Purpose of 'Clinical Resources'

• To provide a written outline of systematic patient assessment and management in the pre-hospital situation.
• To provide standards of Patient Care.
• To provide an educational and refresher resource for St. John clinical staff.
• The Clinical Practice Guidelines / Clinical Skills do not totally dictate or confine the practice of patient care as they cannot remove the element of judgement necessary in each differing emergency circumstance. However, officers must be prepared to justify departures from approved Clinical Practice Guidelines / Clinical Skills. A city environment with an incident five minutes from the hospital will require different management from a country facility needing a two-hour journey.

Relevance

The Clinical Resources Library include skills at all levels of patient care. St John Ambulance clinical staff have been trained and are authorised to perform specific skills or utilise specific equipment. For example, officers using cardiac monitor / defibrillators and medications are to use Clinical Practice Guidelines / Clinical Skills at their authorised level of training as per the Skills Matrix. It should be remembered that one of the best monitors is the eye on the patient and a finger on the pulse.

How to use 'Clinical Resources’

1. Navigation Bar: Use this menu to navigate around the site. Primary menus are activated by a "hover". Every link in the navigation bar is active; by clicking on Neurological for example, will take you to a Contents page of all Neurological sub-pages.
   • In the interest of reserving screen "real estate", the Navigation Bar is condensed into a "Hamburger menu" in mobile view; this resizes to a full-width navbar when the screen size allows.

2. Breadcrumbs: Click on these to be taken back to the Contents page of the respective sections.
1. Home
2. General
3. Introduction

3. Medical Library: The Medical Library is a resource of information whereby officers can seek to improve their own knowledge of conditions, written from a pre-hospital assessment and management perspective.
4. Hyperlinks: Throughout the document, any words that share common references (such as to skills, e.g. Peripheral IV Access) have been hyperlinked to the relevant pages for quick and easy navigation.
5. Treatment section:
Management
• This section details in order what management strategies should be applied, relevant to the presenting condition. The list is skill-specific, based upon the Skill and Medication Matrices; by clicking the Toggle Switch (described below), the management will alternate to between skillsets.

6. Toggle Switch: Click the PARAMEDIC/VOLUNTEER button below to toggle between Volunteer and Paramedic management.
7. Flowchart:
   • This button will take you to a flowchart which is attached to a Clinical Practice Guideline. The flowchart, like the CPG, is also interactive and from the flowchart, you can navigate to various clinical skills associated with the management of this condition.
   Quick Chart
   • The flowchart will always start with the presenting condition, and finish with the patient being transported to hospitals. Beginning and endings will be oblong in shape, whereas Management steps are rectangular, and Decision boxes are diamond.
   • The objects in the flowchart are colour-coded to the respective skillsets, which align with the colours used in the Skills matrix and CPG’s.
   • If an objects refers to a specific skill or medication, clicking on the object will take you directly to that skill or CPG (i.e. hyperlinks).
8. Document Control: Each CPG/Skill has a Document Control panel attached to the bottom.
   • The Date fields indicate when the skill was introduced and when it is due for review.
   • The Purpose section of Document Control will dictate the respective inclusions and exclusions that apply to this CPG/Skill.
   • The Scope of each CPG will always be relevant to all clinical staff (being a single source of truth) and congruent with the Clinical Skill Matrix for officers who are trained and authorised in that particular skill.
   • In the interest of reserving screen “real estate”, the Document Control section of the CPG/Skill is hidden in mobile view; this can be restored by opening the document on a screen size larger than 992px wide.
9. “Accordion” divisions:
   • These objects are coloured grey and the entire row is classed as a button; when inactive, the bar will be adorned with a “+” on the right-hand side. If you click the row, it will expand (i.e. “activate”) and a drop-down section will appear with the relevant information contained within. The adornment will change to a minus sign. The accordion can be “inactivated” by clicking the row again.

Example Accordion
Example Information

10. Select boxes:
    • Select an item from the drop-down box to show the relevant information. On changing, the information will change with the new selection.
    ---Selected Option--- Option 1 Option 2 Option 3 Option 4
11. Medication Calculator: Clinical Resources comes with a Medication Calculator. This tool can be used for patients aged from Newborn through to 11 years of age (for paediatrics, whereby an age-weight estimates will be provided based upon standard growth charts employed when writing SJA CPG’s) right through to adults. This tool will provide expectant Observations for a patient of that age/weight, Cardiac Arrest medications, Post-ROSC medications, CPG-complaint Paramedic Medication calculations as well as Critical Care Medications (i.e. ranges, infusion rates, etc.)

    Age	- Select Age - Newborn 6 months 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years 10 years 11 years

    Weight

    kg

    • Age can be selected in the Select box above; once selected, all the fields will be calculated (i.e. do not press Submit, as this is for the weight entry field).
    • Perth Children’s Hospital has confirmed that as there is no consensus among healthcare professionals regarding age-weight estimations, thus our current methodology of estimation is acceptable. Whilst variations in weight (if using this tool as intended) with respect to the medication dosages administered are unlikely to result in unexpected consequences, Perth Children’s Hospital have confirmed that we should be attempting to use where possible, first-hand knowledge of a child’s weight; in absence of this, estimated ideal weight based upon age is the next best option.
    • If the specific weight of the patient is known, it can be entered in the text-input box (run the calculation by pressing Submit).
    • The calculator will identify whether the entered weight is invalid (i.e. <0) and return “Out of Range”.
    • The calculator will identify and display whether the entered weight is likely to be adult or paediatric, the cut-off being 39kg.
    • The calculator will identify whether the calculated value was entered or approximated based upon age, and will indicate this next to the provided weight.
    • The calculated fields can be found here:
    • Whilst RED, the fields are hidden. By clicking the field/button, the field will be activated, the button will turn GREEN and the relevant information will be shown. If more than one field is activated, they will stack in order of left to right. The reason being ease of browsing/finding the relevant value. Once all fields are activated, the table will show 118 rows (thus making the table unworkably long).

12. Search: The Search Bar will only be available on screens wider than 1200px. The reason for this is multi-factorial;
    • A screen-size greater than 1200px indicates the likelihood of desktop access, likely with internet connectivity. The search function requires server-side processing to function, which requires an active internet connection. In a mobile setting, there is a greater chance that the officer will experience connectivity issues if working remotely.
    • In order to preserve real-estate; in situations whereby the officer is required to search the page for specific fields, the officer should make use of the Index function.

13. Index: The far-right menu item is Index (or the bottom-most item in the mobile nav-bar), and displays a list of all published pages on Clinical Resources. In the interest of offline functionality, officers need the ability to search the site when no server-side access is available. Use your mobile browsers search function to find specific text on the page in order to navigate to this item.

Disclaimer

Once any page from this site is printed or downloaded, it is uncontrolled. It is advised that periodically, all St. John Ambulance clinical staff refer to the web-based Clinical Resources Library and the Clinical Governance Connect page to ensure they have the most up to date information, news and are across relevant clinical discussions. The CPG App that accompanies and is available from the App Catalogue will update automatically in the background; if you find there are any issues with this process, please contact itservicedesk@stjohnambulance.com.au