Diploma in Immediate Medical Care

The Royal College of Surgeons of Edinburgh

SYLLABUS
FROM AUGUST 2009

Dr R J Fairhurst
Convenor Diploma in Immediate Medical Care

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CLINICAL DOMAIN

PATIENT EXAMINATION AND DIAGNOSIS

TREATMENT PLANNING AND PATIENT

MANAGEMENT

HEALTH PROMOTION AND DISEASE/INJURY

PREVENTION

THE INITIAL MANAGEMENT OF EMERGENCIES

CARDIAC CONDITIONS

HEAD, BRAIN AND SPINAL INJURIES

THERMAL INJURIES

THE ADVERSE ENVIRONMENT

TOXICOLOGY

MASS CASUALTIES

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CLINICAL DOMAIN

LIFE THREATENING MEDICAL CONDITIONS

MUSCULO-SKELETAL CONDITIONS

PREGNANCY, CHILDBIRTH AND NEONATAL

RESUSCITATION

ASSESSMENT RESUSCITATION AND CARE OF

THE CHILD

PAIN

EMOTIONAL CARE

PERSONAL PREPARATION

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COMMUNICATION DOMAIN

COMMUNICATION WITH THE PATIENT AND

FAMILY

COMMUNICATION WITH THE CLINICAL TEAM

AND PEERS

COMMUNICATION WITH OTHER

PROFESSIONALS

PROFESSIONAL DOMAIN

ETHICS

PATIENTS

SELF

CLINICAL TEAM AND PEERS

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MANAGEMENT AND LEADERSHIP
DOMAIN

PERSONAL AND PRACTICE

ORGANISATION

LEGISLATIVE

FINANCIAL

LEADERSHIP AND MANAGEMENT

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 Clinical Domain
Major Supporting Competencies
Competency
The Candidate can demonstrate to an appropriate standard the ability to:
(1) 1 Obtain, interpret and record an accurate history that incorporates if
appropriate, mechanism of injury, medical, drug, social, nutritional,
psychological and genetic factors
Patient 2 Identify from the patient upon examination, the symptoms and principle
Examination and problems in relation to the relevant history
Diagnosis 3 Perform a comprehensive examination that is appropriate to the
circumstances and accurately record the findings through communication
with or without a supporting healthcare professional
4 Assess the condition of the patient accurately and identify conditions which
may require urgent treatment or transport to an appropriate facility
5 Generate a differential diagnosis and treatment/management plan based
on evidence through the correct interpretation of clinical findings
6 Assess the influence of systemic diseases and other disabilities (and
associated treatment) on the patient’s condition
7 Keep clinical records (conventional or electronic) in line with recognised
standards
The Candidate can describe in appropriate detail:
8 The signs of abuse or neglect in vulnerable groups and the local procedures
that should be followed when reporting such circumstances
9 The spectrum of patient behaviour which may modify or contribute to the
problems presented
10 The assessment processes required prior to the undertaking of pre-
hospital anaesthesia

Major Supporting Competencies

Competency
(2) The Candidate can demonstrate to an appropriate standard the ability to:
1 Formulate treatment plans appropriate to the injuries or illness of the
Treatment Planning patient
& Patient 2 Discuss management plans with the patient in a manner they can
Management understand
The Candidate:
3 Can obtain valid consent for any proposed action
4 Is able to effectively manage situations where the patient’s wishes and the
proposed actions differ

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 Clinical Domain

Major Supporting Competencies

Competency
(3) The Candidate can demonstrate:
1 Knowledge and understanding of the relationship between human
Health Promotion & behaviour and accidents
Disease/Injury 2 Knowledge and understanding of the prevention of acute medical
Prevention conditions and accidents
The Candidate can:
3 Provide preventative education for the population in a manner they can
understand
4 Describe in appropriate detail the health and injury risks of alcohol and
illegal substances
5 Provide health promotion advice within the contexts of diverse social
norms and value the diversity and ethnicity of the population

