Emergency Medical Technician Clinical Skill · PDF fileEmergency Medical Services Fire...

Emergency Medical Technician

Clinical Skill Competencies

Excerpt from Student Conduct Code Rule: 7.23Article III: Prohibited Conduct

B. Conduct, Rules, and Regulations: Any student found to have committed the following misconduct is subject to the disciplinary sanctions outlined in the Code. 1. Acts of dishonesty, including but not limited to the following:

a. Cheating, plagiarism, or other forms of academic dishonesty. b. Furnishing false information to any College official, faculty member, or office,

including writing bad checks to the College. c. Forgery, alteration, or misuse of any College document, record, or instrument of

identification.

Level I Sanctions

A. Required retest, resubmission, rewrite, additional assignment, and/or alternative assignment. B. Reduction of grade on the evaluation instrument/process (text, quiz, assignment, term paper,

demonstrated skill, etc.). C. Assignment of “F” grade for course. D. Removal from the course. E. Any combination of the above-listed sanctions.

Level II Sanctions

A. Written reprimand. B. Probation. C. Withdrawal from program and/or department. D. Expulsion from SFC. E. Cancellation of test scores, including CLAST, and the rescission or invalidation of College credit

or of any degree awarded. F. Placement of an “XF” on the student’s transcript to indicate academic dishonesty. G. Denial of academic credit. H. Any or all sanctions available under Level I. I. Other appropriate action.

Emergency Medical Services Fire Science Programs

www.sfcollege.edu/centers/kirkpatrick/ems/

EMT-B Lab

Basic Life Support Skills and National DOT Curriculum psychomotor objectives

“Letter to EMS Clinical Preceptors”

To all EMS Clinical preceptors,

I am requesting your assistance. The EMT students are required to be checked off on 15 skills during their Ambulance Clinical Rotations. The student will show you his or her sheet listing the required skills. Each student is to demonstrate proficiency and competency of all skills contained within the sheet.

The student should already have been taught and practiced each skill in lab prior to requesting that he or she be checked off in the field.

I would ask that you allow them to look over and become familiar with the equipment on your ambulance. These sheets may differ from the way you do things in the field; however, at SFC the students are taught using the National DOT Curriculum. You may question some items on the sheets, but please allow the students to first learn from the sheets and then you can teach how you would do things. Feel free to ask the student to perform or demonstrate anything on the sheet. If the student is competent and scores an 80% or above with the skill, please award them the appropriate percentage of points out of the total and sign and date the skill sheet. If the student scores below an 80% place an “R” in the scoring section for retake and sign and date. If you are not comfortable with assisting the students, I understand. Please tell the student that you are not comfortable (please note this on the form) and feel free to contact me. Your input as a professional is valuable.

Thank you for assisting Santa Fe College Emergency Medical Services Programs in developing quality EMT’s that may someday be working with you in the field.

Joseph S. Hillhouse

Lab Coordinator

First Responder | EMT | Paramedic | Fire Science

Institute of Public Safety • 3737 NE 39th Avenue • Gainesville, FL 32609

Office 352.271-2900 • Fax 352.271-2929 • E-mail [email protected]

EMT Clinical Skill Competency Sheet #01

Stretcher Lifting Techniques (1-6.14 & 1-6.15) Skill time N/A

Student must avoid all critical criteria to pass this skill

Form must be completed prior to the completion of EMS clinicals. (If not completed by target date a 20 percent deduction will be applied for each lab late)

Student: _____________________________________________________ Date: _____________________

1. Goal or purpose for this skill: a. To have the student use proper lifting techniques in order to minimize the potential for

injury when moving and transferring a patient from an ambulance stretcher to a hospital type stretcher. Must lift a minimum weight of 150 pounds patient on the stretcher

2. Equipment needed (for instructor preparation) a. Stretcher with 150 lbs

While the student is performing this skill the instructor may ask questions about why the student is doing what they are doing. The student should be able to voice a rational answer to these questions.

# Skill procedure Points possible Points awarded LIFTING

1 Start with the stretcher in its lowest position 1

2 Have one person at the head of the stretcher and one person at the foot of the stretcher 1

3 Make sure the patient is properly secured to the stretcher using 3 straps 1

4

The rescuer should recognize his/her own limitations with lifting and state the need for additional help if presented with heavy lifting situations or unsteady ground when moving a patient.

