Mod-5 is the trauma module. This instructor thinks that this module should be taught before the assessment modules since much of this information is necessary for an EMT to perform a good trauma assessment. At my training center we have a 50 question written exam. We refer to this written exam as the "Hump". Mod-4 was the wall but this test is just a hard but the traditional course has less time to cover the material. There are 6 sub-modules in Mod-5 in this section and should take at least 19 hours to complete.
Lesson 5-1 Bleeding and Shock
Reviews the cardiovascular system, describes the care of the patient with internal and external bleeding, signs and symptoms of shock (hypoperfusion), and the emergency medical care of shock (hypoperfusion).
Lesson 5-2 Soft Tissue Injuries
Continues with the information taught in Bleeding and Shock, discussing the anatomy of the skin and the management of soft tissue injuries and the management of burns. Techniques of dressing and bandaging wounds will also be taught in this lesson.
Lesson 5-3 Musculoskeletal Care
Reviews of the musculoskeletal system before recognition of signs and symptoms of a painful, swollen, deformed extremity and splinting are taught in this section.
Lesson 5-4 Injuries to the Head and Spine
Reviews the anatomy of the nervous system and the skeletal system. Injuries to the spine and head, including mechanism of injury, signs and symptoms of injury, and assessment. Emergency medical care, including the use of cervical immobilization devices and short and long back boards will also be discussed and demonstrated by the instructor and students. Other topics include helmet removal and infant and child considerations.
Lesson 5-5 Practical Skills Lab: Trauma
Provides practice of the assessment and manage¬ment of patients with traumatic injuries.
Lesson 5-6 Evaluation: Trauma Module
Conducts a written and skills evaluation pf MOD-5 to determine the student's level of achievement of the cognitive, psychomotor and affective objectives from this module of instruction.
At our training center our practical test for Mod-5 consists of a 50 question written exam, a seated patient immobilization, a long-bone immobilization and a traction immobilization. Along the way we add in bandaging as part of the assessment. For the hands-on assessments we provide a small scenario for each station.
We test the seated patient in groups of 3 plus one live patient. We typically use a vest-type device (KED). We give our students a scenario similar to this:
"You and your partners are going to be evaluated in the MOD-5 trauma module. You have ten minutes to complete this evaluation. You may use any equipment set before you or request any additional equipment not present. Any information that you would normally see upon arrival will be given to you. I will answer any questions as though I was the patient.
Please remember that I can not read your mind. You may decide not to perform a procedure or assessment - and that may be the correct action depending on the scenario - but I do not know if you made a decision or forgot something. In either case if you say nothing you will fail the point. Please if you make a decision please let me know. The three of you may all pass or some may pass and some may fail. Please correct your partners if you see a problem. Are you ready?"
"You are called to the scene of a motor vehicle crash with a single car and a single patient. The car has struck a tree and the air bags have deployed. The police have secured the scene and gained access to the patient compartment. The patient is seated and is presenting as alert and breathing adequately. You have decided that a rapid trauma assessment is not necessary and begin to take care of your patient"
What I am looking for is teamwork and proper patient care. We have already tested (and hopefully passed) patient assessment so we do not need to retest those skills. We need to see the following tasks to be completed:
- Proper neutral head alignment.
- Correct cervical collar application
- Circulation, motor and sensation assessment in the extremities.
- Securing the vest-type device first to the torso and then to the head with padding as necessary.
- Verbalization tie-down to a long board.
- Re-assess circulation, motor and sensation in the extremities.
In general most student practice this enough so most usually pass this station. There are a few critical failures for this station:
- Failure to properly immobilize the head
- Excessive patient movement that causes cervical spine movement
- Over/under tightening of the torso straps
- Did not re-assess circulation, motor and sensation in the extremities.
We usually test the Mod-5 traction station with 2 students plus a live patient. There are three main types of traction devices in use in the field. These are the Hare traction device (which my training center uses), the KTD (the tent pole like device) and the Sager Splint (which has the pulley system). What ever device is used for testing you need to modify the skill assessment sheet. The skill assessment sheet included in the 1994 DOT curriculum uses the Hare device as its model.
Here is is a general scenario for the Hare traction device:
"You and your partner are going to be evaluated in the MOD-5 trauma module. You have ten minutes to complete this evaluation. You may use any equipment set before you or request any additional equipment not present. Any information that you would normally see upon arrival will be given to you. I will answer any questions as though I was the patient.
Please remember that I can not read your mind. You may decide not to perform a procedure or assessment - and that may be the correct action depending on the scenario - but I do not know if you made a decision or forgot something. In either case if you say nothing you will fail the point. Please if you make a decision please let me know. Each of you may pass or one may pass and one may fail. Please correct your partners if you see a problem. Are you ready?"
"You are called to the scene of an elderly female who has fallen down a flight of stairs. A complete patient assesment has reveled no spinal injury but a swollen and deformed right femur. Please begin your treatment"
Once again we know our students have passes patient assessment so we don't need for a retest. What I am most interested in is the following:
- Did the student assess circulation, motor function and sensation prior to applying the device?
- Students are sometimes so eager to get this station out of the way that they forget this important step. As an instructor I usually make a comment such as the foot is turning blue to see if they are gently reminded.
- Was the device measured properly?
- The actual testing station rarely has a naked patient or even a patient that removes their shoes. The student should be extra careful to make sure they have measured correctly.
- Did the student apply the device correctly?
- Many instructors have rather subjective criteria for whether the device was applied properly. I knew one instructor who placed a penny on the toe of the foot and failed the student if the penny fell after taking up traction. I think that was rather excessive. I look to see if the student made a good faith effort to hold the leg still as the device was applied and that their partner applied the device quickly and correctly.
- Was the extremity moved excessively during the application?
- Was circulation, motor function and sensation assessed after the application of the device?
Some actions that would result in a critical failure would be:
- Did not reassess motor, sensory and distal circulation after splinting
- Loss of traction once established
- The femur was not properly immobilized
- The leg was secured to the device before traction was applied
The assessment for a long-bone injury or a joint injury is very similar to the traction device. We look to see that the splinting device immobilizes above and below the injury site and that distal pulses are assessed before and after splint application. We test two students at a time using the same pre-instructions as for the traction device.
Good luck on your MOD-5 Exams
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