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 Clinical Domain
Major Supporting Competencies
Competency
(4) The Candidate can demonstrate:
1 A thorough understanding of the aims of pre-hospital care
2 An awareness of the role of all the providers of pre-hospital care
The Initial 3 An awareness of the mechanism s of injury, the kinetics of an accident and
Assessment and predict injury patterns
Management of 4 An awareness of the medico legal and potential forensic aspects of patient
Emergencies assessment
5 An understanding of the principles of the primary survey and the
limitations of the secondary survey in Pre-hospital care
6 An awareness of the problems of airway management
7 An understanding of the appropriate use of pre -hospital anaesthesia
8 An awareness of the principles of the respiratory system and the
conditions of respiratory failure and respiratory arrest
9 An Understanding of the principles of oxygen therapy including safety and
monitoring
10 An understanding of the concept of shock and its classification
11 Knowledge of the principles and practice of fluid replacement including
permissive hypotension.
12 An understanding of the principles of haemorrhage control including
haemostatic agents
The Candidate can demonstrate to an appropriate standard:
13 The maintenance of a clear airway in an obtunded patient.
14 The use of postural methods of airway control
15 The use of oropharyngeal nasopharyngeal airways, endotracheal tubes
and laryngeal mask airways
16 The use of surgical airways
17 The use of expired air resuscitation, the pocket mask and the bag-valve-
mask in the management of obtunded breathing
18 The management of acute asthma
19 The management of life threatening chest injuries
20 The management of major haemorrhage
21 The practice of adult basic life support including the recovery position, as
described by the Resuscitation Council (UK)
22 The practice of Advanced Life support, as described by the Resuscitation
Council (UK)
23 Methods of obtaining vascular access
24 An understanding of the management and tasking of the ambulance
service
25 The principles and practice of safe extrication of patients

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 Clinical Domain
Major Supporting Competencies
Competency
(5) The Candidate can demonstrate:
1 An understanding of the main heart conditions causing emergency
problems
Cardiac Conditions 2 An understanding of the principles and management of chest pain
3 An understanding of the principles and treatment of heart failure
4 The identification and treatment of patients with ECG abnormalities in pre-
hospital care
5 The safe use of a defibrillator

Major Supporting Competencies

Competency
(6) The Candidate can demonstrate:
1 An understanding of the principles of the Pre Hospital Management of the
Head, Brain and head injured patient
Spinal Injuries 2 An understanding of the pathophysiology of primary and secondary head
injuries
3 An awareness of the importance of spinal injury and its recognition
The Candidate can demonstrate to an appropriate standard:
4 The assessment and monitoring of a head injured patient
5 The early management of a spinal injury
6 The use of spinal immobilisation devices
7 The removal of a motorcyclist’s helmet

Major Supporting Competencies

Competency
(7) The Candidate can demonstrate:
1 An understanding of the classification of burns by agent, size and depth
Thermal injury 2 An awareness of the causes and management of frostbite
The Candidate can demonstrate to an appropriate standard:
3 The sizing and treatment of burns including airway burns

Major Supporting Competencies

Competency
(8) The Candidate can demonstrate:
1 An understanding of the nature and causes of hypothermia
The Adverse 2 An awareness of the degrees of hypothermia and their treatment
Environment 3 An understanding of the presentation and management of heat cramp,
heat exhaustion and heat stroke
4 An understanding of the treatment of the drowned patient

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 Clinical Domain
Major Supporting Competencies
Competency
(9) The Candidate can demonstrate:
1 An understanding of the Pre Hospital presentation and management of
Toxicology patients with poisoning
2 An understanding of the principles of a CBRN(chemical, biological,
radiological and nuclear) incident
The Candidate can demonstrate to an appropriate standard:
3 The management of a CBRN incident

Major Supporting Competencies

Competency
(10) The Candidate can demonstrate:
1 An understanding of the principles of Triage
Mass Casualties 2 An awareness of other agencies and their role
3 An understanding of the national guidelines for the management of major
incidents
4 An awareness of the national guidelines on emergency preparedness
The Candidate can demonstrate to an appropriate standard:
5 The tabletop management of a major incident

