Supporting training and development: DipIMC practice questions

PHEM curriculum unit C.7 · Cross-cutting theme C: Clinical Governance

The DipIMC is blueprinted against phase 1 of the UK Pre-hospital Emergency Medicine (PHEM) curriculum. This page covers unit C.7, Support training and development.

Below are 2 free practice questions from the DipIMC.Ninja bank, in the Part A single best answer format. Every answer names the textbook page, guideline or statute it was written from, so you can check it rather than take it on trust. The bank holds 4 questions on this unit.

Question 1 · Law, Ethics & Human Factors · Moderate

At 02:00 a district general hospital needs to transfer an intubated, ventilated patient on a noradrenaline infusion to the regional neurosurgical centre. The only doctor free is a core anaesthetic trainee who has never undertaken an inter-hospital transfer, and the unit asks whether the trainee may escort the patient alone. What does the Intensive Care Society and Faculty of Intensive Care Medicine transfer guidance (2019) say about this?

AYes, provided a consultant is available by telephone throughout and the trainee has read the checklist
BYes, once a senior clinician has documented a risk assessment accepting the urgency of the transfer
CYes, if the trainee has completed a transfer e-learning module and the ambulance crew travels with them
DNo, only a consultant may escort a ventilated patient who is receiving a vasoactive infusion
ENo, staff without transfer training and competences should not undertake an unsupervised transfer

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Answer: E

No, staff without transfer training and competences should not undertake an unsupervised transfer

The ICS/FICM guidance requires all staff involved in transfers to be able to demonstrate the competences appropriate to their role, and states that staff without the appropriate training and competences should not undertake unsupervised transfers. It expects staff to receive training in transfer medicine and to gain experience in a supernumerary capacity. A trainee who has never done a transfer and would travel alone meets none of this, however urgent the transfer — urgency is a reason to find a competent escort quickly, not to lower the standard. The patient is also high risk on the guidance's own risk tool (intubated and ventilated, requiring vasopressor support), which calls for a nurse or clinical practitioner plus a doctor or advanced practitioner with critical care and advanced airway competences — so a lone escort is wrong on that ground too. Telephone advice, a checklist or an e-learning module does not make an untrained, unsupervised escort acceptable. The escort need not be a consultant: the tool specifies a doctor or advanced practitioner with the right competences.

Where this comes from

Guidance On: The Transfer Of The Critically Ill Adult (2019)Intensive Care Society and Faculty of Intensive Care Medicine·10.7 Recommendation 10: competences and unsupervised transfers“Staff without the appropriate training and competencies should not undertake unsupervised transfers.”Open PDF at page 16
Guidance On: The Transfer Of The Critically Ill Adult (2019)Intensive Care Society and Faculty of Intensive Care Medicine·10.7 Recommendation 9: training and supernumerary experience“have the opportunity to gain experience in a supernumerary capacity”Open PDF at page 16
Guidance On: The Transfer Of The Critically Ill Adult (2019)Intensive Care Society and Faculty of Intensive Care Medicine·Appendix 7: risk stratification, high risk“Doctor / Advanced Practitioner with critical care”Open PDF at page 36
Guidance On: The Transfer Of The Critically Ill Adult (2019)Intensive Care Society and Faculty of Intensive Care Medicine·Appendix 7: risk stratification, high-risk criteria“CVS unstable and / or requiring inotrope or vasopressor”Open PDF at page 36

law-092 · Law, Ethics & Human Factors · Clinical Governance · Moderate · v2

Question 2 · Law, Ethics & Human Factors · Easy

A paramedic who has just joined a BASICS scheme asks the scheme's training lead which trauma course to take next. The lead describes one course that, like Advanced Trauma Life Support (ATLS), was designed to teach hospital trauma management, but which places its emphasis on team leadership and concurrent activity rather than on ATLS's sequential approach, and which teaches much that is useful pre-hospital. According to the Oxford Handbook of Pre-Hospital Care, which course is being described?

APHTLS
BPHEC
CMIMMS
DETC
EFPOS

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Answer: D

ETC

The Oxford Handbook describes the European Trauma Course (ETC) as designed to reflect European practice more effectively than ATLS. Like ATLS it teaches hospital trauma management, but much of its emphasis is on team leadership and concurrent activity rather than the sequential approach of ATLS, and, like ATLS, it teaches much that is useful to the pre-hospital practitioner. Pre-hospital Trauma Life Support (PHTLS) was developed in the US as a pre-hospital course. Pre-hospital Emergency Care (PHEC) is the three-day course run jointly by BASICS, BASICS Scotland and the Faculty of Pre-hospital Care. Major Incident Medical Management and Support (MIMMS), developed by ALSG, is the standard major incident course. First Person on Scene (FPOS) is a Faculty award with knowledge and practical assessments. None of these is a hospital trauma course built around team leadership and concurrent activity.

Where this comes from

Oxford Handbook of Pre-Hospital Care
- Ch. 1 An approach to pre-hospital care · Other Faculty endorsed courses: European Trauma Course · p. 5“much of the emphasis is on team leadership and concurrent activity”
- Ch. 1 An approach to pre-hospital care · Other Faculty endorsed courses: Pre-hospital Trauma Life Support · pp. 4–7“Pre-hospital Trauma Life Support (PHTLS) training was also developed in the US”
- Ch. 1 An approach to pre-hospital care · Pre-hospital Emergency Care · pp. 4–7“The three-day Pre-hospital Emergency Care (PHEC) course and certificate is organized jointly by BASICS”
- Ch. 1 An approach to pre-hospital care · First Person on Scene · pp. 4–7“both knowledge and practical assessments have to be successfully completed”
- Ch. 1 An approach to pre-hospital care · Major Incident Medical Management and Support course · p. 7“Developed by the ALSG, the Major Incident Medical Management and Support course (MIMMS)”

law-093 · Law, Ethics & Human Factors · Clinical Governance · Easy · v3

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Supporting training and development: DipIMC practice questions

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