St John Clinical ProspectusFebruary 2021

ContentsIntroduction 4

Clinical Pathway overview 5

Clinical courses 6

Overview 6New Zealand Certificate in Emergency Care (First Responder) 7Operations Risk Management 8First Responder Course 9Operations Induction 11Ambulance Driving Course 12New Zealand Diploma in Ambulance Practice (NZDAP) 14Primary Response in Medical Emergencies (PRIME) 17Emergency Medical Assistant (EMA) course 18Major Incident Support Team (MIST) 19Event Co-responder 20Continuing Clinical Education (CCE) 21

Generic course important info 24

English language requirements 24Enrolling on a course 26Pastoral care 26Simulations 27Learner consent and safety 28What to wear 29Completion requirements 29Recommended reading 30Clinical placements and mentors 30Withdrawal from a course or programme 31Disciplinary procedure 32

Assessments 33

Types of assessment 33Advanced Driving Assessment (ADA) 35Assessment attempts 39Assessment and conflict of interest 40Written assessments 41Extensions for assessments 44Assessment results 45

Clinical practice levels and authority to practise 46

Clinical practice levels and authority to practise (ATP) 46First Responder 47Emergency Medical Assistant (EMA) 51Emergency Medical Technician (EMT) 52Paramedic 54Intensive Care Paramedic (ICP) 54Extended Care Paramedic (ECP) 55Rapid Sequence Intubation (RSI) endorsement 57Urgent Community Care (UCC) endorsement 59ATP Credentialing Committee 59ATP review panel 60

The Supervised Clinical Practice Programme and Clinical Internship 61

Tertiary Paramedic Programme 61Tertiary ICP Programme 62Supervised Clinical Practice Programme 62Clinical Internship Programme overview 64Clinical Internship: Precepting phase 66Clinical Internship: Clinical assessment phase 67Clinical Internship: Clinical supervision phase 68Clinical Internship: Clinical discussion phase 68Further information on the Clinical Internship Programme 69

Appeals 70

Appeal against assessment or course removal if appropriate 70Appeal against an advanced driving assessment (ADA) result 72Appeal against a clinical assessment 73

Feedback and complaints 75

Feedback and complaints 75Quality management system (QMS) 76

Other clinical learning resources 77

MySitrep 77Online Learning Campus 79Clinical Wiki 79Clinical Focus 81Clinical apps 81Clinical email addresses 83Notes 84

The Clinical Prospectus outlines the clinical and operational education pathways and other educational resources available to St John personnel. It describes:

> Courses developed and/or delivered by the Clinical Team. > How the Clinical Team interacts with learners, and the associated

processes. > How personnel can access support and deal with complex issues. > How to obtain and maintain a clinical practice level/authority

to practise/clinical endorsement, including entering the Clinical Internship Programme.

> Other clinical resources available to support and enhance learning.

Personnel engaging with education provided by the Clinical Team, or assessment facilitated by the Clinical Team must be familiar with this document and refer to it if they have any questions. Additional assistance or information can be provided by a Clinical Support Officer, or by emailing clindevhelp@stjohn.org.nz.

This Clinical Prospectus may be revoked and reissued at any time at the discretion of the Assistant Clinical Director and/or Assistant Director – Clinical Delivery and Support. Personnel are encouraged not to print this document, but instead refer to the most recent version of the prospectus which will be available on the Clinical Wiki.

Introduction

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Clinical Pathway overview

Note: To maintain a practice level or role, personnel complete all mandatory components of the Continuing Clinical Education (CCE) programme.

Note: First Responders who are required to drive a vehicle must also complete an Ambulance Driving Course (after Operations Risk Management).

NZ Certificate in Emergency Care (First Responder):

> Operations Induction Module > Operations Risk Management Module > First Responder Module > Certificate workbook

New Zealand Diploma/National Diploma

Clinical Assessment

Complete St John General Induction

Complete (or re-validate) Level 2 Workplace First Aid

Certificate

Approved university papers/courses

Successful application, entry and completion of the Paramedic

Internship programme

Successful application, entry and completion of the Intensive Care

Paramedic Internship programme

Apply to ATP and Accreditation Manager for RSI endorsement

with DOM endorsement

Rapid Sequence Intubation

endorsement

Selection by Manager

Self funded

Approved university papers/courses

Refer to page 16 for academic

requirements

Successful completion of New Zealand Diploma/National Diploma pre-entry

quiz (70% pass mark. Quiz available on the Campus)

Complete the Emergency Medical Assistant Workbook

(paid personnel employed as an

Emergency Medical Assistant only)

Join St John

FIRST RESPONDER

PARAMEDIC

EMERGENCY MEDICAL

TECHNICIAN

EMERGENCY MEDICAL

ASSISTANT

INTENSIVE CARE

PARAMEDIC

St John Clinical Prospectus | 5

Overview > The Clinical Team is responsible for the design, development, delivery,

maintenance, and moderation of all internal clinical curriculum in St John. A multitude of courses are offered, some of which personnel will only do once, and others which personnel will attend on a recurring basis in order to maintain their clinical practice level.

> This section provides an overview of each course, to include:

– The topics within the course. – How the course is structured. – The duration of the course. – Pre-requisites for the course. – Whether the course is linked to NZQA unit standards. – The modes of learning included in the course.

Clinical courses

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New Zealand Certificate in Emergency Care (First Responder)

> This certificate course has been designed by St John in consultation with the ambulance sector and is the base qualification for ambulance personnel in St John New Zealand. The purpose of this qualification is to provide New Zealand ambulance personnel with the skills to confidently and competently intervene as a First Responder and sustain life until handover to a more qualified health care professional occurs.

> By completing this qualification, personnel will be able to:

– Operate successfully, lawfully and ethically as a First Responder. (FR) – Assess and manage medical and trauma conditions as a First

Responder. – Make decisions as a First Responder within your designated area of

responsibility. – Communicate and collaborate effectively to achieve the best

outcome as a First Responder.

> This qualification is a 40-credit level 3 certificate requiring participation in online learning activities, in-class modules and post course self-directed learning. The learner has seven months to complete and submit for assessment. Upon successful completion of the required components, the following unit standards will be awarded:

– 28542: Demonstrate and apply knowledge of professional and ethical behaviour in a health or wellbeing setting.

– 29321: Provide basic emergency care. – 29322: Demonstrate knowledge of emergency response systems

in New Zealand. – 29323: Gather and record information to support patient

assessment. – 29324: Demonstrate understanding of the use of common

medications relevant to the emergency care First Responder context.

– 29325: Adapt strategies to manage complex emergency situations arising in an emergency care first response context.

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> This certificate course is divided into two main modules: Operations Risk Management and First Responder.

> A current level 2 First Aid certificate is required as a pre-requisite for entry into the certificate programme.

Operations Risk Management > The New Zealand Certificate in Emergency Care (First Responder) is

comprised of two modules – First Responder and Operations Risk Management (ORM).

> ORM is a two-day course designed to enable new ambulance personnel to identify hazards which they will be exposed to, allowing them to take practical measures to eliminate, isolate or minimise those hazards, and to become familiar with concepts and equipment that are used commonly in ambulance practice.

> Learners are required to complete online learning activities prior to attending the face to face classroom component of ORM. These online learning activities cover the following topics:

– Operations risk management. This learning activity includes sub-topics on communication, infection control, manual handling, scene management and working with young people.

– Electronic patient report form (ePRF). This learning activity provides learners an introduction to the functions of the ePRF, reinforces learning using an interactive scenario situation, and discusses health information privacy.

– National health index (NHI). The NHI database is a powerful tool that has the ability to connect the data collected by the ambulance service with the wider health sector. This learning activity provides a comprehensive overview of the NHI database, our responsibilities in searching the NHI database, and how this impacts on ambulance practice.

– Personal safety awareness. This learning activity has been designed by an external agency called Maybo. It focuses on what action the law allows ambulance personnel to take if they find themselves in a situation where they have to defend themselves.

– Positive interactions and choices. This learning activity has been designed by an external agency called Maybo. It focuses on how to make good decisions when emotions are running high and/or

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personnel are under pressure. It will discuss how to make good choices and communicate positively.

– Understanding human behaviour. This learning activity has been designed by an external agency called Maybo. It focuses on the definition of the rational and emotional mind, the fight/flight/freeze response and how these affect a person’s interactions, triggers of escalation, and the levels of escalation a person may experience.

> The two-day classroom component of ORM covers the following topics:

– Electronic patient report form, to include an introduction to ePRF, how to transfer ePRF information, how to ensure privacy is maintained, and how to troubleshoot ePRF.

– Manual handling, to include techniques, equipment and scenarios. – Risk assessment processes. – Conflict management theory. – Assessing the need for physical intervention, and basic

manoeuvres. – Physical intervention in ambulance practice.

First Responder Course > The New Zealand Certificate in Emergency Care (First Responder) is

comprised of two modules – First Responder and Operations Risk Management (ORM). Due to the manual handling and equipment skills taught within the ORM module, personnel must complete ORM prior to attending a First Responder course. The ORM section of the assessment workbook must be completed as soon as possible after the face to face class time.

> Learners are required to complete online learning activities prior to attending the face to face classroom component of First Responder. These online learning activities cover the following topics:

– Scene management. This includes what to consider when approaching a scene, the types of personal protective equipment (PPE) that are available, what to consider when entering a scene, the equipment required to be taken into a scene and its placement, and what to consider when exiting a scene.

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– Vital signs. This includes the process of obtaining vital signs such as respiration rate, pulse rate, blood pressure, level of consciousness, oxygen saturations, temperature, and blood glucose level.

– Ambulance Communications Centres. The Ambulance Communication Centres are where 111 calls are answered and responses coordinated. This online learning activity includes information on how Comms operates, what tools Comms use to determine the most suitable priority for dispatch, the communication methods through which ambulance personnel can interact with Comms, other functions within Comms, and how response determinants work.

> The in-class component of the First Responder module is four days in duration. It is the foundation clinical course within St John and will provide learners with essential knowledge and skills to perform safely and effectively as a First Responder within St John or organisations who engage in emergency service situations. Topics covered over the four days of in-class learning include:

– Identifying the roles and responsibilities of the First Responder. – Understanding common terminology used by the ambulance

service. – Performing a primary and secondary survey. – Interviewing the patient and any bystanders. – Understanding when and how to take a set of vital signs (including

3-lead ECG acquisition). – Identifying information required for a handover. – Principles of resuscitation, including CPR, AED use, airway

management and oxygen administration. – Understanding and treating shock and trauma – including

haemorrhage control, fractures and dislocations, burns, thermal problems and spinal injuries.

– How to care for yourself and your patient. – Principles of pain relief and how to administer pain relief if

required. – Assessment and treatment of respiratory emergencies including

COPD, asthma, stridor, anaphylaxis, and foreign body airway obstruction.

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– Assessment and treatment options for cardiac chest pain. – Assessment and treatment principles for other medical conditions

including childbirth, stroke, seizures, and diabetic emergencies.

> Learners will be provided with a First Responder Learner Manual in class, which can be kept for future reference as required. They will also be provided with an Assessment Workbook, which includes all assessment information needed as evidence for NZQA requirements. Instructions on submission of this workbook will be provided to the learners in class.

> ‘Recruit’ epaulettes will be issued to those who have completed the First Responder Course, but their Assessment Workbook has not been submitted and signed off by the relevant Clinical Support Officer. ‘First Responder’ epaulettes will be issued following:

– Attendance of the First Responder course, and – Completion of the Assessment Workbook, and – The Assessment Workbook has been submitted and signed off by

the relevant Clinical Support Officer.

Operations Induction > The Operations Induction Course is designed to equip new

personnel with the tools and information required to start working in Operations. The course consists of six national modules (delivered over two days of face to face classroom time) and three local modules that can be modified to suit local needs.

> Many of the topics introduced in Operations Induction are covered in more depth in other foundation courses and are included in this course to provide an overview of how all aspects of Ambulance Operations function, and to ensure that new personnel understand how to access information and know where to find help and support.

> Learners will be provided a workbook in class, and this will be a resource that personnel may keep and refer to as required. Further details regarding the requirements of the Operations Induction course are provided within this workbook and during class.

> Operations Induction is not a pre-requisite for other foundation courses, nor does it require completion of pre-requisite foundation courses.

