Diploma in Emergency Care

Purpose

This qualification is designed to produce a mid-level health worker who is able to provide emergency care services primarily within South Africa, in contexts that range from rural disadvantaged communities to sophisticated, highly developed urban areas. In addition, this qualification aims to produce a competent mid-level health worker who will take cognizance of South African history and be able to adapt to the unique circumstances of a changing South Africa with emphasis on equity in health care and reduction of burden of disease. This qualification primarily has a vocational orientation, which includes professional, vocational, and industry specific knowledge that provides a sound understanding of general theoretical principles as well as a combination of general and specific procedures and their application. The Diploma in Emergency Care defines the competences needed by the Emergency Care Technician.

The purpose of the Diploma is to produce a mid-level health worker qualification, with graduates who are able to work both independently and under supervision in a variety of contexts. This qualification will be particularly useful for:

• Individuals wishing to enter the emergency care profession.
• Existing basic ambulance assistants.
• Existing ambulance emergency assistants.
• Existing operational emergency care orderlies.
• Existing Emergency Care assistants.

Holders of this qualification will operate mainly in and around the ambulance, within wide ranging contexts, including rural, urban, military, coastal, corporate, mass gatherings, homes and workplaces.

The exit level outcomes and assessment criteria will be interpreted and applied within the context of the scope of practice of Emergency Care Technicians (ECT) as defined by the Professional Board for Emergency Care at the Health Professions Council of South Africa (See attached documents as evidence of support for the offering of this qualification from the Professional Board). The learners will have gained experience in applying such knowledge and skills in a workplace context. A depth and specialisation of knowledge, together with practical skills and experience in the workplace, enables successful learners to be allowed registration as an independent practitioner with the ECT scope of practice and to enter a number of career paths and to apply their learning to particular employment contexts from the outset. The National Emergency Care Education and Training Policy explains the background, current situation of emergency care education and provides a framework for emergency care education and training.

Rationale

The majority (72%) of emergency care providers registered with the The Health Professions Council of SA (HPCSA) have only a few weeks of training. Career-pathing, personal growth and development and lifelong learning opportunities are poorly supported by a short course system of skills based training which is not aligned to the National Qualifications Framework (NQF). In response the Minister of Health has promulgated draft regulation that will end short course training in emergency care. The National Department of Health in conjunction with the Professional Board for Emergency Care put forward the Diploma in Emergency Care which is aligned to the NQF and complies with the requirements of the National Qualifications Framework Act 67 of 2008. Qualifications in this area of focus consist of an entry level qualification, a mid-level qualification and a professional Degree allowing access to further postgraduate qualifications. The 240 NQF Level 6 Diploma is the mid-level qualification and will be registered and accredited by the HPCSA as the statutory body.

Given the need for, and the scarcity of professionally qualified emergency care workers in South Africa, the offering of this qualification will play a crucial role in the uplifting of standards in the field of emergency medical care nationally. Learners who exit the current qualifications in Emergency Medical Care - boast a 100% employment rate, partially due to the dire need for Emergency Care workers. This qualification is envisaged to continue to address this need in the foreseeable future.

The Diploma in Emergency Care (Dip EC) is designed to produce health professionals who are independent clinical technicians within the domain of emergency medical care and rescue. The qualification will develop cognitive, technological and scientific enquiry skills in emergency medical care and rescue. Graduates will practice primarily within South Africa, in rural and urban contexts that range from sophisticated emergency medical care facilities to remote primary health care settings. This qualification also aims to promote an understanding of the multi-disciplinary approach to effective and efficient patient care. In addition, this qualification aims to produce a health worker who will take cognizance of South African history and will be able to adapt to the unique circumstances of a changing South African social, political and economic landscape, with emphasis on equity in health care, social upliftment and reduction of the burden of disease.

The qualification will foster career progression and will allow professional development and life-long learning within sectors of emergency medical services industry (e.g. shift manager, communications call-centre operator, etc.). The qualification will address the needs of the emergency medical services industry by providing a technician with an intermediate and advanced scope of practice. The qualification will assist in meeting industries goals of reaching the rural-urban, gender and race equity targets. The emergency care profession will benefit from an increased scope of practice and an educational career path that will aid in the retention of emergency care practitioners within the health care system.

