment for the following substances:
stimulants, hallucinogens, narcotics, sedative/hyponotics,
anti-cholinergics, psychotropics, caustics, petroleum products, alcohols,
hydrocarbons, aspirin, acetaminophen, and calcium channel blockers
      2. For tricyclic antidepressant overdose, list and how to manage
complications and why all patients should be evaluated at a hospital
regardless of initial presentation
      3. Given a description of a suspected OD/poisoning patient, identify
the suspected substance, key elements in differential diagnosis and
appropriate treatment
   AA. Vascular emergencies
      1. Identify the pathophysiology, signs and symptoms, and treatment
of aneurysms

II. Trauma Management
   A. Abdominal trauma
      1. List two categories of abdominal trauma, and the organs most
often injured in each
      2. List the steps involved in the evaluation of possible abdominal
trauma, the signs, and symptoms, and the treatment
   B. Burns
      1. List the signs and symptoms of 1st, 2nd, and 3rd degree burns
      2. List those factors that mandate admission to a burn unit
      3. Identify the history, signs/symptoms, significance, and field
treatment for pulmonary burns
      4. List the steps in assessing the burn patient and the appropriate
treatment
   C. Chest trauma
      1. Identify the pathophysiology, clinical significance, history,
signs and symptoms, and the treatment for tension pneumothorax, open
pneumothorax, flail chest, pericardial tamponade, traumatic asphyxia, and
ARDS
      2. Given a patient with a tension pneumothorax, list the procedure
for field decompression
   D. Ear, eye, and nose trauma
      1. List the steps for management of foreign bodies, and hemorrhage
from the ear and eye
      2. List two hazards associated with blunt trauma to the eye
      3. List four causes of epistaxis, and list the treatment
   E. Pneumatic anti-shock garment
      1. Identify the indications, contraindications, and complications
associated with PASG use
   F. Neck and facial trauma
      1. List problems with airway management, hemorrhage control, and
shock involved with treatment of facial and neck trauma
      2. List considerations in managing each of the following: orbital
blow-out fracture, impaled objects in the face or neck, trauma to the
mouth and jaw, trauma to the teeth,  temporomandibular joint dislocation,
blunt trauma to the neck with inadequate ventilation
   G. Neurological trauma
      1. Define various types of head trauma, associated complications,
and list the steps in treatment
      2. List the pathophysiology, clinical significance, signs, symptoms,
and treatment of neurogenic shock
   H. Orthopedic injuries
      1. List the signs, symptoms, clinical significance and treatment for
fractures and dislocations involving various bones of the body
      2. List four orthopediac emergencies
      3. Identify the objective for splinting and the procedure for
application of various types of splints
   I. Pediatric trauma
      1. Identify the most common causes of pediatric death from trauma 
      2. List at least two anatomical differences between the adult and
pediatric trauma patient that result in different patterns of injury
      3. Differentiate between the physiologic response to hypovolemic
shock in pediatric and adult patients
   J. Radiation emergencies
      1. Given a situation describing a radiation emergency, list
appropriate management including avoidance of self-contamination
   K. Shock
      1. Identify the pumping action of the heart, peripheral vascular
resistance, and blood volume as they pertain to the physiology of the
various types of shock
      2. State the changes in vital signs which usually occur in early
compensated shock and those occurring in later progressive shock
      3. List the body's physiologic reaction to shock
      4. List at least two ways in which the MICT can estimate if
sufficient fluid has been administered to the hypovolemic patient
   L. Spinal trauma
      1. Correctly list the incidents that mandate spinal immobilization
      2. List the signs and symptoms of spinal injury and the treatments
      3. Identify the procedure for applying the Kendrick Extrication
Device, and the long spine board
   M. Multiple systems trauma
      1. Given a description of a patient with multiple systems trauma,
list the appropriate treatment in an appropriate order of priorities
      2. Identify the ten steps in MCI scene command
   N. Wounds and bleeding
      1. List in order the proper techniques for stopping bleeding
      2. List the signs of arterial, venous, and capillary bleeding
      3. List the proper bandaging techniques