1

5 If the rescuer feels he/she can safely manage the situation the rescuer at the head of the stretcher should call for the lift. 1

6 The rescuer should lower into a squatting position maintaining an erect back, bottom down position. 1

7 Once the lift has been called by the person at the head the rescuers should begin to lift the patient using their legs only and maintains an erect back.

1

TRANSFERRING

8 With stretcher at the proper height, prepare the patient for transfer to hospital stretcher. 1

9 Lower rails and unstrap patient from stretcher. 1

Critical Criteria on Next Page

Page 1 of 30SF College Document / Record


10 Without a device (Backboard, Scoop stretcher, etc), the student will lock all applicable wheels and “push” against the stretcher to prevent stretcher movement during transfer.

1

11 Assist or transfer the patient to the hospital stretcher, then raise appropriate rails and/or belt patient to hospital stretcher.

11

Critical Criteria _____ Student did not achieve 80% (9/11) _____ Student unable to verbalize a goal / purpose for this skill _____ Student unable to rationally answer questions from instructor during skills

demonstration _____ Student failed to consider BSI Instructor Comments: Student Signature: ________________________________________ Instructor Signature: _______________________________________



Pulse (1-5.38) Skill time ~1 minutes



Student: _____________________________________________________ Date: _____________________

1. Goal or purpose for this skill: a. To determine the heart’s rate b. To determine the hearts rhythm c. To determine the hearts force

2. Equipment Needed a. BSI b. Watch

3. While the student is performing this skill the instructor may ask questions about why the student is doing what they are doing. The student should be able to voice a rational answer to these questions.

# Skill procedure Points possible

Points awarded

1 Body substance isolation 1 2 Use pads of fingers 1

3

A. Knows the location of the following pulse points and can rapidly locate

1. Radial pulse: located on the thumb side of the wrist 2. Brachial pulse: located under the medial side of the

biceps or on the medial side of the bend in the elbow 3. Carotid pulse: located in the groove of the neck 4. Posterior tibial pulse: located on the medial side of

the ankle 5. Dorsalis pedis: located on the top of the foot

between the big toe and the next toe 6. Femoral pulse: located in the groove of the thigh at

the groin area 7. Apical pulse: with a stethoscope, auscultate over the

nipple on the left side of the chest

7

4

A. Count pulse for 1. minute 2. 30 seconds X 4 3. 15 seconds X 2

3

5 Verbalize

A. Characteristics of a pulse 1. Rate = fast or slow, normal range is 60 – 100 2. Rhythm = regular or irregular 3. Force = strong (bounding) or weak (thready)

3

6 Charts accurately Example: 68, weak, irregular 1



7 Verbalize

A. Definitions 1. Brady = slow; Cardia = heart. Bradycardia = slow heart,

< 60 BPM 2. Tachy = fast, Cardia = heart. Tachycardia = fast heart,

> 100BPM

2

18

Critical Criteria _____ Student did not achieve 80% (15/18) _____ Student unable to verbalize goals for this skill _____ Student fails to consider BSI _____ Student unable to rationally answer questions from the instructor during skill

demonstration Instructor Comments: Student Signature: ________________________________________ Instructor Signature: _______________________________________



Respirations (1-5.32) Skill time ~ 1 minute



Student: _____________________________________________________ Date: _____________________

1. Goal or purpose for this skill: a. To determine the pt's breathing rate. b. To determine the pt’s breathing rhythm. c. To determine the pt’s breathing depth. d. To determine the pt’s breathing effort.

2. Equipment needed (for instructor preparation) a. watch


# Skill procedure Points possible Points awarded

1 Body substance isolation 1

2 Student does not allow patient to realize that respirations are being counted 1

3 Count respiration for 1 minute or 30 seconds x2 1

4

Notes: A. Rate B. Rhythm – regular or irregular C. Depth – shallow, deep or normal D. Effort – labored or non-labored

4

5 Accurate charting Example: R-24, irregular, shallow, labored 1

6 Respiratory terms -A-without; pnea – breath > Apnea – absent breathing -Dys – difficulty ; pnea- breath > Dyspnea – difficulty breathing

2

10




Pulse Oximetry



Student: _____________________________________________________ Date: _____________________

1. Goal or purpose for this skill: a. To measure oxygen saturation in the peripheral tissues. The pulse oximeter functions by

measuring the transmission of red and infrared light through an arterial bed, such as those present in a finger, toe or earlobe.