Recognition of Prior Learning (RPL)

As a higher education institution, there is committed to redress the past inequalities, as stipulated in its mission and vision. It aims to be an accessible centre of excellence by providing opportunity to previously disadvantaged learners. The Faculty of Health and Wellness Sciences has an Admissions Committee that reviews learner intake to ensure targets from the designated groups are met. Prospective learners who are currently employed in emergency medical services and who previously only had access to short course training are given the opportunity to undergo a RPL process that allows them a point of entry to higher education. Learners from the previously disadvantaged designated groups are targeted in the departmental, faculty and institutional recruitment strategies. Previously disadvantaged learners are also targeted at the institution annual Open Day.

Entry Requirements

The minimum admission requirement is

• Senior Certificate (SC), NQF Level 4.

Or

• National Senior Certificate (NSC), NQF Level 4 granting access to Diploma studies.

Or

• National Certificate Vocational (NCV), NQF Level 4 granting access to Diploma studies.

The qualification consists of compulsory modules at NQF Levels 5 and 6 totalling 251 Credits.

Modules at NQF Level 5

• Foundations of Professional Practice, 20 Credits.
• Applied Physics, 12 Credits.
• Applied Anatomy, 12 Credits.
• Applied Chemistry, 12 Credits.
• Applied Physiology, 12 Credits.
• Pre-Hospital Emergency Care - Medical 1, 18 Credits.
• Pre-Hospital Emergency Care - Trauma 1, 18 Credits.
• Pre-Hospital Emergency Care Practice 1, 20 Credits.
• Workplace Clinical Practice 1, 10 Credits.

Total Credits 134.

Modules at NQF Level 6

• Pre-Hospital Emergency Care Medical 2, 25 Credits.
• Pre-Hospital Emergency Care Trauma 2, 25 Credits.
• Pre-Hospital Emergency Care Practice 2, 25 Credits.
• Workplace Clinical Practice 2, 16 Credits.
• Critical Care Transport, 10 Credits.
• Basic Medical Rescue, 16 Credits.

Total Credits 117.

1. Communicate and interact with colleagues and other role players in an ethical, legal and professional fashion.
2. Articulate an understanding of the South African Health Care system including the role and placement of the emergency services within the broader health sector.
3. Recognise the importance of mental health and wellness including the identification and management of stress and burnout in oneself and others.
4. Apply knowledge and understanding of human anatomy relevant to ECTs.
5. Apply an understanding of physiology and bioprocesses relevant to ECTs.
6. Care for, inspect, prepare and operate equipment and resources required rendering emergency care and rescue.
7. Perform appropriate clinical assessment and diagnostics skills.
8. Perform medical rescue in selected contexts.
9. Provide assistance and support in the specialised transport of patients.

Associated Assessment criteria for Exit Level Outcome 1

• Communication with patients, colleagues and other services is effective, clear, direct, and accurate, with appropriate use of media and terminology that is consistent with profession usage.
• Responses during debates show a mature understanding of issues under discussion in one-on-one and group situations.
• Own understanding is clarified and further developed during discussions and opportunity is provided during interactions for the clarification of one another's understanding.
• Professional relationships are characterised by mutual respect, cooperation, accountability, rapport and effective communication.
• Ethical principles of beneficence, autonomy and justice, truth telling, promise keeping and confidentiality are correctly applied in all contexts.
• Confidentiality is maintained in line with medical ethical practices. The need to override the principle of confidentiality when superseded by legal authority is correctly explained and applied in line with accepted protocols.
• Correct explanations are provided of the legal framework within which an emergency service provider and/or practitioner operates.

Associated Assessment Criteria for Exit Level Outcome 2

• The role, function, challenges, goals and strategies of the National Department of Health are correctly described and discussed.
• The different tiers and levels of health care delivery in South Africa are correctly described.
• The EMS is correctly described in terms of structure, funding, role and function, both public and private, within the South African context.
• Explanations are correctly provided of the interdependence and interrelationships occurring between EMS and other Allied Health Care structures.
• Members of the health care team are correctly identified and explained in terms of key roles and responsibilities and the inter-relationships between them.