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> To complete the Operations Induction course, all the following must be completed and signed off.

Module Delivered by Method

Pre-course – Resilience podcast Self-directed Online

Pre-course – Wellbeing and resilience plan Self-directed Digital or print

Module 1 – Introduction to St John Operations Classroom

Module 2 – Joining the Operations team Operations Classroom

Module 3 – Doing the right thing Operations Classroom

Module 4 – Communications Operations Classroom

Module 5 – Health and wellbeing Operations Classroom

Module 6 – ICT, types of leave, and professional bodies Operations Classroom

Module 7 – Local area: People Operations Workbook and on station

Module 8 – Local area: Familiarisation Operations Workbook

and on station

Module 9 – Local area: Processes Operations Workbook and on station

Ambulance Driving Course > The Ambulance Driving Course provides an holistic approach to driver

education, focusing on both skills and knowledge, whilst recognising that attitudes, behaviours, and human factors impact the way people drive.

> Learners must complete pre-course online learning prior to coming to the two-day face to face classroom/practical driving component. This consists of:

– Completion of the online pre-entry quiz, which focuses only on the NZ Road Code and basic driving knowledge.

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– Completion of one online learning activity, which contains information on:

• Attitudes and behaviours. • Fatigue. • High risk driving. • Vehicle induction. • Urgent driving. • Stopping distance. • Road craft. • Efficient driving.

– Completion of the end of online learning quiz, which tests knowledge of information contained within the online learning activity.

> A Clinical Administrator will confirm that learners have completed all of the online modules prior to attending the face to face sessions.

> Learners will then attend two days (16 hours) of face to face classroom and practical driving, with a Clinical Support Officer (with NZTA ‘I’ endorsement) or an externally contracted Driving Instructor. Topics covered during this time include:

– Lower risk team driving. – Policy/legislation. – Vehicle induction. – High risk driving. – Slow speed manoeuvring. – Practical driving operation (note this makes up most of the two

days).

> At the end of the second day, the CSO/Driving Instructor will determine whether each learner is safe and competent to proceed to the next stage (supervised drives). Learners will be required to successfully complete five non-urgent supervised drives and five urgent supervised drives, before progressing to the Advanced Driving Assessment (ADA) and course completion phase. A more in-depth description of supervised drives, and the associated process can be found within the Ambulance Driving Course Learner Manual and the Clinical Wiki.

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> Following completion of all supervised drives, and submission to clindevhelp@stjohn.org.nz, the learner will receive notification that they have provisional permission to operate an ambulance unsupervised. A Clinical Support Officer (with an NZTA ‘I’ endorsement) will be notified and arrange a time to conduct an ADA within six months of completion of the face to face component of the Driving Course. Once the learner has passed their ADA, they have full permission to operate an ambulance unsupervised. This must be completed within six months of the face to face classroom time.

> To see what the ADA template looks like, click here. For more information regarding the ADA process, refer to the ADA section in this prospectus.

New Zealand Diploma in Ambulance Practice (NZDAP)What is the New Zealand Diploma in Ambulance Practice (NZDAP)?

– The NZDAP course is the primary qualification required to apply for authority to practise at EMT level.

– It is a level 5 vocational course delivered by Clinical Support Officers, and consists of approximately 1200 hours of learning, 120 credits, and will take approximately 18 months to complete.

– It is important that anyone undertaking this course is aware of the required commitment, in terms of time and effort. Learners need to allow an average of 10 hours of study per week, plus road time, and classroom time when block courses are being held.

What are the unit standards that make up NZDAP?

The NZDAP is awarded by the New Zealand Qualifications Authority (NZQA) once learners have completed all the required unit standards. The unit standards covered as part of NZDAP are:

> 24858: Demonstrate knowledge of the management of patients with acute diabetic emergency symptoms in an ambulance context.

> 24862: Demonstrate knowledge of management of trauma to the integumentary system, and musculoskeletal injury.

> 24863: Demonstrate knowledge of the management of patients with symptoms of shock in an ambulance context.

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> 24864: Demonstrate knowledge of management of patients with acute obstetric conditions and the newborn in an ambulance context.

> 24865: Demonstrate knowledge of the management of patients with acute paediatric conditions in an ambulance context.

> 24866: Demonstrate knowledge of the management of patients with acute geriatric conditions in an ambulance context.

> 24867: Demonstrate knowledge of environmental conditions and their effects on patients in an ambulance context.

> 24868: Demonstrate knowledge of the management of patients with acute mental illness in an ambulance context.

> 24869: Apply integrated clinical practice in an ambulance context. > 24870: Demonstrate knowledge of pharmacology in an ambulance

context. > 29415: Demonstrate knowledge of management of patients with

acute respiratory and cardiovascular symptoms in an ambulance context.

> 29416: Demonstrate knowledge of the management of patients with acute neurological presentations in an ambulance context.

> 29417: Demonstrate knowledge of the management of patients with acute abdominal symptoms in an ambulance context.

> 29418: Demonstrate knowledge of processes to support patient safety and comply with legislation in an ambulance context.

What are the pre-entry requirements?

Personnel must complete pre-entry requirements before being enrolled on the NZDAP course:

Must have a minimum of six months’ experience as a First Responder before applying for a position on the NZDAP course (using the CDT100 form). Exceptions to the six months’ experience may be considered on application to the Clinical Programme and Moderation Team.

> Must pass a pre-entry quiz online:

– Completed online via Microsoft Forms here. – Requires minimum score of 70% to pass.  – Personnel are allowed two attempts to pass, followed by a six

month ‘cool down’ period before further attempts are allowed. 

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> Must complete the pre-entry checklist:

– Completion of this checklist ensures that learners are competent and confident with all FR skills, and therefore are ready to build on those skills in the NZDAP course. 

– It is a practical FR skills checklist and completion must be observed by someone who has been nominated by the learner’s Station Manager (SM)/Territory Manager (TM).

– The checklist must be signed by the learner, observer, and SM/TM. The completed, signed checklist must be sent to the regional clinical administrator for processing. 

What is the general structure of the NZDAP course?

> Once a learner has been enrolled in a NZDAP course, they will receive an information package providing further information about course structure, timetable, bring your own device (BYOD) specifications, and more.

> The NZDAP course involves many different types of learning and tasks, to include block course attendance, workbook completion, self-directed learning activities, and quizzes. The table below provides an overview of the structure of each module.

Module One

4–5 weeks self-directed

learning

Classroom Days 1–2

Submit Workbook

1a

4–5 weeks self-directed

learning

Classroom Days 3–6

Workbooks and

operational shifts

Submit Workbooks 1b and 1c

Module One

complete

Module Two

4–5 weeks self-directed

learning

Classroom Days 1–5 Workbooks and operational shifts

Submit Workbooks 2a and 2b

Module Two

complete

Module Three

4–5 weeks self-directed

learning

Classroom Days 1–5 Workbooks and operational shifts

Submit Workbooks 3a and 3b

Module Three

complete

Module Four

Workbook and case logs Operational shifts Submit

workbook

Module Four

complete

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NZDAP and the supervised clinical practice programme

> Learners on an NZDAP course are automatically enrolled on the St John Supervised Clinical Practice Programme and may practice skills under supervision as defined with the CPGs after they have been formally taught that skill and passed any required assessments.

> Enrolment on the St John Supervised Clinical Practice Programme will extend to six months past completion of the NZQA qualification, after which time the learner will have to apply to the ATP Team for an extension if they have not yet been granted ATP at EMT level.

Primary Response in Medical Emergencies (PRIME)

> The PRIME programme is funded by the Ministry of Health and ACC and administered by St John. It has been developed to provide both the coordinated response and appropriate management of emergencies in rural locations.

> The PRIME programme utilises the skills of specially trained General Practitioners and/or nurses in rural communities to support the ambulance service where the response time for assistance would otherwise be significant or where higher medical skills than may otherwise be available would assist with the patient’s condition.

> A PRIME practitioner carries a pager and is mobilised by the Ambulance Communications Centre throughout New Zealand following an emergency call. The PRIME programme activates the practitioner within a local roster system that provides a response capability which is usually 24 hours, 7 days a week.

> PRIME practitioners are required to undertake an initial PRIME training course (five days in length) followed by a refresher course for trauma and medical emergencies once every two years.

> For more information on the PRIME programme, or the PRIME training courses (initial or refresher), visit the PRIME page on Heartbeat.

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Emergency Medical Assistant (EMA) course > Emergency Medical Assistants (EMAs) are clinically qualified and

competent ambulance personnel who has been trained to streamline the assessment and treatment provided by personnel with authority to practise (ATP). Their focus is on assisting personnel with ATP to provide optimal patient care.

> The EMA course is a five day course, and learners must complete the following courses prior to attending:

– Operations Induction. – Operations Risk Management. – Ambulance Driving Course. – First Responder.

> Topics covered within the EMA course include:

– Values and professionalism. – Competencies and pre-requisites. – Assessments. – Operations Manual. – Vehicle preparedness. – Vehicle equipment and resources. – Defibrillator familiarisation and use. – CPGs and checklists. – Assisting ambulance personnel (general information). – Crew resource management. – Patient handover. – Assisting an EMT. – Assisting a Paramedic. – Assisting an Intensive Care Paramedic. – Assisting PRIME responders. – Electronic patient report forms (ePRF). – Major incidents.

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> Assessments will be conducted throughout the EMA course, to prove learning. There will be three main types of assessments:

– Self-sign-off. The EMA will read the required material to gain familiarisation and understanding. Once complete, the self-sign-off table will be initialled and dated as complete.

– Crew sign-off. The EMA will work through the learning objectives by way of self-study and crew member-assisted learning to achieve the objectives. Once the requirements have been filled, a crew member with ATP (relevant to the skill) may sign off the EMA in the sign-off tables.

– Clinical Support Officer sign-off. On completion of the training manual (provided in class), a CSO will meet with the EMA for a review of the manual and fill out the completion sign-off form.

Major Incident Support Team (MIST) > The role of MIST is to enable the

deployment of purpose-built Command Units and other specialist major incident vehicles to support frontline ambulance personnel during major incidents or large planned events. Examples of these incidents include the Christchurch earthquakes, Otira bus crash, Kaikoura earthquake, Whakaari/ White Island eruption, and the Christchurch mosque shooting.

> MIST supports the response to these incidents by:

– Setting up radio communications. – Coordinating logistics for patient movement. – Ensuring records are maintained around scene decisions. – Providing structure and a routine framework to larger scenes. – Assisting with the organisation and deployment of clinical

resources. – Setting up tents and other treatment areas. – Deploying consumable caches. – Ensuring scene safety and adherence to health and safety

requirements.

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> A MIST Team Manager is trained to a CIMS4 level and has overall responsibility for ensuring there is a MIST response. A MIST Team Member is trained to a CIMS2 level and is responsible for providing the response and ensuring the Commander on scene is supported.

> MIST personnel do not have to be clinically trained, and the initial MIST training consists of CIMS, ambulance driving, operational risk management, and MIST- specific equipment training (for example, use of radios and other computer infrastructure).

> MIST personnel will be expected to attend one training session per month to ensure currency with equipment and St John equipment is maintained.

> MIST personnel will be involved in a minimum of three simulate deployments per year, conducted in conjunction with Police and FENZ (and other agencies, for example airports), to ensure MIST is in a state of operational readiness, and allied agencies are aware of the MIST capabilities and function.

Event Co-responder > The purpose of the Event Co-responder role is to work alongside a

qualified Event Medic (First Responder or higher), in order to assist in the delivery of Event Health Services as well as provision of basic first aid.

> Event Co-responder is gained after:

– Completion or revalidation of Workplace First Aid Level 2, and – Completion of Operations Risk Management, and – Completion of Operations Induction.

> Some personnel may choose to become Event Co-Responders while on the pathway to becoming a First Responder (as described in the ‘clinical practice levels and authority to practise’ section of this prospectus).

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Continuing Clinical Education (CCE)

What is CCE?

> To enhance patient outcomes and to ensure patient safety, it is imperative to maintain clinical competency. While the responsibility to maintain this competency rests with the individual, St John actively supports this through provision of CCE.

> There are three main components to CCE: formal face to face training, informal face to face training, and independent learning. More information on each can be found later in this section.