Major Supporting Competencies

Competency
(11) The Candidate can demonstrate:
1 An awareness of the presentation and immediate management of
Life Threatening anaphylaxis
Medical Conditions 2 An awareness of the presentation and immediate management of
convulsions
3 An awareness of the presentation and immediate management of
septicaemia including meningitis
4 An awareness of the presentation and immediate management of hypo
and hyper glycaemia
5 An awareness of the presentation and immediate management of stroke
and transient ischemic attacks

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 Clinical Domain
Major Supporting Competencies
Competency
(12) The Candidate can demonstrate:
1 The management of extremity trauma
Muscular Skeletal 2 The management of fractures and dislocations
Conditions 3 The management of open wounds
4 The management of amputations
5 The management of vascular injury
6 The management of crush injury
7 The management of pelvic injury
The Candidate can demonstrate to an appropriate standard:
8 Splintage of the upper and lower limbs and the pelvis

Major Supporting Competencies

Competency
(13) The Candidate can demonstrate:
1 An awareness of the effects of pregnancy on the body and the way this
Pregnancy, may change the assessment and treatment of the injured mother
Childbirth and 2 An understanding of the management of the main emergencies in
Neonatal pregnancy miscarriage, ectopic pregnancy, bleeding and eclampsia
Resuscitation 3 An understanding of the principles of emergency childbirth and field
delivery
4 An awareness of the principles of the resuscitation of the new born

Major Supporting Competencies

Competency
(14) The Candidate can demonstrate:
1 An awareness of the major differences between children and adults
Assessment, affecting resuscitation
Resuscitation and 2 An awareness of the signs of impending respiratory and circulatory failure
Care of the Child in a child
3 Knowledge of the presentation and immediate management of common
life threatening illnesses of childhood
4 Knowledge of the care needed to reduce the likelihood of deterioration of
the very sick child
The Candidate can demonstrate to an appropriate standard:
5 Basic life support for children
6 Advanced life support for children
7 The treatment of choking in infants and children

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 Clinical Domain
Major Supporting Competencies
Competency
(15) The Candidate can demonstrate:
1 An understanding of the causes of pain and the importance of its relief
Pain 2 An awareness of the main methods for relieving pain
3 An awareness of the advantages and disadvantages of Pre Hospital
Anaesthesia

Major Supporting Competencies

Competency
(16) The Candidate can demonstrate:
1 An awareness of stress as it affects pre-hospital care
Emotional Care 2 An understanding of the principles of debriefing and emotional support

Major Supporting Competencies

Competency
(17) The Candidate can demonstrate:
1 An awareness of the personal protective equipment in pre-hospital care
Personal 2 An ability to discuss the choice of equipment for use in pre-hospital care
Preparation 3 A knowledge of infection control in pre-hospital care

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 Communication Domain
Major Supporting Competencies
Competency
The Candidate can demonstrate:
(1) 1. Increase patient awareness and understanding by careful explanation of
treatment options and procedures, and the use of effective communication
Patient &Family skills.
2. Inspire confidence in patients (from all age groups and situations) through
the use of effective interpersonal and communication skills.
3. Present questions to the patient (or carer) in a clear, concise and
understandable manner.
4. Communicate bad news and / or refer patients from different age groups
or situations for specialised treatment in a sensitive manner that causes
the least anxiety possible.
5. Communicate effectively with relatives in a manner which respects the
patient’s dignity, confidentiality and self image.
6. Select and compose a suitable style of written communication that is
appropriate for the patient and / or guardian in different clinical scenarios.
7. Address challenging situations including the effective management of
anger, confusion or misunderstanding of patients.
8. Provide appropriate, relevant and up to date preventive education to
individual patients in a manner that inspires motivation for change.
9. Can identify patients (or carers) with special communication needs and is
able to make arrangements to meet these requirements effectively.
10. Can demonstrate to an appropriate standard the effective management
of all patients through the use of suitable interpersonal & behavioural
skills, including those with anxiety or other special needs.
11. Listens effectively and is responsive to non-verbal cues