2. To possibly detect problems with oxygenation before assessments of blood pressure, pulse and respirations would detect a problem.

3. Equipment needed (for instructor preparation) a. Pulse Oximetry unit

4. While the student is performing this skill the instructor may ask questions about why the student is doing what they are doing. The student should be able to voice a rational answer to these questions.


1 Explain procedure to patient 1

2 Place the non-invasive sensor on the patient’s finger, toe or ear lobe. 1

3 Turn on the Oximetry unit on. 1

4

Awareness: 1. Be cautious in using the pulse oximeter in patients with

anemia and hypovolemia. The reading may be misleading.

2. May give false positive reading in patients with carbon monoxide poisonings, high intensity light, and certain hemoglobin abnormalities.

2

5

Interpretation of Oximetry 100 - 95 % Normal 94 - 91 % Mild Hypoxia 90 - 86 % Moderate Hypoxia 85 % or less Severe Hypoxia

4

9




Critical Criteria

_____ Student did not achieve 80% (8/9) _____ Student unable to verbalize a goal / purpose for this skill _____ Student unable to rationally answer questions from instructor during skills




EKG Monitoring Set-up Skill Time ~ 5 Minutes



Student: _____________________________________________________ Date: _____________________

1. Goal or purpose for this skill is to allow the EMT to connect a three (3) lead heart/cardiac monitor to a patient.

2. Equipment needed (for instructor preparation): a. ECG Monitor



1 BSI 1 2 Shave excessive hair at electrode site 1

3 For oily skin, cleanse with alcohol pad and let dry completely before applying electrode. 1

4 Open pouch and remove electrodes immediately prior to use. The end of bulk pouches should be folded over and electrodes should be used within 30 days of opening.

1

5

Hold the electrode firmly with both hands. 1. Attach electrode wire to electrode patches. 2. Peel electrode from carrier and discard carrier in

appropriate waste receptacle. 3. Carriers are slippery and will become dangerous if

dropped on floor.

3

6

Apply electrode to skin and gently press down around outer edge of electrode in a circular motion to assure firm attachment to the skin.

1. Place the white electrode just below the pt's right clavicle.

2. Place the black electrode just below the pt's left clavicle. 3. Place the red electrode on the left leg area of the pt. 4. IF present, place green electrode on right leg area

4

7 Attach the cable to the monitor and turn the machine on. 1



8 Be aware that electrical appliances, florescent lights, and poor conduction can cause interference in the monitor printout. 1

9

Cautions 1. Electrodes should not be used if the gel is dried out or in

a liquid state. 2. If the electrode site is not dry prior to application,

trapped solvents can cause skin irritation and loss of adhesion.

3. Rapid removal of electrode from a patient may cause skin damage. If the electrode is difficult to remove use alcohol to moisten the adhesive.

4. Under occasional circumstances, alteration of the skin pigmentation may occur after electrode removal.

4

18

Critical Criteria





Temperature Skill Time N/A



Student: _____________________________________________________ Date: _____________________

1. Goal or purpose for this skill is to determine the pt's core temperature 2. Equipment needed (for instructor preparation)

a. Watch b. Thermometer (oral or rectal)

i. Lubrication jelly 3. While the student is performing this skill the instructor may ask questions about why the student is doing

what they are doing. The student should be able to voice a rational answer to these questions.