> For some rounds of CCE, personnel may also be required to complete online learning activities as part of their CCE, prepare cases for discussion prior to CCE attendance, or read aspects of the CPGs and/or First Responder Field Guide.

Minimum annual CCE requirements

> Each clinical practice level has its own minimum annual CCE requirements.

> First Responders are required to complete:

– 8 hours of informal face to face training. – 8 hours of formal face to face training.

> Emergency Medical Technicians (EMTs) are required to complete:

– 16 hours of formal face to face training. – 8 hours of independent learning.

> Paramedics are required to complete:

– 16 hours of formal face to face training. – 16 hours of independent learning.

> Intensive Care Paramedics and Extended Care Paramedics are required to complete:

– 16 hours of formal face to face training. – 24 hours of independent learning.

> Emergency Medical Assistants are required to complete the annual CCE requirements relevant to their clinical practice level.

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Formal face to face CCE

> These are sessions delivered by permanent Clinical Support Officers and focus on elements that are not able to be easily facilitated online, such as simulations, clinical discussions, and skill stations.

> Registration for CCE:

– Depending on your area and role, you may be automatically rostered to attend your CCE session(s) or you may need to book in on a session via MySitrep.

– Personnel must be registered for the CCE session they attend; ‘walk-ins’ cannot be accommodated.

> Personnel may only attend the CCE relating to their current practicing level. The only exceptions are:

– First Responders on the New Zealand Diploma in Ambulance Practice pathway may attend EMT CCE, or

– An EMT practicing as a Paramedic Intern may attend Paramedic CCE (from the period they have been formally accepted into the Internship Programme and assigned a Preceptor), or

– A Paramedic practicing as an approved ICP Intern may attend ICP CCE (from the period they have been formally accepted into the Internship Programme and assigned a Preceptor).

> Attendance of formal face to face CCE:

– Learners attending formal face-to-face CCE must wear operational uniform. This is to:

• Foster a professional learning environment, and • Ensure clothing worn is appropriate to enable practical

sessions, and • Enable operational deployment in the event of a major

incident.

– Personnel who are not able to work frontline may not attend CCE. This includes personnel with ACC injuries and medical problems that do not have a return to work programme enabling them to work frontline on emergency ambulance (or PTS).

– There will be no routine provision of ‘wash-up’ sessions for formal CCE. Any exception to this will be rare and will cater only to those

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who have a valid reason for non-attendance (for example, on ACC or parental leave).

– All personnel are expected to positively engage with the CSO and fellow learners during CCE sessions, to promote a safe learning environment for all.

> Non-attendance of formal face to face CCE:

– CCE attendance is mandatory for all those who hold a clinical practice level.

– Anyone with an authority to practise who fails to attend all required CCE will be referred to the ATP Credentialing Committee for review of their ATP (refer to OMP 4.5).

– First Responders are also expected to attend CCE to maintain clinical competency. Those who fail to complete their CCE requirements will be required to revalidate their clinical competencies as defined by the relevant Clinical Practice Manager (this may be completion of a skills checklist, or re-attendance of some or all of a First Responder course). Failure to comply with the stipulated requirements will result in removal of the First Responder clinical practice level.

Informal face to face training

> This is an aspect of CCE specific to First Responders. It was implemented to recognise the training that occurs locally on station (for example, delivered by Station Managers/Volunteer Team Leaders).

> A bank of lesson plans and associated resources is available on the Clinical Wiki for personnel to download and use for station training.

Independent learning

> This aspect of CCE is designed to recognise the learning/training that personnel undergo externally to St John that is relevant to their clinical practice level (for example, those completing tertiary paramedicine study).

St John Clinical Prospectus | 23

English language requirements > This section is for personnel whose first language is not English,

or who come from a country where the language of instruction in schools is not English.

> If personnel are coming from a country with an annual student visa approval rate of at least 80%, they are required to provide evidence of:

– Achievement of an NZQA- approved English Proficiency Assessment, or

– Achievement of the required score in the internationally recognised English Proficiency tests outlined in Table 1 within the last two years.

Generic course important info

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Table 1

Test Score required

International English Language Testing System (IELTS)

Academic score of 5.5 with no band score lower than 5.

Test of English as a Foreign Language (TOEFL) paper-based test

Score of 530 (with an essay score of 4.5 for test of written English)

Test of English as a Foreign Language (TOEFL) internet-based test

Score of 46 (with a writing score of 20)

Cambridge English Examinations > First Certificate in English (FCE) or FCE for schools with a score of 154, with no less than 154 in each skill, and

> An Occupational English Test (OET) at grade C in all sub tests.

New Zealand Certificate in English Language (NZCEL)

Level 3 achievement with an endorsement of either general, workplace, or academic.

Pearson Test of English (academic) Academic score of 42.

City and Guilds International English for Speakers of Other Language (IESOL)

> B2 communicator, and

> Score of 42.

> If personnel are coming from a country with an annual student visa approval rate of less than 80%, they are required to provide evidence that they:

– Have gained NCEA Level 3 and met New Zealand University Entrance requirements, or

– Hold a Bachelor’s degree of at least three years from New Zealand, Australia, Canada, The Republic of Ireland, South Africa, the United Kingdom, or the United States of America, or

– Have achieved a Certificate in English Language Teaching to Adults (CELTA), or

– Have achieved one of the English Language competency tests specified in Table 1.

St John Clinical Prospectus | 25

Enrolling on a course > If personnel are new to St John, they will be contacted in order to

organise enrolment on foundation courses. > For any other course (for example, New Zealand Diploma in

Ambulance Practice), personnel will need to:

– Be up to date with individual CCE requirements, and – Have line manager approval, and – Fill in and submit the CDT100 form.

Pastoral care

Individual attention

> Everyone is given some individual attention during courses. > Learners should approach a lead Clinical Support Officer in the first

instance if they believe more support is required. > The Operations Manual contains more information on guidance and

support for those employed by St John in a paid or volunteer capacity.

Learning difficulties/disabilities

> If personnel have learning difficulties or a physical disability, additional assistance or guidance can be sought via Clinical Support Officers.

> Personnel may be given one on one tuition to ensure they are developing the skills required to achieve the course requirements. This may include physical ability to complete the course. Assistance of this nature will be arranged in coordination with the line manager.

> If personnel have a known or suspected learning difficulty, they should notify their Clinical Support Officer as soon as feasible prior to the commencement of the course. This will enable development of a learning plan as early as possible to set the learner up for success. This will usually involve the learner undergoing an Education Psychology evaluation initially, and then a subsequent meeting with the learner’s line manager and representative from the Clinical Programme and Moderation Team to develop a robust learning plan to suit the learner.

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> Clinical Support Officers may contact learners if they appear to be having difficulty with learning, to establish remedial measures in collaboration with the learner and Clinical Programme and Moderation Team.

Simulations

What are simulations?

> Clinical simulation is often used as a mode of learning in class. They can sometimes be confused with an assessment as it involves learners doing something practically and having a review of their performance.

> There are two types of simulation – macro-simulations and exercises. > Macro-simulations. These are used throughout all St John clinical

courses. This is when learners are given a brief of an incident and they enter a staged scene and perform their skills on a manikin or someone acting as a patient.

> Exercises. This type of simulation focuses on large-scale incidents associated with on-scene management, rather than focused patient care. The exercise may have one or more of the following components:

– The situation is discussed, and decisions are agreed based on information that is supplied by a Clinical Support Officer.

– Learners work with colleagues and other emergency service workers.

– Learners are involved in an actual scene of a simulated emergency, usually involving many patient actors.

How does a macro-simulation usually work?

> St John tries to make clinical simulation as real as possible. This depends on the facilities that are available where the course is being held. In some locations St John has dedicated simulation rooms, and in other locations a little more improvisation is needed.

> A Clinical Support Officer will brief learners on the incident that they will ‘attend’. Learners will usually work with another learner in a typical two-person crew.

> The simulation may be filmed for debriefing. During the simulation, the other learners from the class may be observing. They may do so

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from another room so that those involved in the simulation are not interrupted by their presence.

> Learners in the simulation will need to treat it like a real incident and do what they would normally do. The Clinical Support Officers work to make the situation as realistic as possible to enable the learner’s interaction and responses to be realistic.

> The manikins often talk – the voice will come from the manikin’s mouth. Therefore, learners will need to talk to the manikin as though they are a real person.

> A Clinical Support Officer may or may not be present with the learner during the simulation, so any patient questioning will need to be directed to the patient (just as would occur in a real situation).

> After the simulation, the gear is tidied away and then the learners join the rest of the class. Learners may watch the recording of the simulation with the rest of the class and everyone will be making notes around points that the Clinical Support Officer wishes to focus on.

> There may be a facilitated group or class discussion about your scenario. During this discussion the Clinical Support Officer may ask specific learners various questions or ask them to expand on their discussion points.

Learner consent and safety

Participation in practical scenarios

> When learners participate in a course, the Clinical Support Officer will use formal and informal instruction and practical scenarios.

> Participation as a simulated patient is expected during scenario sessions.

> Those who actively participate in practical sessions are deemed to have given their consent by virtue of their participation.

> There are some forms of patient assessment that require exposure of certain areas of the body, for example exposure of the chest when obtaining a 12 ECG or exposure of the abdomen when performing an abdominal assessment. For these types of assessments, explicit consent must be obtained and learners may withhold this consent if they are uncomfortable.

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Safety of yourself and others

> You, other learners, and the Clinical Support Officers are expected to comply with good infection control practices in accordance with the Operations Manual.

> You, other learners and the Clinical Support Officers are to ensure all practicable steps are taken to minimise the likelihood of injury and serious harm to themselves or others.

> Those who are on ACC must discuss with their line manager and HR whether it is appropriate to be on an educational course. There are specific rules relating to CCE which can be found in the CCE section within this prospectus.

> The principles outlined in the St John Health, Safety and Wellness Plan will be followed in all activities.

> All personnel must ensure they adhere to principles outlined in the Fatigue Management Policy (HSW 5.11) and the Clinical Operations Fatigue Management and Driving Policy (OMP 3.4.1), available on Heartbeat, as hours spent on a clinical course are considered ‘work hours’ and will impact on the individual’s driving hours. This also includes attendance at sim suite, which is a work-related activity on work premises, so personnel should not be attending prior to a night shift as it will impact on driving hours.

What to wear > Operational uniform must be worn for all classroom sessions and

clinical placements unless otherwise directed by a Clinical Support Officer.

> If operational uniform has not yet been issued, personnel must wear tidy, comfortable, non-revealing clothing and closed-toed shoes.

Completion requirements > Learners must fulfil all elements of each course to pass. > Where a learner does not progress or fulfil the requirements of the

course in a timely manner, a representative from the Clinical Team will notify the learner’s line manager and the learner may be removed from the course or programme.

> Sessions must be completed in the order specified by the Clinical Team and the learner must remain on the same course unless otherwise agreed with the relevant Clinical Practice Manager.

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Recommended reading > Any reading learners are required to complete as part of a course will

be outlined within the course itself. > There are no set textbooks for courses, only some recommendations

which may aid learning. > Stations often keep small libraries of relevant textbooks which

personnel may be able to access. > The Clinical Wiki is also an excellent resource for clinical personnel,

where articles, skill sheets, podcasts, instructional videos, and other publications such as Clinical Focus can be found.

Clinical placements and mentors > A clinical placement may include working on ambulances, at

events, or at a medical facility and may be part of course or programme completion requirements. Personnel must know what the requirements are for the specific course or programme they are registered for/enrolled in.

> The learner’s operational line manager is primarily responsible for ensuring their personnel on St John courses get the clinical placement they need (this is why course enrolment applications require manager sign-off ). In some circumstances, clinical placement may be organised by a Clinical Support Officer.

> Most clinical placements will require a portfolio of evidence to be completed. Part of a portfolio often involves completing exemplars on incidents when the learner was involved (either directly or indirectly) with patient care. The requirements of exemplars vary from course to course so learners will need to establish what is required for their course.

> When learners are working at a clinical placement, they are able to administer the skills of the practice level that they would gain on successful completion of the course, providing:

– They have been trained to perform the skill(s), and – The skill(s) are practiced under the direct supervision of someone

holding the clinical practice level being studied for (or above). Refer to the St John Clinical Procedures and Guidelines for more information.