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 Communication Domain
Major Supporting Competencies
Competency
The Candidate can demonstrate:
(2) 1. Work effectively as part of a team.
2. Interact effectively with members of the clinical team & peers and
Clinical Team describe how each can contribute to patient care.
& Peers The Candidate:
3. Provides treatment for patients from all age groups and situations in an
organised and efficient manner through appropriate interaction with other
members of the clinical team.
4. Communicates with all members of the clinical team & peers in an
appropriate manner, which inspires confidence, motivation and teamwork
5. Is able to interact with all members of the clinical team and peers to an
appropriate standard, in practice policies, rules and regulations, health &
safety procedures and appropriate clinical techniques.
6. Understands the need for, and can organise and facilitate, team training
events.
7. Work effectively as part of a team.
8. Interact effectively with members of the clinical team & peers and
describe how each can contribute to patient care.
9. Provides treatment for patients from all age groups and situations in an
organised and efficient manner through appropriate interaction with other
members of the clinical team.

Major Supporting Competencies

Competency
The Candidate can demonstrate:
(3) 1. Communicate effectively with other professionals verbally and in writing.
2. Present professional knowledge effectively to a wide range of lay and
Other professional individuals.
Professionals The Candidate:
3. Communicate effectively (verbally and in writing) with referral bodies, and
a willingness to seek advice when necessary.
4. Discuss professional matters in an appropriate manner.
5. Communicate effectively (verbally and in writing) with relevant healthcare
institutions.
6. Is able to explain the advantages of association with professional bodies
and peer groups.

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 Professional Domain
Major Supporting Competencies
Competency
The Candidate can demonstrate to an appropriate standard:
(1) 1. An understanding and the application of the principles of General Medical
Council (GMC) / Nursing and Midwifery Council (NMC) / (HCPL)
Ethics publications on standards for professionals, that provide guidance on
professional and personal conduct.
2. An understanding and the application of the principles of ethical behaviour
relevant to Pre-hospital care, including honesty, confidentiality, personal
and professional integrity and appropriate moral values.
3. A professional approach to patient complaints and accepts responsibility
for his/her actions where appropriate.
The Candidate:
4. Respects and values diversity and interacts with patients, staff, peers and
the general public without discrimination
5. Is able to explain in appropriate detail the actions available to be taken
with regard to those colleagues who are underperforming or behaving
unethically.
6. Can demonstrate appropriate interpersonal skills in dealing with difficult
patients or colleagues whose behaviour is unprofessional.

7. Adheres to appropriate guidelines where necessary.

Major Supporting Competencies

Competency
The Candidate:
(2) 1. Provides compassionate care for all patients.
2. Demonstrates effective and ethical decision making.
Patients 3. Provides treatment for all patients with courtesy and respect, provides
treatment options that are sensitive to the needs of the patient, and
recognises the patients’ right to choose.
4. Maintains honesty and confidentiality with all patients.
5. Interacts with patients without discrimination.
6. Maintains the confidentiality and security of patient records, with respect
to contemporary legislation.
7. Regularly reviews the outcomes of treatment given in an effort to provide
the highest standards of patient care, and understands the importance of
clinical audit and its regular implementation.
8. Provides relevant and appropriate preventive education for each patient in
a manner that he / she can understand.

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 Professional Domain
Major Supporting Competencies
Competency
The Candidate can demonstrate to an appropriate standard:
(3) 1. A thorough understanding of the professional responsibility of a
Healthcare Professional and his/her role within and outside the NHS.
Self 2. A commitment to Continuing Professional Development (CPD) through
regular efforts to update and improve knowledge and skills, and the
incorporation of these skills into everyday practice.
3. An understanding of the importance of Continuing Professional
Development within Pre-hospital care and its recording.
4. The ability (and commitment) to self assess and reflect upon his/her own
capabilities and limitations in order to provide the highest standards of
patient care
5. The ability to critically evaluate new techniques and technologies.
6. The ability to critically evaluate published research and integrate this
information to improve the quality of care for the patient.
7. The ability to recognise, integrate and reflect on learning opportunities
within the workplace.
8. Knowledge and understanding of the principles involved in clinical audit
and peer review, and is willing to participate in such activities.
9. Knowledge and understanding of the value of performing and receiving
appraisal.
The Candidate:
10. Understands the significance of practising while impaired by alcohol, other
drugs, illness or injury and can describe the dangers associated with these
situations.
11 Is aware of the issues regarding the safe use of motor vehicles in an
emergency and the laws relating to them