III. Field Observation Lab
   A. Closely observe all aspects of EMS operations
   B. Write a patient report on each patient contact

IV. Advanced Cardiac Life Support
   A. Successfully complete an Advanced Cardiac Life Support course

V. Psychomotor Skills Labs
   A. Demonstrate competency in all component motor skills
   B. Run a cardiac emergency simulation according to skill criteria
   C. Given a simulated respiratory or cardiac emergency,  diagnose and
treat the patient according to established medical protocol

Methods of Evaluation of Competencies:

Evaluation of student mastery of course competencies will be accomplished using the following methods:

Cognitive - competency will be verified through 6 homework
assignments, 6 quizzes, and 3 module finals. Quizzes and module finals
will be blueprinted. Items will represent a variety of question types and
levels of taxonomy, each of which is tied to a course competency. The
module final exam must be passed before the student can proceed to the
next module.

Motor Skills - competency will be verified by faculty observation of motor
skills performance utilizing skills task analysis as the standard.

Affective - competency will be evaluated by field preceptors utilizing
field evaluation instruments, two program staff using lab evaluation
instruments.

Medical Director - synthesizing information about student's progress in
each of the three domains, the course medical director will make a final
decision about terminal competence, and thus course completion.

Grading Scale:
   Cognitive:
   94-100% = A
   86- 93% = B
   80- 85% = C - minimum passing score
   70- 80% = D
     < 70% = F

6 homework assignments @  80 points each
6 quizzes              @ 120 points each
3 module exams         @ 400 points each
Total didactic points = 2400

Motor skills: pass/fail
Affective evaluations: pass/fail

Note: Successful course completion requires passing grade in didactic work
AND successful demonstration of skills competency, AND acceptable
evaluation of ALL affective competencies.

Caveats:

1. Students will have provided proof of health conducive to being in a health care environment. In addition, drug screening and other requirements may be imposed by clinical agencies. Students are responsible for any and all costs related to their health care or other imposed requirements. Students will also need to provide their own transportation to and from scheduled clinical activities. They will also need to be dressed and prepared appropriately as outlined in the MICT Student Manual dress policy.
2. Students entering the health programs should be aware that they will be in contact with other individuals having a variety of health problems in which etiology (cause) may or may not be known. This exposure places health program students in the "high risk" category for health problems. Programs have specific precautionary requirements based on the type of exposure and/or clinical agency policies. It is the responsibility of each student to follow the program guidelines for necessary precautions against contracting and transmitting disease. Students experiencing any injury or health risk (including blood borne or airborne exposure to disease) must report it immediately to the assigned instructor and seek necessary medical treatment.
3. Transportation to and from clinical/field agencies is the responsibility of the student; thus access to a dependable automobile is a necessity. Communication from and to program faculty and field/clinical preceptors in a timely manner is essential and therefore the student must maintain a working home telephone as well as carry a pager at all times, and maintain an email account which he/she checks regularly.
4. Students are expected to comply with the JCCC Student Code of Conduct as detailed in the JCCC College Catalog. Failure to comply may result in a faculty decision regarding program promotion and constitute a reason to fail the course.
5. Students are expected to comply with the attendance and other program policies described in the MICT Student Manual.
6. A grade of "C" or better is required for the course and promotion to MICT III.
7. "During the course of the paramedic program (MICT I, II, III, IV) there are various fees required from year to year in addition to tuition. The fees include items such as textbooks, uniforms, specialty classes, pagers, state and national exams, and other miscellaneous costs. These fees average about $1,500 for the entire program. As the actual amounts are subject to change they are listed in the Course Syllabus for each academic year."

Disabilities:

If you are a student with a disability, and if you will be requesting accommodations, it is your responsibility to contact Access Services. Access Services will recommend any appropriate accommodations to your professor and his/her director. The professor and director will identify for you which accommodations will be arranged.

JCCC provides a range of services to allow persons with disabilities to participate in educational programs and activities. If you desire support services, contact the office of Access Services for Students With Disabilities (913) 469-8500, ext. 3521 or TDD (913) 469-3885. The Access Services office is located in the Success Center on the second floor of the Student Center.