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> The learner’s operational line manager is responsible for organising and allocating mentors where required, although commonly the learner or Clinical Support Officer may organise this.

> A mentor is either assigned to the learner or is someone who the learner happens to be working with. The mentor must be working at a clinical practice level which is at least the equivalent of the practice level that the learner is studying for.

> The mentor must not be a member of the learner’s immediate family or partner unless agreed in advance with the lead Clinical Support Officer, the learner’s line manager, and the mentor. Failure to seek agreement beforehand may deem portfolio entries invalid.

Withdrawal from a course or programme

Withdrawal from a course or programme initiated by the Clinical Team

The Clinical Team reserves the right to remove learners from a St John course at any time, noting that this will only occur where there is a valid reason to do so. The following is an indicative list of reasons a learner may be removed from a course:

> Failure of two attempts at an assessment. > Time enrolled in the New Zealand Diploma of Ambulance Practice

exceeds 18 months. > Time enrolled in the New Zealand Certificate of Emergency Care (First

Responder) exceeds seven months. > Failure to submit (or sit) an assessment by an agreed deadline (this

includes workbook requirements). > Failure to complete all CCE requirements. > A clinical competency review advises the learner that they are

removed from a course following investigation of an adverse incident. > Failure to adhere to a remedial action plan (RAP). This may be a

result of:

– Failing to adhere to the timings within a RAP. – Failing an assessment against the requirements of a RAP.

> Failure to demonstrate clinical competence at the learner’s current practice level.

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> The learner’s professional conduct during a course does not align with St John’s values. This will be a joint decision between the relevant Clinical Practice Manager and the learner’s line manager.

> The workbook fails to demonstrate safe and competent practice on the second submission.

> The workbook fails to demonstrate safe and competent practice on the first submission if the learner has been issued an extension past the two-year course expiry date.

> The learner changes organisational roles to a position that no longer supports that clinical practice level, authority to practise or endorsement.

> The learner has not provided proof of identification within seven working days.

Withdrawal from a course or programme initiated by the learner

> If a learner wishes to withdraw from a course or programme, they should contact:

– Their line manager, and – Their lead Clinical Support Officer or Clinical Administrator.

> If a learner wishes to withdraw from the Clinical Internship Programme, they should contact the Clinical Internship Manager.

Disciplinary procedure > For the duration of the course, learners are subject to the disciplinary

procedures of St John. > Those in St John who are supplied accommodation after hours are

subject to the disciplinary procedures and usual HR policies of St John.

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Types of assessment

General

> Most internal St John clinical courses have some form of educational assessment because assessment of learning is an important part of teaching.

> Assessment methods for each individual course can vary and are explained in more detail in the relevant course manuals.

> Assessments will be fair, valid, consistent and transparent. > It is the learner’s responsibility to ensure they are clear about the

requirements of any assessments that they are completing or submitting (this includes portfolios of evidence).

> If a learner is unsure about the requirements of an assessment, they should contact their lead Clinical Support Officer at the earliest opportunity for clarification.

Assessments

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Formative assessment

> Formative assessments are generally used as an indication of progress through a course. Types of formative assessment include (but are not limited to):

– Assignments. – Examinations. – Practical demonstrations. – Simulations. – Verbal assessments. – Workplace assessments.

> Formative assessments are used to identify whether there is a requirement for remedial work, which can be conducted over the duration of the course (as required) rather than at the end of the course.

> The Clinical Team reserves the right to remove a learner from a course where substantive failure of a formative assessment has occurred.

Summative assessment

Summative assessments are assessments that the learner must pass in order to progress. Types of summative assessment include (but are not limited to):

> Assignments. > Examinations. > Practical demonstrations. > Simulations. > Verbal assessments. > Workplace assessments. > Workbook completion.

Practical clinical assessment

> Parameters of practical assessment:

– Learners may be required to participate in practical assessments where their individual skills and knowledge will be tested.

– Prior to the start of a practical assessment, the learner may ask assessors to clarify any requirements.

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– During the assessment session, learners are required to demonstrate individual competence and use only the resources provided.

– Video recording is common in practical assessments. The file provides evidence of the assessment and may be used for moderation purposes. Learners may review your video files on request.

> Sharing or receiving of assessment information:

– Learners must act with integrity and not ask fellow learners for assessment information, share information, or seek support during an assessment as this may disadvantage others who are yet to be assessed.

– If a learner shares or receives assessment information that unfairly advantages them during an assessment session, they will be referred to the appropriate manager who will decide the appropriate course of action.

– The appropriate manager will notify the learner in writing of the decision within ten working days of the referral. This may result in removal from the course or programme.

Advanced Driving Assessment (ADA)

What is an Advanced Driving Assessment (ADA)?

> The purpose of an ADA is to ensure personnel maintain a safe level of competency in the operation of an ambulance and to ensure personnel can demonstrate contemporary knowledge of the New Zealand Road code and associated regulations.

> All operational personnel are required to undertake an Advanced Driving Assessment (ADA) every three years.

> The ADA process will be fair, transparent, nationally equitable and in line with other assessment processes outlined within this prospectus.

Standards

> The ADA will be conducted in the type of vehicle personnel being assessed would normally drive in their working role. In situations where personnel hold more than one driving role within St John, they should be assessed in the type of vehicle that poses the greatest risk.

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> The ADA will be conducted by New Zealand Transport Agency (NZTA) qualified St John Clinical Support Officer Driving Instructors (CSOs) or on occasion, externally contracted Driving Instructors.

> The ADA will be conducted using a St John ADA form which has been developed to industry accepted standards.

> The ADA will be based on a NZTA Class 1 driving standard. > Personnel will be assessed using specifically developed driving routes,

noting that variability may occur based only on traffic conditions on the day.

> ADA routes will follow the same type of structure with a similar type of traffic exposure, noting this may be difficult to achieve in some rural areas.

> ADAs should occur in areas where there is enough variability in traffic conditions to demonstrate full competence in the driving task(s), noting this may be difficult to achieve in some areas. Clinical Practice Managers (CPMs), in consultation with Field Operations, will determine where personnel will be assessed.

> Where possible an ADA will occur during working hours, noting this will need to comply with aspects of OMP 3.4.1 Clinical Operations Fatigue Management and Driving Policy and operational workload.

> The step-by-step technical aspects of how an ADA will occur will be consistently followed by the national team of St John CSOs and will be subject to the same moderation processes as other areas within the Clinical Team.

> The Driving Review Panel will provide a level of oversight and will consist of:

– Assistant Director of Operations Clinical Delivery and Support – Clinical Programme & Moderation Manager – People & Organisational Strategy representative – Transport Service Licence (TSL) holder – Health, Safety & Wellbeing Manager – Two (2) St John CSO DIs (including the CSO Driving Subject Matter

Expert).

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> The responsibilities of this panel are to:

– Review all first-time ADAs with a competency score of 1 (the assessing CSO will be responsible for alerting the panel as soon as these occur through the CSO Driving SME).

– Review all Advanced Driving Reassessments with a competency score of 1 or 2 (the assessing DI will be responsible for alerting the panel as above).

– Routinely review a selection of ADAs to assist with moderation.

Delivery method

Three delivery options are available for consideration, however Clinical Practice Managers will ultimately be responsible for ADA delivery:

> Option 1

– DI is based at a specific location in a response restricted assessment vehicle where ADAs start and finish.

– Personnel will be allotted timeslots. – Appointing timeslots are managed by the appropriate line

Manager in conjunction with the Clinical Team. – Personnel will then be taken through an ADA based on process as

described. – The ADA may be interrupted for PURPLE response if required. If

this occurs the ADA will stop.

> Option 2

– DI based at a central location, e.g. Hub, station or hospital, with response restricted assessment vehicle and a second person operationally available for the day.

– Personnel are swapped off the vehicle with the spare operational person and an ADA is completed based on process as described.

– Consideration will be given with respect to operational workload, fatigue management and rest/meal breaks.

– The ADA may be interrupted for PURPLE response as required and if this occurs the ADA will stop.

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> Option 3

– DI starts day at a central location, e.g. Hub, station, spoke or hospital.

– DI joins an operational vehicle which remains response capable and assesses both personnel around operational workload based on process as described.

– Once both personnel have been appropriately assessed, the DI would attempt to move to another vehicle and this would continue as necessary.

> An ADA will not be conducted:

– During any level of response, or – If personnel are due for a rest/meal break, or – If it interferes with any other aspect of OMP 3.4.1 Clinical

Operations Fatigue Management and Driving Policy.

Documentation

> The St John ADA form must be utilised when conducting an ADA. > A PDF version of the St John ADA form is available, however the

electronic version located on MySitrep is where the final report will be filed.

Results

> Based on guidelines surrounding interpretation of the ADA form, the CSO will be responsible for writing comments and recommendations on the ADA template regardless of the final competency score.

> DIs will inform personnel of the result immediately upon completion of an ADA due to the immediate operational driving consequences of a failed ADA.

> If, during a first or second ADA attempt, personnel are unable to meet the required standard by receiving a competency score of 1 or 2, the CSO will immediately contact either the Line Manager, Shift Supervisor/Manager or the on-call Duty Executive to inform them of this. Importantly, CSOs have no authority to manage or enforce driving consequences of any personnel secondary to a failed ADA result.

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> If personnel fail a first-time ADA attempt by receiving a competency score of 1 or fail an Advanced Driving Reassessment with either a score of 1 or 2, the assessing DI will need to notify the Driving Review Panel through the National CSO DI SME.

> The outcome of not meeting the required ADA standard may include increased supervision, remedial training and/or restricted driving duties.

> For a first-time ADA resulting in a competency score of 2, the CSO will generate a remedial action plan (RAP). For competency scores of 1 or reassessment scores of either 1 or 2 the Driving Review Panel will support the remedial process. The relevant line manager in conjunction with the Clinical Team will then manage remedial support utilising current performance improvement plan processes.

Communication

> Clear communication will be sent to all personnel required to undertake an ADA and the ADA template will be made available to all personnel to view on Heartbeat and the Clinical Wiki.

> Ongoing communication will occur to all CSOs to ensure a nationally consistent approach.

Assessment attempts A learner may have up to two attempts at demonstrating competence for a summative assessment (provided they are within their course timeframe).

If the learner does not demonstrate competence

> If a learner does not demonstrate competence after a summative assessment, they will be interviewed by a Clinical Support Officer and a remedial action plan will be developed and implemented.

> A remedial action plan will be agreed as soon as possible following an assessment attempt. The learner will then be reassessed at an agreed date after remedial learning has occurred.

> If a learner does not demonstrate competence after reassessment, they have an interview with a Clinical Support Officer, however no further opportunities will be made available for reassessment at this time. The case may be reviewed in accordance with the appeal

St John Clinical Prospectus | 39

process. An outcome of the appeal process may be that the learner is offered further assessment opportunities after a period of further study.

Level 3 Certificate in Emergency Care (First Responder):

> This programme must be completed within the maximum time frame of seven months.

> The seven months starts when the training agreement is lodged with St John’s Industry Training Organisation (ITO), Skills.org (usually the first day of the ORM class time).

New Zealand Diploma in Ambulance Practice (NZDAP):

> Any enrolment on a NZDAP course is valid for a maximum of 18 months. This is taken from the time you start the course (this may be when online learning begins ahead of classroom time).

> After 18 months learners may be removed from the course. > The NZDAP course is designed so it can be easily completed within

18 months. > Learners should keep in mind that the maximum period includes

any remedial work, reassessment, and remaining current with all CCE requirements.

> If a learner is having difficulty with the completion of any assessments within your course, they should contact their lead Clinical Support Officer as soon as possible to discuss a plan in order to meet the required deadline.

Assessment and conflict of interest > The Clinical Team will take best endeavours to avoid conflict of

interest when assessing. > Assessment should be undertaken by assessors who have not had any

direct relationship with the learner or their educational journey. > The following examples are of situations where there may be a conflict

of interest:

– The assessor has been involved in a previous assessment attempt. – There is a family or personal connection between the learner and

the assessor.

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> The following are not considered conflicts of interest:

– The learner and the assessor have worked together at an operational incident.

– The learner and the assessor work together operationally infrequently.

Written assessments

Submitting written assessments for marking

> On completion of a written assessment, the learner will be required to submit it for marking by the due date (specified within the relevant course).