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 Professional Domain
Major Supporting Competencies
Competency
The Candidate can demonstrate:
(4) 1. Is able to explain in appropriate detail the actions available to be taken
with regard to incompetence, impairment or unethical behaviour from
Clinical Team colleagues.
& Peers 2. Interacts with patients, colleagues, team members and peers without
discrimination.
3. Is respectful and co-operative with colleagues, staff and peers, and can
demonstrate a commitment to the maintenance of high levels of
professionalism, training and safety for staff.
4. Understands the dynamics of multi-professional working and how these
can contribute to the delivery of quality patient care.

Leadership and Management Domain

Major Supporting Competencies
Competency
The Candidate can demonstrate to an appropriate standard:
(1) 1. The efficient management of time and resources on a daily basis.
2. An understanding of the organisation of the Emergency Services.
Personal & 3. An understanding of different professional working and contractual
Practice agreements.
Organisation 4. The full, accurate and secure maintenance of patients’ records.
5. An understanding of the considerations to be made during the selection,
care and maintenance of equipment for Pre-hospital care.
6. An understanding of the requirements for and processes involved in risk
assessment within the workplace and resultant action.
7 An understanding of the need for safety to be paramount and the methods
to ensure this is maintained.
8 An understanding of the principles of safe moving and handling as they
relate to the pre-hospital care.
9. The prioritisation of professional duties effectively and appropriately when
faced with multiple tasks and responsibilities.
10. The effective use and understanding of relevant IT systems.
11 The analysis of patient safety incidents and the development of strategies
(e.g. significant event analysis) to reduce the risk of reoccurrence.
12. The use of research data and evidence-based knowledge in his or her
approach to clinical practice.
The Candidate can describe in appropriate detail:
13. The procedures for local, critical, incident reporting systems.

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 Leadership and Management Domain
Major Supporting Competencies
Competency
The Candidate:
(2) 1. Takes an appropriate responsibility for health and safety issues in Pre-
hospital care, including those relating to patients, oneself and Health Care
Legislative Professionals. The Candidate has up-to-date knowledge and understanding
of infection control procedures and is competent in the implementation of
these in daily practice.
2. Has up-to-date knowledge and understanding of discrimination legislation.
3. Can describe in appropriate detail the principles of consent.
4. Can demonstrate appropriate knowledge and understanding of legislation
that impacts on Pre-hospital care.
The Candidate can demonstrate to an appropriate standard:
5. An understanding of the legal issues relating to health & safety and
infection control (including COSHH – Control of Substances Hazardous to
Health), and where to get additional information if necessary.
6. An understanding of the definitions of the legal & ethical obligations of a
Health Care practitioner and the definition of fitness to practice according
to the GMC, NMC & HCPC.
7. An understanding of grievance procedures and complaints, and how /
when to seek the advice of a professional indemnity organisation.
8. An understanding of the importance of membership of a professional
indemnity organisation.

Major Supporting Competencies

Competency
(3) The Candidate can demonstrate to an appropriate standard:
1. An understanding of business management and development including the
Financial ability to produce a business plan.

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Major Supporting Competencies
Competency
The Candidate:
(4) 1. Demonstrates effective leadership within the healthcare team, where
appropriate.
Leadership 2. Identifies opportunities for quality and safety improvement, and develops,
implements and evaluates strategies to improve quality where possible.
3. Understands the principles of adult learning, and facilitates the learning of
patients, families, carers, team members, other health professionals and
the public as appropriate.
4. Understands the role of being a mentor and role model for other members
of the healthcare team.
5. Understands how to act in the interests of patients who have been subject
to clinical harm or errors.
The Candidate can demonstrate to an appropriate standard the ability to:
6. Select, implement and evaluate the effectiveness of teaching strategies to
facilitate others’ learning.
7. Accept and provide effective feedback in a manner that motivates and
encourages learning.
8. Give an effective presentation that uses relevant teaching materials and is
targeted to the level of understanding and expectations of the audience.
9. Demonstrate skills and competencies to others in an effective manner

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