Associated Assessment Criteria for Exit Level Outcome 3

• The need for mental wellness on the part of the emergency care provider is correctly explained by highlighting its role and importance, with particular reference to the impact on job effectiveness.
• Techniques are correctly described to identify and manage own stress and stressful situations.
• Personal stress disorders and stress factors are correctly identified based on an accurate reading of symptoms and patterns.
• Methods for dealing with challenges that may result in affecting mental wellness are identified and or explained in line with established protocols.
• Possible problems within the emergency service environment are correctly identified in terms of their sources, impact and means for preventing or minimising their negative impact.

Associated Assessment Criteria for Exit Level Outcome 4

• The thorax is correctly explained in terms of its composition, general form, spatial orientation, structures and position of the cavities.
• Explanations of the normal abdominal anatomy are correctly provided together with an ability to integrate surface topographical and clinical anatomy of the abdomen to patient assessment and care.
• The pelvis is correctly explained in terms of its structure and contents, with particular attention to gender.
• The structures of the lower extremity are correctly explained in terms of composition and relative position.
• The structures of the upper extremity and back are correctly explained in terms of composition and relative position.
• The structures of the head and neck are correctly explained in terms of composition and relative position.
• The anatomical differences between adults and children are correctly described consistent with prevailing theories.
• The anatomical adaptations to pregnancy are correctly explained in line with prevailing theories.

Associated Assessment Criteria for Exit Level Outcome 5

• The organisation of the body is correctly explained with respect to the cellular physiology, the tissue physiology, the major systems, homeostasis and feedback.
• Physiology of the human body is correctly explained in terms of the principles of support and movement.
• The control systems of the body are correctly explained in terms of the nervous and endocrine components.
• The special senses are correctly explained in terms of function.

The following systems are correctly explained in terms of functioning

> The nervous system.

> The cardiovascular system.

> The lymphatic system and immunity.

> The respiratory system.

• The digestive system.

> The reproductive system.

• The integumentary system.
• The muscular-skeletal system.

> The urinary system.

• The fluid, electrolyte and acid-base dynamics are correctly explained with reference to impact on human physiology.
• The key principles of microbiology are correctly explained and applied to emergency medical care contexts in general, with particular reference to communicable diseases and infection control.
• The physiological differences between adults and children are correctly described consistent with prevailing theories.
• The physiological adaptations to pregnancy are correctly explained in line with prevailing theories.

Associated Assessment Criteria for Exit Level Outcome 6

• Emergency vehicles are correctly identified according to specific tasks within the emergency care environment.
• The emergency vehicle is set up ergonomically and maintained in a state of constant readiness. Vehicle problems are identified and reported according to local operational procedures.
• Emergency equipment is correctly checked with required regularity and is maintained in a clean, disinfected and ready state at all times as per local procedures. Troubleshooting of equipment failure is successful in identifying problems, and appropriate actions are taken to address identified problems according to local procedures.
• Emergency equipment is correctly identified and described in terms of indications, contra-indications, precautions, complications, use and, where applicable, assembly.
• Vehicles are operated with due respect for other road users and in compliance with the Road Traffic Act and prevailing road conditions. The vehicle is controlled under operating conditions, with effective use of warning devices and with due respect and safety for other road users.
• The correct procedures relating to registration, modification and marking of emergency service vehicles are explained as per the regulations.
• The relevant legislation is described as it relates to emergency vehicles responding to incidents, and transporting patients and or pressure cylinders.
• Navigation is carried out effectively using appropriate navigational tools.
• Procedures to be followed should a vehicle become involved in an accident are explained and or demonstrated in line with relevant legislation.
• Communication devices are used according to established protocols to ensure effective communication.
• A variety of communication devices are compared to identify their fundamental components, principles of operation, advantages and disadvantages.
• Emergency care equipment related to the care of ill or injured patients is explained in terms of function, storage, maintenance and use.

Associated Assessment Criteria for Exit Level Outcome 7

• Patients are correctly assessed in a pre-hospital emergency context consistent with the scope of practice of an Emergency Care Technician.
• Assessment is carried out in a manner that is professional and consistent with principles of medical history taking.
• Assessments are carried out in accordance with accepted medical principles of physical examination within the ECT scope of practice.
• Clinical assessments successfully identify life threatening symptoms/conditions.

