> For the complete documentation index, see [llms.txt](https://cgn.gitbook.io/sop/llms.txt). Markdown versions of documentation pages are available by appending `.md` to page URLs; this page is available as [Markdown](https://cgn.gitbook.io/sop/sop-fire-ems-department/als-training-guide.md).
# ALS Training Guide
**Paramedic Training**
The purpose of this training is to teach, as well as train, any EMT in skills and scenarios so that the EMT can successfully become a Paramedic. As a trainer, it is your responsibility to make sure that all subjects are covered.
**Classroom**
Go over the cheat sheet for both EMT and Medic as they will be using skills from both disciplines.
Make sure the trainees understand that as a medic, when they are the lead medic on a scene, they need to take control and as well as be confident in their abilities as a Paramedic.
Try to go in-depth on Assessment to see if you can’t pick their brain on what a common diagnosis for something would be.
**ALS treatment and things seen in the field**
Below are some things that are commonly seen in the field, go over each thing with the trainee and discuss the bullet points as well as pick their brain to see if they know any of this information. Do your best to show the trainee how to do some of the procedures and how we would do them in-game as well as teach them what is something they would possibly see to cause these injuries.
**Heart Attack**
* Heart attacks can come up with many different symptoms, some of the most common will be severe chest pain that may be radiating to their left arm.
* Vitals: BP will be elevated prior to the event then, during it, will drop.
* Make sure you RP that you get a 12-lead EKG ASAP when you get on-scene. This is what will determine if the person is having a heart attack or not due to the electrical activity in the heart being interrupted.
* If a patient has any kind of chest pain, make sure you recommend that you take them to the hospital due to the fact that, on-scene, you cannot completely determine if the patient is having a cardiac event, that can only be determined by drawing blood.
**Shock:**
**Traumatic Shock:**
* Usually during traumatic shock, the patient’s perfusion will be low so they will most likely be pale.
* Vitals: A patient's vitals will be odd to the normal person as their body is attempting to compensate for a bleed somewhere. Their BP will be low and their pulse will be elevated.
**Anaphylactic Shock:**
* The patient is most likely going to be swollen or having a hard time breathing
* Treatment: .30 mg epinephrine IV or IM or EPIPEN then transport
**Septic Shock:**
* Vitals: Temp >100.4, BP: Low, Pulse: could be elevated late signs
* Treatment: Fluid Bolus (get 2 IVs run wide open with saline)
**Stroke:**
* Strokes can present with different symptoms.
* Common stroke symptoms:
* * Sudden numbness or weakness in face, arm, or leg, especially on one side of the body.
* Sudden confusion, trouble speaking, or difficulty understanding speech.
* Sudden trouble seeing in one or both eyes.
* Sudden trouble walking, dizziness, loss of balance, or lack of coordination.
* Sudden severe headache with no known cause.
**Trauma**
**Pneumothorax (Collapsed Lung)**
* Patient will present with absent breath sounds from one side of their chest when you listen to it via stethoscope.
* If a patient has a puncture wound in their chest; that wound could be sucking. (i.e. air going into the chest cavity).
* Treatment: Occlusive Dressing, taped on 3 sides or, using a chest decompression needle or DART, insert into the patient chest below their clavicle and above the nipple line.
**Bleeding (Internal)**
* If the patient is showing signs of internal bleeding an easy medication that can be given is TXA which promotes clotting in the blood
* Internal bleeding can show as a rigid abdomen or a large amount of bruising
* Patient will look very pale as their perfusion is beginning to lack
* If you are on the **TEMS** you are capable of giving blood, this is one of the best ways to give more volume
* * If you are on the ambulance make sure you stop the bleeding before you give saline otherwise you will just dilute the blood
**Bleeding (External)**
* If an extremity is bleeding; tourniquet 3 inches above and, if bleeding doesn’t stop, you can always add another tourniquet. But use only if holding pressure with gauze doesn’t work.
* For anything bleeding under the diaphragm, use quikclot and stuff the wound to make sure the clotting portion of the quikclot reaches the source of the bleed
* Anything that could be bleeding in the chest area, use an occlusive dressing to keep air out.
* For bleeding in the neck, quikclot will work but you are best going to stop the bleeding if you physically stick your fingers in the wound and attempt to hold pressure at the source.
Emphasize if the patient is conscious and not seriously injured talking to them to see what’s wrong. A lot of what they will diagnose will come from what the patient says.
Like give them a quick scenario as a classroom
Give them the patient presentation and vitals as a civ would in game.
* Vitals
* What their injuries are
* You act as the patient
* Have however many trainees you have do it together.
* At the end, comment on what they could have done better and what they did well on
**Scenario**
* Set up an ALS scenario that the trainee will most likely see on a patrol anywhere where you see fit
* Have them respond from a station near where you set your scenario up as they would in patrol
* Observe the trainee as they work the scene; if they make a mistake, try and react to the mistake in the scenario so that they know they made a mistake and see if they try and correct it.
* After the scenario is complete, go over where the trainee did well as well as where they could have improved
**Post-Training**
**\* Location: Teamspeak**
* Go Over the Portion in the SOP
* Fly Car
* Tell the Recruit's they have to get Fly Car Cert. in order to drive the Fly Car
* Medflight
* Let the Recruits know they can go in Medflight as a Flight Medic
* At the end of the training, I would like you to highly encourage the trainee for their first few patrols as a paramedic to be with a Medic Trainer so that they can get help with field experience as a paramedic. If there are any concerns about a trainee direct them to the Fire COC. It is ultimately up to you as a trainer to make sure that the trainee is ready to do their job as a paramedic.
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