> If the Clinical Team do not receive the learner’s assessments before or on the due date, their line manager will be notified, and the learner may be removed from the course.

> Electronic submission:

– This will be the most common method of submission. – The lead Clinical Support Officer will inform learners of the specific

process for the course. – Alternatively, learners may email it to their lead Clinical Support

Officer and clindevhelp@stjohn.org.nz.

> Submission by post/courier:

– Learners may elect to submit a written assessment via post/courier. Ensure a copy has been made prior to sending the assessment.

– The postal/courier addresses can be found in table 2.

> All components of a course (including all assessments) must be successfully completed prior to any end of course assessments are attempted.

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Table 2

Method of submission AddressPost St John Clinical Administration

Private bag 14902

Panmure

Auckland

Courier to Auckland St John Clinical Administration

Building 5, 666 Great South Road

Greenlane

Auckland

Courier to Christchurch St John Clinical Administration

Christchurch Justice and Emergency Services Precinct

PO Box 1443

40 Lichfield St

Christchurch

Referencing

> All assessments must be referenced using APA referencing style (7th edition).

> Referencing is required to:

– Acknowledge use of other’s material in the assessment and to avoid plagiarism.

– Show anyone assessing your work the extent of your research. – Enable assessors to locate the work that has been cited.

> The American Psychological Association website is a great resource to help personnel learn how to reference and provides examples of how to reference different sources.

Plagiarism

> Plagiarism is prohibited in any assessments you submit as part of a clinical course.

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> Plagiarism can be:

– Copying the work of another learner. – Copying directly from textbooks, the web and other work without

correct citation. – Failing to acknowledge sources including learner’s own work used

for another purpose.

> Any final piece of work that you submit must be your own independent work. This is an important consideration when working in study groups or having discussions with other learners on assessments.

> Learners are not permitted to share information pertaining to assessments/examinations/questions with other learners within St John.

> If it is found that a learner has plagiarised or shared assessment information, they will be referred to the relevant Clinical Practice Manager who will decide on the appropriate course of action which may include:

– Notifying the learner’s line manager. – Removal from the course or programme. – Exclusion from further study. – Warnings or dismissal from St John.

Marking your written assessments

> A Clinical Support Officer will mark submitted assessments. > Once the assessment has been marked, the learner will be contacted

via email and/or by phone to advise them of the outcome and discuss the results.

> If areas of the assessments require attention, then a Clinical Support Officer will contact the learner.

> If an assessment requires re-submission, a Clinical Support Officer will confirm that this is required, and how to re-submit.

> Re-submissions are not permitted if the course time has expired.

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Extensions for assessments > An extension may be requested in extenuating circumstances at least

14 days before the due date (exceptions include hardship, sickness, or bereavement).

> If a learner needs an extension, they must contact their lead Clinical Support Officer as soon as issues affecting the completion of a course/assessment become apparent.

> The reason(s) for an extension request must be compelling. > The request should be in writing (email) to the learner’s lead Clinical

Support Officer and must include:

– The reason for requesting the extension, and – The current status of the assessment or portfolio of evidence, and – The length of the extension requested, and – Supporting documentation (for example, medical certificates) to

support the request if possible.

> Once the request has been received, this will be passed on to the relevant Clinical Team Manager.

> The Clinical Team Manager, in consultation with the Clinical Programme and Moderation Team, will determine the outcome of the extension, taking into consideration all relevant information.

> Extensions will not be granted if:

– The learner has not completed the required work without good reason.

– The total time since the course was started exceeds 18 months for NZDAP or seven months for New Zealand Certificate in Emergency Care (First Responder).

– Operational exposure or clinical placement time gained was inadequate.

– The learner was unable to ‘find the time’ to complete an assessment or portfolio of evidence.

– The learner did not understand the intent or requirements of the assessment.

– The learner has changed roles within St John.

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– The learner (or their line manager) prioritised work over completing the assessment or portfolio of evidence.

– The application has occurred within 13 days of the assessment due date.

> In the event of hardship, sickness, or bereavement, the Clinical Programme and Moderation Team or Assistant Director – Clinical Delivery and Support, may grant extensions within 13 days of the assessment due date however such extensions will not exceed a total of six months past the original assessment.

Assessment results > Learners will be provided with their assessment results by the Clinical

Team. > Where NZQA credits are available, the learner’s results are lodged with

NZQA.

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Clinical practice levels and authority to practise (ATP)

What is authority to practise (ATP)?

> Ambulance personnel cannot legally supply or administer prescription medicines to patients unless they have authority to practise, or they are a registered health practitioner with the ability to supply or administer prescription medicines described within their scope of practice.

> In addition, services restrict the use of some items of clinical equipment and the performance of some clinical procedures to personnel at specified practice levels.

> ATP is the authorisation of a person to use the St John Clinical Procedures and Guidelines (CPGs) by the St John Clinical Director.

> Personnel may not use the CPGs without authority to practise. > Authority to practise is granted at a specified practice level and

each practice level has a delegated scope of practice that defines the medicines and interventions that personnel may administer or perform when treating patients. This information can be found in the St John CPGs.

Clinical practice levels and authority to practise

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> Interventions that are not described within the delegated scopes of practice (for example automated defibrillation) may be provided by all personnel.

What are the different ATPs in St John?

> St John has five clinical practice levels:

– First Responder. – Emergency Medical Technician (EMT). – Paramedic. – Intensive Care Paramedic (ICP). – Extended Care Paramedic (ECP).

> Four of the five clinical practice levels require an ATP and operate using the St John Clinical Procedures and Guidelines:

– Emergency Medical Technician (EMT). – Paramedic. – Intensive Care Paramedic (ICP). – Extended Care Paramedic (ECP).

> First Responders are not issued an ATP and operate using the First Responder Field Guide, not the Clinical Procedures and Guidelines.

> It is important to understand that gaining an external educational qualification does not automatically equate with gaining a particular ATP (which is a separate internal process).

First Responder

Gaining a First Responder clinical practice level

> To gain a clinical practice level at First Responder, personnel must:

– Complete the Level 3 Certificate in Emergency Care (First Responder), or

– Apply for recognition of current competency via the ATP Team.

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> To gain a First Responder clinical practice level through St John personnel must:

– Complete all learning and assessment requirements for the Operations Risk Management module, to include online learning, attendance of two days of class time, and completion of all associated workbook activities.

– Complete all learning and assessment requirements for the First Responder Course, to include online learning, attendance of four days of class time, and completion of all associated workbook activities.

– Complete the on-road consolidation of skills, including case logs in the associated workbook.

– Complete the First Responder application form with endorsement from their Territory Manager or District Operations Manager and send the completed form to ATP@stjohn.org.nz.

> To gain a First Responder clinical practice level through AUT, personnel must:

– Successfully complete the first two semesters of a Bachelor of Health Science (BHSc) in Paramedicine at AUT.

– Complete all requirements to achieve provisional permission to drive an ambulance non-urgently and urgently unsupervised in line with the St John Ambulance Driving Course.

– Complete OMF 4.5.6 First Responder practice level recognition application form with endorsement from their Territory Manager or District Operations Manager and send the completed form to ATP@stjohn.org.nz.

> To gain a First Responder clinical practice level through Whitireia, personnel must:

– Successfully complete the first two semesters of a Bachelor of Health Science (BHSc) in Paramedicine at Whitireia.

– Complete all learning and assessment requirements for the Operations Risk Management module, to include online learning, attendance of two days of class time, and completion of all associated workbook activities. Submit this workbook to clindevhelp@stjohn.org.nz.

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– Complete all requirements to achieve provisional permission to drive an ambulance non-urgently and urgently unsupervised in line with the St John Ambulance Driving Course.

– Complete OMF 4.5.6 First Responder practice level recognition application form with endorsement from their Territory Manager or District Operations Manager and send the completed form to ATP@stjohn.org.nz.

> To gain a First Responder clinical practice level through Fire and Emergency New Zealand, personnel must:

– Complete the four-day First Responder course for FENZ. – Complete all learning and assessment requirements for the

Operations Risk Management module, to include online learning, attendance of two days of class time, and completion of all associated workbook activities. Submit this workbook to clindevhelp@stjohn.org.nz.

– Complete the First Responder online learning. – Complete all First Responder- associated workbook activities.

Submit this workbook to clindevhelp@stjohn.org.nz. – Complete OMF 4.5.6 First Responder practice level recognition

application form with endorsement from their Territory Manager or District Operations Manager and send the completed form to ATP@stjohn.org.nz.

Attestation process

> The attestation process is for those who wish to gain the Level 3 Certificate in Emergency Care (First Responder) and have completed the First Responder programme prior to 1 April 2016.

> Personnel can be attested for the Level 3 Certificate in Emergency Care (First Responder) if they:

– Hold a First Responder clinical practice level or above, are up to date with CCE, and are clinically active, or

– Are an AUT or Whitireia student who has completed semester two of the BHSc and have been issued a First Responder clinical practice level.

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> The attestation process requires:

– Submission of an application to begin this process by emailing clindevhelp@stjohn.org.nz.

– Completion of a paediatric resuscitation attestation arranged with the relevant regional Clinical Practice Team within three months of application to complete attestation.

– Completion of two observation checklists by completing on-road shifts. These checklists will be provided to the individual by the person organising the attestation.

– The individual applying must be up to date with all CCE requirements.

– Completion of the First Responder application form with endorsement from the individual’s Territory Manager or District Operations Manager.

– Personnel may be asked to complete consolidation of road shifts through a mentor report. This mentor report template will be provided to the individual by the person organising the attestation.

– Note: Personnel who hold an older version of the First Responder course (i.e. course completion prior to 2016) may find they do not have the appropriate pre-requisite qualifications to enrol in the New Zealand Diploma in Ambulance Practice. In these instances, personnel may apply to the Clinical Programme and Moderation Manager for direct entry into the programme.

Maintaining a First Responder clinical practice level

To maintain a First Responder clinical practice level, personnel must:

> Complete all CCE requirements. (Note: personnel can apply to the ATP Credentialing Committee for an exemption for CCE completion. Examples may include parental leave and ACC leave).

> Complete the requirements of the volunteer agreement regarding operational exposure at events or frontline shifts.

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Review and removal of a First Responder clinical practice level

> A First Responder clinical practice level will automatically be removed if the individual resigns from St John.

> If personnel wish to return to operational status within 12 months of leaving St John, then with approval from their Line manager and the relevant Clinical Practice Manager, the First Responder clinical practice level can be reinstated.

> If personnel have a period of absence of more than two years with no clinical activity or CCE attendance, they will be required to complete both the Operations Risk Management course and the First Responder Course again.

> If personnel have a period of absence of more than 12 months but less than two years, they will be required to complete a basic competency review.

> If personnel do not complete the Level 3 New Zealand Certificate in Emergency Care (First Responder) within seven months without a valid reason, they will be removed from the First Responder pathway by the Clinical Practice Team following consultation. At this stage the individual is not permitted to be operational at First Responder level.

Crewing an ambulance as a First Responder

> Personnel may second crew an ambulance or First Response unit when they have:

– Successfully completed the Operations Induction course, and – Successfully completed the Ambulance Driving Course online

learning, classroom time, and the five non-urgent supervised drives, and

– Completed the Level 3 New Zealand Certificate in Emergency Care (First Responder) qualification. This includes successful completion and marking of the assessment workbook and verification from NZQA that the learner has completed the qualification.

Emergency Medical Assistant (EMA)

What is an Emergency Medical Assistant (EMA)?

> Emergency Medical Assistants (EMAs) are clinically qualified and competent ambulance personnel who have been trained to

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streamline the assessment and treatment provided by personnel with Authority to Practise (ATP).

> The role of an EMA is to facilitate patient assessment, treatment, transport or referral, in support of a lead clinician (ambulance personnel with ATP), as part of an emergency ambulance crew.

> EMAs complement the lead clinician by supporting clinical care, crew resource management, manual handling, advanced driving, scene management (including the management of major incidents), de-escalation, physical intervention, procedural preparation and infection control.

How do you become an EMA?

> EMAs complete the same foundation education as everyone else. This includes:

– Operations Induction. – Ambulance Driving Course. – The Level 3 New Zealand Certificate in Emergency Care (First

Responder). This includes the Operations Risk Management and First Responder modules and associated workbook completion.