1 Body substance isolation 1 2 Check condition of thermometer before using 1 3 Explain procedure to patient 1

4 Identifies oral/rectal thermometer

A. Oral is a blue tip B. Rectal is a red tip

2

5

Identifies locations which temperatures may be taken a. Axillary (armpit) b. Oral c. Rectal

3

6 Verbalize Lubricate thermometer is rectal temp is taken (verbalize)

7 Turn on and/or insert thermometer 1 8 Wait until unit beeps or acquires temperature 1

9

Reads Accurately (norms) A. Axillary – 97.6 F (least accurate) B. Orals – 98.6 F C. Rectal – 99.6 F (most accurate)

3

10 Charts Accurately Example – T 100.2 A or T 100.2 O or 100.2 R 1

14





demonstration _____ Student failed to consider BSI _____ Student failed to explain procedure to patient _____ Student unable to chart accurately Instructor Comments: Student Signature: ________________________________________ Instructor Signature: _______________________________________



Oxygen Tank Preparation (2-1.37) Skill Time ~ 3 Minutes



Student: _____________________________________________________ Date: _____________________

1. Goal or purpose for this skill is to change an oxygen cylinder and regulator for service 2. Equipment needed (for instructor preparation)

a. Portable oxygen tank (D or E) b. Oxygen regulator c. Oxygen tank wrench



1 Verbalize

Identify portable (“D” and “E”) and fixed cylinder a. "D" tanks are small and use for portable O2 devices. b. "E" tanks are medium and used for thumpers, etc c. "R", “H”, “K” and "M" tanks are large and used to

maintain O2 supply to wall outlets.

1

2 Open the tank valve and check the tank pressure if pressure is less than 200 psi then tank needs changed. 1

3 Turn tank valve off and open flow valve to remove air from the regulator. 1

4 Get a new tank. 1 5 Check tag on tank to identify if tank is full or empty. 1 6 Remove tape protecting outlet and save "O" ring. 1 7 Remove the regulator from the empty tank. 1 8 Remove the old "O" ring from the regulator. 1 9 Place a new "O" ring on the regulator. 1

10 Crack the tank valve to blow dust from tank outlet. 1 11 Place the regulator on the new tank and tighten into place. 1 12 Turn tank on. 1 13 Check for air leaks and retighten if needed. 1 14 Check the tank pressure 1

15 Turn tank valve off and open flow valve to remove air from the regulator 1

16 Store tank in secure area until ready for use 1 16




Nebulizer / Updraft Set-Up Skill Time ~ 3 Minutes



Student: _____________________________________________________ Date: _____________________

1. Goal or purpose for this skill is to administer a unit dose of medication to a patient who is having bronchospasms associated with bronchitis, emphysema or asthma

2. Equipment needed (for instructor preparation) a. Nebulizer Set-up b. Oxygen supply tubing c. Albuterol/Atrovent (simulation acceptable) d. Oxygen source



1

Student correctly identifies the components 1. One nebulizer set-up ( mouth piece, T-piece ) 2. One oxygen supply tubing. 3. Albuterol 2.5 mg / Atrovent 0.5 mg of medication 4. Unhumidified oxygen with a flow meter.

A minimum of 700 p.s.i. is needed in a "D" cylinder

4

PROCEDURE FOR ASSEMBLY 2 Assemble oxygen supply tubing to the nebulizer. 1 3 Connect the top of the nebulizing chamber. 1 4 Connect the T piece to the top of the nebulizing chamber 1 5 Connect the mouth piece to the “T” piece. 1 6 Connect the oxygen supply tubing to the oxygen flow meter. 1

7 Set the flow meter to 6 8 liters / minute and watch for the medication to mist. 1

10




Intubation Set-Up Skill Time N/A



Student: _____________________________________________________ Date: _____________________

1. Goal or purpose for this skill is student should successfully be able to identify the equipment. 2. Equipment needed (for instructor preparation)

a. Universal Precaution Equipment b. Correct Size ET Tube. c. Stylet (used as a guide wire for the ET tube) d. 10cc Syringe e. Laryngoscope (Miller blade is straight / Macintosh is curved blade) f. Tape (1 inch) or ET Tube securing device g. Lubrication Jelly h. Stethoscope i. Bag-Valve-Mask with O2


# Skill procedure Points possible Points awarded THE STUDENT WILL IDENTIFY THE FOLLOWING EQUIPMENT

1 Universal Precaution Equipment 1 2 Correct Size ET Tube. 1 3 Stylet ( used as a guide wire for the ET tube) 1 4 10cc Syringe 1

5 Laryngoscope ( Miller blade is straight / Macintosh is curved blade) 1

6 Tape (1 inch) and/or ET Tube holding device 1 7 Lubrication Jelly 1 8 Stethoscope 1 9 Bag-Valve-Mask with O2 1 9




Critical Criteria





IV Set-Up Skill Time ~ 5 Minutes



Student: _____________________________________________________ Date: _____________________

1. Goal or purpose for this skill is to prepare the correct IV set up for the specific situation. The Paramedic will inform you which set is appropriate.