Associated Assessment Criteria for Exit Level Outcome 8

• Effective communication and operational working components of a single person rope access system are described and demonstrated.
• Single person High Angle Rescue access operations are correctly carried out using rope rescue techniques and equipment appropriate to the situation.
• The science of fire behaviour is described in terms of its impact on rescues and the applications of principles of safety in a fire and or low visibility environment.
• Personal protective equipment is correctly used in line with standard operating procedures.
• Methods of fire extinguishment are described and demonstrated.
• Hazardous materials and situations are correctly identified and described in terms of their potential impact and methods to avoid or minimise their harmful effect.
• Self-contained breathing apparatus is correctly used in line with standard operating procedures.
• Search and rescue operations are carried out in line with established and validated procedures and maximize the potential for affecting a safe rescue of patients from a fire and or low visibility environment.
• Vehicle collisions, stabilisation techniques and extrication principles are described in line with the related principles of physics.
• Descriptions are provided of structural and damage characteristics of different types of motor vehicles.
• Vehicles in various positions are stabilised as per established procedures.
• Safety zones are established using scene security barriers, patient protection and personal protective equipment in line with standard operating procedures.
• Appropriate tools and techniques are used to create access and egress openings to extricate an entrapped patient.
• Entrapped patients are stabilised, removed and packaged in accordance with standard procedures.
• The management of large multi casualty scenarios is correctly described and demonstrated in line with established procedures.

Associated Assessment Criteria for Exit Level Outcome 9

• Patients are correctly categorised and backup is called for critically ill or unstable patients.
• Patient history is correctly taken and handover from a referring health worker is effected according to organisational procedures. This includes a routine examination of the patient and obtaining vital signs.
• Preparation of the patient for transportation is correctly carried out with due regard for mode of transportation.
• Standard transport equipment is correctly identified in terms of what it is used for, when to use it and basic operation.
• Hospital beds to stretcher transfers are correctly carried out using appropriate ergonomic procedures and techniques.
• Correct descriptions of the importance, role and or function are provided in relation to pre-hospital and interfaculty transport of patients.
• Hydration and nutritional status of the patients are correctly maintained in line with specified requirements.
• Ventilation and temperature control is correctly maintained in line with the patient's needs.
• Vehicle fuel consumption and oxygen and fluid requirements are correctly calculated to ensure they are sufficient for the duration of the transfer.
• Basic nursing procedures are correctly maintained for the duration of the transfer, including turning, cleaning, emptying catheter bag and prevention of pressure sores.
• Support is provided to emergency care practitioners through effective team work, clear communication, careful following of instructions and effective execution of tasks allocated.
• Patient handover to receiving facility, filing and record keeping are carried out in line with organisational procedures and requirements.
• The aviation environment is correctly described in terms of atmospheriology.
• Stresses of flight are correctly described in terms of causes, effect and treatment.
• Influences from the aero-medical environment are correctly described in terms of their effect on equipment and procedures.
• Aero-medical transportation considerations are correctly described.
• Spatial disorientation, as it affects pilots, is correctly described in terms of causes, effects, methods for prevention and corrective actions.
• Types of aircraft used for aero-medical transportation are correctly described in terms of general characteristics, aircraft safety and landing zone requirements, basic survival, primary and secondary considerations, emergency procedures, and loading and unloading of patients.
• The procedures for air evacuation of patients are correctly described and applied in line with air evacuation principles and criteria.

Formative Assessment

• Learning and assessment are integrated. The scheme of work includes tests and assignments, practical work and competency evaluation of practical skills. The process is continuous and focuses on smaller sections of the work in limited number of outcomes.

Summative Assessment

• Summative assessments evaluate the learners' abilities to manage and integrate a larger body of knowledge and to achieve the stated outcomes. The summative assessment also focuses on the learners' ability to integrate knowledge and skills in the particular area of specialisation.
• Summative assessments include theory and practical assessment.

Integrated Assessment

• Integrated assessment strategies across related modules and critical cross-field outcomes will be developed. Learners will also be assessed in simulated work environments.