> Personnel will also be required to attend a five-day EMA course. Refer to the ‘Emergency Medical Assistant Course’ section in this prospectus for more information.

> EMAs must achieve and maintain a clinical practice level.

Emergency Medical Technician (EMT)

Gaining an ATP at EMT level

> There are three key steps to gaining an ATP at EMT level:

– Complete one of the approved pathways for fulfilling qualification requirements.

– Application to the ATP Manager with District Operations Manager (or equivalent) for endorsement to progress to a clinical assessment day (CAD).

– Successful completion of an EMT CAD.

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> Approved pathways for qualification requirements:

– Gain the Level 5 New Zealand Diploma in Ambulance Practice. – Gain the Diploma in Paramedic Science from AUT. – Gain a Bachelor of Health Science (or equivalent) from a

Paramedicine Accreditation Committee-accredited programme. – Complete the first three semesters of a Bachelor of Health Science

in Paramedicine at AUT or Whitireia. – Apply to the ATP Credentialing Committee for approval to progress

to Clinical Assessment. To be granted approval applicants will need to demonstrate to the committee that they are clearly making decisions and performing interventions in their existing practice at an EMT level.

> Application process to the ATP Manager is as follows:

– Personnel must complete OMF 4.5.1 ATP application form with endorsement from their Territory Manager or District Operations Manager and send the completed form to ATP@stjohn.org.nz.

> EMT CAD:

– EMT clinical assessment is designed to ensure that candidates are safe to practice independently. The clinical assessment will not solely focus on academic knowledge but will also focus on personnel being operationally ready and safe. Candidates that pass the EMT clinical assessment will be automatically granted EMT ATP.

– EMT Clinical assessment will have two components:

• Skill stations: require satisfactory demonstration of clinical skills, including the ability to communicate an understanding of the clinical rationale associated with the skills.

• Clinical interview: consists of scenarios requiring the demonstration of good clinical knowledge and judgement, including the ability to: take a logical history, make a differential diagnosis, discuss treatment and demonstrate an understanding of appropriate pharmacology and pathophysiology.

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Maintaining an ATP at EMT level

Refer to OMP 4.5 Authority to Practise to understand the requirements for EMT ATP maintenance.

Paramedic

Gaining an ATP at Paramedic level

> There are three key steps to gaining an ATP at Paramedic level:

– Complete one of the approved pathways for fulfilling qualification requirements. See the ‘tertiary paramedic programme’ section in this document for details.

– Apply and be accepted into the Clinical Internship Programme. – Successful completion of a Paramedic Internship.

Maintaining an ATP at Paramedic level

Refer to OMP 4.5 Authority to Practise to understand the requirements for Paramedic ATP maintenance.

Intensive Care Paramedic (ICP)

Gaining an ATP at ICP level

> There are three key steps to gaining an ATP at ICP level:

– Complete one of the approved pathways for fulfilling qualification requirements. See the ‘tertiary ICP programme’ section in this document for details.

– Apply and be accepted into the Clinical Internship Programme. – Successful completion of an ICP Internship.

Maintaining an ATP at ICP level

Refer to OMP 4.5 Authority to Practise to understand the requirements for ICP ATP maintenance.

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Extended Care Paramedic (ECP)

Gaining an ATP at ECP level

Current requirements:

1. Eligible ECP roles include:

a. Be appointed into an eligible ECP role. Working on a Romeo unit, orb. Working in a designated rural area that includes ECPs in the skill

mix model, orc. Working in a contracted primary healthcare role (e.g. supporting a

DHB or PHO), ord. In another role where it has been deemed beneficial for

ambulance personnel to hold an ATP at ECP, and this has been approved by the Clinical Management Team.

2. Complete an Introduction to ECP course including clinical assessment:

a. Attend a five day introduction to ECP course facilitated by the St John Clinical Directorate, including completing required online learning and reading prior.

b. Pass clinical assessment during the course, which will include skill stations and clinical discussion.

3. Attend clinical placement:

a. Attend 32 hours of clinical placement within a general practice, urgent care, allied health, rural hospital, emergency department or Romeo unit setting (crewed with another ECP) to gain exposure to primary care and practice clinical assessment and ECP skills.

4. Commence postgraduate study:

a. Enrol in the AUT Postgraduate Diploma in Health Science (Paramedicine) including designated ECP papers*, or

b. Enrol in a Postgraduate Diploma from another tertiary institute** that covers the ECP competencies.

c. Complete the postgraduate diploma within three years.

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5. Attend a follow-up education day after three months of practice as an ECP:

a. Attend a one-day follow-up education session to discuss cases, practice skills, and enable the Clinical Team to answer questions and assess ECPs understanding of key concepts.

Requirements from July 2023:

1. Complete approved postgraduate qualification:

a. Successfully complete the AUT Postgraduate Diploma in Health Science (Paramedicine) with designated papers* with at least a B grade average, or

b. Complete a postgraduate diploma from another tertiary institute** that covers the ECP competencies with at least a B grade average.

2. Apply for an ECP role (as above). 3. Complete clinical internship:

a. Attend a two-day Introduction to ECP course facilitated by the St John Clinical Directorate, including completing required online learning prior, and

b. Attend a 32-hour clinical placement with a general practice, urgent care, allied health, rural hospital, or ED setting to gain exposure to primary care and practice clinical assessment and ECP skills, and

c. Work on a Romeo unit with another ECP for two blocks, andd. All cases involving ECP skills are reviewed by another ECP for six

months and regularly discussed.

4. Pass a clinical assessment day:

a. Pass a CAD including skill stations, clinical interview, and live-actor simulation.

* Designated ECP papers include PARA808 (Community and Remote Paramedicine), HEAL824 (Advanced Assessment and Diagnostic Reasoning), and PHMY803 (Pharmacology Science and Therapeutics).

** Other postgraduate qualifications covering ECP competencies will be considered by the ATP Credentialing Committee on a case-by-case basis.

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Maintaining an ATP at ECP level

To maintain ECP ATP, personnel must meet all the following criteria:

> Be a member of St John. > Attend all mandatory CCE modules. > Actively participate in audit and reportable event processes. > Maintain the required minimum level of clinical exposure. > Meet the minimum level of clinical exposure for ECPs within any

calendar year:

– Completion of a minimum of 144 hours of clinical exposure, and – A minimum of 100 patient contacts.

> Remain working in a designated ECP role. > Undertake 40 hours of clinical placement per year. > Establish a collegial relationship with another health professional

working in primary care to discuss/reflect on cases and record these reflections in MySitrep.

> Complete the postgraduate diploma within three years (note: this criteria is only for those who obtain ECP ATP in 2020–2022).

> More information on ATP maintenance can be found in OMP 4.5 Authority to Practise.

Rapid Sequence Intubation (RSI) endorsement

The process for gaining RSI endorsement

Intensive Care Paramedics must complete the following to be eligible to apply for RSI endorsement:

> Meet the educational requirements by:

– Completing the required postgraduate papers at AUT (PARA802 Resuscitation Physiology and 588302 Advanced Resuscitation), or

– Apply to the ATP Credentialing Committee for approval of any other qualifications/current competencies.

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> Have a minimum of 12 months experience practising at ICP level, following completion of the Clinical Internship Programme and be currently practising at that level.

> Currently work from a rostered position in an area that is designated to have personnel at ICP level within the skill mix model.

> Complete an ATP application form (OMF 4.5.1) with District Operations Manager endorsement and send to the ATP Credentialing Committee via ATP@stjohn.org.nz.

> Notification of an application being accepted or declined will be provided to the applicant and the respective District Operations Manager (or equivalent level) in writing.

> Approved applicants will be referred for an RSI clinical assessment.

RSI clinical assessment

> RSI clinical assessment is designed to ensure you are safe to practice as an RSI-endorsed ICP.

> Clinical assessment includes:

– Skill stations. This requires satisfactory demonstration of clinical skills, including the ability to communicate an understanding of the clinical rationale associated with the skill.

– Simulated scenarios. This requires demonstration of the ability to manage a scene, lead a team and provide appropriate treatment.

– Clinical interview. This requires demonstration of good clinical knowledge and judgement, including the ability to take a logical history, make a provisional diagnosis, discuss treatment, and demonstrate an understanding of appropriate pharmacology and pathophysiology in an interview context.

> The cost and coordination of travel to clinical assessment is the responsibility of your and/or the relevant operational manager.

> You and your operational line manager will be advised of the outcome of your clinical assessment in writing within five working days of the assessment.

> If you are successful in your assessment, you will be granted RSI endorsement.

> You may only have two attempts at RSI clinical assessment. Successful aspects of separate attempts at clinical assessment are unable to be aggregated in order to achieve an overall pass.

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> If you have not passed clinical assessment after your second attempt, you will need to consolidate for a minimum of six months before re-applying.

> The appeal process is outlined in the ‘appeals’ section of this document.

> All enquiries regarding RSI and the pathway to gain RSI endorsement must be sent to ATP@stjohn.org.nz.

Maintenance of RSI endorsement

> Personnel with RSI endorsement are required to maintain their ATP at ICP level.

> There is not currently a defined number of RSIs that personnel must perform annually. However, personnel are required to complete any additional self- directed learning as defined and communicated by the Clinical Directorate.

Urgent Community Care (UCC) endorsement > The UCC Course was a specialist course that used to be run by the

Clinical Team where there was a specific need for an extended scope of Paramedic or ICP practice to support primary health.

> Following the rollout of Extended Care Paramedics, no further UCC endorsements will be issued and the UCC endorsement will be formally withdrawn on 30 June 2023.

> Until 30 June 2023, personnel with the UCC endorsement may continue to practice UCC skills and medicines within the ECP CPGs.

ATP Credentialing Committee > The function of the ATP Credentialing Committee is to provide

consistency in decisions regarding:

– Reviewing and credentialing of overseas qualifications. – Reviewing adverse incidents and healthcare complaints and

performance. – Reviewing ATP enquiries and ATP maintenance.

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> The ATP Credentialing Committee has representation from:

– The ATP Team. – Clinical Directorate. – Patient Safety and Quality. – Field Operations. – People and Organisational Strategy. – Clinical Programme and Moderation Team.

ATP review panel > Issues of serious poor clinical performance are escalated to the ATP

review panel. > An explanation of this panel and process can be found in the

ATP review podcast on the Clinical Wiki.

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Tertiary Paramedic Programme

Qualifications and ATP

Gaining an external educational qualification does not automatically equate with gaining a particular ATP; this is a separate internal process. Refer to the ‘clinical practice levels and authority to practise’ section of this document for more information.

Paramedic qualification

> To achieve a Paramedic qualification, personnel must complete a Bachelor of Health Science in Paramedicine. This programme is available through AUT and Whitireia.

> The qualification can be completed full-time (three years, 360 credits) or part-time.

> Both AUT and Whitireia offer recognition of prior learning (RPL) for those with vocational ambulance qualifications:

– If personnel have current EMT ATP, AUT will award 105 credits and Whitireia will award 120 credits.

– If personnel have current Paramedic ATP, AUT will award 120 credits, and Whitireia will award 240 credits.

The Supervised Clinical Practice Programme and Clinical Internship

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> AUT offers learners the opportunity to gain up to 45 additional credits via RPL challenge exams in the following papers:

– 576101 Paramedic science. – 576401 Haemodynamics in the acute patient. – 577101 Cardiology.

> St John also recognises Bachelors degrees in paramedicine from CAA-accredited universities.

> St John will consider Bachelors degrees from non CAA- accredited universities (or equivalent qualifications).

Tertiary ICP Programme

Qualifications and ATP

Gaining an external educational qualification does not automatically equate with gaining a particular ATP; this is a separate internal process. Refer to the ‘clinical practice levels and authority to practise’ section of this document for more information.

Intensive Care Paramedic qualification

> Postgraduate studies are now the minimum qualifications needed to be eligible for ICP ATP.

> To achieve an ICP qualification, personnel must complete a St John-approved postgraduate qualification.

> This is currently available through AUT as a Postgraduate Certificate in Critical Care Paramedicine. The papers that must be completed are:

– HEAL814 Practice Pursued. – PARA805 Contemporary Intensive Paramedicine.