2. Equipment needed (for instructor preparation)

1. Gloves 2. IV Solution 3. Administration Set (60,15 or 10 gtt set ) 4. Tourniquet 5. Alcohol Prep 6. Gauze 7. 7. 1 inch Tape (2 pieces approx 6 inches long)

8. ½ inch Tape (2 pieces approx 6 inches long) 9. Tegaderm 10. IV Needles 11. Blood Tube of each color 12. Vacutainer Holder 13. Vacutainer Leur Adaptor



1 BSI

2

Select correct type of IV solution requested by the paramedic. 1. Inspect expiration date. 2. Inspect for cloudy fluid. 3. Inspect for leaks. 4. Inspect for correct solution.

4

3

Select correct type of IV administration set requested by the paramedic.

1. Adult Setup (Macro Setup) = 10 or 15gtt/ml primarily used to replace fluids

2. Pediatric Setup (Micro Setup) = 60gtt/ml primarily used as medication access line.

2

4 Remove IV bag from packaging and remove rubber cap.. 1

5 Remove administration set from packaging and remove plastic cap from end (if needed) maintaining sterility and insert into IV bag.

1

6 Pinch Tubing and squeeze drip chamber to fill ½ full. 1 7 Release tubing and open stopcock and flush air out of line. 1



8 Hang bag from IV pole and turn stopcock off and replace cap maintaining sterility (if needed). 1

9 Set up needle, tape, gauze, gloves, and tourniquet for easy access by medic. 4

12

Critical Criteria


demonstration _____ Student failed to consider BSI _____ Student failed to inspect medication/fluid Instructor Comments: Student Signature: ________________________________________ Instructor Signature: _______________________________________



Blood Glucose Set-Up Skill Time ~ 5 Minutes



Student: _____________________________________________________ Date: _____________________

1. Goal or purpose for this skill is to field test a patient’s blood-sugar level.

2. Equipment needed (for instructor preparation) a. Glucometer b. Dextrostix c. Lancet d. Alcohol prep e. 4x4's f. Band-Aid



1 BSI

2

The student correctly identifies the components 1. Glucometer 2. Dextrostix 3. Lancet 4. Alcohol prep 5. 4x4's 6. Band-Aid

6

3 Body Substance Isolation 1 4 Explain procedure to patient. 1

5 Using an alcohol prep, cleanse the patients finger that is to be pricked ( usually index or ring finger ) 1

6 Place Dextrostix in glucometer 1

7

Using a lancet, pierce the finger for blood return (EMTs not allowed in Florida). ** Note: If patient has poor circulation or the finger is cold you may have to milk the finger to enable you to get the drop of blood required to test glucose.

1

8 Place lancet in sharp container 1 9 Place a drop of blood on the dextrose strip. 1

10 Wipe patient’s finger with 4x4. 1



11 Place band-aid on finger 1 12 Place 4x4 in bio-hazard bag 1

13 If reading is below 60 mg / dl (or what your local protocol states) with an altered level of consciousness the patient is symptomatic for the administration of Dextrose 50%.

1

** Note: Be sure you familiarize yourself with the type of Glucometer your agency is using **

17


demonstration _____ Student failed to consider BSI _____ Student failed to properly dispose of sharps Instructor Comments: Student Signature: ________________________________________ Instructor Signature: _______________________________________



Impaled Object (eye / body) (5-2.32) Skill Time ~ 5 Minutes



Student: _____________________________________________________ Date: _____________________

1. Goal or purpose for this skill is to secure and stabilize an object that has been impaled into the body to prevent movement that would cause further harm.

2. Equipment needed (for instructor preparation) a. Bulky Dressing b. Tape c. Bandages



1 BSI 1 2 Cut away clothing from area. 1 3 Stabilize the object using bulky dressing. 1

4 If dealing with impaled object to eye place a cup over dressings to prevent further inward motion of object and cover uninjured eye to prevent motion.

