Competency Framework
The competency base presented below is a guide to units wishing to take on the physician / paramedic model as the basis of care.
The UK HEMS Helicopter Crew Course (HCC) is a dedicated course that aims to teach and test these competencies at the start of a career in helicopter or pre-hospital medicine.
The list is extensive, but not exhaustive. Not all competencies will be relevant to all units, and equally some units will need additional ones. These should however be considered a basic set.
These are competencies for the practice of pre hospital care; transport of the critical ill patient requires a different skill set.
1. Knowledge
A. Trauma
Mechanism of injury
Injury patterns and prediction
Principles of extrication
C spine clearance
Blunt chest trauma
Penetrating chest trauma
Brain Injury
Maxillo facial trauma
Injured spine
Abdominal trauma
Extremity trauma
Crush injuries
Traumatic Asphyxia
Trauma in special situations - children, pregnancy, terrorism
Firearms
Blast Injury
B. Pre-Hospital anaesthesia
Pharmacology of agents
Indications for pre hospital anaesthesia
Prehospital RSI
Maintenance of anaesthesia
Complications of pre hospital anaesthesia
Ventilation
Monitoring (standards, principles, pitfalls)
Failed airway
C. Sedation & Analgesia
Pharmacology of agents
Principles of safe sedation and analgesia
Procedural sedation and analgesia
Choice of analgesic / sedative
D. Fluid Resuscitation / Hemorrhage Control
Access
Clinical endpoints
Principles of hemorrhage control, tourniquets and haemostatic agents
E. Obstetrics
Physiological changes of pregnancy
Illnesses of pregnancy
Normal Child birth
Post partum care
F. Medical
Sepsis
Acute Coronary Syndromes
Acute cardiac failure
Brain Attack
Respiratory Emergencies (Asthma / Pneumonia / Pneumothorax)
Meningococcal disease
Anaphylaxis
Acute confusional state
Infection control
G. Advanced Life Support
Cardiac arrest protocols
Peri arrest care
Post arrest care
H. Paediatrics
Ill child
NAI
Paediatric Life Support
I. Miscellaneous
Near drowning
Environmental illness - heat & cold
Electrocution
Burns
Elderly
J. Aviation
Radio procedure and communication technology
Navigation - GPS and map
HEMS legislation
Crew flying hours
Principles of flight
Night time operations
Limitations of operations in adverse weather
K. Tasking
Tasking methodologies
L. Transport to Hospital / Handover
Effects of aviation on patient physiology
The gas laws, vibration and acceleration
Effects of transport medium on monitors
Appropriate choice of vehicle
Hospital Triage / over flight
Patient packaging
Handover techniques
Documentation
M. Major Incidents
DOH guidance and back ground
Major Incident Infrastructure
Command and control
Role of physician
Role of the helicopter
CBRN incidents
N. Situational awareness
Scene and team safety
Multi agency working - fire, police, rescue, ambulance
Personal protective equipment
Human Factors / Crew Resource Management
O. Clinical Governance
Elements of governance system
Application to people, practice and equipment
P. Ethics / Legal Issues
Diagnosis of death
Basic forensic science / protection of evidence
The principles of consent / treating the incompetent patient
Recording / carriage / storage of controlled drugs
Q. Rescue / Special Environments
Confined space
Water
Industrial
Rail
Fire
Bombings
Firearms incidents
2. Skills
A. General
History taking
Patient assessment
Venous and introsseous access
Hospital handover
Safe care of invasive lines
Safe loading and unloading of patient, with rotors running and rotors off.
Securing the patient in transfer
Hand washing
B. Trauma
Extrication Skills
Limb & pelvic splintage
Haemorrahge control
Spinal immobilisation
Pleural drainage
Thoracotomy
Minimal movement techniques
Control of maxillo facial haemorrahge
Amputation
C. Pre-hospital Anaesthesia
Provision of prehospital RSI
Failed intubation drill
Cricothyroidotomy
Laryngeal mask insertion
Airway Adjuncts - NPA & OPA
Safe drug delivery
D. Obstetrics
Management normal childbirth
E. Medical
Rapid recognition common ECG abnormalities - especially STEMIS
F. Advanced Life Support
Effective external / internal cardiac massage
Safe defibrillation in the pre hospital environment
G. Aviation
Application of aviation laws to safe HEMS tasking
Route / mission planning - including time appreciation
Evacuation techniques
Actions on adverse incidents
Clear communication skills
HLS assessment
Refuelling drills
H. Major Incident
Effective command and control - CSCATT
Understanding of cordons and decontamination
Minimum Core Competencies
I. Multi Agency Working
Inland water rescue
3. Attitudes
A. General
A commitment to clinical governance in all its forms
Understands the importance of mission debriefing
Initiates / supports research
Media handling
Understands when to seek senior help
An ability to work under pressure
Demonstrates vigilance and safety at all times
Physical fitness
B. Aviation
Commitment to Crew Resource Management
Maintain communications with base, ambulance service and hospitals.
C. Major Incident
Ability to take on / relinquish command roles
D. Multi Agency Working
Effectively liaises with site controller
4. Workplace Training Objectives
The Ability to transfer an un-resuscitated patient, safely from an austere environment to an appropriate medical facility.
5. Recommended requirements to support training
Access to HCC
Access to MIMMS,ALS, PHTLS, PHECC and equivalents
Access to peer reviewed journals relevant to pre hospital care