Supervised Clinical Practice Programme

What is the Supervised Clinical Practice Programme?

> The Supervised Clinical Practice programme is the way in which St John registers and tracks those who:

– Are currently completing a clinical qualification that requires clinical placement.

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– Have completed a clinical qualification and intend to apply to the Clinical Internship programme.

– Are non-St John personnel who are completing clinical placement with St John.

Enrolling in the Supervised Clinical Practice Programme

> The following personnel are automatically enrolled in the Supervised Clinical Practice Programme and do not need to apply to be enrolled:

– Personnel enrolled in the New Zealand Diploma in Ambulance Practice.

– Personnel enrolled in the St John Clinical Internship Programme. – Personnel enrolled in the St John Sponsorship Programme. – Non-St John personnel enrolled in a paramedic degree or a

postgraduate programme with a tertiary provider in New Zealand requiring placement.

> All other personnel (including St John personnel enrolled with a tertiary provider, St John personnel intending to apply for an internship position, students and New Zealand Defence Force medics) must apply to be enrolled in the Supervised Clinical Practice Programme.

> To apply to be enrolled in the Supervised Clinical Practice Programme, personnel must complete the enrolment form (OMF 4.5.4) located on the ATP page of Heartbeat and submit it via ATP@stjohn.org.nz.

> The names of students who have been accepted into the Supervised Clinical Practice Programme will be published on Heartbeat, detailing the practice level at which they may provide treatment under supervision.

> Personnel will not usually be enrolled in the Supervised Clinical Practice Programme for longer than two consecutive years at one practice level, unless this is a requirement of a tertiary programme or they apply to the ATP Credentialing Committee via ATP@stjohn.org.nz.

> Personnel will not usually be granted the ability to provide treatment under supervision two levels above their current practice level. For example, EMTs will not be granted the ability to provide treatment under supervision at the practice level of ICP, except during the time they are completing clinical placement in a suitable postgraduate programme with a tertiary provider.

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Un-enrolment from the Supervised Clinical Practice Programme

> Personnel will be un-enrolled if:

– They are no longer enrolled on a course which requires clinical placement, or

– They provide treatments and/or medicines they have not been trained to use and do not fall within the scope of practice of the ATP being sought, or

– District Operations Manager endorsement for supervised clinical practice is withdrawn.

Clinical Internship Programme overview

What is the Clinical Internship Programme?

> This is a programme run by St John to provide a fair and equitable process for personnel transitioning to Paramedic or Intensive Care Paramedic ATP. It is designed to promote clinical excellence and patient safety through a consistent Internship process.

> The Clinical Internship Programme will not look exactly the same in all parts of New Zealand as we acknowledge that metro, urban and provincial requirements are different.

> The Clinical Internship Programme is a four-phase programme (outlined in Figure 1).

> The amount of time you as an Intern will spend in each phase is dependent on your clinical competency, vocational experience, and personal motivation.

> The Clinical Internship Programme is overseen by the Clinical Internship Manager, noting that as an Intern, you will continue to report to your operational line manager.

> District Internship opportunities will be at the discretion of operational management and available in accordance with the workforce plan.

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Figure 1

Precepting phase

1:1 with a preceptor(12–40 shifts)

Clinical assessment day

Clinical supervision

Clinical discussion

Clinical consolidation period with close auditing (6 months)`

Based off one case study provided by the intern from the supervision phase

(Maximum two attempts)

How do I apply for an Internship?

> Applications to the Clinical Internship Programme will be received and managed via a recruitment process. This process will involve:

– Operational manager rating of applicant’s clinical and behavioural performance.

– Academic qualification. – A review of reportable events and complaints. – Clinical quiz. – Length of service.

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Clinical Internship: Precepting phase

What is precepting?

Precepting is the formal relationship that exists between a senior and clinically competent Preceptor and an Intern. The objective of precepting is to support and guide an Intern through a designated pathway with clearly agreed upon end goals and timelines.

Who is a Preceptor?

> A Preceptor is a Paramedic or ICP who has a portfolio with Clinical Delivery and Support to oversee and support an Intern within the Clinical Internship Programme.

> A Preceptor works with an Intern to develop their confidence as an autonomous practitioner.

> There are three primary components to the role of a Preceptor:

– To provide focused support through a period of precepting. – To actively prepare the Intern for clinical assessment. – To provide remote supervision, feedback and clinical review

through a period of clinical supervision, through to ATP issuance.

What does precepting include?

> Interns will work with one or two Preceptors for a minimum of twelve (12 hour) shifts, to develop confidence as an autonomous practitioner (or equivalent number of hours). It is expected that only exceptional candidates with significant previous experience will complete the precepting phase within 12 shifts.

> Paramedic Interns will practice within the Paramedic delegated scope of practice under direct supervision. On the rare occasion that a Paramedic Intern operates in the absence of their Preceptor, their independent clinical practice level remains at EMT.

> ICP Interns will practice within the ICP delegated scope of practice under direct supervision. On the rare occasion an ICP Intern operates in the absence of their Preceptor, their independent clinical practice level remains at Paramedic.

> When an Intern successfully completes all of the requirements of the precepting phase, they progress to the clinical assessment phase. If the clinical assessment day is passed, the Intern will be issued with a provisional ATP.

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What if the requirements of precepting are not met?

> If an Intern does not meet the requirements of the precepting phase, they may have a Remedial Action Plan (RAP) put in place.

> At the conclusion of the RAP, the Intern must have completed all requirements of the precepting phase to remain in the Clinical Internship Programme. Failure to meet the requirements will result in removal from the programme.

> Re-entry into the Clinical Internship Programme may be considered after six months by the review panel with endorsement from the individual’s operational line manager.

Clinical Internship: Clinical assessment phase

> Successful completion of precepting will result in progressing to the clinical assessment phase. This phase is designed to ensure personnel are safe to progress to the clinical supervision phase, where they can practice independently within the scope of their provisional ATP.

> Clinical assessment includes:

– Skill stations. This requires satisfactory demonstration of clinical skills, including the ability to communicate an understanding of the clinical rationale associated with the skill.

– Simulated scenarios. This requires demonstration of the ability to manage a scene, lead a team and provide appropriate treatment.

– Clinical interview. This requires demonstration of good clinical knowledge and judgement, including the ability to take a logical history, make a provisional diagnosis, discuss treatment, and demonstrate an understanding of appropriate pharmacology and pathophysiology in an interview context.

> Interns that fail clinical assessment must return to the precepting period for further precepting of no less than 12 shifts (maximum 16) before returning to clinical assessment.

> Interns may only have two attempts at clinical assessment. Successful aspects of separate attempts at clinical assessment are unable to be aggregated in order to achieve an overall pass.

> If Interns have not passed clinical assessment after the second attempt, this will result in removal from the Clinical Internship

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Programme. They will need to consolidate for a minimum of six months before re-applying.

> The appeal process is outlined in the ‘appeals’ section of this document.

For information on RSI clinical assessment, refer to the ‘RSI endorsement’ section of this prospectus.

Clinical Internship: Clinical supervision phase

> Interns can progress to clinical supervision once they have successfully completed clinical assessment.

> Clinical supervision is a period where the Intern will work independently with remote supervision from their Preceptor.

> When an Intern moves to the clinical supervision phase, they will:

– Practice independently within the scope of their provisional ATP (noting they are encouraged to have a low tolerance for seeking clinical advice).

– Wear the appropriate Intern epaulettes to ensure easy identification in all clinical settings.

– Continue to work with their Preceptor on a regular basis to review learning objectives and discuss cases.

> Clinical supervision will last for six months and allows the Intern to consolidate clinically while remaining under close review (to further develop clinical reasoning and decision making).

Clinical Internship: Clinical discussion phase > Provisional ATP will remain in place for six months. > At the completion of this six months, you will be required to submit a

portfolio of evidence and attend a clinical discussion with the Clinical Director or Deputy Clinical Director, and one or two Clinical Support Officers.

> The clinical discussion will be based off one of the six case studies provided in your portfolio of evidence.

> This clinical discussion can be done in a face to face meeting or via teleconference.

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> Successful completion of the clinical discussion will complete the internship and ATP will automatically be issued.

Further information on the Clinical Internship ProgrammeFor more information about the Clinical Internship Programme:

> Email the Clinical Internship Manager at clinicalinternship@stjohn.org.nz.

> Read the Clinical Internship Programme overview document. > Visit the Clinical Internship Programme page on Heartbeat.

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Appeal against assessment or course removal if appropriate

The process for appealing against an assessment or course removal

> If personnel perceive that an assessment is unfair, invalid, inconsistent, or punitive, they have the right to appeal.

> The appeal must be submitted ahead of the individual’s next assessment.

> If the appeal relates to the first attempt at an assessment, then it must be made before the remedial action plain is agreed and signed.

> Personnel must notify their lead Clinical Support Officer in writing within ten business days of the assessment. If the individual does not have a lead Clinical Support Officer, then clindevhelp@stjohn.org.nz should be emailed.

> The lead Clinical Support Officer will discuss the concern with the individual, and if the situation cannot be resolved by conversation, then the individual should appeal in writing to the Clinical Programme and Moderation Team using the appeal application form CDT053.

Appeals

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> Once the Clinical Programme and Moderation Team receive the appeal, the individual’s direct line manager and Territory Manager (or equivalent) will be notified.

> The Clinical Programme and Moderation Team will review all the assessment material, including (but not limited to):

– Assessment sheets. – Online records and work. – Written material. – Audio files. – Video files.

> A decision will be made, or a meeting will be arranged at a mutually agreeable time within ten business days of receiving the appeal form.

> If a meeting is arranged, this will be between the individual and a Clinical Team representative (commonly the Clinical Programme and Moderation Team, a Clinical Practice Manager, or a Clinical Team Manager). The individual may choose to bring up to two support people if they wish.

> The meeting will be carried out in a conciliatory manner and in accordance with St John HR policy. The purpose of the meeting will be for the individual to state their case and for the Clinical Team representative to present the findings of the review conducted to date. It is likely that there will be further investigation subsequent to the meeting.

Process after a review decision has been reached

> If the appeal is upheld, the results of the assessment will be entered into the individual’s record.

> As a result of the appeal being upheld, the individual may have:

– Their assessment outcome overturned, or – Their assessment attempt voided and an additional attempt at the

assessment may be allowed, or – An apology may be offered.

> If the appeal is dismissed and the individual is not satisfied with the outcome, then they must notify the Clinical Programme and Moderation Team within 20 working days. Upon receiving this

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notification, the Clinical Programme and Moderation Team will escalate the appeal to the Assistant Director – Clinical Delivery and Support who will review the appeal to determine whether further review is appropriate.

> If required, a review panel will be formed. This will usually consist of:

– The Deputy Chief Executive – Ambulance Operations (or delegate). – A General Manager. – The Clinical Director (or delegate) – The Assistant Director of Operations – EAS (North or South) or a

District Operations Manager (from another area of the country). – The Head of Patient Safety and Quality.

> The panel will review the investigation conducted by the Clinical Programme and Moderation Team and make a final and binding decision. Specialist advice may also be sought from a third party (for example, People and Organisational Strategy) if required. This will occur within two months of escalation to the Assistant Director – Clinical Delivery and Support.

> Note that the review panel will only be formed where there is some possibility that further review of the appeal may result in a different decision, or if the circumstances are unusual. In other circumstances, the appeal will be declined by the Assistant Director – Clinical Delivery and Support and this final decision is binding.

Appeal against an advanced driving assessment (ADA) result

> Advanced Driving Assessments are subject to the same moderation processes currently utilised elsewhere in the Clinical Team and appeals will follow the process outlined within this prospectus.

> EROAD will be used to support ADAs in the case of moderation or appeal.

> If personnel believe that any assessment result is unfair and cannot be resolved by conversation then they may appeal in writing to the Clinical Programme and Moderation Manager using the CDT053 form.

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Appeal against a clinical assessment

The process for appealing against a clinical assessment

> If personnel choose to appeal an assessment, this must be submitted in writing to the Clinical Programme and Moderation Team using the appeal application forms CDT052 (if it is an appeal relating to process) and CDT053 (if it is an clinical- related appeal) within ten business days of the assessment.

> Once the Clinical Programme and Moderation Team receive the appeal, the individual’s direct line manager and Territory Manager (or equivalent) will be notified.