1

5 Cover any open wound with sterile dressing and stop bleeding. 1 6 Secure the dressing using bandaging or tape. 1 6




Amputated Parts (5-2.34, 2.35) Skill Time N/A



Student: _____________________________________________________ Date: _____________________

1. Goal or purpose for this skill is have the student properly package an amputated part for transport. 2. Equipment needed (for instructor preparation):

a. Artificial (simulated) amputated part b. Waterproof bag c. Cool packs (simulated if necessary) or cooler with ice if normally available



1 BSI 1

2

Attempt to remove any gross contaminants from the amputated part by irrigating with sterile saline solution or gently cleansing with sterile saline solution on a sterile sponge.

Do not attempt a thorough cleansing of the amputated part

1

3 Place a few moistened sterile 4 x 4's into a waterproof container (freezer bag, clean garbage bag, etc). 1

4 Place the amputated part wrapped with the moist 4 x 4‘s into a waterproof container. 1

5 Place waterproof container into cold area. 1

6

Transport the amputated part with the patient but out of the patient's sight.

Do not place amputated part directly on ice, causes freezer burn

1

6




Critical Criteria


demonstration _____ Student failed to consider BSI _____ Student places amputated part directly onto ice Instructor Comments: Student Signature: ________________________________________ Instructor Signature: _______________________________________



Sling and Swathe (5-3.11) Skill Time ~ 3 Minutes



Student: _____________________________________________________ Date: _____________________

1. Goal or purpose for this skill is to splint clavicle and humerus injuries.

2. Equipment needed (for instructor preparation) a. 2 - triangular bandages b. Safety Pins (optional)



1 BSI 1 2 Manual stabilization of injury 3 Check (PMS) Pulse, Motor, Sensory 1

4 Fold forearm on injured side across chest, slightly elevated toward opposite shoulder. 1

5 Place triangular bandage between the arm and the trunk with the point toward the elbow. 1

6 Bring the bottom of the triangular bandage over the outer part of the arm and tie a knot to the side of the neck. 1

7 Pin or tie the pointed end to form cup for elbow. 1 8 Keep fingers exposed to check circulation. 1

9 Wrap wide cravat or roller gauze around injured arm and body as swathe to pull shoulder back and secure injured arm to body. Tie knot on uninjured mid-axillary side of body.

1

10 Recheck the (PMS) pulse, motor, sensory. 1 11 Transport in a sitting position. 1

11





demonstration _____ Student failed to consider BSI _____ Student failed to check PMS prior/after splinting Instructor Comments: Student Signature: ________________________________________ Instructor Signature: _______________________________________



Rigid Splint (5-3.11) Skill Time ~ 3 Minutes



Student: _____________________________________________________ Date: _____________________

1. Goal or purpose for this skill is to immobilize an injured extremity of an infant, child, or adult patient that is suspected of being fractured to prevent the occurrence of any further damage.

2. Equipment needed (for instructor preparation) a. 2 – Rigid Splints b. Kling or Cravats c. Bandaging Material



1 BSI 1 2 Manual stabilization of injury 1 3 Expose extremity 1 4 Manually stabilize extremity. 1 5 Cover any open wound with sterile dressing and stop bleeding. 1 6 Check for (PMS) pulse, motor, sensory distal to the fracture site 1

7 If circulation is absent, make one attempt to align the extremity to improve circulation. 1

8

Long Bone injuries - Apply two well-padded board splints extending beyond the joint above and below the injured area.

a. Upper extremities - one on the anterior and posterior sides

b. Lower extremities - one on the medial and lateral sides Joint Injuries - immobilize bone above and below the joint in the position found.

1

9 Secure the splint in place with cravats or wraps entire leg in roller gauze. 1

10 Make sure hand and foot are immobilized in the position of function 1

11 Check (PMS) pulse, motor, sensory after splinting. 1 11





demonstration _____ Student failed to consider BSI _____ Student failed to check PMS prior/after splinting Instructor Comments: Student Signature: ________________________________________ Instructor Signature: _______________________________________


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