> The Clinical Programme and Moderation Team will review all the assessment material, including (but not limited to):

– Assessment sheets. – Online records and work. – Written material. – Audio files. – Video files.

> Clinical appeals may be presented by the Clinical Programme and Moderation Team to the ATP Credentialing Committee and may take up to six weeks to provide a review decision.

> Process appeals will be reviewed by the Clinical Programme and Moderation Team and may take up to four weeks to reach a review decision.

The process once a review decision has been reached

> If the appeal is upheld the results of the assessment will be entered onto the individual’s record. As a result of the appeal being upheld, the individual may have:

– The assessment outcome overturned, or – The assessment attempt voided and an additional attempt at the

assessment may be allowed, or – An apology may be offered.

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> If the appeal is dismissed and the individual is not satisfied with the outcome, then they must notify the Clinical Programme and Moderation Team within 20 working days. Upon receiving this notification, the Clinical Programme and Moderation Team will escalate the appeal to the Assistant Director – Clinical Delivery and Support who will review the appeal to determine whether further review is appropriate.

> If required, a review panel will be formed. This will usually consist of:

– The Deputy Chief Executive – Ambulance Operations (or delegate). – A General Manager. – The Clinical Director (or delegate). – The Assistant Director of Operations – EAS (North or South) or a

District Operations Manager (from another area of the country). – The Head of Patient Safety and Quality.

> The panel will review the investigation conducted by the Clinical Programme and Moderation Team and make a final and binding decision. Specialist advice may also be sought from a third party (for example, People and Organisational Strategy) if required. This will occur within two months of escalation to the Assistant Director – Clinical Delivery and Support.

> Note that the review panel will only be formed where there is some possibility that further review of the appeal may result in a different decision, or if the circumstances are unusual. In other circumstances, the appeal will be declined by the Assistant Director – Clinical Delivery and Support and this final decision is binding.

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Feedback and complaints

Feedback

> St John welcomes feedback on all clinical courses. > Learners may be invited to complete a course evaluation at the end

of a course to enable continuous improvement in course content and delivery.

> Outside of a course evaluation, personnel may provide feedback about any course to clindevhelp@stjohn.org.nz.

Complaints

> All complaints will be dealt with confidentially and every effort will be made to come to a satisfactory resolution.

> If personnel have a complaint about any aspect of a course, in the first instance they should verbally report these concerns to a Clinical Support Officer. If appropriate, the Clinical Support Officer will respond to the complaint at that time, and the complaint may be resolved.

> If the complaint is not able to be resolved, personnel may submit the complaint in writing to the relevant Clinical Practice Manager. This complaint should be submitted within 48 hours of the original complaint.

Feedback and complaints

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> The Clinical Practice Manager will then appoint a nominee who will arrange a meeting within five working days of the date on the written complaint. The goal of this meeting is the resolution of any issues raised within the complaint. Both the individual and the Clinical Support Officer may have a support person at the meeting.

> When resolution of the complaint is not achieved between the individual and the Clinical Support Officer, the matter will be reviewed by the relevant Clinical Practice Manager. The outcome of this review will be determined within one week, and all parties will be informed.

> If the issue has still not been resolved, the Clinical Practice Manager will refer this to the Assistant Director – Clinical Delivery and Support for review and determination of an outcome.

Quality management system (QMS) > St John must meet its own quality criteria as well as those applied by

the New Zealand Qualifications Authority (NZQA) and the Industry Training Organisation (ITO) for the Ambulance Sector Skills.org.

> All learners are subject to the policy contained within the St John:

– Operations Manual, and – Clinical Prospectus, and – People & Capability policies, and – Any associated documents.

> These documents inform and remind learners of the policies that may regularly affect them during course attendance.

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MySitrepThe MySitrep platform is available to personnel who hold a clinical practice level and is designed primarily to track clinical learning and maintenance. There are a variety of functionalities on MySitrep currently, with more currently under development. The functionalities available now include:

> Tracking patient contacts

– The MySitrep portfolio will display the number of patient contacts in the previous 12 months.

– Each contact is listed displaying:

• The primary clinical impression. • Job number. • Patient age, status and sex. • The ability to create a journal relating to the job. • The option to view more job details, including chief

complaint, date attended, interventions performed, medicines administered, initial and final patient status, and a link to eTriage.

Other clinical learning resources

St John Clinical Prospectus | 77

> Tracking patient contact hours. This is a display of the time spent in contact with a patient, that is, the time from locating at a scene to clearing from the incident.

> Tracking medicines and interventions performed. The MySitrep portfolio will display each medicine administered and intervention performed by the individual, including the number of times each has been performed/administered.

> Viewing the latest QCPR score. During CCE, personnel are required to perform two minutes of continuous chest compressions on a QCPR manikin. The Clinical Support Officer observing will upload the individual’s score to their portfolio.

> Viewing the latest Advanced Driving Assessment. When personnel undergo an ADA, the assessment template (also available here on the Clinical Wiki) is embedded into MySitrep and will be filled in by the CSO/ Driving Instructor conducting the assessment. The result of the ADA, and the date it was undergone will be listed in each individual’s MySitrep portfolio.

> Development of case logs and reflective logs. Personnel have the ability to fill in a case log for any patient contact they have had, or a reflective log on any incident attended/learning experienced. There is also the ability to do a ‘quick reflection’, where individuals can note down thoughts on an incident attended, with the intention of writing a full reflective log later.

> Creation of an individual profile. This is an area where personnel can write a personal statement about who they are as a clinician. There is also the option to add relevant qualifications, relevant experience, and awards and achievements.

> ‘Book a seat’ in a CCE session. MySitrep is the platform through which personnel can book in to attend their required CCE. In the future, this is likely to extend to enrolment/registration for other clinical courses.

> The ability to log any relevant independent learning and/or check in to a St John education session. This adds to your record of learning and ensures you are able to log learning you choose to do outside of St John time (for example, conference attendance or tertiary study).

> The ability to export the portfolio to a PDF. This enables personnel to export all relevant information within their MySitrep portfolio into an aesthetically pleasing PDF.

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> Viewing Clinical Support Officer contacts. Where personnel have had a Clinical Coaching contact, and the Clinical Support Officer has written notes or feedback, this is able to be viewed by the individual.

> Link to OnDemand. The OnDemand aspect of MySitrep is in the early days of development and will contain multiple interactive learning activities in the future.

Online Learning Campus > The St John online learning campus is a learning management

system (LMS) platform accessed via Heartbeat (listed in Quick Links). It contains a bank of online learning activities and other clinical resources and is available to St John personnel 24/7.

> The campus helps to deliver and track completion of compulsory online learning activities as part of a clinical course (for example, Ambulance Driving or Operations Risk Management).

> It also hosts other non-operational learning activities and learners are given access on an as required basis (usually the first 30 days of employment with St John).

> The Clinical Team has commenced a transition away from using the campus, and towards the Clinical Wiki and MySitrep platform instead. Personnel are advised to refer to the clinical resources on the Clinical Wiki and MySitrep as a priority and engage with online learning activities on the campus only as directed.

Clinical WikiThe Clinical Wiki is an online platform accessible to St John personnel, and contains a multitude of resources for furthering and refreshing clinical knowledge. The type of resources available on the Clinical Wiki include (but are not limited to) articles, podcasts, skill sheets, instructional videos, lectures, quizzes, patient pathways and internal publications (such as Clinical Focus, Education Station, and the 12 lead ECG compendium).

The range of topics is immense, and all resources are divided into libraries:

> Anatomy and physiology. > Pharmacology. > Patient pathways.

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> Clinical Procedures and Guidelines. > Clinical Focus database. > Equipment, skills, and treatment tips. > Medical conditions. > Trauma. > Miscellaneous. > Staff education and wellbeing. > Important notices (Safety Alerts and Clinical Updates).

Other Clinical Wiki functionalities include:

> Being able to ask any question by clicking on the ‘ask’ button. This question is subsequently sent by email to a monitored Clinical Wiki inbox.

> Being able to write and submit your own article for potential publication by clicking on the ‘contribute’ button.

> The Wiki banner on the home page. This is updated regularly and is designed to draw attention to new additions to the Clinical Wiki, or other important clinical messaging.

How to access the Clinical Wiki:

> Go direct to the Clinical Wiki website at wiki.stjohn.org.nz. You will need to log in using your St John username and password when prompted.

> Via Heartbeat, either by searching ‘Clinical Wiki’ or by going to ‘Quick Links’.

> Via the St John CPG app, in the ‘more’ tab.

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Clinical FocusClinical Focus is a magazine published by the Clinical Innovation and Learning Team approximately four times per year and is specifically developed for clinical personnel. It contains information and articles on case studies, pathophysiology, emerging evidence, clinical audit, ‘great saves’ (real incidents attended by ambulance personnel on the road), treatment tips, patient pathways, upcoming courses and/or clinical resources, clinical equipment, and much more.

All previous issues are available here on the Clinical Wiki.

Clinical appsAs well as a paper-based version of the Clinical Procedures and Guidelines (and First Responder Field Guide), personnel can download and use the CPG app and/or First Responder Field Guide app to their smartphone, or access them via the ePRF/MDT tablets.

CPG app

> The CPG app is designed for personnel who have an authority to practise at EMT or above and is based on the pocket edition of the CPGs.

> It can be downloaded from here on the Clinical Wiki. Only those with a St John username and password can download and use the CPG app.

ClinicalFocus

Winter

Issue 22 | August 2020

5 Non-transport during level four

14 Winter blues 23

Mountain rescue 26 Inside perspectives of Indian culture

ClinicalFocus

Back to the future

Issue 19 | October 2019

8 New Zealand

Chinese culture

10 Where to

next?

17 Pressure injury

prevention

26 Cardiac arrest:

1999 vs. 2019

ClinicalFocus

Chemical, Biological & Radiation

Issue 17 | April 2019

8 Exposure to gases, fumes or

solvents

12 Adrenaline in

cardiac arrest

20 Measurement

and treatment of

pain

22 Major incidents –

Lessons from the

front line

ClinicalFocus

Animals

Issue 20 | December 2019

6 When time equals brain cells

18 Snakes on an ambulance!

21 Attending a job on a farm

27 The benefit of furry friends

St John Clinical Prospectus | 81

> The CPG app contains:

– Dynamic flow charts for each procedure (the text colour changes depending on the clinical practice level selected on the app home page, to make it clear what personnel can/cannot do).

– Red flag tables and checklists. – Medicine calculator (dosing changes depending on the patient

weight selected on the app home page). – Quick links to contact the Clinical Desk or Air Desk, request/

notification codes, safety alerts, clinical updates, podcasts, MySitrep, and Peer Support.

– A hospital directory, which is tailored to the location selected (personnel can turn location services on if they choose, or manually select their location). This in turn provides important information on hospitals in that area, such as address, opening hours, capabilities (e.g. whether it is PCI capable, or a designated major trauma hospital), and contact numbers.

– The ability to provide feedback on the app itself.

> There is also a PRIME version of the CPG app which can be downloaded from the PRIME website.

First Responder Field Guide app

> This app is designed for personnel who have a clinical practice level at First Responder, and Emergency Medical Assistants without an authority to practise. It can be downloaded from here on the Clinical Wiki.

> It is based on the paper-based version of the First Responder Field Guide.

> This app contains procedures, skill lists, and checklists that provide guidance on treating patients when personnel with ATP are not present. It also has links to contact the Clinical Desk or Air Desk, and the ability to feedback on the app itself.

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Clinical email addresses

Clinical excellence

> The clinical.excellence@stjohn.org.nz address is where personnel can send clinical questions/queries relating to clinical equipment, clinical research, Clinical Procedures and Guidelines, medicines/interventions, patient pathways and other clinical messaging (for example, Clinical Updates and Safety Alerts).

> From time to time, a call for feedback on a specific topic may be requested on a podcast or through other communication avenues. Often, this feedback is asked to be sent to the clinical excellence inbox.

> Note that this inbox is not monitored daily and so response times may vary, but we will endeavour to answer every email.

Clinical development help

> The clindevhelp@stjohn.org.nz address is where personnel can send queries relating to clinical courses, such as course registration or enrolment, course feedback, and submission of workbooks (as instructed by your lead Clinical Support Officer).

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Notes

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